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Feb 2018
Introduction and aims Previous research has focused primarily on the severity of the alcohol hangover. Much less is known about the duration of the alcohol hangover. The objective of this analysis was to examine the average duration of the alcohol hangover. Design and Methods N=811 Dutch students, aged 18-30 years old, completed a survey on alcohol consumption and their latest alcohol hangover. Overall hangover severity was reported for every two hours after waking up (starting 4am until midnight). Hangover duration was calculated from the moment of stopping alcohol consumption until the first time hangover severity scores reached zero. Results During the drinking session that resulted in their latest hangover they consumed a mean (SD) of 5.9 (6.2) alcoholic drinks, followed by 6.5 (2.0) hours of sleep. The start of the alcohol hangover was not assessed, as it can be assumed that BAC approached zero while participants were sleeping. From the moment of stopping alcohol consumption, the average duration of the alcohol hangover was 18.4 (3.8) hours. For the majority of drinkers, hangover duration ranged from 14 to 23 hours. Alternatively, the hangover lasts approximately 12 hours from the time of waking up. Hangover duration correlated significantly with hangover severity and total sleep time, but no significant association was found with the number of alcoholic drinks that were consumed. Discussion and Conclusions The duration of the alcohol hangover ranged from 14 to 23 hours, with an average of 18.4 hours after stopping drinking, or alternatively, about 12 hours after waking up.
Nov 2017 DOI 10.14302/issn.2641-7669.ject-17-1725
The Agency for Toxic Substances and Disease Registry (ATSDR) lists cadmium as one of its priority hazardous substances. The agency conducted a comprehensive literature review of cadmium and used the information to develop a toxicological profile that identified the full range of health effects associated with exposure to cadmium. It included an assessment that identified screening levels, termed health guidance values or minimal risk levels (MRLs), below which adverse health effects are not expected. In this paper, we describe how MRLs for cadmium are derived. For the acute inhalation MRL, the traditional no observed adverse effect level or lowest observed adverse effect level (NOAEL/LOAEL) approach is used; for the oral intermediate MRL, the benchmark dose (BMD) approach is used. MRLs were developed for the most sensitive route-specific end points, other than mortality and cancer that were sufficiently supported and justified by the data. These included an acute duration (1–14 day exposure) inhalation MRL of 0.03 µg Cd/m3 for alveolar histiocytic infiltration and focal inflammation in alveolar septa and an intermediate duration (15–365 day exposure) oral MRL of 0.5 µg Cd/kg/day for decreased bone mineral density
Apr 2017 DOI 10.14302/issn.2644-1101.jhp-17-1460
The objective of this study was to study the selection of seat location by individuals in a group in a confined environment and to identify the factors leading people to prefer one location to another. We analyzed the seating location of students in a lecture hall over the course of two academic programs of different durations (19 days and 44 days). The goal was to determine the rate at which participants would settle into a specific seat location. Unobtrusive photography was used to collect objective data on an hourly basis. Results showed that in both courses participants began to settle into a specific location from the second day of class. Twenty percent of the participants had settled after 4-7 days or 15.5 hours in class. Settling continued for the duration of the shorter course. However, in the longer course settling stopped after 28.5 days on average. The plateau in the number of settlers depended on the number of days, not on the time actually spent in class. At the end of the longer course 52.5% of the participants had settled, compared to 38.9% in the shorter course. Settling into the same seat location can be interpreted as a strategy to establish a personal territory. These results indicate that about half of a cohort expresses the need for establishing a personal territory when in a confined and crowded environment, and this process takes about one month.
May 2026 DOI 10.14302/issn.2574-4518.jsdr-25-5773
Introduction Sleep quality is a fundamental determinant of human health and well-being. Modified Intravascular Laser Irradiation of Blood (ILIB), a non-invasive therapeutic modality, has emerged as a potential intervention for sleep-related disturbances. Proposed mechanisms include reduced blood viscosity and platelet aggregation, activation of superoxide dismutase, increased oxygen bioavailability, enhanced microcirculation, elevated serotonin levels, and decreased cortisol concentrations—physiological processes intricately involved in sleep regulation, mood modulation, and the stress response. Objective To evaluate the effects of Modified Intravascular Laser Irradiation of Blood (ILIB) on sleep quality in individuals with self-reported sleep disturbances. Methods A randomized, placebo-controlled clinical trial was conducted with participants who reported poor sleep quality. Subjects were randomly assigned to one of two groups: the intervention group received ILIB using a 660 nm red laser, while the control group received a placebo treatment (light emission with sub-therapeutic power, <1 mW). Both groups underwent the same treatment schedule. Sleep quality was assessed at baseline and after six treatment sessions using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Results Participants in the ILIB group showed statistically significant improvements in the primary outcome of global sleep quality. PSQI scores decreased from 10.24 at baseline to 6.47 post-treatment. ESS scores showed a non-significant change from 10.44 to 10.12. These results suggest enhanced overall sleep quality and reduced sleep latency, although the observed reduction in daytime sleepiness did not reach statistical significance. Conclusion Modified Intravascular Laser Irradiation of Blood appears to be a promising non-invasive approach for improving sleep quality. The clinical outcomes observed are comparable to those reported in both pharmacological and behavioral sleep interventions, particularly in terms of PSQI improvements. These preliminary findings support the need for further research to clarifyunderlying mechanisms, optimize treatment parameters (e.g., dosimetry and duration), and expand outcome assessments to include biomarkers and polysomnographic data.
Mar 2026 DOI 10.14302/issn.2994-6743.ijstd-26-6060
Objective To describe the clinical features and real-world treatment of people living with human immunodeficiency virus (PLHIV) using fixed-dose or free combinations of 2-drug regimens (2DR) of antiretroviral therapy (ART). Design Italian retrospective cohort study. Methods Data were extracted from PLHIV who initiated or switched to 2DR: Group 1 (fixed dose), Group 2 (free combination). Results Group 1 was younger and more predominantly male, and had shorter time from AIDS-defining diagnosis to 2DR-ART and from diagnosis to baseline, a lower prevalence of resistance, and fewer comorbidities than Group 2. Median baseline viral load was <50 copies/mL in both groups, but Group 1 had a higher mean due to outliers. The most common ART classes before switching to 2DR were Integrase Strand Transfer Inhibitor (INSTI)-based (48.97%), Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)-based (22.73%), and Protease Inhibitor (PI)-based (16.53%). Distribution varied: Group 1: INSTI-based (53.13%), NNRTI-based (24.31%), and PI-based (15.04%); Group 2: INSTI-based (29.41%), PI-based (23.53%), and NNRTI-based (15.29%). After switching, Group 1 was on dolutegravir/lamivudine (79,33%) and dolutegravir/rilpivirine (20,67%); Group 2 mostly on INSTI-PI (52.81%), followed by NNRTI combinations, mainly with doravirine (19.10%). Duration of ART after switching was shorter in Group 1. Conclusion Italian PLHIV on 2DR fixed-dose combinations were younger, virologically suppressed individuals at baseline, with a shorter lead time from diagnosis, lower prevalence of resistance and lower comorbidity rate compared to those on free combinations. These findings underscore an unmet need for 2DR fixed-dose combinations, as the free combinations were predominantly utilized for more challenging populations.
Dec 2025
Background Research and drug development industries have multiphase drug screening procedures, which can be debated. As a result, harmful products may still reach for public health service delivery due to vulnerabilities in the process. Main body A wide range of test compounds have delayed manifestation of undesired effect on the study subject, with the time to undesired effects after acute exposure being weeks and months. Acute toxicology in a preclinical trial also has limited clinical value as its lethal dose is the endpoint for a conclusion, and death sometimes occurs after a scheduled period of acute toxicology. Countless resources are wasted, and numerous new drugs are introduced into the pharmaceutical market with assumed safety analysis every year due to vulnerable multi-procedures in preclinical trials. The principal use of collected data from a preclinical trial is to support regulatory categorization and harmful labelling decisions. However, the data can also be used to derive safe use threshold levels, which may lead to the use of unsafe material. The criteria for classification and labelling also differ among countries, sometimes among authorities within the same country. The fundamental concept of toxicology states that ‘all chemical substances are potential poisons depending on the amount and duration of exposure. However, the toxic property of a test compound cannot be created or eliminated by simply the amount administered to study animals. Conclusion All xenobiotics are poisons at any amount with different severity that can be calculated using biological parameters.
Dec 2025 DOI 10.14302/issn.2688-5328.ijp-25-5402
Background Prescribing appropriate analgesics with optimal dosages based on patients' pain severity is challenging, especially when multiple painkillers are involved. Tracking and analyzing the effectiveness of analgesics and their dosages over time is crucial for pain management. Existing systems lack the ability to integrate analgesic equivalent doses with temporal trends in pain scores, hindering effective decision-making. Methods We developed a Clinical Support System that calculates the daily oral morphine equivalent dose and analyzes trends in consumed equivalent doses of analgesics. The system provides a graphical user interface that displays medication prescriptions, actual medication usage, and pain scores. It offers features such as correlating analgesic drug usage with pain intensity, trend analysis of analgesic drug usage and pain intensity, and identification of effective oral morphine equivalent doses. Results The system overcomes previous barriers in drug analysis by providing real-time calculation of oral morphine equivalents and trend analysis of pain duration. It assists physicians in prescribing appropriate and safe medication dosages, enhancing medication safety for patients. Conclusions Our clinical support system offers a comprehensive solution for analyzing trends in consumed equivalent doses of analgesics. It integrates medication prescriptions, actual usage, and pain scores, providing decision-making support for pain management.
Dec 2025 DOI 10.14302/issn.2324-7339.jcrhap-25-5515
Background Peripheral neuropathy (PN) is a common and debilitating complication in people living with HIV (PLHIV). While HIV itself contributes to neuropathy, certain antiretroviral therapy (ART) drugs, particularly nucleoside reverse transcriptase inhibitors (NRTIs) such as stavudine (d4T) and zidovudine (AZT), are known for their neurotoxic effects. Objectives To evaluate the impact of ART on HIV-associated peripheral neuropathy (HIV-PN) and to determine whether certain ART regimens increase the risk or severity of neuropathy. Materials and Methods A cross-sectional study was conducted among 158 HIV-positive patients. Neuropathy was diagnosed using clinical criteria, Total Neuropathy Score (TNS), and nerve conduction studies (NCS). Patients were grouped based on their ART regimen, and statistical analysis was performed to assess the association between ART type and peripheral neuropathy severity. Results It was noted that patients on older NRTIs (stavudine, zidovudine) had significantly higher rates of peripheral neuropathy (p=0.002) and tenofovir-based regimens were associated with lower peripheral neuropathy prevalence (p=0.01). There was a significant correlation between the duration of ART exposure and peripheral neuropathy severity (p<0.001), suggesting a cumulative neurotoxic effect. Conclusion Older ART regimens, particularly stavudine and zidovudine, significantly contribute to HIV-PN. The study supports the WHO recommendation to phase out neurotoxic ART and highlights the importance of early ART regimen optimisation to prevent long-term neurological complications.
Dec 2025 DOI 10.14302/issn.2694-2283.jsem-25-5827
Background Mind–body exercises are frequently used to support well-being during the menopausal transition, but perceived physical and psychological outcomes associated with practices such as the 3D Movement Method have not been quantitatively assessed. Objective To examine associations between characteristics of the 3D Movement Method and women’s self-reported physical and mental improvement during the menopausal transition. Methods Cross-sectional survey data from 330 women aged ≥ 35 years were analyzed using general linear models. Perceived physical progress and mental improvement were each assessed using single-item, 15-point scales. Independent variables included practice frequency, duration of experience, explanation clarity, satisfaction, baseline health status (SF-36 Physical and Mental Component Summary scores), age, and menopausal status. Results The model for physical progress was significant, F(16, 144) = 6.26, p < .001, R² = .41. Greater practice frequency, longer experience, clearer instructional explanations, and higher satisfaction were each independently associated with higher perceived physical progress. The mental improvement model was also significant, F(16, 96) = 2.25, p = .008, R² = .27, identifying satisfaction as the sole significant predictor. Baseline health, age, and menopausal status did not predict outcomes in either model. Conclusions Perceived physical progress was shaped by structured engagement parameters consistent with deliberate-practice principles, whereas perceived mental improvement was primarily linked to subjective satisfaction, a pattern compatible with motivational accounts of engagement. The 3D Movement Method may support women’s health across the menopausal transition when designed to optimize clarity, engagement, and experiential quality.
Nov 2025 DOI 10.14302/issn.2470-0436.jos-25-5503
Purpose Create a new diagnostic and therapeutic framework for patients with Exudative Age-Related Macular Degeneration (ARMD) and choroid imaging biomarkers of non-neovascular choroidal pathology who have persistent neovascular exudation during the course of monotherapeutic interventions. Methods Retrospective, longitudinal case series study of 25 eyes from 23 patients with the referral diagnoses of treatment resistant Exudative ARMD who had persistent neovascular exudation despite various monotherapies. Inclusion criteria required choroidal imaging biomarkers of non-neovascular pathology including a thickened subfoveal choroid (greater than 300 microns) and vessels (subjectively dilated choroidal vessels in Haller’s layer) on Optical Coherent Tomography (OCT), choroidal neovascularization on IVFA and OCT Angiography (OCTA), as well choroidal leakage noted on indocynanine green videoangiography (ICG). Treatment consisted of OCTA and ICG - Directed Photodynamic Therapy (PDT) Triple Therapy, hereafter described as Combination Therapy, to areas of choroidal hyperpermeability and choroidal neovascularization. Combination therapy consisted of an anti-Vascular Endothelial Growth Factor (VEGF) intravitreal injection on Day 0 followed by half-fluence PDT and 2 mg intravitreal triamcinolone acetonide on Day 3-14. Results All study patients had treatment resistant Exudative ARMD defined as persistent subretinal and/or intraretinal fluid during their course of monotherapeutic interventions. Complete resolution of all exudation occurred in 23 eyes (92.0%) at 8 weeks. The mean duration of action was 155.6 weeks, with 72.0% of eyes leak free greater than 100 weeks. The mean vision at baseline was 0.46 ± 0.42 LogMAR, best corrected visual acuity (BCVA). 8 weeks after treatment, the vision was 0.35 ± 0.38 LogMar, an improvement of over one line, and this was maintained at one year. The baseline central subfield thickness (CST) was 296.4 ± 136.1 microns and improved by 111.4 ± 105.4 microns at 8 weeks after treatment. Treatment duration was negatively associated with the Caucasian race. Conclusions Patients with subretinal and/or intraretinal fluid secondary to Exudative ARMD should have a complete baseline multimodality imaging study to confirm the presence of neovascularization and whether choroidal hyperpermeability coexists. This study shows that patients with Exudative ARMD and persistent neovascular exudation despite monotherapuetic interventions often have choroidal biomarkers of non-neovascular choroidal pathology and that ICG and OCTA-directed PDT Triple Therapy resulted in complete resolution of all exudation in 92.0% of patients at 8 weeks with a reduction in central subfield thickness (CST) of 111.4 microns. The vision improvement at 8 weeks was 0.11 ± 0.38 LogMar and was sustained over 1 year. The mean duration of action was 155.6 weeks, with 72.0% of eyes leak free greater than 100 weeks. Additionally, this study shows that the treatment that addresses both pathological processes is successful and should be considered as a primary protocol when the biomarkers are present at baseline or as a secondary protocol if indeed the neovascular leakage is persistent despite monotherapy. Summary Patients with an Exudative ARMD with persistent neovascular exudation despite anti-VEGF monotherapy and who have imaging biomarkers of non-neovascular choroidal pathology often have two pathophysiological processes: choroidal hyperpermeability and angiogenesis. A proposed framework provides the rationale for OCTA and ICG-directed PDT Triple Therapy which successfully resolves 92% of the leakage that was persistent after various monotherapeutics.
Nov 2024 DOI 10.14302/issn.2574-4518.jsdr-24-5271
Background/Aim Obstructive Sleep Apnea (OSA) is a prevalent disorder characterized by recurrent respiratory disturbances during sleep. Patients with Type 2 Diabetes Mellitus (T2DM) and obesity exhibit a substantial susceptibility to OSA (23%–86%). People with OSA have a high risk of several comorbidities like insulin resistance, cardiovascular disease, depressed mood and hypertension. Thus, the objective was to comprehensively evaluate the risk of OSA among T2DM patients in India. Materials and Methods A cross-sectional survey was conducted across four cities in India involving 2,000 T2DM patients. The survey gathered data on patient demographics, clinical endpoints, and estimated the risk of OSA using an app which included the STOP BANG questionnaire. Multivariate logistic regression analysis was used to evaluate the association between OSA risk and key variables such as age, gender, BMI, and HbA1c. Result Overall, 63.9% of T2DM patients were identified as high risk and 27.3% were at intermediate risk for OSA development. Results of the multivariate logistic regression demonstrated that patients with high BMI ≥35 had significantly greater odds (OR: 5.70; p<0.00) of developing OSA; males had 2.75 times higher odds (p<0.00) and patients with HbA1c value >8% had higher odds (OR: 1.22; p<0.00) of developing OSA. Conclusion OSA risk and prevalence are significantly higher in T2DM patients than in the general population with a notable escalation in patients who are overweight/obese, older, and have prolonged diabetes duration. Early screening using digitalization with a highly sensitive, cost-efficient, and valid tool like STOP-BANG followed by appropriate intervention for OSA can not only reduce the eventual economic burden but can improve patient outcomes.
Jul 2024 DOI 10.14302/issn.2641-4538.jphi-24-5017
Background Frailty is an ageing-associated state linked to poor prognostic outcomes. Chronic inflammation due to HIV-infection, AIDS-related infections. and the adverse effects of antiretroviral therapy (ART) all contribute to frailty in people living with HIV/AIDS (PLHA). Frailty has been comprehensively studied in populations comprising predominantly of Caucasian PLHA. However, there remains a dearth of such data in Indian populations, especially in younger PLHA. Methodology This cross-sectional study aimed to estimate the prevalence of frailty in PLHA (18 - 50 years) who had been on ART for 24-60 months and identify markers linked to frailty. Frailty was assessed in 152 subjects using the Fried frailty-index. Parameters measured included the mid-upper arm and calf circumferences, pain-severity (using the Brief Pain Inventory), highly-sensitivity C-reactive protein, d-dimer, and interleukin-6. Results The prevalence of frailty and pre-frailty were 6.58% and 23.02%, respectively. Reduced grip strength and self-reported exhaustion were associated with frailty (15.79% and 13.16%, respectively). Low calf-circumference and mid-upper arm circumference were not significantly associated with frailty/pre-frailty. The prevalence of pain was 21.7% and both pain severity and pain interference were significantly associated with frailty/pre-frailty. CD-4 counts at the time of assessment showed an inverse association with frailty. Elevated C-reactive protein (CRP of 0.04 associated with 0.49 probability of frailty (95% CI 0.40 – 0.59), CRP of 0.12 associated with 0.63 probability of frailty (95% CI 0.47 – 0.76)). D-dimer levels were not significantly associated with frailty /pre-frailty. Conclusion In this first-of-its-kind study on frailty in young PLHA (mean age 37 years) from the Indian sub-continent, the prevalence of frailty and pre-frailty was 6.58% and 23.02%, respectively. Multivariate analysis showed a strong association of frailty with pain severity, CD4 count at time of assessment, hs-CRP levels and duration of ART.
Apr 2024 DOI 10.14302/issn.2690-4721.ijcm-24-5030
Typhoid fever, caused by the human restricted pathogen Salmonella Typhi, remains a major global public health concern. Even after successful treatment, approximately 3-5% of patients with typhoid fail to clear the bacteria within one year and become chronic carriers. Most typhoid carriers have gallstones in their gallbladder, and biofilm formation on gallstones is highly correlated with chronic carriage. This study’s goal was to identify asymptomatic typhoid carriers in an endemic setting in Kenya, and to compare acute versus chronic isolates. A cohort of typhoid fever patients identified through blood and/or stool culture, and their household contacts, were followed up after treatment to detect longitudinal S. Typhi stool shedding. An abdominal ultrasound scan was used to identify individuals with gallstones. A total of 32 index patients and 32 household contacts were successfully followed-up. Gallstones were detected in 4 cases and 1 household contact. The duration of S. Typhi shedding was significantly longer in individuals with gallstones compared to those without, P<0.001. Eighty-three (83) S. Typhi strains were tested for susceptibility to commonly used antimicrobials and examined by in vitro biofilm formation assays. Out of 37 infected individuals, 32.4% had infections caused by multidrug resistant (MDR) S. Typhi strains and only 18.9% were infected by susceptible strains. Non-MDR strains formed significantly better biofilms in vitro than the MDR strains (P<0.001). This study provides data on S. Typhi chronic carriage that will influence public health approaches aimed at reducing typhoid transmission and the burden of infection.
Apr 2024 DOI 10.14302/issn.2329-9487.jhc-24-5040
Objective Hypertensive crisis is an increasingly frequent medical condition in our context. Its management in medical emergencies is a real challenge for physicians. Few data on hypertensive crisis are available in Chad. The aim of this study was to investigate the epidemiological, clinical and prognostic characteristics of hypertensive crisis in the medical emergency department of Reference National Teaching Hospital in N'Djamena. Patient and methods This was a prospective cohort study running from 1er March 2020 to October 31 2020. Patients presenting with a sudden and severe rise in blood pressure (systolic ≥ 180 mmHg and/or diastolic ≥ 110 mmHg) with or without acute target-organs damage, had been consecutively included and followed up over a period of one (01) month. Epidemic and clinical characteristics on admission, and morbidity and mortality parameters during the course of the disease were collected. The Kaplan-Meier method and the Cox model were used to analyze survival and factors associated with death, with a significance level of p<0.05. Results Of the 3978 hypertensive patients admitted to medical emergencies, 252 had a hypertensive crisis, i.e. a prevalence of 6.3%. Two hundred and seventeen (217) patients were included in the study, divided into 149 cases (69%) of hypertensive emergency and 67 cases (31%) of hypertensive hypertensive urgencies. The mean age of the patients was 55.2 ± 14 years (20 and 80 years) and 67% were male. Hypertension was known in 138 patients (64%). At least one complication was present on admission in 69% of patients. Complications were classified as cardiac (50.7%), neurological (38.2%), kidney impairment (46.5%) and ocular (46.1%). The average number of antihypertensive drugs used was 2 ± 0.83 14. Calcium antagonists (86.5%), diuretics (35.5%), converting enzyme inhibitors or angiotensin II receptor antagonists (33.3%) and betablockers (18%) were the pharmacological classes prescribed. Good compliance during follow-up was observed in 124 patients. One-month survival was 84% for all patients, with a 16% mortality rate. Factors associated with death were the duration of hypertension, and the occurrence of cardiovascular, renal dysfunction and ocular disease (p < 0.05). Conclusion Hypertensive crisis is a frequent pathology in sub-Saharan Africa, with high morbidity and mortality. Prevention requires early detection and effective management of hypertension.
Apr 2024 DOI 10.14302/issn.2641-4538.jphi-24-5044
Objective To study changes of cell morphology in BALF in children with Mycoplasma pneumoniae pneumonia (MPP). Methods From December 2021 to May 2022, a group of 32 children diagnosed with Acute MPP and admitted for treatment in the Pediatrics Department and PICU of the First Affiliated Hospital of Xinxiang Medical University were selected for our study. These patients underwent bronchoalveolar lavage as part of their clinical assessment. For comparison, we included a control group comprising 10 children who were not infected but had bronchial foreign bodies. We investigated the cellular composition in the bronchoalveolar lavage fluid (BALF) using Wright-Giemsa staining and microscopic evaluation, aiming to understand the relationship between shifts in cell proportions and extra-pulmonary symptoms associated with MPP. Results In this study, a total of 42 cases were enrolled, with 32 cases in the study group and 10 cases in the control group. There were no statistically significant differences in gender, age, height, weight, and BMI between the two groups (p > 0.05). The study group exhibited significantly higher levels of neutrophil percentage (GRA%), CRP, D-dimer, and LDH in blood routine tests compared to the control group (p < 0.05). Furthermore, the proportions of neutrophils (%) and macrophages (%) in BALF were significantly higher in the study group compared to the control group (p< 0.05), while the proportion of lymphocytes (%) in BALF showed no statistically significant difference between the two groups (p> 0.05). Conclusion In the acute phase of MPP in children, BALF is predominantly composed of neutrophils. A lower proportion of lymphocytes in BALF is associated with a higher incidence of extra-pulmonary manifestations and longer hospitalization duration.
Mar 2024 DOI 10.14302/issn.2640-690X.jfm-24-5016
Background Antibiotics are the most prescribed medications worldwide. Global consumption rose by 65% in 76 low and middle-income countries between the years 2000 and 2015. According to the World Health Organization, improper administration of antibiotics occurs in over 60% of people with upper respiratory tract infections. Inadvertent antibiotic use has been identified as a contributor to antimicrobial resistance. Outpatient antibiotic use accounts for around 80-90% of all antibiotic use in patients. Clinical officers are non-physician healthcare workers who have received less training, have a more restricted scope of practice than physicians. Clinical officers are key service providers in this country especially at the primary healthcare level. Objective The study assessed the factors that influence antibiotic prescribing for upper respiratory tract infections by clinical officers. Method A prospective study was carried out at 20 public hospitals in Kiambu County, on 36 clinical officers and 600 patient prescriptions. The parameters measured were patient factors, prescriber factors, institutional factors and how they affected the antibiotic prescribing practices by either being rational or irrational. Rational prescribing was identified as prescribing the right drug, at the right frequency, in the right duration, right dose for the right indication. Prescriptions were considered irrational if they did not satisfy any of the rational indices. Data was collected via a questionnaire from the clinical officers while WHO prescription checklist was used to collect data from patient encounters. Data was analyzed using Statistical Package for Social Sciences version 22.0 (SPSS v22.0) with P-value, Confidence Interval and Odds Ratio. Results A total of 600 patient encounters were recorded and 79.8% of the 479 encounters had an antibiotic prescription for URTI, 91% of the antibiotics prescribed were the right dose, 98% had the right frequency, 75% had the right duration, and only 23% had the right indication. Patients above 65 years were more likely to receive an antibiotic prescription OR 3.98 CI 0.91,17.41 P=0.17 compared to children under 12 years old. Males were more likely to receive an antibiotic, but this was not significant OR 1.06 CI 0.70, 1.59 P=0.79. A total of 28 (4.6%) patients had fever, and all received antibiotics. A total of 36 clinical officers were sampled and only 5 (13.8%) were found to have rational prescriptions (P=0.63), prescriber age (P=0.92), prescriber level of education (P=0.99) and prescriber work experience (P=0.22) were not associated with antibiotic prescription. As per institutional factors, availability of antibiotics (P=0.026) and availability of prescription guidelines (P=0.012) were associated with rational prescription of antibiotics. Conclusion The study indicated that there was a high antibiotic prescription rate deviating from the WHO standard. It demonstrated that most antibiotic prescriptions were irrational.
Jan 2024 DOI 10.14302/issn.2642-9241.jrd-23-4809
Introduction People living with HIV (PLHIV) are susceptible to developing non- communicable chronic respiratory diseases. Our objective was to study the spirometric profile of this population. Material and methods This was a descriptive and analytical cross-sectional retro-prospective study conducted from March 15 to June 15, 2022 and relating to the analysis of the medical files of asymptomatic and eligible for spirometry PLHIV, aged 18 years and above. They were received in the voluntary counselling and testing (VCT) centres of one of the two pulmonology departments in Abidjan. Results The study involved 54 subjects including 22 men (40.7%) and 32 women (59.3%) with an average age of 48.9 years. The majority of patients were non-smokers (81.4%) and the main history was pulmonary tuberculosis (35.2%). Only 29.6% had chronic respiratory symptoms and 42.6% had a normal BMI. The frequency of spirometric abnormalities was 57.4%. These spirometric abnormalities included 40.7% peripheral obstructive pattern; 9.3% restrictive pattern; 3.7% asthma and 3.7% COPD. A more than 10 years duration of HIV infection (p=0.001 OR= 0.2 (0.1 – 0.7)) and a duration of ART of at least 10 years (p=0.001 OR= 0, 2 (0.1 – 0.7)) were significantly associated with the existence of ventilatory abnormalities. Conclusion The high frequency of ventilatory anomalies in PLHIV independently of the existence of chronic respiratory signs leads us to propose spirometry in the follow-up assessment of PLHIV while paying particular attention to those on ARVs for more than 10 years.
Aug 2023 DOI 10.14302/issn.2641-5518.jcci-23-4646
Introduction The idea of HLSSM2 is to get the least easy surgical intervention, as arthroscopic surgery begins with examining the shoulder joint, and the location and size of the lesion are determined, then open over the lesion with an open surgical approach that is very limited for surgical repair; not using arthroscopic instruments but conventional surgical instruments in the second step. Figure 1 Figure 1. Methods Clinical experience with this technique consists of 44 cases over a period of thirty-one months, this study was from September 2020 to May 2023. All cases were done as outpatients and under general anesthesia. Results The mean duration of the operation was 35 minutes, and the minimum duration was 25 minutes. There was no major nerve or vascular injury in all cases. This technique is simple, safe, and good cosmetically satisfactory for all patients after full recovery about three months after the procedure, and it is cost-effective. One 43-year-old female patient suffered pain and stiffness during the first six months after surgery and was not very satisfied, she did not stop visiting us till now, she was not happy because of shoulder pain and tenderness. Conclusion It can be used by experienced hand surgeons in shoulder arthroscopy and in Mini Lateral Shoulder Approach (MLSA)3, especially in countries where shoulder arthroscopic release and repair with suture anchors are expensive4 or not available. This technique is not very simple but is available, safe, cosmetically satisfactory, and cost-effective.
Mar 2023 DOI 10.14302/issn.2994-6743.ijstd-22-4411
Background HIV causes immunosuppression, which reduces the body's immunity to diseases like COVID-19 by decreasing CD4 cells. The goal of this study is to determine whether persons living with HIV/AIDS (PLWHA) who are using anti-retroviral therapy (ART) are willing to accept the Coronavirus illness 2019 vaccination and the factors that influence their decision. Method From February 15 to March 15, 2022, 332 PLWHA on ART participated in this facility-based cross-sectional study. The correlation of outcome variables with predictors was investigated using binary and multivariable logistic regression. Result Of the 332 study participants, 110 (33.1 %) and 118 (35.5 %) had poor knowledge and a negative attitude toward the COVID-19 vaccination, respectively. Approximately 31 (9.3%) of study participants believe ART medications can also prevent COVID-19 infection. The willingness to receive the COVID-19 vaccine was 66.3 % with a 95 % confidence interval (60.9, 71.5). Knowledge, attitude, educational status, marital status, residency, duration, and monthly income were all significant predictors of willingness to receive COVID-19 vaccination. Conclusion Increased sensitization regarding the necessity of vaccines and the negative consequences of diseases, particularly among PLWHA, should be emphasized in the preparation of the COVID-19 immunization campaign involving prominent individuals such as health professionals and religious leaders.
Oct 2022 DOI 10.14302/issn.2641-5518.jcci-22-4323
Introduction Primary sarcomas of the breast are <0.1% of all malignant tumours of the breast. To date, there are 13 major breast sarcoma series in English literature. This study adds to these series characterizing primary breast sarcoma among Philippine patients. Methods All breast biopsies from the pathology records of the University of the Philippines-Philippine General Hospital (UP-PGH) were searched for breast sarcoma cases from January 2000 to December 2010. Metaplastic carcinomas and phyllodes tumors were excluded. Results There were 52 patients (45 female, 7 male) ranging in age 25-83 years (median 46 years). Majority had lump, ten cases with pain. No history of previous cancer was given. No history of prior radiation was found. Histopathological diagnoses were spindle cell sarcoma (n=13), fibrosarcoma (n=6), liposarcoma (n=6), MPNST (n=5), stromal sarcoma (n=5), angiosarcoma (n=4), MFH (n=4), leiomyosarcoma (n=3), rhabdomyosarcoma (n=3), chondrosarcoma (n=2), and synovial sarcoma (n=1). Tumors were with grade 1 (n=18), grade 2 (n=8), and grade 3 (n=10). Necrosis was noted in 6 cases. Simple mastectomy was done in 19 cases (37%), MRM in 31 cases (59%), while 2 far advanced had no surgery (3%). None had adjuvant radiotherapy or chemotherapy. The duration of follow-up for 45 patients ranged from 1 – 117 months, excluding those who were lost to follow-up. All 15 deaths were due to progressive disease. Recurrences were observed in 9 patients. The disease-free survival (DFS) and overall survival (OS) was 73%and 75%, respectively. On multivariate analysis, DFS and OS were significantly correlated with size (HR=113.63; p=0.019 and HR=77.36; p=0.037), grade (HR=20.73 ; p=0.003andHR= 39.57; p= 0.004), and having a histology of angiosarcoma (HR=35.20 ; p=0.005and HR= 50.74; p=0.007), respectively. Conclusion Sarcoma remains an important clinical entity among primary breast cancers.
Oct 2022 DOI 10.14302/issn.2379-7835.ijn-22-4316
Background Growing scientific evidence points to the benefits of human milk for the growth and development of a newborn. Compelling evidence has confirmed the benefits not only for full-term babies but also for preterm infants. Objective This survey was planned by the Italian Ministry of Health together with the Italian Association of Donor Human Milk Banks (AIBLUD) and aimed to evaluate the activity of human milk banks (HMBs) in Italy in the period 2018-2020, analyzing several items and the impact of the COVID-19 pandemic. Methods Following the two surveys performed in 2012 and 2016, a third survey was planned in the year 2021 to evaluate possible changes in the activity of the Human Milk Banks (HMBs) operating in Italy. A questionnaire was sent to all the 41 HMBs officially operating in Italy in the year 2021 with the purpose to obtain national data concerning milk banks activity, number of donors, volume of human milk collected, and other information related to the years 2018, 2019 and 2020. Additional questions related to the impact of the COVID-19 on the activity of HMBs in the year 2020 were included. Therefore the questionnaire proposed in this third survey collected fundamental data on the donation of human milk with the implications related to the COVID-19 pandemic. Results 90% of the banks (37/41) responded to this survey. The collected data confirm the results of the second survey (2016), with a high level of adherence to the Ministerial Guidelines and the AIBLUD recommendations. The application of the principles of the HACCP system continues to improve (89%), while in the last three years there has been a sharp decline in the home collection service for donor human milk (68%). This decline is mainly linked to the interruption of this service due to the limitations imposed by the pandemic. In 2020 (the year of the COVID-19 pandemic) there was a clear reduction in the number of donors with a return to the values of 2016. The volumes of milk collected, and the average duration of donation, however, remained high. The reasons linked to the reduction in the number of donors are described. Conclusion This survey underlines the high quality standard of Italian HMBs and the usefulness of this service for the national health policy. Despite the difficulties due to the COVID-19 pandemic, the Italian HMBs have maintained an efficient and safe service and have guaranteed the collection of satisfactory volumes of donor milk. Lack of information represents the most important barrier to the donation of human milk.
Jun 2022 DOI 10.14302/issn.2641-5518.jcci-22-4171
Purpose Is it safe to excise only the external portion of the pacemaker wires? This presentation aims to find out the proper way to manage pacing wires postoperatively. Methods We report 5-cases of sub-xiphoid abscesses and sinuses after valve surgery. Each case presented with a recurrent abscess that opens and drains its contents through a sinus around the lower-most portion of the xiphoid process. The duration between open heart surgery and evolution of these abscesses varied between 18 and 60 months. Valve surgeries were mitral and/or aortic valve replacement. Surgeons usually insert pacemaker wires to control any persistent post-operative arrhythmias that can affect hemodynamic circulation. On the day of discharge, some surgeons (not in our center) usually excise the pacemaker wires. Results The remaining intra-thoracic portions underwent some degree of corrosion that caused a state of chronic inflammation, sinus track formation and abscess evolution. This indicated radiological examination and surgical exploration to extract these foreign bodies. These 5 cases were diagnosed and operated upon between 15th January 2022 and 1st March2022, all at Abo-Khalifa Emergency Hospital-Ismailia, Egypt. Conclusions This confirms the significance of total withdrawal of the external pacemaker wires. Surgeons should not apply tight sutures at the site of insertion of the wires.
Jan 2022 DOI 10.14302/issn.2379-7835.ijn-21-4059
Aim There is limited published data describing the characteristics of the paediatric population prescribed semi elemental formulas. This retrospective observational audit aimed to describe the characteristics of the paediatric patients who have been prescribed a hydrolysed whey protein, medium chain triglycerides (MCT) based formula, Peptamen Junior® and the nutritional outcomes. Methods A retrospective observation audit was completed on a cohort of patients that was prescribed a semi elemental formula between 2016 and 2019 from a single tertiary paediatric medical centre. Data variables were collated such as patient characteristics, indications and modalities of administration, duration and tolerance to the formula. Results Data was collated on 375 patients with a median age of 6.2 years. The main underlying medical conditions were haematological/oncology (67%), gastrointestinal disorders (10.7%) and neurological conditions (9.4%). The most common indications for use were chemotherapy related side effects (36.2%), post bone marrow transplant (25.8%) and gastrointestinal symptoms (17.9%). The formula was rarely used as a sole source of nutrition, with 88% patients requiring accompanying forms of nutrition support. The majority of orders prescribed were of standard concentration (80.8%) and tolerance was recorded in 82.8% of patients. Conclusion The semi elemental formula Peptamen Junior® appears to be well tolerated in paediatric patients with a variety of medical conditions that have complex pathologies and may have wider scope of use in a more diverse group of medical conditions than currently indicated.
Dec 2021 DOI 10.14302/issn.2691-8862.jvat-21-3999
Vaccines symbolize the main pandemic control tool in the world, which is why they are the object of study in many investigations. In this work, the Abdala vaccine was characterized in terms of adverse reactions by conducting a survey and statistical processing of the data taken through distribution graphs of the same, developed in the Minitab software 16. Of the people involved, 47.67% presented Symptoms that were mild to moderate with the presence of pain in the area of the injection, drowsiness and decay, mainly. Based on the distribution of the data in histograms, the duration of these symptoms was approximately 1 day. Likewise, it was observed that the symptoms occur mainly in females, for 33.72% of the cases in the first dose and 23.26% after the second dose was applied.
Aug 2021 DOI 10.14302/issn.2639-3166.jar-21-3883
Despite the existing several Sugar manufacturing companies in Sudan, there is an acute shortage in sugar supply, therefore the government imports Sugar to bridge the gap. One of the strategies to be followed is the introduction of Sugar beet (Beta vulgaris) crop, mainly for sugar production. This crop has several advantages over Sugarcane such as short duration, less water requirement, in addition to other uses like animal feed. Therefore it became necessary to have good understanding of agricultural operations, cultural practices and adaptation. However, the main objective of this study was to assess the effect of Nitrogen fertilizer and plant spacing on vegetative growth of Sugar beet. This study was conducted at the farm of the College of Agriculture, University of Bahri, Alkadro, Khartoum State-Sudan; during the season 2016/2017. The experiment was arranged in Split plot in Randomized Complete Block Design with six treatments and four replications. Two plant spacing (15 and 20 cm.) were used as main plot, referred as (S1, S2) along with three levels of Nitrogen fertilizer (40, 80 and 120 kg/ha.), as subplot; referred as (N1, N2 and N3) and the control (0). Data regarding leaf number, leaf area index (LAI), leaf dry weight (g) (LDW), root diameter (mm.) and root fresh weight were recorded and statistically analyzed. The results showed S2 (20 cm) increased all the studied plant characters, namely the leaf number (29.139), leaf area index by (7.54), leaf dry weight (g) to (89.870), root diameter (mm) (94,992), root fresh weight (g) (695.80) compared to S1(1015 cm). On the other hand; the application of N3 (120 kg/ha.) increased the lead number (30.956), leaf Area Index (8.841), Leaf dry weight (102.47), root diameter (97.955) and root fresh weight (851.77) compared to S2 and S1 as presented in (table 4, table 5 and table 6).
Aug 2021 DOI 10.14302/issn.2639-3166.jar-21-3858
The Fall armyworm (Spodoptera frugiperda) is considered among the economic important pests in Sudan. Therefore, it became necessary to study and understand its biology and find out the appropriate control measure (s). To achieve the above objective, experiments based on Randomized Complete Block Design (RCBD) were carried out during the period from September 2018 to August 2019, where the Fall armyworm (FAW) was reared in the laboratory and fed on a nutrient médium composed of Corn leaves. The results displayed the ranges of eggs laid by a female was 890–1169. The egg incubation period ranged between 3-13 days. The larval duration ranged between (13-50) days and the pupal duration was between (7-20) days under a temperature of 21-300c and a Relative Humidity (RH) of 65 ± 5%. The longevity of the adults was 1-20 days, and the range of the full lifecycle was (24-100). However, six generations of FAW were obtained within one year. This study concludes that in Sudan FAW breeds continously throughtout the year and it recommends further studies on the biology and effective management of this invasive pest
Jun 2021 DOI 10.14302/issn.2641-4538.jphi-21-3859
In Rwanda, 38% children aged 6-59 months are stunted. In Ngoma District, stunting rate is estimated at 41% among the children aged below 5 years. The study objective was to evaluate the prevalence and factors contributing to under nutrition among children aged 6- 59 months in Ngoma District. Cluster sampling was used to determine the study participants for each sector within 14 sectors by considering the sample size of 442. The WHO Anthro software version 3.2.2 was used to determine the nutritional status of the children. SPSS version 24 was used for analysis. Of 442 children participated in the study 50.9% of them were females, 24.4% were aged 15-23 months and the majority of children (89.8%) born with normal birth weight. Study findings revealed that the prevalence of under nutrition was 33.7% for stunting, 3.6% for wasting and 6.6% underweighted. Poor sanitation facility (AOR: 4.1, 95%CI: 1.83-9.3, p=0.001), poor diet (AOR: 1.9, 95%CI: 1.18-3, p=0.008) were significantly associated with stunting. Factors such as lack of hand-washing facilities (AOR: 2.5, 95% CI: 1.013-6.3, p=0.047), not eat vegetables (AOR: 4.4, 95%CI: 1.7-10.96, p=0.001), and not eat fishes (AOR: 4.1, 95%CI: 1.6-10.6, p=0.003) were associated with wasting. Short breastfeeding duration (AOR: 4.5, 95%CI: 2.9-7.2, p=0.001), not eat vegetables (AOR: 1.9; 95%CI: 1.1-3.05, p=0.008), and not eat eggs (AOR: 2, 95%CI: 1.3-2.9, p=0.001) were associated with underweight. Poor families with under-five children need continuous support that will assist them to improve nutritional status of their children.
Apr 2021 DOI 10.14302/issn.2575-1212.jvhc-21-3759
The present study was initiated to improve the farm animals’ productivity through the use of medicinal plants. More specifically, to determine in female cavies the effects of aqueous extract of avocado seed powder (AEASP) on the estrous cycle, the levels of LH, estradiol and tissues (ovarian and uterine) biomarkers of oxidative stress. For the trial, 24 female cavies with regular estrous cycles were selectedamong 40 trough observation of 4 estrous cycles. They were randomly shared into 4 groups of 6 females each, comparable in term of body weight (bw) (463.60±77.69 g). They received by gavage 1 mL/kg bw of distilled water for the control and 100, 200, 400 mg/kg bw of AEASP respectively for the groups EA100, EA200 and EA400. Subsequently, 3 estrous cycles were studied every day during all the treatment period. At the end, the cavies were slaughtered at the estrus phase; blood, ovaries and uterus were collected for analysis. As result, the AEASP significantly (p<0.05) increase the duration of the estrus phase in females of group EA100, without affecting significantly the duration of the estrous cycle as referred to the control. It significantly reduce the serum level of total cholesterol and increase (p<0.05) the serum concentration of LH in cavies of group EA100 compared to the control. AEASP significantly increase the serum concentration of estradiol in all treated females as referred to the control. It significantly increase the level of malondialdehyde (MDA) in the ovaries of the females of group EA400. In the uterine tissue, superoxide dismutase (SOD) increase significantly in the cavies of group EA200 compare to the control. We can conclude that the AEASP increase the duration of the estrus phase of cavies without affecting the duration of the estrous cycle. Subsequently, it increases the serum concentration of LH and estradiol.
Dec 2020 DOI 10.14302/issn.2998-4785.ijne-20-3617
Background Overuse and abuse of antibiotics resulted in emergence of multidrug-resistant organisms (MDRO), increased rates of invasive candidiasis, prolonged hospital stay, NEC (Necrotizing enterocolitis), LOS (Late onset sepsis) or death. Restriction of the prescription, switching to a narrower spectrum and stopping antibiotics when not needed are some of the major approaches to antibiotic stewardship. Methods We identified restricted antimicrobials and devised an antimicrobial justification form. Clinicians needed to fill the form before prescribing restricted antimicrobials thereby comparing the antimicrobial usage pattern before and after the introduction of form. Babies enrolled before the introduction of the justification form were labelled as Group 1, and as Group 2 after justification form. The HIC (hospital infection control) staff nurse paid daily visits to NICU to monitor number of babies started on restricted antibiotics and whether the forms were duly filled or not. Any lag would be intimated to the Head HIC team for rectification. Any change of antibiotic within the restricted group also warranted justification. Culture report notified within 48 – 72 hrs so as to facilitate the stoppage of antibiotics in case of negative culture. Results There was a statistically significant reduction in the usage of restricted antimicrobials in the Group B as compared to Group A 150 (40.54%) vs 190 (49.35%) (p = 0.01). There was a statistically significant increase in the % of babies de-escalated from high end antimicrobials in Group B as compared to Group A 90 (60%) vs 56 (29.47%) (p = <0.0001). Duration of restricted antimicrobials reduced from 13.78 ± 2.7 days in Group A to 9.9 ±1.8 days in Group B (p = <0.0001). No difference in the number of babies started on any antibiotic between both the groups (p = 0.1). Conclusion Introduction of the antibiotic justification form as a part of antimicrobial stewardship program resulted in an overall reduced usage of restricted antimicrobials along with rapid de-escalation.
Dec 2020 DOI 10.14302/issn.2379-7835.ijn-20-3406
Calocybe indica, a tropical edible mushroom and it is popular because it has good nutritive value and it can be cultivated commercially on a large scale. Mushrooms are in the great demand everywhere and hold a unique place in the world today due to their typical taste and rich in protein, vitamins, minerals. Other than nutritional value, it is also playing a major role in medicinal field. Milky mushroom is known to have anti-oxidant and anti-cancer effect. Paddy in particular used as a substrate in Milky mushroom considered as inexpensive and it is a popular variety among people because of its distinct flavor, higher protein content and shorter cropping duration compared to other cultivated mushrooms. The present study designed to explain how the mushroom was cultivated using paddy straw in India.
Sep 2020 DOI 10.14302/issn.2379-7835.ijn-20-3369
Background Since swine flu has been declared pandemic in 2009 it has become a major challenging public-health problem associated with high morbidity and mortality. 25(OH)D deficiency is also pandemic and has been reported to be clinically correlated with decreased immunity and respiratory infections. The possible role of vitamin D in infections is implied from its impact on the innate and adaptive immune responses. This study is planned to evaluate clinical significance of 25(OH)D status on course and outcome in hospitalized cases of swine flu and to compare it with normal healthy subjects living in the same vicinity to evaluate if vitamin D is having any protective effect. Material & Methods Present prospective cross-sectional study was conducted on 79 RT-PCR confirmed cases of swine flu admitted during recent epidemic. All patients were evaluated thoroughly by clinical history physical examination and laboratory investigations as per Performa and followed-up during hospital stay. 25-hydroxyvitamin D (25(OH)D) estimation was done by electro-chemiluminescent Assay in all the cases and it was also done in 36 normal healthy family members of study patients living in the same vicinity (control group). Results High prevalence (70.9%) of low (≤30ng/ml) status of 25(OH)D was observed in cases of swine flu as compared to control group. 25(OH)D status was associated with severity of illness. Mean value of 25(OH)D in mechanically ventilated patients was 9.81±6.43 while it was 22.76±11.35 ng/ml in patients who do not required ventilation (p<0.05). Mean 25(OH)D level in patients who stayed in hospital for <5 days was 28.60±8.79 ng/ml, 24.18±11.67 for 6-10 days and 8.23±2.12 for >10 days (p<0.01). Mean value of 25(OH)D in patients who died was 9.59±5.90 ng/ml as compared to 23.13±11.62 ng/ml who survived (p<0.01). Conclusion Our study suggests that 25(OH)D may have preventive role for swine flu infection. Low level of 25(OH)D is associated with high morbidity in terms of increase requirement for mechanical ventilation, multiorgan dysfunction and long duration of hospital stay. 25(OH)D deficiency is associated with high mortality in swine flu. 25(OH)D status should be given due consideration in high risk patients especially during winter season.
Sep 2020 DOI 10.14302/issn.2694-1198.jge-20-3515
The solution of a genetic-mathematical problem of interaction of the human population cells and virus population to a problem of pandemic COVID-19 is submitted. The mathematical model based on the Hardy - Weinberg law consisting of two interdependent differential equations is used. The equations reflect time dynamics of the human cells and virus populations during their interaction. Solutions of the differential equations are found and results of these solutions are analyzed. The estimation of duration pandemic is received at use of parameters of the human liver cells and a flu virus.
Jun 2020 DOI 10.14302/issn.2691-8862.jvat-20-3417
Background Decreased antioxidant ability is one of the worsening conditions in AIDS.We aimed to evaluate total antioxidant ability among others, and their variation in HIV infected patients following their CD4+T cells count and viral load, in a context of new ART scarcity in most LMICs. Material and Methods We conducted a cross sectional study on 167 individuals (76 controls, 33 treatments naïve and 58 HIV-1 infected patients on ART). We assessed their plasma total antioxidant ability (FRAP), malondialdehyde (MDA) and thiol (SH) groups using standard spectrophotometric methods, then we calculated lipid peroxidation index (LPI). Statistical analysis was performed using GraphPad Prism 6. Data were analyzed by two-tailed unpaired t-test for two groups’ comparison and ANOVA for more than two groups. Pearson correlation between CD4+T cells count, viral load and the above markers was determined; P ≤ 0.05 was considered statistically significant. Results The following controls/naïve/treated subjects’ values for FRAP(mM) (1.907±0.074/1.77±0.05/1.695±0.03); MDA(μΜ) (0.781±0.081/1.115±0.118/ 1.342±0.109); SH (μΜ) (2.747±0.130/1.582±0.197/1.498 ±0.140)and LPI (0.43±0.61/ 0.61±0.7/2.59±0.83) were all obtained with P ≤ 0.05. The FRAP increased only with 3TC+TDF+EFV and 3TC+ABC+NVP cART while MDA decrease significantly with the later(p=0.027). MDA and LPI significantly increased in heavily treated patients with p<0.0014 and p=0.0001 respectively. overall, the patients showed an increase of viral loads following a decrease of CD4+T cells (r= -0.803, p=0.016) but 3TC+TDF+EFV seem to better manage the both. The only significant correlation was established between SH groups and CD4+Tcells count (r=0.447; p=0.0006); Conclusion Our study showed that thiol groups may be protective againstCD4+Tcells count depletion and that the cART 3TC+TDF+EFV, 3TC+ABC+NVP may be helpful in fighting against free radical generation and particularly 3TC+TDF+EFV as controlling CD4+Tcells count and viral load in long term treated patients. The study particularly showed the implication of cART in increasing lipid peroxidation index following the treatment duration in heavily treated patients, which aggravated their conditions in an area where drug options are limited, calling for new drugs availability and personalized medicine.
Jun 2020 DOI 10.14302/issn.2577-2279.ijha-20-3403
This study evaluated the effects of aluminum sulphate exposure on the histology of adrenal gland of Wistar rats. Thirty adult Wistar rats were used for this study. The Wister rats were divided into three groups; group A was the control animals and tagged C, group B animals received 10g of alum dissolved in 1000cm3 of distilled water and were tagged T1, group C animals received 50g of alum dissolved in 1000cm3of distilled water and were tagged T2, via drinking water for duration of four weeks. Twenty-four hours after the last administration, the rats were sacrificed by cervical dislocation. The adrenal gland was excised and preserved in 10 % formosaline after which it was routinely processed for hematoxylin and eosin staining (H&E). Histological observations showed normal cell distribution in the control group but treated group revealed evidences of cellular obliteration& hemorrhagic necrosis. The results obtained from this study suggest that aluminum sulphate has a damaging effect on the structure of the adrenal gland.
Jun 2020 DOI 10.14302/issn.2372-6601.jhor-20-3372
Immune thrombocytopenia currently called under its’ new name, immune thrombocytopenic purpura (ITP) is a disease characterized by thrombocytopenia, in which the body attacks its own platelets due to the disorders in immune system. The pathophysiology of this disease includes increased platelet destruction and most megakaryocyte production in bone marrow. The most common clinical manifestation of ITP is mild or severe progressive bleeding that could result in death. ITP is generally named as primary or secondary ITP according to thrombocytopenia severity, disease duration, bleeding status and secondary occurrence of the disease. Currently for diagnosis, despite the blood count, antiglobulin test and laboratory tests that can detect platelet-bound antibodies, they are not enough for definitive diagnosis. Like the difficulty in diagnosis, ITP treatment is quite complicated which varies depending on age, characteristics and risk of the patient. It is classified as first, second and third-line treatment options. Also, depending on the condition of patients, combined treatment might be an option which increases the complexity of the treatment. Unfortunately, discussions related to different clinical applications in diagnosis and treatments continue recently. For this reason, we considered that preparation of a review containing recent updates in diagnostic approaches and treatment options in ITP will be remarkable and beneficial for physicians interested in this subject.
May 2020 DOI 10.14302/issn.2641-4538.jphi-20-3338
This study investigated the acute toxicity of Clariasgariepinusfingerlings. The fingerlings of Clariasgariepinuswere acclimatized for 1 week before the range-finding test was carried out at varying concentrations. Sublethal concentration (viz: 0.00ppm, 10.80 ppm, 18.00 ppm, 25.20 ppm, 32.40 ppm and 39.60 ppm of the 2,4-D Dimethylamine salt) were made in a rectangular aquarium. Each experimental concentration was carried out in triplicate with 10 fish each. The media were renewed at every 24 hours throughout the experimental duration viz: 96 hours. When the fish were introduced into the aquarium containing the toxicants, they exhibited some behavioural changes including opercular movement, air gulping and irregular swimming pattern. The mortality rate significantly increased as the concentration of the 2,4-D Dimethylamine salt increased for each of the exposure duration. The LC50 values at 24, 48, 72 and 96 were 86.15 ppm, 36.28 ppm, 18.72 ppm and 15.68 ppm, respectively. From the findings of this study, there is a need for exercise caution in the use of 2,4-D Dimethylamine salt based herbicides close to the aquatic ecosystem.
Apr 2020 DOI 10.14302/issn.2470-0436.jos-20-3273
Objective To identify common ocular and non-ocular signs and symptoms of patients with chiasmal lesions presenting to ophthalmologists. Methods This is a three year case series of patients who presented to Rizal Medical Center Ophthalmology OPD clinic, diagnosed as cases of chiasmal lesion with a complete neuro-ophthalmogical exam, ancillary test and neuroimaging. Data collected include patient profile, ocular and non ocular symptoms, duration of blurring of vision (BOV), best corrected visual acuity (BCVA), Color Vision, Optic nerve (ON) description, Visual field defects (VFD) and size & location of chiasmal lesion. Results A total of twelve patients were included with 1:1 M:F ratio and a median age of 39 years. Blurring of Vision was the presenting symptom in 10 cases, bulging of the eyes and headaches in the remaining cases. Associated symptoms include: non specific headache in all; diplopia in 3 (1 with and 2 without motility defects); and systemic symptoms related to hormonal imbalance in 2 cases. Best corrected vision ranged from 6/6 to no light perception (NLP). Color vision was affected in all cases. ON palor was seen in 6 (50%) and disc edema in 1 case. VFD include Junctional scotoma (58.33%), bitemporal hemianopia (33.3%) and generalised scotoma (8.3%). Neuroimaging revealed pituitary lesions in 10 cases, 1 craniopharyngioma and ON glioma with chiasmal extension. Conclusion Ocular and non ocular symptoms seen were comparable to other studies except that Junctional scotoma was the most common VFD identified in the included population of our case series. This highlights the importance of VF testing among patients complaining of unilateral visual loss to rule out a chiasmal lesion.
Mar 2020 DOI 10.14302/issn.2574-612X.ijpr-20-3213
Introduction Scientific evidence has established the benefits of meditation and sound vibrations on emotional and physiological health. Aim of the Study The study explored changes in mood and Heart Rate Variability (HRV) after HSB Sound Bath Meditation on healthy individuals. The objectives of the study were to understand if a 40-minute-long seated HSB Sound Bath Meditation results in changes (a) in mood measured via Positive And Negative Affect Scale (PANAS) and Abbreviated Profile of Mood States (POMS) Survey and (b) in physiological parameters, as measured by HRV. Methods The psychological parameters were measured with PANAS (N=77) and Abbreviated POMS, (N=17). The physiology was measured with HRV parameters such as Heart Rate (HR), Stress Index (SI) and Root Mean Square of Standard Deviation (RMSSD) using the EmWave Pro device (N=15). HRV data analysis was conducted with Kubios HRV Premium and analyzed using a paired T-Test. Results All the subjects after meditation showed improvement in Positive Affect (PA) and a reduction in Negative Affect (NA). The HRV parameters showed a trend showing overall relaxation with a significant reduction in HR, SI and an increase in RMSSD. Consistent with changes in positive, negative mood and HRV, all the participants showed a reduction in tension, anger, fatigue, depression and confusion and improvement in esteem related affect and vigor. Conclusion The findings show that seated HSB Sound Bath Meditation session has a positive impact on mood-related measures and physiology. Future work in this area could explore comparison with a control group and a longer study duration comprising multiple sessions.
Mar 2020 DOI 10.14302/issn.2766-8681.jcsr-21-3719
Background Since receiving unexplained pneumonia patients at the Jinyintan Hospital in Wuhan, China in December 2019, the new coronavirus (COVID-19) has rapidly spread in Wuhan, China and spread to the entire China and some neighboring countries. We establish the dynamics model of infectious diseases and time series model to predict the trend and short-term prediction of the transmission of COVID-19, which will be conducive to the intervention and prevention of COVID-19 by departments at all levels in mainland China and buy more time for clinical trials. Methods Based on the transmission mechanism of COVID-19 in the population and the implemented prevention and control measures, we establish the dynamic models of the six chambers, and establish the time series models based on different mathematical formulas according to the variation law of the original data. Findings The results based on time series analysis and kinetic model analysis show that the cumulative diagnosis of pneumonia of COVID-19 in mainland China can reach 36,343 after one week (February 8, 2020), and the number of basic regenerations can reach 4.01. The cumulative number of confirmed diagnoses will reach a peak of 87,701 on March 15, 2020; the number of basic regenerations in Wuhan will reach 4.3, and the cumulative number of confirmed cases in Wuhan will reach peak at 76,982 on March 20. Whether in Mainland China or Wuhan, both the infection rate and the basic regeneration number of COVID-19 continue to decline, and the results of the sensitivity analysis show that the time it takes for a suspected population to be diagnosed as a confirmed population can have a significant impact on the peak size and duration of the cumulative number of diagnoses. Increased mortality leads to additional cases of pneumonia, while increased cure rates are not sensitive to the cumulative number of confirmed cases. Interpretation Chinese governments at various levels have intervened in many ways to control the epidemic. According to the results of the model analysis, we believe that the emergency intervention measures adopted in the early stage of the epidemic, such as blocking Wuhan, restricting the flow of people in Hubei province, and increasing the support to Wuhan, had a crucial restraining effect on the original spread of the epidemic. It is a very effective prevention and treatment method to continue to increase investment in various medical resources to ensure that suspected patients can be diagnosed and treated in a timely manner. Based on the results of the sensitivity analysis, we believe that enhanced treatment of the bodies of deceased patients can be effective in ensuring that the bodies themselves and the process do not result in additional viral infections, and once the pneumonia patients with the COVID-19 are cured, the antibodies left in their bodies may prevent them from reinfection COVID-19 for a longer period of time.
Sep 2019 DOI 10.14302/issn.2379-7835.ijn-19-2968
Physical activity (PA) decreases in late adolescence and young adulthood when this age cohort enters the workforce with many being employed in the foodservice industry. Daily energy expenditure can be divided between occupational physical activity (OPA) and leisure-time physical activity (LTPA). Although LTPA is known to be associated with positive health benefits, a limited number of studies have investigated the influence of OPA on LTPA in young restaurant servers. This study measured via accelerometry, OPA and LTPA for a 7-day period from a sample of young adult servers (n = 7, 23-29 years old) from two restaurants. Resting metabolic rate was measured via indirect calorimetry and inputted into the AMP 331 accelerometer for energy expenditure calculations. Energy expenditure patterns were compared to age- and sex-specific normative data, occupational classifications, and the Canadian PA Guidelines to Healthy Active Living (CPAG). Energy expenditure results and step count values were higher for working versus non-working days and working versus non-working periods. Daily, working energy expenditure was approximately equal to normative data, while non-working daily energy expenditure was lower. The working period energy expenditure placed this population in the ‘exceptionally active’ OPA classification. Minimum PA levels, based on CPAG were met each day, however 10,000-steps-per-day were only achieved on working days. None of the participants logged LTPA and therefore 100% of their PA came from OPA. More research is needed over a longer duration and at different times in the year to identify the effect OPA has on LTPA in this population.
Sep 2019 DOI 10.14302/issn.2574-450X.jom-19-3000
Background Polycystic ovarian syndrome (PCOS) is increasingly being diagnosed and treated with sometimes variable lifestyle advice and pharmacological interventions. Obesity is considered as the sole culprit and variable definitions in clinics compound the understanding of pathogenic heterogeneity of this syndrome. We evaluated the differences between various simple to calculate anthropometric indices along with some anthropometric-biochemical equations in subjects with or without PCOS. Objective To compare traditional measures like waist to hip and height ratio (WHpR and WHtR), BMI, newer markers depicting central obesity like Abdominal Volume index(AVI), Body roundness index (BRI), A Body Shape index (ABSI), Conicity index (C-index) along with biochemical-anthropometric equations like lipid Accumulation Products (LAP), Visceral Adiposity Index (VAI) and Chinese Visceral Adiposity Index (CVAI) for diagnosing PCOS as per the Rotterdam criteria Design Cross-sectional analysis Place & Study Duration Naval hospital, Islamabad from Jan- 2018 to July- 2019 Subjects and Methods From our finally evaluated 333 female subjects we initially compared the differences for the presence of hirsutism as per modified Ferrimen Gallwey scores and biochemical hyperandrogenism by measuring free androgen index (Total testosterone/SHBG x 1000. We evaluated waist circumference, BMI, WHpR, WHtR,AVI, BRI, ABSI, C-index along with biochemical-anthropometric equations like LAP, VAI and CVAI for differences in subjects diagnosed to have PCOS by Rotterdam criteria or ultrasonography alone. Results Differences in hirsutism as defined by modified FG score between subjects defined to have PCOS or otherwise as per Rotterdam defined criteria were as [(PCOS=169, Mean=17.33 + 9.05) (No PCOS=164, Mean=8.21 + 5.74), p< 0.001] and ultrasound [(PCOS=87, Mean=16.95 + 9.57) (No PCOS=246, Mean=11.38 + 8.51), p< 0.001]. Similarly, the differences in FAI between subjects defined to have PCOS or otherwise as per Rotterdam criteria and ultrasound were as [(PCOS=169, Mean=6.41 + 4.88) (No PCOS=164, Mean=2.77 + 1.79), p< 0.001] and [(PCOS=87, Mean=5.75 + 5.01) (No PCOS=246, Mean=4.22 + 3.68), p= 0.011]. Anthropometric measures and anthropometric-mathematical equations were raised in non-PCOS subjects than PCOS subjects. Lean-PCOS demonstrated lower degree of hirsutism and biochemical hyperandrogenism in comparison to obese-PCOS. Conclusion Hirsutism and free androgen indices were raised in PCOS females. Anthropometric based measurements were not different in PCOS cases and non-PCOS females. Lean-PCOS demonstrated lower degree of hirsutism and biochemical hyperandrogenism in comparison to obese-PCOS.
Sep 2019 DOI 10.14302/issn.2574-4518.jsdr-19-2950
Background Children with autism spectrum disorders (ASD) often have difficulties settling to sleep and maintaining asleep through the night. Sleep difficulties are linked to challenging behaviour so understanding the causes of these difficulties is vital. Possible explanations are: (1) that irregular innate cycles lead to difficulties maintaining/initiating sleep at the appropriate times; (2) that children with ASD fail to learn from the contingencies that teach neurotypical children to initiate and maintain sleep. If the cycles are innate then small externally imposed changes in routine will not affect the sleep cycle. Methods The sleep records of 46 children with autism and moderate to profound intellectual impairments attending a residential school were examined to identify the effects of spring time change and weekend leave on 1) the times children went to sleep, 2) the length of their sleep and 3) the number of sleep disruptions. Manual staff recordings of the children’s sleep were conducted and data for these variables were analysed using repeated measures analysis of variance. Results A later sleep time was found in children regarding their sleep onset on Sunday after the time change (average onset was 9:57 p.m. ((s.e. = 8.49 minutes) versus 10:17 p.m. (s.e. = 8.19 minutes), with analysis of variance of sleep onset time showing a significant effect (F (3,41) = 5.02, p = 0.005). However, only two out of three comparison groups showed statistically significant effects (March 23rd versus March 30th mean difference = 0.39, p = 0.003; March 30th April 13th mean difference = 0.36, p = 0.03). No statistical difference was found between March 30th versus April 6th or other sleep parameters in any groups (i.e., sleep duration or night time awakenings). Similarly, no change in any sleep parameters (i.e., sleep onset or awakenings) were found when Sundays sleep parameters were compared to Mondays and/or Tuesdays. Conclusions In this small pilot study, small changes of day/night cycles appear to have few effects on the sleep patterns of children with ASD attending a residential school. While no significant sleep pattern change was found in this population due to change of clock times or weekend visits, larger epidemiological studies addressing other unexamined variables to better delineate changes in ASD are needed.
Aug 2019 DOI 10.14302/issn.2379-7835.ijn-19-2876
Infant and young child feeding (IYCF) practices directly affect the nutritional status of children under two years of age, and ultimately, impact child survival. These practices are influenced by maternal knowledge and attitudes as well as socio-demographic and cultural factors; and an understanding of such factors is important to scaling up IYCF practices. This study was designed to assess the role of religion on knowledge, attitude and infant feeding practices among Christian and Muslim lactating mothers in Ibadan North Local Government Area (LGA), Oyo State. The descriptive cross-sectional study was conducted among 320 lactating mothers in the LGA. Eight focus group discussions were carried out among Christian and Muslim lactating mothers. An adapted pre-tested questionnaire was used to collect information on socio-demographic characteristics and IYCF knowledge, attitude and practices of the respondents. Knowledge on IYCF was assessed on 14-item scale, and the scores categorised as: ˂5.60 poor, 5.60–10.88 fair, and ˃10.88 good knowledge. Attitude was assessed on 13 statements from the IOWA Infant Feeding Attitude scale with lowest and highest obtainable score of 13 and 65 respectively. A score of ˂44 was ranked as poor, and ˃44 points good. Data were analysed using descriptive statistics and one-way ANOVA. Qualitative data was analysed thematically. Mean age of respondents was 30.0±4.9 years, 55.9% were Muslims, and 63.8% had fair knowledge. There was no significant difference in fair knowledge categorisation (63.7%, 63.8%), but there existed slight difference in good (20.7%, 21.3%) and poor (15.6%, 14.9%) knowledge of the Muslim and Christian respondents respectively. Mothers with poor attitude constituted 56.0%. Muslim religion directly supports pre-lacteal feeding and duration of breastfeeding while the other indirectly supports breastfeeding. Religious practices directly and indirectly affect knowledge, attitude and practices of nursing mothers on infant feeding; hence, healthcare Professionals should pay more attention to nutrition education in religious houses using the infant and young child feeding module.
Jun 2019 DOI 10.14302/issn.2639-3166.jar-19-2858
The objective of this study was to evaluate the effectiveness of endophagous Encyrtid parasitic wasp Aenasiusarizonensis (Girault) (Hymenoptera, Chalcidoidea), as a natural enemy for controlling the Mealybug, Phenacoccussolenopsis Tinsley (Hemiptera: Pseudococcidae). Where a Randomized Complete Block Design (RCBD) was adopted. Both, field survey and Laboratory experiments were conducted to study some biological characteristics of the parasitoid A. arizonensis. The results of field study revealed that, the parasitioid was available most of the year, and was highly effective on adults and last larval instar of the mealy bug, P. Solenopsis, with a total percentage of parasitism of 31.26%. While the laboratory results showed that, the duration from oviposition to adult emergence were similar for both male and female. Longevity of male was 23± 2.33 days and female 23.37±1.89 days. Mean daily fecundity in terms of number of Parasitized hosts /female / day ranged from 20 to 24. The sex ratio was 1:1.6 for the male and female in the progeny. Generally, a mass rearing of this parasitoid, with a conservation and augmentation releases could help in the application of an effective management strategy for the control of the cotton mealy bug in the field.
Mar 2019 DOI 10.14302/issn.2643-0282.imsj-19-2672
Recently, annual swarm of invasive Erythrean schyphozoan RhopilemanomadicaGalil, 1990 appeared along Egyptian Mediterranean coasts causing beach closures and fishing problems. The present study conducted survey and field monitoring on R. nomadica during blooming season in the Egyptian Mediterranean coast throughout three consecutive years (2015-2017). Three main features of R. nomadica bloom were addressed; viz starting date, duration and maximum density of aggregation. In 2015, the bloom started on 28 July, and over the following two years the bloom starting date shifted earlier being 19 July in 2016 and 15 June in 2017. The duration of the bloom varied yearly giving the longest duration in 2017 when the bloom continued in high density for a month. The highest density of R. nomadica was about 896 medusae/1000 m3 in 2017. The medusae diameter ranged between 21 to 112 cm. The average bell diameter for each year displayed gradual increasing values over the years. The consistent annual R. nomadica blooming was attributed to the high level of eutrophication and ecosystem degradation occurred along the Mediterranean coast since last decades. The shifting in the annual bloom starting date and duration may reflect the adaptation of R. nomadica to the climate change effect on the Mediterranean Sea temperature.
Jan 2019 DOI 10.14302/issn.2643-6655.jcap-18-2541
Many researchers have devoted considerable attention to the impact of individual-level factors on child mortality, but little is known about how family and community characteristics affect health of children. Trend in child mortality as well as its determinants, has long been the subject of academic and policy debates. In spite of this, the problem of child mortality remains as daunting as ever. In fact, advancement in medical sciences and the upsurge in information and telecommunication technology equipment have not significantly reduced child mortality in the country, unlike in the West. The Multilevel proportional hazards model for data that are hierarchically clustered at three levels was applied to the study of covariates of child mortality in Nigeria. This study merges two parallel developments of statistical tools for data analysis: statistical methods known as hazard models that are used for analyzing event-duration data and statistical methods for analyzing hierarchically clustered data known as multilevel models. These developments have rarely been integrated in research practice and the formalization and estimation of models for hierarchically clustered survival data remain largely uncharted. The model was estimated using the Newton-Raphsons numerical search approach. The model accounts for hierarchical clustering with three random effects or frailty effects. We assume that the random effects are independent and follow the Exponential and Weibull distribution. The results indicate that bio-demographic factors are more important in infancy while socioeconomic factors and household and environmental conditions have a greater effect in childhood. Furthermore, there is significant variation in child mortality risks even after controlling for measured determinants of mortality. Also, factors that fall under family and community level are more significant indicating that child survival is most controlled or determined by family and community factors and variables at the child level is not weighty. This suggests that there may exits unobserved or unobservable factors related to mortality.
Nov 2018 DOI 10.14302/issn.2474-9273.jbtm-18-2348
The transition to university can be a stressful time in a student’s life. Recent evidence demonstrates declining mental and physical health in college and university students compared to the general public. A prospective cohort study investigating mental and physical wellness over the course of a semester in a sample of first-year undergraduate students (N=74; 65%F) from nine faculties was completed at a large university in Canada. Sixty-eight (92%) students with a mean (SD, ±) age 18.2 ± 1.1 yrs., weight 67.9 ± 15.5 kg, height, 168.5 ± 11.6 cm and waist circumference 81.3 ± 9.8 cm completed the SF-36V2 quality of life questionnaire at the beginning and end of the semester in Fall 2014. A decrease in vitality (p=0.003), social functioning (p=0.004), emotional state (p=0.014), and mental health (p=0.019) outcomes as measured by the SF-36v2 occurred during the semester. In addition, aggregate mental health significantly declined from the beginning to the end of the semester (p <0.001), while physical health did not change (p=0.242). The importance of promoting and increasing awareness of campus wide mental health strategies should be considered a priority for first year undergrad students. Particularly, because students in their first year may take longer than one semester to adjust to the increased work load and although difficult to speculate it is possible that both mental and physical health would decline over the next (second) semester. Future research should aim for longer study duration.
Oct 2018 DOI 10.14302/issn.2379-7835.ijn-18-2228
Introduction: Organophosphate (OP) pesticide poisoning is a major challenging public-health problem in developing countries. Vitamin D deficiency is pandemic, yet it is the most under-diagnosed and under-treated nutritional deficiency in the world and it has been reported to be clinically correlated with psychiatric illness and manifestation of severe systemic inflammatory response syndrome like ARDS. Thus vitamin D deficiency may affect clinical course and outcome in cases of OPP. Aim: To evaluate status of 25 hydroxyvitamin D (25(OH)D) level in OP poisoning and its correlation with outcome of such patients. Materials and Methods: Serum 25(OH)D levels were measured at the time of hospitalization by electro-chemiluminescent Assay in 96 patients (76 male and 20 female) suffering from OP poisoning. Diagnosis of OP poisoning was made by history of poisoning including container of the poison brought by patient’s relative, clinical examination and measurement of serum butyrylcholinesterase activity. All patients were evaluated as per Performa and follow up till discharge. Results: Mean level of 25(OH)D in our cases was 24.57±9.91ng/ml and 66.7% had low levels of 25(OH)D. Our study shows linear relationship between 25(OH)D level and duration of hospital stay. All cases of OP poisoning who developed severe manifestations like ARDS, Intermediate syndrome (IMS) were having significant 25(OH)D deficiency. Our study also shows lower levels of 25(OH)D were associated with poor outcome (11.27±3.21vs 27.02±8.54, p<0.001). Conclusion: Vitamin D deficiency in OP poisoning is associated with longer hospital stay, more requirement of ventilator support and high prevalence of complication (ARDS and IMS) and poor outcome. Awareness of 25(OH)D level in patients with OP poisoning may be important to improve outcome.
Sep 2018 DOI 10.14302/issn.2470-5020.jnrt-18-2185
Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) provides efficient treatment for the alleviation of motor signs in patients with Parkinson's disease (PD), but more studies about gait and functionality are needed. We aimed to understand whether short-term DBS treatment will can relieve the symptoms of PD patients, specifically we examined its effect on motor-cognitive-complication parameters, fine motor skills and daily living activity (DLA) of these patients. Method: Ten patients from Mustafa Kemal University Neurosurgery Department were recruited. The assessments were made twice, first time preoperatively, which was within one week prior to the surgery, second time postoperatively, which was 55-65 days post treatment. The motor scores, DLA scores, mental scores and complication scores were measured with Unified Parkinson's Disease Rating Scale (UPDRS), fine motor skills measured with The nine-hole peg test (9-HPT), balance measured with Berg Balance Scale (BBS) and falling risk measured with Timed Up and Go Test (TUG). Results: 10 patients (5 female, 5 male) aged between 40-60 (mean=49.44±6.69 years) were included in the study. Duration of the disease’s mean was 5.60 years. We found significant difference between pre-op and post-op results in UPDRS DLA, UPDRS motor, UPDRS complication, UPDRS total score and TUG tests (Table 2). There was no significant difference between preop-postop assessment in UPDRS mental, BBS and 9-HPT results (p>0.05). Discussion: Balance, walk and fine motor impairment occurs almost always in Parkinson’s disease and resulting in difficulties with daily living activities. We found that DBS has positive effect on PD complications, balance and walking abilities. PD patients that have falling risk and multiple motor symptoms may have benefit from DBS.
Sep 2018 DOI 10.14302/issn.2328-0182.japst-18-2281
The role that Vitamin D plays in human health is no more hidden in this modern age where every individual carries the knowledge treasure in the pocket (The internet) but the unjustified deficiency or insufficiency is still a research question waiting for the answer from research community all over the world. Normal levels (30-50 ng/ml) are necessary for the development of teeth and bones in children and bone mineralization in adults. The deficiency or insufficiency causes rickets, arthralgia, arthritis, osteoporosis and Osteomalacia. Study Design: Observational study. Study Setting: Department of Orthopedic LUMHS Jamshoro. Study Duration: from April 2017 to Oct 2017. Sampling: 600 patients were selected through Consecutive sampling. Statistical Analysis: Descriptive statistics like mean, Standard deviation, minimum, and maximum were calculated Using SPSS version 22.Mean of two genders was compared using t-test setting <0.05 as level of significance. Results: Mean serum vitamin –D level was 16.11+10.07ng/ml in men while it was 16.63+11.73 ng/ml in women. 62% of the study population was found deficient (<20ng/ml) while 16.33% were having insufficient levels (<30ng/ml) and only 12% showed normal levels (30-50ng/ml). There was no significant difference between the two genders, p value 0.59 Conclusion: Vitamin –D deficiency is very common in both genders with no significant difference between males and females.
Aug 2018 DOI 10.14302/issn.2324-7339.jcrhap-18-2202
Background: Ideally, disclosure of HIV status to infected children and adolescents should involve both health care workers and parents/caregivers. Most studies on disclosure in children have focus mainly on parents/caregivers with little information on health care workers. We conduct this study to evaluate the practice, perception of the healthcare workers in our health facility on disclosure to infected children and adolescents. It is envisaged that such information will help in the design of better strategies on disclosure in our environment. Methods: A cross sectional hospital based study was conducted among health care workers at the special treatment clinic, and heart to heart unit of the University of Abuja Teaching Hospital, Gwagwalada from January to March 2017 for the above objective. A structured questionnaire was used to collect information on disclosure among the healthcare workers, which include among others: their bio-data, knowledge, perception, and practice on disclosure in the two service areas of the hospital. Results: Of the 80 health care workers interviewed, 60(75.0%) were females, 11(13.8%) were doctors, 9(11.3%) nurses, 17(21.3%) monitoring/evaluation/record clerks, and 16(20.0%) were either voluntary counseling and testing counselors or adherence counselors. Their mean age and duration in service in the two areas were 39.70±7.10 and 7.93±4.99 years respectively. Over half 48(60.0%) of the health care workers were unaware of the hospital having guideline on disclosure, 64(80.0%) have not been trained, and 68(85.0%) does not know any key information on disclosure. While all 80(100%) felt that disclosure was a good practice for better adherence, only 16(20.0%) had actually disclosed, with 6(37.5%) not seeking any formal permission from parent/caregivers before disclosing. Ages 8-16 years was recommended by 60(75%) as the appropriate age to disclose, however 28(35.0%) recommended age 14-16 years. Over half of the respondents 58(72.5%) admitted that disclosure should be a shared responsibility between themselves and the caregivers, most however perceive their role as only preparing the parents/caregivers for disclosure, and providing ongoing counseling to both the parents/caregivers and the children and adolescents. Lack of training on disclosure, and none availability of guideline in the health institution were major setback on the ability of the healthcare providers to fully participate in disclosure process. Conclusion: While healthcare providers support the idea of disclosing at mid and late adolescent, their perceived role was that of support and provision of ongoing counseling. Lack of training and none availability of disclosure guideline affects their perceived role. There is need to train and retrain healthcare workers on disclosure guideline, and making such guideline available in the health facilities.
Aug 2018 DOI 10.14302/issn.2641-9467.jgrc-18-1936
Four nitrogen forms and four biofertilizer were application as well as their interactions on growth analysis of sugar beet (Beta vulgaris L). The important results could be summarized as follow. Urea treatment achieved maximum increase in Leaf Area Index were 69.71, 81.32 and 166.54 at 120, 140 and 160 day in the 1st season, respectively, The highest one was 160.6 in the 2nd also was ammonium nitrate application at 160 days. Urea treatment inclusion in seeds with ntrobin application resulted the highest values of leaf area index (LAI), crop growth rate (CGR) and leaf area duration (LAD) and in the 1st season. A slight increase was 0.03 g/week in this case was found due to urea treatments as compared with the others treatment at the period from Relative growth rate (RGR3) in the 1st season. Ammonium nitrate treatment achieved the maximum values from Crop Growth Rate was 39.16 g/day in (CGR1), 93.24 and 13.5 g/day in (CGR2) and (CGR3) from urea treatment at the 1st season. The highest net assimilation rate was 0.66 g/dm.week achieved by ntrobin as compared the others treatment whereas, the lowest one 0.11 g.dm /week with the phosphorine application. Ammonium sulphate treatment with (phosphorin + ntrobin) obtained the highest net assimilation rate (NAR) in the 1st season. The highest values from leaf area duration were 0.11, 0.19 and 0.15 dm2/week achieved with urea and ntrobin in the 1st season at (LAD2), (LAD3) and (LAD4). Ammonium nitrate treatment with phosphorin obtained the highest leaf area duration (LAD) in the 2nd season. Generally, it could be recommended that fertilizing sugar beet plants variety Ymer with nitrogen forms inoculated with biofertilizer (ntrobin 600gm/fed) increased the growth of sugar beet plants under sandy soil conditions.
Aug 2018 DOI 10.14302/issn.2640-6403.jtrr-18-2158
Purpose of Study: To study reparative osteogenesis and tissue integration characteristics for implanting three-dimensional mesh structures of titanium nickelide into a bone cavitary defect. Material and Methods: The authors modeled cavitary defects of femoral metaphysis experimentally in Wistar rats divided into an experimental group and control one. The study duration was 60 days in total. The methods of radiography, those of light and electron microscopy, X-ray electron probe microanalysis used. Results: Under implantation the defect was filled with cancellous bone the volumetric density of which more than 1,5-fold exceeded control values (р < 0.001). The implant had biocompatibility, osteoconductive and osteoinductive properties, it stopped inflammatory processes. The membrane protective barrier which prevented connective tissue sprouting was formed on the implant surface in the defect periosteal zone. The osteointegrative junction was formed being persisted up to the end of the experiment. Reparative osteogenesis was performed by direct intramembranous and apposition type. Conclusion: The implant of three-dimensional mesh titanium-nickelide structures has marked osteoplastic properties, and it can be successfully used in orthopedic surgery.
Aug 2018 DOI 10.14302/issn.2474-3585.jpmc-18-2178
Several studies examine the musculoskeletal pain (MSP) in university students sustaining physical load as part of their compulsory learning. However, only two somewhat outdated cross-sectional studies examine the physical education teacher (PET) students. This study aimed to explore the neck, shoulder and low back MSP prevalence in Greek PET students in a series of academic years. The Nordic Musculoskeletal Questionnaire was used to record the past 12-month neck, shoulder and, low back pain, across three academic years (n = 479). The year association to MSP prevalence was examined with the cross-tabulation analysis (using the column proportion test for the year comparison) and, the gender association to MSP prevalence with the χ2 test (SPSS 22.0, p ≤ 0.05). The year association to MSP prevalence was not significant (p > 0.05). The overall prevalence was 67.6%, with multiple pain at 25.7% and, the low back presenting the highest prevalence (40.9%). Women reported a higher prevalence of neck (36%) and low back (47%) pain (p ≤ 0.05). The majority of pain and time loss duration was 1-7 days. The low back required higher medical attention (19.0%) than the neck (9.2%) and the shoulder (12.9%). The recurrent pain was at 30%, with the previous injury/accident rate at 5.8%, 14.4% and 14.6% for the neck, shoulder and low back. Our PET students present an alarming MSP prevalence. Due to their distinct work demands as PE teachers, entering working life with the healthiest possible musculoskeletal system is of critical importance. Thus, university authorities should consider strategies for the prevention of MSP risk.
Apr 2018
The presence of bronchiectasis is considered an aggravating factor in COPD patients. In particular, the coexistence of bronchiectasis and COPD was associated with greater frequency and severity of exacerbations. The aim of this study is to investigate the impact of bronchiectasis in patients with COPD exacerbation. We retrospectively collected data from 212 patients admitted to the hospital with diagnosis of COPD exacerbation. In order to detect the presence of bronchiectasis, only patients that had received a chest HRCT scan examination were included in the study. We compared clinical and functional data between COPD patients with bronchiectasis and those without bronchiectasis. The prevalence of bronchiectasis was 31,6% in this study. The presence of bronchiectasis in COPD patients was associated with increased risk for isolation of PPMs in the airway (56,1% vs 28,3%, p 0,02), and in particular of Pseudomonas Aeruginosa (17,5% vs 5,6% p 0,02), and with a longer duration of hospitalization (8,22 ±3,67 vs 6,88 ± 3,43 days, p=0.004). These results could encourage efforts to optimize medical care for patients with COPD and bronchiectasis. Clinical trials with treatments for infective component are needed to investigate their impact on the reductions of exacerbations and improvements in the disease course.
Feb 2018 DOI 10.14302/issn.2689-4602.jes-18-1967
A strict definition of the hierarchy of material systems is formulated. Based on this definition, the main hierarchical structure of the Universe was divided to 15 levels belonging to 2 branches. Process of the Universe evolution (megaevolution) is considered as hierarchogenesis, i.e., a process of new hierarchy levels formation. The main driver of the hierachogenesis is an attraction that takes different forms for different steps of the megaevolution. Duration and time of each this step on the Universe timeline were estimated using the data of the other investigators. Biological evolution is considered as essential part of the general megaevolution where symbiosis plays role of the hierarchogenetic attraction. Semantic consideration of the hierarchogenesis allowed to build a mathematical model of its dynamics. It appeared that this model describes general megaevolution of the Universe well enough to estimate time of macromolecules appearance, that is still unknown, and to predict when the next hierarchogenetic step will take a place.
Feb 2018 DOI 10.14302/issn.2577-2279.ijha-18-1918
Purpose of Study To study reparative osteogenesis and tissue integration characteristics for implanting three-dimensional mesh structures of titanium nickelide into a bone cavitary defect. Material and Methods The authors modeled cavitary defects of femoral metaphysis experimentally in Wistar rats divided into an experimental group and control one. The study duration was 60 days in total. The methods of radiography, those of light and electron microscopy, X-ray electron probe microanalysis used. Results Under implantation the defect was filled with cancellous bone the volumetric density of which more than 1,5-fold exceeded control values (р < 0.001). The implant had biocompatibility, osteoconductive and osteoinductive properties, it stopped inflammatory processes. The membrane protective barrier which prevented connective tissue sprouting was formed on the implant surface in the defect periosteal zone. The osteointegrative junction was formed being persisted up to the end of the experiment. Reparative osteogenesis was performed by direct intramembranous and apposition type. Conclusion The implant of three-dimensional mesh titaium-nickelide structures has marked osteoplastic properties, and it can be successfully used in orthopedic surgery.
Feb 2018 DOI 10.14302/issn.2329-9487.jhc-18-1932
The aim of this study was to assess the use of ambulatory acoustic cardiography during the initial data collection of the longitudinal study of a rural population in Switzerland (n=297, mean age 48.9 ±16.5 years, 57% female). Ambulatory acoustic cardiography non-invasively can assess sleep disordered breathing (SDB) and provides markers of left ventricular systolic and diastolic dysfunction. The percentage of the third heart sound detected during sleep decreased significantly across age groups (age < 40 years, 40-60 years, > 60 years) for both genders (males, p=0.04; females, p=0.02). The percentage of a fourth heart sound detected exhibited an increasing trend for both genders with age suggesting increased diastolic dysfunction with aging. Mean electromechanical activation time (EMAT) during sleep was within the normal range across age groups and both genders (male 93.7 ± 11.6 ms, female 94.6 ± 13.0 ms), and did not vary significantly with age. A large proportion of subjects had a high likelihood of sleep disordered breathing (17.6%). Baseline characteristics categorized by SDB severity indicate increasing age, male gender and being overweight (BMI ≥ 25) to be associated with greater SDB severity. Acoustic cardiography findings categorized by SDB severity reveal increased nocturnal non-dipping heart rate, presence of atrial fibrillation, prolonged QRS duration and QTc interval, increased percentage of fourth heart sound detected, and longer EMAT to be significantly associated with greater SDB severity. Overall, acoustic cardiography detected a very low prevalence of systolic dysfunction, age-related increases in diastolic dysfunction and a moderate prevalence of sleep disordered breathing.
Feb 2018 DOI 10.14302/issn.2640-690X.jfm-17-1900
Background PMPS nowadays is common due to advances in both; diagnosis and treatment of cancer breast. Choosing proper treatments can improve the patients’ quality of life. Cancer breast is common and quite important disease and female in our family must be aware of it. Improvement of the diagnosis and treatment PMPS lead to increased patient’s satisfaction and decrease fear of cancer breast. Objective Discuss different methods for management of PMPS with less side effects, adequate analgesia, improvement of quality of life, and better patient satisfaction in the future. Methods Treatment approaches include both pharmacological interventions and non-pharmacological strategies. However, current treatments of the PMPS are near-optimal and prevention much better than treatment. Conclusion Continuous perioperative thoracic epidural Fentanyl–bupivacaine infusion was much better in pain relief, less sedating effect and shorter duration of hospital and ICU stay than continuous perioperative entanyl intravenous infusion in patients undergoing major upper gastrointestinal cancer surgery.
Dec 2017 DOI 10.14302/issn.2694-1201.jsn-17-1815
15 children with variable intractable seizure disorders who were on multiple anti-convulsant medications were treated with pulse monthly doses of parentral dexamethsone varying from 4 – 7 months. EEG and clinical response were assessed periodically as well at the end of the study. 53% of the patients showed clinical response and EEG response. Hypertension was noted in 6, hypokalemia in 3 and hyperglycaemia in 1 patient. The ultimate compliance from the parents for this treatment was seen among 12 patients because of its proven efficacy and parents of seven patients insisted to continue the treatment for long duration.
Oct 2017 DOI 10.14302/issn.2381-862X.jwrh-17-1750
Background The prevalence of obesity and type 2 diabetes is escalating at an alarming rate in many developed as well as developing countries. Irisin is a novel muscle and adipose drived chemokine that is, proteolytically processed from the product of the FNDC5 (fibronectin type ш domain containing 5) gene. The purpose of this study is to examine the effect of three kind of training on irisin in sedentary obese women. METHODSː33 obese women (medium age: 37.99 ± 3.7 year, height: 1.55 ± 0.03 meter, BMI: 34.6 ± 5.07 kg/m2) participated in the study, on three groups, including endurance, resistance and concurrent. Results After 8 weeks exercise we did not find significant differences in fasting glucose, insulin, HOMA-IR and irisin between the groups (P>0.05), but glucose and insulin in resistance groups and irisin in all groups had significant changes (P<0.05). Conclusions In summery in this study in contrast to hypothesis there were no difference between groups of training. It can be hypothesise that the increase of irisin in obese people is one of the preventing ways against of obesity's side effects. Exercise could improve the signaling pathways and consume the fat accumulations, therefore at the end of exercise duration, irisin decreased.
Aug 2017
Objectives: To describe the frequency, clinico-laboratory characteristics and treatment outcomes of patients with juvenile idiopathic arthritis (JIA) in Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria. Methods: This is a retrospective review of patients with JIA seen over a five-year period at the rheumatology clinic and children ward of LASUTH. We reviewed the folders of 28 patients from our unit records. The demographics, baseline clinical and laboratory characteristics, treatment given and patient outcomes were extracted and analyzed. Results: A total of 28 patients with JIA were managed over the study period. Twenty one (75%) patients among our JIA cases were female and the mean age at presentation was 9.8±3.9 years. The mean duration of symptoms before diagnosis was 21.8±5.7 months. Polyarticular JIA (PJIA) constituted 14 (50%) cases, while oligoarticular and systemic-onset JIA (SoJIA) constituted 9 (39.3%) and 5 (17.9%) of the JIA cases respectively. Anaemia was present in 20 (71.4%) patients, leucocytosis in 16 (57.1%) and thrombocytosis in 11 (39.2%). Twenty five (89.2%) patients had elevated erythrocyte sedimentation rates (ESRs), 21 (75%) had elevated C-reactive protein levels and 23 (82.1%) patients had hyperferritinaemia. Positive antinuclear antibody (ANA) was found in 5 (17.8%) patients. Mortality was documented in 2 (7.1%) patients both of whom were SoJIA cases. Eleven (39.3%) patients were lost to follow up. Conclusion: Unlike the common report of oligoarticular JIA (OJIA) being the most frequent subtype of JIA in various series from North America and Europe, PJIA was the most frequent subtype seen among our patients and this variant accounted for half of all JIA cases seen. There were no cases of psoriatic, enthesitis-related or undifferentiated JIA and most patients had haematological abnormalities and high levels of inflammatory markers at presentation.
Aug 2017 DOI 10.14302/issn.2688-5328.ijp-17-1581
Background Capsaicin 8% patch reduces peripheral neuropathic pain. Based on the concept of neuropathic pain (NeP) in mixed low back pain (LBP) it is hypothesized, that an exclusively lumbar capsaicin 8% patch is an effective treatment of mixed LBP. The aim is a proof of this concept and to identify predictors of responsiveness. Methods This prospective stratified study included 54 chronic, mixed, LBP patients with spontaneous pain >3/10 on the NRS (0-10) and a painDETECT Questionnaire (PDQ) score >12 meaning possible or likely (>18) NeP. Pain intensity, PDQ, and quantitative sensory testing (QST) were assessed at baseline. After a one-hour capsaicin 8% treatment on the low back, follow-up was carried out regularly over three months. Response was determined at one month (≥30% pain reduction) and predictors were compared accordingly. Results The average change in pain intensity at week four was -1.1 (-0.50;-1.71, 95%CI, p < 0.001). Twenty-one (39%) patients responded at one month with a mean pain reduction of -3.1 (-4.0;-2.3, 95%CI) and even 10 of the 21 responders showed a ≥ 50% pain reduction. No pain reduction was seen in 33 (61%) patients (p = 0.42). Responders and non-responders did not differ at any baseline parameter: NRS (p = 0.85), PDQ score (p = 0.47), duration of pain (median of 48 and 36 months) nor QST profiles. Conclusions Lumbar capsaicin 8% patch is an effective treatment in about 40% of chronic patients with mixed neuropathic LBP. However, predictors for response could not be identified.
Aug 2017
Objectives: To identify the clinical epidemiological characteristics of patients with juvenile idiopathic arthritis (JIA) monitored at the Lucidio Portella Children’s Hospital (HILP) in northeastern Brazil and to ascertain the frequency and forms of presentation, the most affected joints, the most common joint involvement for each form, the frequencies of positive rheumatoid factor (RF+) and positive antinuclear antibodies (ANA+) in the various forms of presentation, and the most common complications. Methods: A study was conducted with 74 medical records of patients with JIA monitored at HILP between January 2010 and January 2013. Descriptive statistics were used for statistical analysis. Results: JIA was predominant in females with a mean age at onset of 5.2 years and a median disease duration of two years. The most frequent initial form of presentation was oligoarticular (63.5) arthritis, and the most affected joint was the knee (86.4%). The knee was most affected by oligoarticular arthritis, the wrist, knee, and ankle were affected by RF+ polyarticular arthritis, and the knee, ankle, and cervical spine were affected by systemic arthritis. RF+ was observed in 8.5% of the oligoarticular arthritis cases. ANA+ were present in 27.7% of the oligoarticular cases, in 22.2% of the systemic arthritis cases, and in 11.1% of the RF+ polyarticular arthritis . The most common complications were deformities (20.3%) and uveitis (14.9%). Conclusion: The findings for JIA patients in a referral hospital in northeastern Brazil were consistent with the literature regarding most of the evaluated criteria.
Aug 2017
Objectives Increased neurovascular (NV) reactivity has been shown in patients with relapsing-remitting multiple sclerosis (RRMS) during the acute exacerbation period. However, the NV reactivity after several attacks is not known. We, therefore, have investigated the patients by transcranial Doppler (TCD) using simple visual stimulation after the repeated attack periods. Patients and Methods Thirty patients (22 females and eight males, mean age 40 years) with RRMS were examined at least two times. The average TCD examination interval was 26.7 months (range 4-120 months). Mean attack number was 3.8 (range 2-8 times), average disease duration was 57 months (range 4-124 months), and average Expanded Disability Status Scale (EDSS) value was 2.5 (range 1-5.5). We performed transcranial Doppler recordings from the P2-segments of both posterior cerebral arteries simultaneously during simple visual stimulation. The NV reactivity was defined as a relative increase of the blood flow velocities during visual stimulation. Results The NV reactivity to simple visual stimulation was significantly lower in the second test on both sides (31.5±9.2% and 29.2±7.2%; right and left side, respectively) from those of the first test (38.3±11.9% and 36.0±11.9%; right and left side, respectively) (p<0.001). Conclusion The present study is the first study examining neurovascular reactivity in patients with RRMS during repeated attacks using the transcranial Doppler to our best knowledge. Our results suggest patients with RRMS after repeated exacerbation periods have less reactive neurovascular units in the occipital cortex. The possible explanation might be the repeated demyelination, and insufficient remyelination with longer disease duration may lead glial dysfunction resulting neurovascular unit impairment. If so, functional TCD may be useful for the determining of the disease progression. However, the exact cut-off point is not known.
Aug 2017 DOI 10.14302/issn.2470-0436.jos-17-1666
Purpose: To evaluate early versus late immunomodulatory therapy (IMT) for patients following initial diagnosis of Vogt-Koyanagi-Harada (VKH) disease. Methods: Retrospective review including all VKH patients seen 5/1/2014 to 4/1/2016 at LAC+USC. Early IMT was defined as starting an immunomodulatory agent within 3 months of corticosteroid initiation. Results: Twenty-seven patients were included, of whom 15 received early IMT and 8 received late IMT. Early IMT patients trended toward greater improvement in vision compared to late IMT (logMAR 0.59 vs. 0.11; p=0.14) with no differences in ocular complications including ocular hypertension (p=0.53) and cataract (p=1.0). Patients receiving early IMT averaged 0.93 recurrences versus 2.13 recurrences for late IMT (p=0.092). Of patients successfully taper off oral corticosteroids, the early IMT group was tapered in an average of 8.3 months versus 19.8 months for late IMT (p=0.0019). Conclusions: Early IMT in VKH may allow for shorter duration of corticosteroids with similar visual outcomes, ocular complications, and disease recurrences.
Aug 2017 DOI 10.14302/issn.2372-6601.jhor-17-1606
Several interactions exist between thyroid and kidney function in many disorders. Many publications explored the relationship between thyroid diseases (TD) and chronic kidney diseases (CKD). However, the morphological thyroid changes in patients with CKD or End Stage Kidney disease (ESKD) were not fully explored. The aim of this study is to explore the morphological and the functional abnormalities of the thyroid gland among ESKD patients as detected by Doppler ultrasound. Patients and Methods: All of the 92 ESKD patients at our center were consented and included in the study. Demographic and clinical data and biochemical and hormonal profiles were recorded. Every patient received a dedicated ultrasound scan of the thyroid gland. GE ultrasound system with Doppler capabilities and high frequency transducer was used. Grey scale imaging and Doppler ultrasound were used to image the thyroid gland for every patient. Taking the thyroid morphology detected by ultrasound and the thyroid function as the dependent variables, all other parameters of age, sex, BMI, occupation, residence, duration of time on dialysis and other comorbilities were taken as independent variables and their relationship to the dependent variables was further studied using appropriate statistical tests. Results: Thyroid nodule(s) presence was found to be the most prevalent thyroid morphology detected on ultrasound scanning. Fifty three patients (57.6%) were found to have ultrasound detected nodule(s). The nodule presence was correlated to different independent variables and was found to significantly correlate with age only. The thyroid function as reflected by the level of thyroid hormones was also studied for correlation with the independent variables. No correlation was found between the thyroid function and the presence of nodules. Conclusion and Recommendation: Ultrasound detected nodules are very common in ESKD patients. The presence of nodule significantly correlates with patient age denoting its degenerative nature. Ultrasound screening of the thyroid in ESKD patients may be cost effective. However, we recommend a larger multicenter study for better results.
Jun 2017 DOI 10.14302/issn.2474-3585.jpmc-17-1506
Despite the generally accepted benefits of exercise on sleep there remains limited research on potential differential effects by exercise type. The purpose of the present study was to examine short-term and chronic effects of aerobic and resistance exercise on various sleep quality parameters, as well as sleep duration. Generally healthy, previously sedentary young (27±3 years) men completed a 16-week aerobic and 16-week resistance exercise program in random order separated by a minimum of 6 weeks with no formal exercise. Each exercise program consisted of three supervised exercise sessions per week. Quality and duration of sleep was determined with a multi-sensor device that was worn prior to, during week 1 and week 16 of each exercise program. A total of 8 participants provided valid data on time spent awake after sleep onset, sleep latency, total sleep time, sleep efficiency and time spent in bed for both exercise programs. During week 1, aerobic exercise was associated with a significant decline in sleep latency (-6.5±6.8 min) and time in bed (-39.2±42.2 min) while resistance exercise was associated with a decline in time spent awake after sleep onset (-21.6±16.7 min) and increased sleep efficiency (4.3±4.8 %). Effects were no longer significant after 16 weeks of exercise. These results indicate that aerobic and resistance exercise have beneficial effects on quality of sleep, particularly in the short-term, but the specific exercise-induced changes vary by exercise type.
Jun 2017 DOI 10.14302/issn.2576-9359.jot-17-1570
Chronic bodily pain after lung transplantation has received little attention. Therefore, the aim was to provide a multidimensional assessment of self-reported chronic pain 1-5 years after lung transplantation and its relationship with self-reported psychological general well-being (PGWB) and self-efficacy. This multicenter, cross-sectional study is a part of the Swedish national study: Self-management after thoracic transplantation (SMATT). In total, 117 lung transplant recipients, all white, due for their yearly follow-up at one (n=35), two (n=28), three (n=23), four (n=20) or five years (n=11) after transplantation were included. Of these, 113 reported their pain on the Pain-O-Meter (POM), which provides information about pain intensity, quality, location, and duration. In addition, they responded to the PGWB instrument and the Self-Efficacy instrument for managing chronic disease. The prevalence of pain was 51% after 1 year, 68 % after 2 years, 69.5 % after 3 years, 75 % after 4 years and 54.5 % after 5 years. Women experienced higher pain intensity and worse sensory and affective burden than men. Psychological general well-being was the main factor that contributed to the experience of pain. Better perceived psychological well-being lowered the odds for pain, while higher self-efficacy reduced the probability of experiencing pain. Many of the lung recipients lacked pain treatment and were uncertain about the reasons behind their pain. Chronic bodily pain is a common and serious symptom up to five years after lung transplantation. Female lung recipients experience more pain and pain related illness than men.
May 2017 DOI 10.14302/issn.2470-0436.jos-17-1453
Purpose: High intraocular pressure (IOP) is known to result in retinal ganglion cell (RGC) loss, both with chronically raised intraocular pressure (such as with glaucoma) and with acute raises in pressure (due to injury or acute angle closure). Because IOP is often raised during ocular surgery, the purpose of this study was to evaluate the effect of transient moderate IOP on retinal function, RGC survival and the expression of Connexin 43 (Cx43) and glial fibrillary acidic protein (GFAP), ubiquitously expressed central nervous system (CNS) proteins that are known to be elevated during the retinal inflammatory response to injury. Materials and Methods: Wistar rats were exposed to transient IOP at 40 mmHg for 5 or 30 minutes, and 60 mmHg for 5 minutes (via cannulation of the anterior chamber with a saline reservoir raised to a height corresponding to the desired IOP), mimicking potential IOP rises during surgery such as DSAEK and some laser procedures (LASIK and femtosecond laser cataract surgery). Separate groups of animals had IOP maintained at 10 mmHg for 5 or 30 minutes as cannulation controls, or 120 mmHg for 60 minutes as positive controls. Changes in the optic nerve and retina were assessed immunohistochemically for GFAP and Cx43 expression. Retinal function was assessed using electroretinography (ERG) recorded at baseline and 14 days after the IOP rise and compared with RGC counts. Results: Results showed that there was a differential GFAP labelling pattern observed in the anterior optic nerve in the 40 mmHg 30 minute and 60 mmHg 5 minute groups 4 hours after manipulation. Gap junction protein Cx43 was minimally up-regulated in the retina in the short-term. There was, however, minimal long-term effect on retinal function and no RGC loss. Conclusions: n conclusion, elevations of IOP that are short in duration such as those occurring during surgical procedures, do not cause significant changes long-term in retinal function or RGC survival. Key Messages: Cx43 and GFAP are known to be elevated during the retinal inflammatory response to injury. No previous study has explored the effect of moderate and relatively short increases in IOP on the initial inflammatory response. We observed a mild glial inflammatory response in the anterior optic nerve, but only a minimal up-regulation of Cx43. However, transient and moderate IOP rises did not induce long term disruption to RGC function or number as measured by electrophysiology and RGC counts, respectively. This is applicable to clinical practice, as it means the IOP elevations that occur during some surgical procedures are unlikely to be causing long term damage in retinal function or RGC survival.
Mar 2017 DOI 10.14302/issn.2474-7785.jarh-16-1348
Background and Objective: Cognitive stimulation training was effective in reducing risk of cognitive decline and dementia in patients with mild cognitive impairment. The present study aimed to explore factors that contribute to regular participation and practice cognitive stimulation training for elderly patients with mild cognitive impairment. Materials and Methods: Data were collected through individual face-to-face interviews with 25 elderly subjects with mild cognitive impairment, and analyzed using interpretive description method. Results: Five core themes emerged from the analysis of data: (i) program with four subthemes of “interesting session, ” “effective teaching materials,” “suitable duration and frequency” and “small group activities;” (ii) group facilitators with three subthemes of “good explanation,” “always facilitate” and “friendly personality;” (iii) homework assignments with two subthemes of “suitable content” and “can adapt in daily living;” (iv) family members with two subthemes of “supporting” and “sharing;” (v) before and after class notification. Conclusion: Increasing awareness of holistic factors including in clinic and at home should be emphasized in planning cognitive stimulation training. Having an effective program and facilitators and collaboration from family member were the keys of successful training.
Jan 2017 DOI 10.14302/issn.2574-4372.jesr-16-1395
Calcium (Ca2+) plays a central role in regulating many biological processes in the cell from muscle contraction to neurotransmitter release. The need for reliable fluorescent calcium indicator dyes is of vast importance for studying many aspects of cell biology as well as screening compounds using phenotypic high throughput assays. We have assessed two of the latest generation of calcium indicator dyes, FLIPR Calcium 6 and Cal-520 AM for studying calcium transients (CaTs) in induced pluripotent stem cell (iPSC) -derived human cardiomyocytes. FLIPR Calcium 6 and Cal-520 dyes both displayed robust CaTs with a high signal-to-noise ratio (SNR) and were non-toxic to the cells. The analysis showed that CaT amplitudes were stable between measurements, but CaT duration was more variable and tended to increase between reads. Two methods were compared for drug-screening hit-selection; difference in average (unstandardized) and standardized difference. The unstandardized difference was better for assessing CaT amplitude, whereas standardized difference was equal to or better for assessing CaT duration. In summary, FLIPR Calcium 6 and Cal-520 are suitable dyes for drug-screening using iPSC-derived human cardiomyocytes.
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.
Dec 2016 DOI 10.14302/issn.2379-8572.joa-16-1369
The purpose was to discover if medial branch blocks (MBBs) of the cervical spine can be used as a diagnostic tool to identify patients with somatosensory tinnitus. MBBs are a diagnostic tool to confirm the diagnosis facet joint pain in patients with neck pain. It is not known, if MBBs are also suitable for testing other symptoms than pain. However, the existence of neural connections between the auditory system and the cervical region can be assumed. Included were 22 consecutive patients presenting with tinnitus, who had received MBBs in a ten years’ period. Patients were tested with a MBB with bupivacaine and triamcinolone. Injections were performed with fluoroscopic visualization using established techniques. The mean follow-up time was 6.2 weeks. Tinnitus was analyzed through the global clinical impression of the patient. Seven patients (31.8 %) experienced a significant improvement of the tinnitus. In one patient a thermal radiofrequency neurotomy was done after positive response to two MBBs. The pain relief and a significant reduction of the tinnitus sustained at the follow-up examination 20 weeks after the denervation. No statistically significant difference was found in age, gender, duration of symptoms, additional neck pain or vertigo, or side or level of the intervention. This pilot study shows the feasibility to identify patients with somatosensory tinnitus with MBBs. Further studies with the primary intention on tinnitus are necessary to prove the significance of MBBs. After a positive response to MBBs, treatment with radiofrequency neurotomy is the rational consequence.
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.
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.2574-4526.jddd-16-1203
Background: Iron deficiency is a common reason for referral to a gastroenterologist. Objective: To identify predictors of colorectal cancer in patients referred to a gastroenterologist for iron deficiency. Methods: This was a retrospective review of consecutive patients referred to one of two gastroenterologists for assessment of iron deficiency. The office files and electronic health records were reviewed for all patients. Clinical data, such as hemoglobin level, and clinical symptoms were recorded. The final diagnosis was that of the attending gastroenterologist. Variables associated with a diagnosis of colorectal cancer by univariate analysis were entered into a multivariate logistic regression model to identify variables independently associated with the diagnosis of colorectal cancer. Results: Two hundred and seventy eight patients were included in this study. One hundred and fifty-eight (56.8%) were female. Mean age was 60.7 years (± 16.7 years). The most common causes of iron deficiency were: menorrhagia 16.2%, colorectal cancer 14%, use of aspirin or non-steroidal agents 11.2% and regular blood donation 7.2%. In 11.5% of patients, no cause was found. In univariate analysis, lower hemoglobin, greater age, shorter duration of iron deficiency, weight loss, symptoms from anemia and NSAID use were associated with colorectal cancer. In multivariate analysis, only older age (OR=1.06; 95% CI 1.04-1.09) and symptoms from anemia (OR=2.19; 95% CI 1.20-4.0) were independently associated with colorectal cancer. Conclusions: Colorectal cancer was found in 14% of patients referred to a gastroenterologist because of iron deficiency. Older age, and symptomatic anemia may help predict a diagnosis of colorectal cancer.
Jun 2016 DOI 10.14302/issn.2471-2175.jdrt-15-836
Cellulitis is an acute, spreading pyogenic inflammation of the dermis and subcutaneous tissue, usually complicating a wound, ulcer, or dermatosis. Inappropriate diagnosis of cellulitis is a problem and would need prospective rather than retrospective studies to quantify the extent. There is one national guideline for the management of patients with cellulitis. The aim of this study is to determine the validity of Crest guideline in the patients with non-facial cellulitis. This prospective cohort study was conducted on all Adult patients with cellulites who were admitted at Resole-Akram and Sina emergency department between November 2013 and January 2014. Based on admission duration, the patients were randomly divided into two groups including primary and secondary outcome, <24-hours or >24-hours admission, respectively. Out of 89 admitted patients, 55% were hospitalized over 24 hours and 20% of them had significant systemic symptoms. The most patients (n= 42) had either systemically ill or systemically well or class II followed by classes I (n=28), III (n=18), and IV (n=1). There was significant relevancy between age, fever, PR, infected organ, leukocytosis, diabetes mellitus, IUDA, human bite, and primary outcome. In conclusion, factors associated with admission were age, presence of multiple comorbid conditions, diabetes mellitus, human bite, IUDA, infected organ, leukocytosis and fever. These results showed that the decision in the emergency department was mostly the same as Crest guideline and the prospection of admission and discharge of these patients was almost according to the educations of Crest guideline.
May 2016 DOI 10.14302/issn.2470-5020.jnrt-15-908
Objective: We aimed to investigate homocysteine levels and carotid intima-media thickness (CIMT) in Parkinson’s Disease (PD), to determine relationship of these parameters and as well as to determine whether CIMT in patients with PD was associated to age, disease duration, age of disease onset, stage, the Unified Parkinson Disease rating scale (UPDRS), the drugs used in therapy. Methods: The study population consisted of 55 PD patients (37 male) and 25 healty subjects. The severity of neurological impairment was assessed with UPDRS and the Hoehn-Yahr scale. CIMT and homocysteine levels were measured. Anti-parkinsonian treatments were recorded and the total daily dose of levodopa was calculated for each patient. Results: Homocysteine levels were significantly higher in the patient group compared to the control group (p=0.002). A positive correlation was found between CIMT and homocysteine (r=0.29 p=0.03), but no a relationship between CIMT and UPDRS scores, disease duration, age of disease onset, and stage. Mean levodopa dosage did not predict CIMT 0.6 mm (AUC: 0.546, 95%CI 0.372-0.720, p=0.59). Homocysteine 14 µmol/l predicted CIMT 0.6 mm with 64% sensitivity and 69% specificity (AUC: 0.654, 95%CI 0.488-0.819, p=0.07). Dıscussion: This study revealed that homocysteine levels in levodopa + dopa decarboxylase enzyme inhibitor (DDEI) group were increased which was correlated with a mild increasement of CMIT. This might indicate to the importance of clinical and radiological follow up of PD patients who are under treatment of levodopa + DDEI. Conclusion: Our Findings May Suggest The Role Of CIMT As A Meaningful Clinical Marker For Follow-Up Of Patients With PD
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.
Oct 2015 DOI 10.14302/issn.2379-8572.joa-15-691
Background. Nasopharyngeal carcinoma (NPC) is a rare disease in the pediatric age group; it represents 1% of all pediatrics malignancies, however, it is the predominant malignancy arising in the nasopharynx in this age group. Although NPC is a chemo-radiosensitive disease yet, the optimal dose of radiotherapy and optimal timing of chemotherapy is still not standardized. Methods. This is a retrospective study including all the newly diagnosed pediatric NPC who were diagnosed and treated at the Children Cancer Hospital Egypt (CCHE) during the period from July 2007 to December 2012. All imaging studies (e.g., CT or MRI scans) were reviewed by a senior head and neck radiologist for proper staging and assessment of tumor response. Patients were staged according to AJCC staging system. Modified version of the Response Evaluation Criteria in Solid Tumor (RECIST) was used to assess response. Results. Twenty-six patients were diagnosed and received treatment as NPC in CCHE. Median age was 12 years (range 7.8-17 years). There was a male predominance. Eleven patients (42.3%) were stratified as stage 4, and 11 (42.3%) as stage 3. All patients received 3 cycles of neo-adjuvant chemotherapy followed by concurrent chemo-radiotherapy. IMRT was used to deliver radiotherapy in all patients. The overall response rate (CR and PR) to induction therapy was 73%, 19.3% had SD, while 7.7% had PD. By the end of the study, 18 patients (69.2%) were alive in CR, 5 patients (19.2%) had PD, and 3 patients (10%) lost for follow up. The Mean duration of follow up was 35 months, range 5-66 months. The 3 year OS and EFS and rates were 84.6% and 69.3 % respectively. OS for M0 was 91.3% and for M1 33.3% with statistical significance (p =0.032). Conclusion. Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy using IMRT lead to good clinical end results with limited toxicity. Metastatic disease at presentation was identified as the adverse prognostic factor.
May 2015 DOI 10.14302/issn.2574-4518.jsdr-14-554
Introduction: Night Eating Syndrome (NES) is a phenomenon combining aspects of both sleeping disorders and Eating Disorders (EDs). To the best of our knowledge, few studies to date have examined NES among patients with EDs. None examined ED patients with and without NES in clinical settings by comparing their sleep disturbances using the new NES diagnostic criteria 1. This study aimed to compare subjective and objective sleep patterns and ED-related psychopathology among NES patients with and without binge eating (BE) behavior. Method: The sample included 71 women, ages 19-62, referred for assessment to a hospital Eating Disorders Clinic. Measures included self-report questionnaires, psychiatric evaluation and actigraph recording for one week. Participants were divided into three subgroups: those with NES without BE behavior (NES-only, n = 17), with both NES and BE behavior (NES-BE, n = 22), and with BE behavior without NES (BE-only, n = 32). Results: Regarding objective sleep monitoring, only one group difference emerged: significantly longer sleep duration for the NES-only group than the other groups. Subjectively, both NES-only and NES-BE groups described significantly more sleep disturbances than the BE-only group. Moreover, only one inter-group difference emerged in ED-related psychopathology: According to new NES diagnostic criteria, the NES-only and NES-BE groups reported significantly higher levels of NES symptoms than the BE-only group. Conclusions: Groups' similarities in sleeping disturbances and psychopathology level and differences between objective and subjective sleep disturbances raise the question of whether NES should be considered part of the BE-only subgroup, calling for further research.
Feb 2014 DOI 10.14302/issn.2324-7339.jcrhap-13-191
Objective: This cross-sectional study examined cognitive subtypes and influential factors in HIV-positive (HIV+) adults. Method: Two-step cluster analysis was conducted on a neurocognitive test battery in a sample (N = 78) of adults and older adults with HIV (Mage = 46.1). Next, cognitive, functional, and mental and physical health differences were compared between the HIV+ clusters and an HIV- reference group (N = 84; Mage = 47.9). Results: A two-cluster solution emerged, with a lower performing cluster exhibiting poorer performance across all domains except psychomotor speed, and a “normal” cluster displaying similar performance as the HIV- group. The most influential factors to classification in the lower performing cluster were older age and presence of stroke and hypertension. There were trends for longer duration of HIV-infection, higher unemployment rates, and greater prevalence of Hepatitis C co-infection in the lower performing cluster. Conclusions: These findings suggest that there are not unique cognitive subtypes in HIV, but rather a subset of individuals who exhibit globally normal performance and those with below average performance. Older age and the related cardiovascular comorbidities of both aging and HIV medications may be key influential factors to variability in neurocognitive functioning in this population and thus should be considered in future studies. Implications for research and practice are provided.
Nov 2013 DOI 10.14302/issn.2328-0182.japst-13-185
Background: Antidepressant agents are commonly implicated in drug overdose, and the toxicological profile varies between agents. Clinical data concerning overdoses are not systematically sought or evaluated in pharmacovigilance. The present study sought to examine the feasibility of collecting Emergency Department data concerning antidepressant overdose. Methods : Presentations to York Hospital due to intentional antidepressant overdose were studied between 2010 and 2011. Data collected were the type of antidepressant, dose, co-ingested drugs, duration of hospital stay, and need for critical care. Community National Health Service prescription data were evaluated across York and North Yorkshire region. Results : There were 250 overdose episodes. These involved a selective serotonin reuptake inhibitor (SSRI) in 183 (73.2%), and a tricyclic in 45 (18.0%), equivalent to 24 episodes per 100,000 prescription items (95% CI 21-28 per 100,000) and 11 per 100,000 (8-15 per 100,000) respectively (P<0.0001). Citalopram was the most commonly prescribed, and associated with 22 overdose episodes per 100,000 (17-27 per 100,000). Fluoxetine was associated with 32 overdose episodes per 100,000 (24-41 per 100,000) (P=0.032 versus citalopram), whereas the lower rates were observed for amitriptyline (13, 9-17 per 100,000) (P=0.004) and dosulepin (2, 0-10 per 100,000) (P=0.001). Conclusions : A higher than expected number of overdose episodes involved an SSRI based on National Health Service primary care prescribing, and fewer episodes involved a tricyclic antidepressant. Clinical outcomes differed between agents, indicating the feasibility of using Emergency Department data to detect different patterns of toxicity between antidepressants. Further work is required to examine whether systematic collection of clinical toxicology data might enhance existing pharmacovigilance systems.
May 2013 DOI 10.14302/issn.2324-7339.jcrhap-12-137
Background: HAART has resulted in significant decline in morbidity and mortality from HIV. However, it is unclear if the trends have continued in the current HAART era. An understanding of healthcare utilization patterns is important for optimization of care and resource allocation. We examined the diagnoses for hospitalizations of patients with HIV and their clinical and demographic profile years after the introduction of HAART. Methods: A retrospective audit of the HIV admissions from July 2009 through June 2010. The case notes of all the adult admissions where one of the discharge diagnoses was HIV infection was reviewed. Data including the demographics, date of diagnosis, treatment and the follow up details, admission outcome and the final diagnosis were extracted from the case notes. Results: Over the 12 months period there were 154 admissions where one of the discharge diagnosis was HIV infection, and this accounted for 2.9% of all medical admissions in adults. 103(67%) admissions were in persons who were known to be HIV infected prior to the current admission. HIV infection was diagnosed for the first time during the current admission in 51(33%) cases. Nearly two-thirds of those hospitalized, had a CD 4 cell counts of < 200/µL and 63 (66%) had a viral load greater than 50,000 copies/ml. Over all, opportunistic infection was the commonest (47%) discharge diagnosis, followed by serious bacterial infections and HIV nephropathy. The median duration of hospitalization was 6 days (Range 2 to 71 days). There were 49 (32%) deaths. Conclusions: A significant proportion of patients admitted with HIV infection were still diagnosed on admission and were found to be severely immunosuppressed. An opportunistic infection continues to be the commonest discharge diagnosis in HIV infected patients.