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May 2026 DOI 10.14302/issn.2572-3030.jcgb-26-6307
Faisst Arne-C.Corresponding author
The development of tumor biomarkers derived from blood, or its components, has become pivotal in advancing early cancer diagnosis. Malignant transformations induce cancer-specific alterations in the transcriptome, proteome, and secretome of tumor cells. Recent studies highlighted similar alterations in peripheral blood mononuclear cells (PBMCs) in cancer patients, which appear to mirror the state of transformation in tumor cells. These findings suggest an intercellular communication–driven mechanism rather than a systemic inflammatory response and, in addition to current ctDNA-based liquid biopsy biomarkers, point to a novel, simple, and highly robust approach for the early detection of cancer. Using this phenomenon to advance PBMC-based biomarker development, it will be essential to achieve 3D in vitro tumor models that reproduce a highly physiological tumor microenvironment (TME). Likewise, more enhanced 3D ex vivo models are required to enable the replication of cell-to-cell and organ-to-organ communication. These systems will guide the self-organization of mixed microenvironments derived from different tissues and enable them to accurately reproduce the molecular connections underlying these alterations. In this study, an innovative new modular 3D co-culturing approach was used to expose PBMCs to lung tumoroids, under physiologically relevant conditions. Changes in DNA fragmentation of PBMCs in the presence of lung cancer were quantified and used as a biomarker. To validate the predictiveness of this biomarker, our results were compared with clinical data from a clinical evaluation study. Similar to the clinical trial observations, PBMCs, when exposed to lung tumoroids, showed a significantly lower level of DNA fragmentation (37%). This modular 3D co-culturing model showed a predictiveness of the clinical data of > 90%, demonstrating its power to monitoring cell-to-cell communication effects and support the development of blood-based biomarkers.
May 2026 DOI 10.14302/issn.3070-3379.jwc-26-6201
R. Hodgson BruceCorresponding author
A sustainable global net-zero carbon emission is when emissions are equivalent to the uptake of carbon by global terrestrial and aquatic plants. To meet that objective, an approximate 50% reduction of fossil-fuel emissions was estimated for net-zero by 2050 using carbon dioxide concentrations and mass emission monitoring by NOAA and related references. From that data, the initial target level of reduction to obtain net-zero was selected for year 2000 to minimise effects of climate change on environmental damage. The recent finding that about half global emissions are taken up from the atmosphere and increases global terrestrial and aquatic plant growth, including agriculture plants for food production, indicates it is important to maintain the year 2000 levels in the atmosphere. It was concluded as renewable energy was found to need support, it could be supplemented by electricity production remaining after obtaining net-zero, which also supports the atmospheric carbon dioxide levels for their important global ecological contribution.
May 2026 DOI 10.14302/issn.2574-4518.jsdr-25-5773
Peres de Sousa LucasCorresponding author
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.
Feb 2026
DeRoche ChristinaCorresponding author
The current research assessed gaps and barriers related to perinatal mental health service access by parents during COVID-19, as well as service providers’ knowledge and provision of PMAD services, in one Northern community, where rural and remote healthcare is a daily reality, and recruitment and retention of qualified professionals is a significant issue. Two mixed-methods surveys were designed, one to assess PMAD knowledge and service provision via a volunteer sample of service providers, and another to assess PMAD service need and access among a volunteer sample of new parents. Results indicated that many parents waited too long for services, and some parents in need of PMAD services didn’t receive them. Interestingly, higher-income parents were more likely than lower-income respondents to desire services and support for PMADs. Although most providers screened for, were trained in, and treated and/or referred patients with PMADs, they reported feeling as though they were working in silos, unaware of what other providers offered.
Feb 2026 DOI 10.14302/issn.2576-6694.jbbs-26-5964
Flanagan DennisCorresponding author
The combination of ultrasonography (US) and cone beam computed tomography (CBCT) has been proposed as a multimodal imaging strategy capable of uniting realtime softtissue assessment with highresolution threedimensional visualization of osseous structures. This study critically evaluated whether such integration provides measurable diagnostic or workflow advantages in mandibular imaging. Despite strong theoretical justification, the combined use of US and CBCT failed to demonstrate clinically meaningful improvements in diagnostic accuracy, confidence, or efficiency when compared with CBCT alone. Fundamental physical mismatches, hardware incompatibilities, geometric constraints, and operatordependent variability limited the anticipated synergistic benefits. These negative findings underscore the importance of reporting unsuccessful integration attempts to guide future research and prevent premature clinical adoption of technically incompatible imaging paradigms.
Dec 2025 DOI 10.14302/issn.2688-5328.ijp-25-5402
Yang Shih-ChiehCorresponding author
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.
Nov 2025 DOI 10.14302/issn.2476-1710.jdt-25-5775
A. Kaufman ErinCorresponding author
A number of developmental factors increase risk for adolescent rumination. This particular kind of repetitive negative thinking pattern often begins in the context of familial stressors and parental modeling. Though rumination can be effectively targeted with rumination-focused cognitive behavioral therapy (RF-CBT), it is unknown whether caregiver-child co-rumination (1) affects caregiver views of their child’s psychopathology, (2) or interferes with youth rumination- focused treatment. The present study uses data from a randomized clinical trial of RF-CBT to examine whether caregiver-child co-rumination, or caregivers’ own rumination patterns, are associated with bias in parental perception of their adolescent’s depression symptoms. We also examine if co-rumination scores at baseline moderate rumination scores for youth at treatment termination, and whether treatment effects dampen or decay more significantly post-treatment among youth with higher caregiver-child co-rumination. Youth (N = 76) were randomized to either 10-14 sessions of RF-CBT (n = 38) or treatment as usual (TAU; n = 38) and completed interviews and surveys at pre-treatment baseline, post-treatment, and 3-, 6-, 9-, and 12-month follow up. Results indicate that neither caregiver rumination nor co-rumination scores bias caregivers’ views of their child’s depression symptoms. In terms of reduction in child’s rumination scores, estimated treatment effects were larger for patients with higher baseline co- rumination scores, and there was no statistically significant difference in treatment effect decay over time in high versus low co-rumination groups. Results indicate co-rumination overall does not dampen the effect of RF-CBT, and those experiencing the highest levels of co-rumination may benefit most from treatment.
Nov 2025 DOI 10.14302/issn.3070-3379.jwc-25-5549
Chukwuma Sr ChrysanthusCorresponding author
This short communication/mini-review immensely emphasizes human health to explicate and elucidate management of the global scourge associated with the determinants and impact of vulnerabilities to extreme hydrologic events and climate change in the absence of risk reduction and their concomitant sequelae. The most effective approach for risk reduction associated with biodiversity, environmental, and health vulnerabilities due to climate change and extreme hydrological events, an ecological framework must take into cognizance exposure, vulnerability, and resilience. This framework emphasizes the significance of understanding the inextricable linkage between ecosystems and human communities are exposed and susceptible to hazards, sensitivity to these hazards, and capacity to cope, adapt and recuperate. Risk reduction incorporates structurally attenuating exposure, strengthening resilience, and sustainably enhancing overall vulnerability management. Extreme weather and climate-associated incidents impinge on human health with consequential morbidity, mortality and socioeconomic challenges and constraints. Climate change and extreme event have altered the frequency, intensity, geographic distribution, and propensity as drivers for change in the future. The indicted variables include hydrological events, such as precipitation, floods and droughts as well as heat waves, wildfires, global warming, extreme temperatures, and hurricanes. The pathways inextricably-linked with extreme events to economic dissipation, human health prognosis and outcomes remain inexplicably diverse and complex; and thus, difficult to predict due to their emergence and reemergence from local, societal and environmental factors which influence disease burden.
Jun 2025 DOI 10.14302/issn.2766-8681.jcsr-25-5555
Natasha Dharmakusumah TaniaCorresponding author
The roof of an HCl fiber-reinforced plastic (FRP) chemical tank failed by accident after it had been operated for less than its expected lifetime. A possible cause is the change in day and night temperature, which lead to the cyclic change in the concentration of HCl vapor in contact with roof part. To investigate this possibility, a detailed analysis on the durability of the material exposed to cyclic solution concentration is required. In this research, vinyl ester-glass fiber composite specimens were exposed to 35 mass % and 0 mass% of HCl alternately at 40°C to replicate cyclic concentration exposure in both the vapor and liquid phases. The mass uptake and penetration depth of HCl as well as the strength loss of the material were investigated. Mass uptake and thickness change in vapor phase shows two times higher than liquid phase, at 3.5% and 6% respectively. This occurs due to differences in the concentration of solutions that diffuse to the specimen in the vapor phase and liquid phase. This phenomenon arises from variations in the concentration of solutions that diffuse to the specimen in both vapor and liquid phases. The diffusion process is facilitated by osmotic pressure, leading to material swelling and contributing to their degradation. The result of flexural strength measurement of specimens indicated a decreasing trend as exposure time increased. The flexural strength decreases by up to 36% due to plasticization. The Cl and water content profile in specimens that obtained from elemental mapping of cross-sections using Energy-Dispersive X-ray Spectroscopy (EDS) are enhancing the study on how materials degrade, which may be a reason for damage to FRP tank roofs.
Mar 2025 DOI 10.14302/issn.2637-6075.jpae-25-5464
R. Hodgson BruceCorresponding author
Antarctic krill is an important component of the zooplankton production in the Southern Ocean and is a major food source for baleen whales. The role of commercial fishing and predation by whales on Krill abundance has been investigated here using the innovative ecosystem-based fishery management, EBFM which maintains the krill to whale food web ecosystem stability. The literature indicates the Krill fishery may have been overfished, so it was reduced to the current annual upper limit of 0.62 million tonnes for support other predators of krill, such as seals, penguins and flying sea birds. However, recent literature suggests a moderate reduction in krill catch in the Antarctic Peninsula area due to its importance for whale migration to temperate areas. The Peninsula area catch was estimated to be reduced by about 10% due to additional concerns about climate change effects on krill abundance in the Southern Ocean, reducing overall catch to 0.556 million tonnes, moderately higher than the maximum taken in 2022. Hence, the krill biomass fishing was reduced to allow for predation by baleen whales and other predators, giving a full ecosystem-based fishing mortality similar to that previously estimated to maintain krill production in the Southern Ocean.
Sep 2024 DOI 10.14302/issn.2769-2264.jw-24-5269
S. Speer MiltonCorresponding author
Significantly decreased rainfall run-off into the dams that feed the Darling River in eastern Australia during the Millennium (1997–2009) and Tinderbox (2017 –2019) Droughts coincided with reduced river levels along the Darling River. The rainfall reduction was due to accelerated global warming since the mid-late 1990s. During this period, unmonitored river water extraction from the streams that feed the Darling River was diverted to crops, on-farm dams, and to storage in the Menindee Lake system. This practice exacerbated the effect of the two droughts because streamflow that reaches the Darling River ceased in several upstream rivers, and in the Darling River. Using Darling River height levels, before and after the mid-late 1990s, it is shown that global warming is the key factor reducing Darling River levels in the last 53 years, even allowing for river water diversion and extraction. Between the periods 1972-1997 and 1998-2024 the Darling River mean heights, in the towns of Bourke, Wilcannia and Menindee, were all found to drop by statistically significant amounts. The catchment area rainfall has found to be decreasing due to global warming induced atmospheric circulation changes. Reducing water extraction either before or after it reaches the Darling River is unlikely to stop the short-medium term decline in Darling River levels.
Sep 2024 DOI 10.14302/issn.3070-3379.jwc-24-5199
Fidele NizeyimanaCorresponding author
Rwanda is a small Central African country. A land with thousands of hills and mountains. It is a low-income country and one of Africa's fastest-growing economies. It is home to a variety of ecosystems, such as mountainous rainforests, gallery forests, savanna woodlands, wetlands, aquatic forests, and agroecosystems. From rising temperatures to changing rainfall patterns, the hidden dangers of climate change are unmasking themselves in the form of various health risks. Every year, many deaths, bodily injuries, and house collapses, among other repercussions, are documented as detrimental effects of climate change events on public health. This article delves into the intricate relationship between climate change and public health in Rwanda, exploring the adverse effects it has on vulnerable communities. By shedding light on this pressing issue, we can better understand the urgency of taking action to mitigate the impact of climate change on public health as well as potential solutions to the current predicament. The authors researched several literatures to develop their perspectives on the subject and explored potential solutions to protect the well-being of Rwandans in the face of this global crisis.
Jun 2024 DOI 10.14302/issn.2379-7835.ijn-24-5117
Hoon Kim DoCorresponding author
In this study, the efficacy and safety of DKB-131 (extract of Siraitiagrosvenorii) in adults of both genders presenting mild symptoms of knee arthritis were evaluated in comparison to a placebo. This clinical trial was randomized, double-blind, multicenter, and lasted for 12 weeks. A total of 120 participants with Visual Analogue Scale (VAS) scores of 30 mm or higher in the knee area and Kellgren & Lawrence Grade I or II knee arthritis on X-ray were enrolled, with 60 subjects randomized to receive DKB-131 and 60 subjects receiving placebo. Following 12 weeks of consumption, the change in K-WOMAC total score assessed in the per protocol (PP) set revealed a reduction of 21.86±15.98 points in participants who received DKB-131 (p<0.0001), whereas those in the placebo group exhibited a reduction of 14.92±16.66 points (p<0.0001). This demonstrated a statistically significant difference between the test groups (p=0.0389). Additionally, significant differences were observed between the DKB-131 and placebo groups in the changes in K-WOMAC pain (p=0.0157) and physical function (p=0.0447). For the secondary efficacy endpoint, the change in Visual Analogue Scale (VAS) scores, analyzed in the PP set after 12 weeks of consumption, the test group showed a reduction of 17.82±13.80 mm (p<0.0001), while the control group exhibited a reduction of 11.81±13.99 mm (p<0.0001), indicating a statistically significant difference between the test groups (p=0.0359). Safety evaluations including hematological tests, biochemical tests, and urinalysis revealed no clinically significant differences between the consumption groups. Additionally, vital signs (pulse, blood pressure) and anthropometric measurements (body weight) did not exhibit clinically significant differences between the consumption groups, confirming the safety of DKB-131. We propose that the consumption of DKB-131 is safe for humans and may contribute to joint health. Trial registration (CRIS.NIH.go.Kr): KCT0008527
Apr 2024 DOI 10.14302/issn.2329-9487.jhc-24-5040
Dangwe Temoua NaibéCorresponding author
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.
Mar 2024 DOI 10.14302/issn.2640-690X.jfm-24-5016
Murigi KevinCorresponding author
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.2574-4496.jtc-23-4835
Hussein Saleh Hussein AbbasCorresponding author
The prevalence of thyroid cancer is rapidly increasing worldwide, majorly due to overdiagnosis and overtreatment methods of differentiated thyroid cancer. The emergent and potent preclinical models, high-throughput molecular techniques, and genetic expression microarrays have delivered deeper insights into understanding the molecular features in oncogenesis. Thus, molecular markers have become a promising tool in managing thyroid cancer for differentiating benign and malignant tumors, prognosis, recurrence, and determination of novel therapeutic targets. In differentiated thyroid cancer, molecular markers are majorly utilized for guiding the development of indeterminate thyroid nodules on fine needle aspiration (FNA) histologies. Dissimilar to this, in advanced thyroid cancer, molecular markers permit targeted treatment of a modified signaling cascade. Determining causal mutation of targeted kinase receptors in advanced thyroid cancer can depict a promising treatment strategy with mutation-targeted tyrosine kinase inhibitors to reduce progression and eradicate mutation effects when conventional methods fail to manage. This review will focus on the molecular landscape and discuss the impact of molecular markers on the prognosis, treatment, and surveillance of differentiated and anaplastic thyroid cancer.
Dec 2023 DOI 10.14302/issn.3070-1937.ijbt-23-4714
M. Gaji AhmedCorresponding author
Background and Objectives Duffy (FY) blood group system is implicated in transfusion incompatibilities and haemolytic disease of the foetus and newborn (HDFN). The primary objective was to determine the Duffy phenotype among indigenous pregnant women in Gombe, Gombe State, Nigeria. Materials and Methods This was a Cross sectional study where simple random sampling was employed on consented participants. Two hundred and fifty nine pregnant women attending antenatal clinic at Federal Teaching Hospital Gombe were randomly recruited into the study. About 3mls of blood was taken, and Duffy antigen typed by standard tube technique (LORNE LABORATORY UK). Results Among the Indigenous tribe, the percentage of Fy(a+b+) was seen in 2.2% of Fulani and 3.4% of Tangale, Fy(a+b-) phenotype was seen in 4.3% of Tangale, 6.8% of Fulani,9.5% of Tera, 10.3% of Hausa and 10.5% of Waja. Fy(a-b+) phenotype was seen in 5.3% of Waja, 7.6% of Fulani,8.7% of Tangale, 9.5% of Tera and 12.5% of Bolawa. Fy(a-b-) phenotype was seen in 2.4% of Tula,6.4% of Bolawa,7.3% of Waja, 7.8% of Tera, 17.8% of Tangale, 11.8% of Hausa and 46.5% of Fulani. About 84.6% of the study population had the null Duffy phenotype. Conclusion The research showed the phenotypic distribution of Duffy blood group among the study participants with relatively high percentage of null Duffy phenotype hence possible risk of alloimmunisation.
Dec 2023 DOI 10.14302/issn.2329-9487.jhc-23-4848
Dangwe Temoua NaibeCorresponding author
Introduction Rheumatic heart disease is mostly common in low-income or developing parts of the world, such as Sub-Saharan Africa, with a high morbidity and mortality rate. There are few data that are available in Chad on rheumatic heart disease. Our objective was to study the clinical, echocardiographic, therapeutic, and progressive aspects of rheumatic heart disease at the Renaissance University Hospital Center and the National Reference Teaching Hospital in N’Djamena, Chad. Patient and methods This was a prospective, multicenter and observational cohort study, covering a consecutive series of patients consulted and/or hospitalized for rheumatic heart disease, documented by an echocardiogram from January 2015 to January 2021. Results Among the 4456 patients consulted and/or hospitalized, 398 cases of rheumatic heart disease (8.9%) were collected, and 364 patients had met the inclusion criteria. The mean age was 31.2 ± 14.4 years, and 193 patients (53%) were female. On admission, heart failure was present in 214 patients (58.8%), ischemic stroke in 10 patients (2.7%) and supraventricular arrhythmias such as atrial fibrillation in 94 patients (25.8%) and atrial flutter in 6 patients (1.6%). Mitral regurgitation was observed in 49.7% (n=181) of cases, aortic regurgitation in 33.2% (n=121), mitral stenosis in 31.3% (n=114), and aortic stenosis in 7.7% (n=28). At least two valvular disorders were combined in 48.4% of cases. A surgical intervention such as a heart valve replacement and/or valvuloplasty was performed in 80 patients (22.2%). At least one rehospitalization was noted in 56.9% of patients. Forty-two of the 150 patients free of heart failure at inclusion (28%) had experienced the first episode of decompensated heart failure during follow-up. On the other hand, in 119 patients (55.6%), it was the second episode of decompensated heart failure. Other progressive complications included atrial fibrillation (13.8%), thromboembolic complications (6.3%), infective endocarditis (6.0%) and prosthetic valve dysfunction (1.4%). Altogether, the mortality rate was 10.4%. It was 9.9% in non-operated patients compared to 12.5% in operated patients (p=0.49). Conclusion The present study shows that morbidity and mortality of rheumatic heart disease remain high in our context and often affect children, young adults, and women. Treatment is essentially based on cardiac surgery which is not available in Chad.
Oct 2023 DOI 10.14302/issn.2379-7835.ijn-23-4737
J. Johnson JeremyCorresponding author
Bitter melon is a popular fruit cultivated in Southeast Asia and other tropical climate regions. Bitter melon has been used in traditional medicine because of its numerous medicinal benefits, including having hypoglycemic effects. This has an indication for diabetic patients, and several clinical trials have provided evidence that orally administered bitter melon extract can reduce A1C and blood sugar levels in diabetes patients. In vitro and in vivo mechanistic studies suggest that bitter melon’s anti-diabetic actions work through intra- and extra-pancreatic mechanisms. Herein we summarize and highlight these mechanistic and clinical studies that have demonstrated the hypoglycemic effects of bitter melon in type 2 diabetes patients.
Aug 2023 DOI 10.14302/issn.2688-5328.ijp-23-4624
James AndersonCorresponding author
Periauricular Vagus Nerve Stimulation (pVNS) has been proven safe and effective in reducing chronic pain and related comorbidities in numerous clinical studies. This multicenter, interventional study used a non-randomized, interrupted time-series analysis to test the efficacy of an 8-week treatment protocol using the Stivax neurostimulator device. Subjects (n=33, 15 F, 18 M, age 40-77) were recruited at 3 clinic sites in California and Colorado. All subjects had long-term chronic pain and had failed other treatments. Subjects were treated with the Stivax device 3 times (2 weeks on, 1 week off). Subjective assessments of pain (Visual Analog Scale), disability (Oswestry Disability Index), depression (PHQ-9), and activity (IPAQ-E) were collected at baseline and weekly. Objective blood levels of pain-related cytokines collected at the end of weeks 2 and 8. Most subjects reported reduced pain, disability, and depression, with increased activity levels. At the end of week 8, subjects reported an average reduction in pain by 38.5% (3 subjects reported no pain), depression by 43.6% (2 subjects reported no depression), disability by 38.6% (2 subjects reported no disability), and an average 26.1% increase in activity level (5 subjects doubled their activity level). Levels of the pain-related cytokines IL-1ꞵ, IL-2, IL-3, IL-7, IL-10, IL-15, IL-17α, IL-21, TNF-α, IFN-γ, and FLT3-ligand showed improvement at week 8. pVNS is believed to “reset” central sensitization underlying chronic pain and other central sensitization syndromes, engaging the body’s pain modulation systems. Our results indicate that pVNS can clinically significantly improve chronic pain and associated morbidities without adverse effects.
Jul 2023 DOI 10.14302/issn.2574-450X.jom-23-4654
Hodges StephanieCorresponding author
Background Nearly 40% of the adult population in the United States are considered obese by current standards, which equates to approximately 93 million people. Obesity is a chronic disease that is linked to more than 40 other diseases, including hypertension, heart disease, stroke, diabetes, and at least 13 distinct types of cancers. The direct and indirect costs of obesity have been estimated at up to $210 billion annually. Local Problem In Cumberland County, North Carolina, 34% of the adult population was considered obese. The aim of this quality improvement study was to increase effective care (screening, patient engagement, and referral to treatment) in adult patients with a BMI greater than 30 kg/m2 to 75% within 90 days. Methods A rapid cycle plan-do-study-act framework was used to evaluate four focus areas concurrently over 8 weeks with a small test of change completed in each 2-week cycle. Interventions An expanded screening with a checklist, shared decision-making tools (SDMTs), and a referral to treatment checklist were implemented. Activities from the team engagement plan were initiated. Results The effective care of patients increased by 42 percentage points while engaging both the patients and the staff. Conclusions Utilizing standardized communication, SDMTs, checklists, and management plans improved effective care while motivating and enabling patients to take control of their care and make sustainable lifestyle changes that enhance overall health.
Jul 2023 DOI 10.14302/issn.2997-1977.jd-23-4588
Mboko Byamungu FreddyCorresponding author
Introduction Acute diarrhea remains one of the major health problems in developing countries. According to the WHO, rotavirus contributes to approximately 40% hospitalizations and is the leading cause of severe diarrhea in children 0-5 years old. The objective was to determine the prevalence of rotavirus and the sociodemographic and clinical profile among children with diarrhea in 4 hospitals in the DRC. Methods This study is documentary, retrospective and analytical taking two periods, before and after introduction of the vaccine, i.e. January 2017 to December 2018 and January 2020 to December 2021 in 4 hospitals, i.e. 2 in Kinshasa and 2 in Lubumbashi. Results Total 1872 children, 924 (49.4%) of whom were enrolled before the introduction of the vaccine and 948 (50.6%) after. Only 1737 had performed serology, of which 875 (50.4%) were rotavirus positive and 862 (49.6%) were negative. Positive results, a reduction of 30.6% is noted since the introduction of the vaccine. The predominant age range was 6 to 11 months. The male gender was predominant at 56.7%. Diarrhea was found in 88.5%, vomiting in 73.7% and fever in 73.9%. Before vaccination, the risk was more: 11 times to have diarrhea, 9-10 times the frequency between 3-10 times a day, 9 times vomiting, 2 times fever and 2 times to have a positive result. Conclusion From this study, we note a reduction frequency due to diarrhea unlike previous years, probably attributable to the vaccine.
Mar 2023 DOI 10.14302/issn.2470-0436.jos-23-4444
A. Byrd WilliamCorresponding author
A 27-year-old male presented one week after surgical repair of his fractured left zygomatic arch, 5 weeks post-assault, complaining of persistent blurred vision in the left eye and worsening migraine headaches. Magnetic resonance images (MRI) revealed no intra-orbital pathologies or optic neuropathy but demonstrated a clearly delineated air-filled space of the left anterior clinoid process (ACP). No vision threatening pathologies were identified and surgical treatment was not recommended. His blurred vision remained at 6-month follow up. We report a case of delayed vision loss and headache post zygomatic fracture repair surgery in patient with a confirmed ipsilateral ACP pneumatization.
Jan 2023 DOI 10.14302/issn.2329-9487.jhc-22-4362
PIO MachihudeCorresponding author
Objective To describe the epidemiological, clinical and arterial Doppler ultrasound aspects of abdominal aortic aneurysm (AAA). Material and Methods This is a prospective study with descriptive and analytical aims carried out from January 2019 to March 2022 (3 years) at the cardiovascular exploration center (CEC) "Saint-Esprit" of the association of the people's doctors for the research on cardiovascular diseases (AMP-MCV), at the clinic "Le Printemps" and at the University Hospital of Kara. All patients who underwent arterial Doppler ultrasound of the lower limbs for any reason in these centers during the study period were included. Ultrasound scans were performed or confirmed by a physician with a diploma specializing in vascular Doppler ultrasound. Results We retained 32 Doppler ultrasound scans out of 739 performed for AAA with a frequency of 4.38%. The mean age was 73.5± 9.07 years. The sex ratio M/F was 1.4. The cardiovascular medical history (84.38%) found was: hypertension (33.33%), diabetes (18.52%), dyslipidemia (33.33%) and a combination of diabetes and hypertension (14.81%). The circumstances of discovery were: downstream MI ischemia (72%), incidental finding on abdominal ultrasound (15.63%) and De bakey sign (6.25%). The location of the aneurysms was subrenal (84.4%), suprarenal (9.4%) and both (6.2%). AAAs were fusiform (71.9%) and saccular (28.1%). The size of the aneurysms was greater than 5 cm in 78.17% of patients. High blood pressure increases the probability of the occurrence of subrenal AAA while dyslipidemia increases the occurrence of fusiform AAA. Diabetes increases the probability of occurrence of AAA larger than 7cm. AAAs were thrombosed in 75% of patients. There were extensions of the aneurysms to the iliac arteries in 70.59%. Downstream embolic complications represented 46.88%, in the form of occlusions and tight stenoses. Spontaneous mortality was 81.24%. Conclusion Arterial Doppler ultrasonography is a very important tool in the screening, positive and lesion diagnosis of AAA. The risk factors for AAA are: age over 60 years, male gender, hypertension, diabetes and dyslipidemia. Early detection remains essential, because the spontaneous prognosis is poor.
Dec 2022 DOI 10.14302/issn.2473-1005.jdoi-22-4360
Millstein PhilipCorresponding author
Department of Restorative Dentistry, Harvard School of Dental Medicine, Boston, MA. USA
Contact intensity is a significant factor in immoveable implant restorations. This study visually compares the use of four occlusal contact indicators one of which measures contact intensity and surface area in a single subject. The need for an occlusal contact indicator that can be used with fixed implant restorations is examined. Three contact indicators used in practice are visually compared to a novel system where pressure sensitive information and surface area can be evaluated numerically and stored. Findings suggest that intensity and surface area should be measured upon implant placement. Limitations of this observational study are discussed. Directions for future research and more systematic study are offered
Oct 2022 DOI 10.14302/issn.2381-862X.jwrh-22-4315
Nazempour AnahitaCorresponding author
OB/Gynecologist, fellowship of infertility and IVF, Sarem fertility and infertility research center (SAFIR), Sarem women’s hospital, Tehran, Iran.
Background Polycystic ovary syndrome (PCOS) is a serious multifactorial disorder. This study intended to assess the effect of cinnamon supplementation on estradiol level, and fasting- and two-hour (2 hpp) insulin and sugar levels in women with PCOS. Material and Methods This study was a double-blinded randomized clinical trial (RCT), conducted between January 2019 until December 2020, at Gynecology Clinic Sarem Women’s Hospital in Tehran, Iran. Patients with PCOS, 130 subjects (65 person/ group) were diagnosed using Rotterdam diagnostic criteria. All participants received daily treatment consisting of 1500 mg metformin and 1000 mg cinnamon per day for 12 weeks. An evaluation of serum AMH level was conducted before and after the completion of therapy. Results Cinnamon supplementation significantly reduced the estradiol, fasting glucose and 2hpp glucose, fasting insulin and 2 hpp insulin, BMI and weight levels after intervention. The highest reduction was observed in fasting glucose, 2 hpp insulin, and estradiol groups after intervention (P<0.05). There was a significant difference between the means of BMI (P<0.01), fasting sugar (P<0.01), and 2 hpp glucose (P<0.01) before and after intervention. Conclusion Cinnamon supplementation, as a safe herbal product, can be prescribed with metformin to improve the symptoms and complications of PCOS.
Oct 2022 DOI 10.14302/issn.2381-862X.jwrh-22-4228
U.O Anyanwu,Corresponding author
National Obstetrics Fistula Centre, Abakaliki
Background Gender based violence (GBV) refers to any violence targeted at an individual or group on the basis of their gender. It could occur in different forms with several clinical manifestations. The authors have described several clinical manifestations of GBV in a tertiary health centre, knowledge of which would help in case identification and early clinical management. Methods Retrospective descriptive study of all clients seen at a gbv clinic over a sixteen months period.Data was obtained from case records and clinical presentations were entered into excel. Data analysis was done usingIBM SPSS Statistics for Windows, version 25. The results were presented in frequency tables and graphs Results Of 86 clients studied, 56(65.1%) were of pediatric age (< 18years) while 30(34.9%) were adults with a mean age of 18.33+11.64(range 1-64years).72(82.6%) belonged to the low social class. Physical abuse in the forms of battering, human bite, walking and sitting disturbances, hearing loss possibly from slapping or hitting and red eye possibly from trauma on the eye, constituted 37.6% of the clinical presentations. Other presentations were; sexual abuse in the form of forced sex which constituted 34.9%, while gynaecological / obstetrics presentations in the forms of bleeding per vagina, pregnancy due to forced sex and vaginal pain made up 13.9%. Emotional/psychological abuse was observed in all clients irrespective of their different presenting complaints. Conclusion While various forms of physical abuse were common, emotional abuse was present in all clients but masked probably due to prioritization of physical injuries. Therefore we recommend that all GBV survivors be screened for psycholocal abuse and psychotherapy given.
Sep 2022 DOI 10.14302/issn.2329-9487.jhc-22-4252
Kumari Nuthalapat RamaCorresponding author
Additional Professor of Cardiology, Department of Cardiology, Nizams institute of medical sciences, Panjagutta, Hyderabad, Telangana state, India
Background Prevalence of coronary artery disease is between 7-13 percent in urban and 2-7 % in rural India1. The alarm in rise in the prevalence of coronary risk factors like diabetes, hypertension, dyslipidemia, smoking, central obesity and physical inactivity2. The correlation between these risk factors and the severity of coronary atherosclerosis, assessed by angiography which may be either single or multivessel is less consistent with studies reporting conflicting results 3,4. Therefore our study aims to understand the proper correlation between risk factors and severity of coronary artery disease in an Indian population Methods This study was conducted in the department of cardiology, NIMS hospital Hyderabad which receives patients from the urban as well as rural areas of Telangana. the patients admitted in the department of cardiology, NIMS hospital Hyderabad that presented with acute coronary syndromes and diagnosed to have coronary artery disease (single vessel/multivessel disease) on coronary angiography taken for study. Sample Size is 150 Results Among the 150 subjects, males were 111(74%) and females were 39(26%). Mean age of the study population is 55.2 ± 11.4. Among SVD group 73.65% were males &26.3% were females. Among MVD group 76.2% were males & 23.7% were females. Mean age for SVD was 53±14.4 years, while mean age foe MVD was 58.6±14.5 years. For ACS mean age of presentation for females is 60.7±11.4 and for males mean age of presentation is 55.1±12.6. MVD (57.2%) were more common among smokers than SVD. In <45 years age group SVD (69.2%) were more common than MVD (30.8%). In 45- 70 years age group and >70 years age group MVD were more common than SVD with 69.6% and 66.6% respectively, which is statistically significant. MVD (60%) were more common among hypertensives than SVD. Among non-hypertensives MVD (41.8%) was less common than SVD (58.2%) MVD was common among all age groups, which is statistically signicant. Among STEMI group SVD (58.3%) was more common than MVD (41.7%). Among NSTEMI group MVD (62%) was more common than SVD (38%).Correlation between groups was statistically significant. Among SVD study group, LVEF was commonly between 30-45% & very few with LVEF <30% MVD was associated with more severe LV dysfunction as compared to SVD in acute MI. The difference in ejection fraction between the two groups was statistically significant P value=0.0002. In hospital MACE Among SVD there was 1 MI (due to stent thrombosis) who had to TVR (primary PCI) & rest were asymptomatic and discharged in normal state MVD there were in hospital deaths (due to refractory cardiogenic shock) rest were asymptomatic and were discharged in normal state. This difference between the two groups was statistically insignificant. Conclusion Multivessel disease in ACS were seen more commonly among elderly as compared to young subjects where single vessel disease were more common. Females especially elderly more commonly have multivessel disease. Mean age for multivessel disease was higher than single vessel disease. Among <45 years age group, SVD was more prevalent among smokers, obese and physically active. Multi vessel disease is more prevalent among patients with risk factors like diabetes, hypertension, dyslipidemia and physically inactive. Subjects with family history of premature CAD presented early and correlated well with prevalence of SVD.NSTEMI presented more with multi vessel disease. In echocardiographic wall motion analysis, a depressed regional segment of infarcted area with remote hyperkinesis predicted SVD where as remote area hypokinesis predicts more multivessel disease. In hospital outcomes were seen among multi vessel disease as compared to single vessel disease although not statistically significant.
Aug 2022 DOI 10.14302/issn.3070-3379.jwc-22-4233
Emmanuel EkpaCorresponding author
Biology Unit, Faculty of Science, Airforce Institute of Technology Kaduna
Man’s activity and/ or inactivity continually impedes the environment in many ways. Sometimes, these impediments could be negative with catastrophic consequences. Emission of greenhouse gases, desert encroachment, deforestation, global warming, and general environmental degradation by different human practices poses a lot of threat to this planet. It has therefore become imperative to explore novel ways or technologies in checkmating hazards emanating from these disasters. Biotechnology which simply refers to the use of living organisms or their parts particularly microorganisms to produce materials for human and animal consumption comes in handy. The aim of this paper is to do a brief review on the merits of applying this technology in mitigating hazards arising from climate change. Focus will be centered on agricultural and industrial biotechnology more as a result of their involvement in land and environmental related matters. Manipulation of crops via genetic engineering for varieties with stress resistance, phytoremediation, tissue culture of orphan crops, and so many other biotechnological practices will be examined so as to highlight their role in stemming disasters caused by climate change. In conclusion, the paper will attempt to explain the reason why developing countries like Nigeria should also join the global race in curtailing this menace via her indigenous biotechnology.
Jan 2022 DOI 10.14302/issn.2379-7835.ijn-21-4059
Ford KristynCorresponding author
Bachelor of Nutrition and Dietetics, Accredited Practising Dietitian (APD), Department of Nutrition and Dietetics, The Royal Children’s Hospital, Melbourne Australia, Address: 50 Flemington Road, Parkville VIC 3052
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.
Nov 2021 DOI 10.14302/issn.2473-1005.jdoi-21-3988
Muhamad Abu-HusseinCorresponding author
Practice limited to Children's Dentistry, Aesthetics Dental Clinic, Athens, Greece
Edentulism is considered a poor health outcome and may compromise quality of life. Implant-supported overdentures provide a good opportunity for dentists to improve the quality of life and oral health. Atrophic mandible poses a significant challenge to successful oral rehabilitation with dental implants. The aim of this case report is to demonstrate the concept of immediate functional loading in the mandible using unsplinted implants to support a locator attachment supported overdenture.
Oct 2021 DOI 10.14302/issn.2473-1005.jdoi-21-3976
Kasuga TaichiCorresponding author
Faculty Shinmyouzu Dental Clinic and Oral and Maxillofacial Surgery, Nerima, Tokyo 178-0061, Japan
Auto transplantation is a fast and economical option when a suitable donor tooth is available for replacement of a tooth considered impossible to treat. The purpose of this case report is to describe methods used for autotransplantation and its advantages for cases with a missing bilateral mandibular firstmolar, as compared with a dental implant, removable partial denture, and other methods of prosthesis. In the present patient who underwent auto transplantation, clinical and radiographic outcomes were considered satisfactory at one and two years postoperatively. Bone healing was observed around the roots of transplanted teeth, which showed good function. In autotransplantation cases, even when the donor tooth has complete root formation, a high success rate can be achieved when the patient is properly selected and treated. Although the chance of root resorption remains because of necrotic pulp and periodontal irritation during manipulation, auto transplantation should be considered as a good treatment modality in feasible cases. Based on the present findings, even though autotransplantation is not common in general dental practice, we consider that it offers a clinically and economically viable alternative as compared to other more complicated prosthetic and dental implant treatments. The purpose of this report is to show that auto transplantation is a superior treatment method for single molar defects as compared to other prosthetic methods, as the periodontal ligament of the patient can be used and cutting adjacent teeth is avoided. In addition, it is a treatment method that can effectively utilize a wisdom tooth.
Jan 2021
Vladimir Leonidovich MartynovCorresponding author
Doctor of Medical Sciences, Associate Professor, National Research Nizhny Novgorod State University named after N.I. Lobachevsky (UNN), Russia
The presence of numerous complaints of a gastroenterocolitic nature in patients with proven NBZ and CNDP and a sharp regression of these complaints after surgical correction of NBZ and CNDP allows us to conclude that the causes of these pathological manifestations are the failure of the Bauhinia valve and chronic violation of the duodenal patency, and the most adequate surgical aid for elimination of clinical manifestations of reflux disease is bauginoplasty with simultaneous duodenojejunostomy.
Jan 2021 DOI 10.14302/issn.2639-3166.jar-21-3703
Nuti MarcoCorresponding author
Institute of Life Sciences, School of Avanced Studies Sant’Anna – Università di Pisa, 56124 Pisa (Italy)
Since a decade in Apulia, south-east of Italy, an increasing number of olive trees developed the quick decline syndrome (OQDS) leading to partial or total dessication of the canopy and subsequent death. Currently six million of olive trees show the symptoms of the decline, despite the mitigation measures which were undertaken to contrast the progression of the dessication. Associated with the syndrome, several phytopathogenic fungi were detected in the rhizosphere, endosphere and phyllosphere of the trees, along with the phytopathogenic bacterium Xylellafastidiosasubsp. pauca. Alongside, other pathogenic events were clearly identified, mostly defeating soil resilience: salinization, pollution, erosion, decline of biodiversity. Further events include delays in the adoption of appropriate mitigation measures not directed to challenge solely a bacterial pathogen, misuse of the territory, erratic agronomic management practices. The OQDS impacted also societal aspects. All the above concurrent causes strongly suggest that (1) the olive quick decline in Apulia is not a too symplistic epidemic outbreak due to a bacterium, but rather a syndemic outbreak formed by several diverse biotic and abiotic pathologies and (2) only a more holistic approach can help coping with the uncertainties and difficulties of an enduring co- existance with this syndemic events.
Dec 2020 DOI 10.14302/issn.2692-1537.ijcv-20-3652
Alghamdi MohammedCorresponding author
Infectious disease consultant, King Fahad General Hospital
Background The use of hydroxychloroquine in coronavirus disease (COVID-19) pandemic raised significant concerns as regards safety and efficacy in hospitalized patients. The objective was to examine the effect of hydroxychloroquine on clinical improvement and mortality among hospitalized patients with COVID-19. Methods A prospective cohort study was conducted at four general hospitals in the Western region, Saudi Arabia. Patients who had absolute or relative contraindication for using hydroxychloroquine were excluded. Patients concomitantly receiving other medications including azithromycin, antivirals, and supportive treatment were not excluded. Results A total 267 patients were included in the current analysis; 185 (69.3%) on hydroxychloroquine and 82 (30.7%) on non-hydroxychloroquine treatments. The average age was 46.0±13.3 years and 78.3% of the patients were males. Approximately 95.9% of the patients were symptomatic with mild (50.6%), moderate (32.6%), severe (8.2%), or ARDS symptoms (4.5%). Compared with no hydroxychloroquine, those on hydroxychloroquine had significantly longer length of stay (11.5±7.1 versus 7.8±4.3 days, p<0.001), more ICU admission (22.7% versus 9.8%, p=0.012), and more intubation (12.4% versus 3.7%, p=0.026). Improvement of symptoms (84.3% versus 81.7%, p=0.595) and hospitalization death (7.0% versus 1.2%, p=0.071) were not significantly different between groups. With exception of length of stay, the association of hydroxychloroquine with the above negative outcomes disappeared after adjustment for several factors including disease severity and concomitant use of azithromycin. Conclusions Hydroxychloroquine is not associated with better improvement of symptoms compared with other treatments. Moreover, it is associated with longer length of stay but not mortality or ICU admission in adjusted analysis.
Nov 2020 DOI 10.14302/issn.2470-5020.jnrt-20-3596
Kombate DamelanCorresponding author
University of Kara (Togo)
Background Reversible posterior encephalopathy syndrome (RPE) is a clinical and radiological entity characterized by the acute or subacute fitting of symptoms covering headache, vomiting, visual disturbances, seizures and impairment of consciousness. The pathophysiology of RPE syndrome is poorly described. RPE syndrome is characterized by a reversible cerebral edema of often posterior topography in magnetic resonance imagery (MRI). Cases Presentation We consider RPE syndrome four cases under various conditions that are known as airplane flight, hypertension, non-steroidal anti-inflammatory medication, pregnancy and oldness with several pathologies. The RPE was described with several symptoms like headaches, vomiting, focal motor deficit, paresthesia, seizures, disorders of consciousness and photophobia. The imagery findings were varying from cortical hypersignals in Flair sequences to edema of both cortex and sub cortex. The outcome was good with a complete regression of symptoms and imagery lesions. Conclusion The pathophysiological mechanism of RPE syndrome remains unknown. High blood pressure, renal failure and drugs (anti-depressants, NSAIDs, immunosuppressants) are the most etiological factors. The diagnosis is based on clinical arguments and brain MRI. The main location is posterior. The clinical outcome was good with all the patients in our study, no recurrence was noted.
Sep 2020 DOI 10.14302/issn.2644-1101.jhp-20-3524
Zheng YuannanCorresponding author
Department of Physical Education, Zhejiang University, Hangzhou, China
In recent years, rock climbing has become increasingly popular around the world. However, due to its challenging and competitive nature, it is common for rock climbers to encounter frustration. It leads to negative emotions, reducing participation, and withdrawal behavior, which requires effective self-regulation. Therefore, the purpose of this study was to explore the causes and self-regulatory mechanisms of frustration in rock climbing. Using qualitative methods, 15 rock climbers were interviewed, and 6 themes were identified by thematic analysis. Task comparison and social comparison are the main causes of frustration in rock climbing. The self-regulatory mechanism of task comparative frustration includes focusing on tasks and habitual reflection. The self-regulatory mechanism of social comparative frustration involves emotion regulation and changing goal orientation. It is suggested that future rock climbers, especially beginners, deal with frustration through the self-regulatory mechanisms that can help them enjoy and pursue rock climbing.
Sep 2020 DOI 10.14302/issn.2379-7835.ijn-20-3369
Kishan Gupta BalCorresponding author
Senior Professor, In-charge Medical ICU, Department. of Medicine, S.P.Medical College, Bikaner.
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.
Aug 2020 DOI 10.14302/issn.2324-7339.jcrhap-20-3003
Kant Tiwari SatyaCorresponding author
Department of Internal Medicine, All India Institute of Medical Sciences, India
Human immunodeficiency virus (HIV) is a retroviral disease in which the viruses copy their genetic material into the genetic material of the human beings. Infected cells remain infected for the whole of their life. First discovered in the year 1981, Human immunodeficiency virus infections is considered to be a pandemic by the World Health organization.
Aug 2020 DOI 10.14302/issn.2574-612X.ijpr-20-3491
Amjad KarismaCorresponding author
PhD Fellow, Institute of Social Welfare and Research, University of Dhaka, Bangladesh.
Climate change is a global challenge which is likely to affect the mankind in substantial ways. Not only climate change is expected to affect physical health, it is also likely to affect mental health. Increased frequency of disasters with climate change can lead to posttraumatic stress disorder, adjustment disorder, and depression. Changes in climate may require population to migrate, which can lead to acculturation stress. It can also lead to increased rates of physical illnesses, which secondarily would be associated with psychological distress. Using a qualitative approach, this research explores the mental health status of migrant women in two urban slum areas in Dhaka city. The purpose of this study is to perform a review of existing secondary data and present mental health scenario of climate migrant women among slum dwellers and amplified gaps in knowledge regarding psychological health care system in Bangladesh. It is found that there is a lack of mental health preparedness and response in majority parts in the country specially the city slum, where aid cannot be reached to the sufferers. The paper concludes with a discussion of what can and should be done to tackle the expected mental health issues consequent to climate change and migration.
Jun 2020 DOI 10.14302/issn.2643-2811.jmbr-20-3402
Stanley Raj A.Corresponding author
Department of Physics, Loyola College, Chennai, Tamilnadu- 600034, India.
This research paper focuses on rainfall variations in Tamil Nadu, India using Wavelet, Linear regression and Artificial Neural Networks model from 2004 to 2017. As the rainfall is the key factor in understanding climate change, the seasonal datasets from 2004-2017 of Tamil Nadu state has been taken for study. The salient feature of this study is the application of Neural Networks and wavelet analysis. It reveals that the rainfall variations are ambiguous that it does not maintain a constant pattern. Wavelet coefficients of multiresolution spectrogram reveals that the intensity of rainfall in each year. Linear regression model divulge the pattern of rainfall followed in every season and the results show that except winter season all other season suffers deficient rainfall. The deficiency of rainfall may be due to different parameters like ElNino or LaNina pattern or global warming. Results showed that all seasons except winter does not maintain consistency in the rainfall variability. Winter season provides the positive slope values of 4.7 and 0.6 for January and February respectively. Moreover Artificial Neural Networks training provides prominent results of Regression value 0.98 which is comparably high with other seasons taken for study.
May 2020 DOI 10.14302/issn.2692-5257.ijgp-20-3368
Mango LucioCorresponding author
Head for Higher Education in Healthcare, University of International Studies (UNINT) – Rome, Italy
General practitioners are the first contact between the person, the family and the community with the health system. The philosopher and epistemologist K. Popper (1902-1994) recommended the need to register errors, in order to know them, catalog them and therefore prevent them. J.Reason in 1963 introduced the systemic approach to the study of errors with the theory of latent errors. The knowledge of the causal factors, or which in any case contribute, of possible errors, as well as of the latent gaps in the system, is a fundamental prerequisite for the construction of paths aimed at improving the quality of assistance, structures and organizational aspects.
Apr 2020 DOI 10.14302/issn.2474-7785.jarh-20-3301
Amjad KarismaCorresponding author
PhD Fellow, Institute of Social Welfare and Research, University of Dhaka, Bangladesh.
Bangladesh many older people spend their life in not only the unwell health but also in poverty which is major risk for the elderly population. This is especially true for older women, who suffer from various difficulties ensuing from prejudices to gender, widowhood and old age. Climate migrants start living in urban slums are in search of better and secure life. But urban slums located mostly in low lying environmentally hazardous area coupled with inadequate facilities like food, shelter, sanitation, health care make their life even worse. Older Women are the vulnerable groups in society in terms of climate change, movement; haphazard growth and unhealthy environment are the target group for this research. This study represents the nature and extent of elderly abuse of climate migrant urban poor women slum dwellers in Dhaka city in Bangladesh context. Besides, this paper also observe the socio-economic status of the study respondents and try to find out the self-stated reasons of elderly abuse. This study conducted both quantitative and qualitative types study on two slums of Dhaka with purposive sample survey, KII and in depth qualitative interview of selected climate migrant slum dwellers while purposive sample size of 50. Decreasing in earning capacity, inability and economic dependency, health hazard, maladjustment, changing social values have a separate role in the connection of older abuse. Planned migration, awareness program implantations against elderly abuse and secured socioeconomic factors are suggested through this paper to lessen exposure to further neglecting of elderly climate migrant women in urban slums.
Apr 2020 DOI 10.14302/issn.2641-5526.jmid-20-3248
I. Kheder SalahCorresponding author
Faculty of Pharmacy, National University, Khartoum, Sudan
Objective This study conducted to assess health care practitioners’ knowledge and perceptions of hand hygiene among health professional working in clinical settings in Khartoum State - Sudan. with the specific objective of determining the association between their stance on hand hygiene and the general demographic characteristics of these health-care professionals. Methodology This is a cross-sectional study conducted between July and November 2017 using a modified form of WHO questionnaire for knowledge and perception that was included 22 items was sent online to health care workers via social media. The data obtained entered and analyzed by SPSS version 24. Chi-square and test of independence were used as a test of significance. A p-value of < 0.05 was considered statistically significant for all purposes. Result 437 hospital staff were responded to the questionnaire. (99.3%) was found to have good knowledge. 197(45.2%) had good perception and 239(54.8%) had fair perception. Formal hand hygiene training was found to have no association with knowledge levels of hand hygiene, but the fair perception was higher in the respondents who didn’t receive formal training. Conclusion The present study highlights the hand hygiene knowledge and perception. Most health care workers were found to have good knowledge, and the majority was found to have a fair perception. Formal hand hygiene training courses were found to have no association with knowledge but it may be reflected in practice. The importance of training sessions regarding hand hygiene was noticed in the perception level.
Apr 2020 DOI 10.14302/issn.2692-5257.ijgp-20-3299
Luis Turabian JoseCorresponding author
Specialist in Family and Community Medicine, Health Center Santa Maria de Benquerencia, Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain
The coronavirus disease 2019 (COVID-19) pandemic is something new that baffles us. The dominant health model and the theory that supported it until before COVID-19 are refuted or invalidated by observing the current tragically situation, which also implies lasting changes in that new medical model. Consequently, once the urgency of the epidemic is over, the conceptual and organizational building of medical care can no longer be rebuilt in the same way. Based on the COVID-19 experience, it is necessary to rethink what kind of knowledge can emerge. Some of the concepts with clinical-epidemiological implications that have to be re-evaluated since the COVID-19 pandemic are: 1. Large epidemics or changes do not arise from an event similar to the "Big Bang", but rather they develop slowly and underground, so a surveillance system must be instituted; 2. Re-evaluate what we understand by "evidence-based medicine"; 3. Patient-centered care is inadequate and must be replaced by community-centered care; 4. Telecare and changes in the organization of consultations; 5. Hospitals and health centers are "biological bombs" that act as vectors of disease and must change their architecture, organization and use; 6. The end of the nursing home model; 7. Change of habits; and 8. Social media can democratize information and help communities organize.
Apr 2020 DOI 10.14302/issn.2691-5014.jphn-20-3295
Bittmann StefanCorresponding author
Department of Pediatrics, Ped Mind Institute (PMI), Gronau, Germany
This review catalogs clinical landmarks of COVID‑19 across newborns, children, and adolescents, including MIS‑C, risk factors, and considerations for vaccination and school policies.
Apr 2020 DOI 10.14302/issn.2832-4048.jsm-20-3211
Papaconstantinou JohnCorresponding author
The Department of Biochemistry and Molecular Biology, The University of Texas Medical Branch, Galveston Texas 77555-0643
Aging mammalian skeletal muscle satellite cells (MuSCs) undergo a decline of stem cell/progenitor cell proliferative and regenerative capacity, and the development of a physiological milieu characteristic of a state of chronic sterile inflammation. p38αMAPK and ERK1/2 are two major signaling pathways that regulate the age-associated decline of MuSC proliferative capacity. In this review we propose the following mechanism that links the p38αMAPK pathway to the decline of self-renewal and regenerative capacity of aged MuSCs: a) the HS-FGF-2-FGFR1-p38αMAPK-Axis, a tightly linked homeostatic signaling complex, is in synchrony with the autoinhibition of FGFR1; b) autoinhibition contributes to the Axis’ regulation of the homeostasis of P-p38αMAPK activity in juvenile MuSC; c) this combination of protein-protein interactions is characteristic of a juvenile cytoplasmic milieu of beneficial P-p38αMAPK activity and d) includes Sprouty1 inhibition that supports the stimulation of FGF-2 --> miR-29a; e) the miR29a dismantles the basement membrane in preparation for the initiation of replication; f) an age-associated impaired, dysregulated, over-sulfated heparan sulfate ligand (HS)-FGF-2 fails to activate FGFR1 in aged MuSCs; g) this uncouples its regulation of p38αMAPK and ERK1/2 pathways and results in desensitization of FGFR1; h) desensitization of FGFR1 and Sprouty1 interaction in aged MuSC uncouples their regulation of P-p38αMAPK in the aged MuSCs; i) this enables a state of chronic sterile inflammation to promote and sustain an increased level of P-p38αMAPK activity; and, j) the increased activity of P-p38αMAPK in aged MuSC stimulates the production of cell cycle inhibitors, miR-1 and miR-133, thereby attenuating the expression of the cell cycle regulators, SP1 and cyclin D1, resulting in a G1/S arrest; j) the increased level of p38αMAPK activity promotes the apoptosis of the aged activated MuSCs. This mechanism involves the synergistic interactions of HS-FGF2-FGFR-1, Sprouty (spry1), miR-1, miR-133 and miR-29a that unify the extracellular niche and intracellular milieu for the juvenile vs age-associated regulation of proliferative capacity of the MuSC. Our hypothesis unifies these interactions with the role of the extracellular niche and intracellular milieu in the stimulation of juvenile proliferation vs age-associated decline of skeletal muscle satellite cell self-renewal and regenerative proliferation. Word Count = 344
Mar 2020 DOI 10.14302/issn.2641-4538.jphi-20-3261
Dzinamarira TafadzwaCorresponding author
Department of Public Health, Mount Kenya University Rwanda, Kigali, Rwanda
Efforts to control the Human Immunodeficiency Virus epidemic in Rwanda have seen remarkable success over the years. Effective antiretroviral therapy has played great role in improving longevity among people living with HIV/AIDS (PLWH). While this is the case, there are various nutritional challenges, which are often faced, among PLWH. Guided by the Rwanda country guidelines for nutritional management for PLWH and WHO recommendations, this study aimed to explore the perspectives of health care providers (HCPs) working with PLWH on nutritional challenges faced by their clients in Kigali, Rwanda. We conducted a qualitative study using in-depth interviews to collect data. A non-probability purposive sampling was employed to recruit HCPs. Data analysis was based on the naturalistic paradigm. We followed the hybrid approach in conducting thematic analysis. Three themes were identified. First, HCPs had good knowledge on nutritional requirements for PLWH. They demonstrated good communication skills and adequate counseling skills that were necessary for addressing concerns on nutrition from their clients. Secondly, it emerged that HCPs perceived a lack of resources to be the major challenge faced in nutritional management of their clients. From theme three, it emerged that, from HCPs experiences, food insecurity and lack of feeding supplements were the main causes of malnutrition among PLWH in Kigali, Rwanda. From the HCPs perspective, there is a need to improve healthcare institutions capacity to manage nutritional challenges faced by PLWH. To achieve this, policy makers need to channel adequate resources for this cause.
Mar 2020 DOI 10.14302/issn.2692-5257.ijgp-20-3164
Luis Turabian JoseCorresponding author
Specialist in Family and Community Medicine, Health Center Santa Maria de Benquerencia, Regional Health Service of Castilla la Mancha (SESCAM), Toledo, Spain
There is a gap between theoretical knowledge about strategies and the techniques or methods to apply in the practice of the consultation to improve compliance. Within the framework of these strategies, a number of techniques to be used in certain situations can be cited: 1) Assessing readiness to change, importance and confidence; 2) Instruments for decision support; 3) Technique of the "pros and cons"; 4) Auto-monitoring techniques; 5) Technique of "information exchange"; 6) Feedback technique; 7) Brainstorming; 8) The “typical day”; and 9) Practical reminder systems for taking medication. A certain technique is not a universal procedure, but it is usually refined by trial and error, based on past experiences, and their choice and design are the responsibility of the general practitioner.
Feb 2020 DOI 10.14302/issn.2641-5518.jcci-20-3166
Bruno Bidin Brooks JosephCorresponding author
Department of Structure and Function, UNIMES- Universidade Metropolitana de Santos, São Paulo, Brazil
This case documents a pseudotumoral CNS lesion in Behcet's disease with sustained response to infliximab therapy. Clinical evolution, neuroimaging changes, and rationale for TNF‑alpha inhibition are detailed. The report supports considering biologic therapy for refractory neuro‑Behcet manifestations under specialist guidance.
Jan 2020 DOI 10.14302/issn.2379-7835.ijn-20-3159
Zhou Fang-QiangCorresponding author
Shanghai Sandai Pharmaceutical R&D Co. Ltd., Shanghai, 200127 China
Pyruvate holds superior biomedical properties in increase of hypoxia tolerance, correction of severe acidosis, exertion of anti-oxidative stress and protection of mitochondria against apoptosis, so that it improves multi-organ function in various pathogenic insults. Particularly, pyruvate preserves key enzyme: pyruvate dehydrogenase (PDH) activity through direct inhibition of pyruvate dehydrogenase kinas (PDK), as a PDH activator, in hypoxia. Therefore, pyruvate is robustly beneficial for cell/organ function over citrate, acetate, lactate, bicarbonate and chloride as anions in current medical fluids. Pyruvate-enriched oral rehydration salt/solution (Pyr-ORS) and pyruvate-based intravenous (IV) fluids would be more beneficial than WHO-ORS and current IV fluids in both crystalloids and colloids, respectively. Pyruvate-containing fluids as the new generation would be not only a volume expander, but also a therapeutic agent simultaneously in fluid resuscitation in critical care patients. Pyruvate may be also beneficial in prevent and treatment of diabetes, aging and even cancer. Pyruvate clinical applications indicates a new revolutionary medical advance, following the WHO-ORS prevalence, this century.
Oct 2019 DOI 10.14302/issn.2639-3166.jar-19-3015
Gupta RajCorresponding author
Centre for Advancement of Sustainable Agriculture, National Agriculture Science Centre Complex, Todapur Road, New Delhi, 110012, India
Monsoon rains provide relief from the sweltering summer heat conditions, replenish depleted profile moisture to breathe new life in soils. With appropriate management of rain water, Indian summer monsoons boost the level of ‘reservoir of life’. Our inability to manage spatial and temporal rainfall variation features of deficit and excess rainfall episodes and their interactions with soil variability is a major cause of uncertainty in agricultural production. In the past, entire focus of national efforts was on rainwater harvesting, storage and distribution through canal networks and greater reliance on ground water pumping to meet immediate crop water demands. These approaches have resulted in wide spread problems of natural resource fatigue and unsustainable water supplies. This paper analyses the complexities of climate change-land degradation-food security nexus and suggests the need for adopting alternate approaches emphasising on in situ conservation of rain water and its efficient use such as to reverse the processes that contribute to land degradation in specific landscapes.
Jun 2019 DOI 10.14302/issn.2379-7835.ijn-19-2845
J. Johnson JeremyCorresponding author
University of Illinois at Chicago, College of Pharmacy, Department of Pharmacy Practice
The mangosteen fruit is a popular Southeast Asian fruit consumed for centuries. There have been a variety of xanthones isolated from the fruit, bark, roots and leaves with each having unique chemical and physical properties. Previously, the most abundant xanthone α-mangostin has been shown to inhibit CDK4. Herein we describe the role of selected xanthones from the mangosteen inhibiting CDK4. The evidence we provide here is that key functional groups are required to inhibit the CDK4 protein to prevent the phosphorylation of downstream targets critical to inhibiting uncontrolled cell cycle progression. To define the properties of xanthones for inhibiting CDK4 we utilized a cell free biochemical assay to identify inhibitors of CDK4. The following xanthones were used for the analysis: α-mangostin, β-mangostin, γ-mangostin, gartanin, 8-desoxygartanin, garcinone C and garcinone D, 9-hydroxycalabaxanthone, and 3-isomangostin These results further substantiate the unique pharmacological properties of individual xanthones and how a mixture of xanthones may be responsible for a multi-targeted effect in cell based pharmacology systems.
May 2019 DOI 10.14302/issn.2639-3166.jar-19-2780
Masoero GiorgioCorresponding author
Accademia di Agricoltura di Torino, Italy
The inoculation of soil with a bio-fertilizer (BF), with arbuscular mycorrhiza fungi, characterizes a Symbiotic (S) agriculture mode, aimed at promoting the yield and health of crops through modifications in the rhizosphere as well as in the plant phenotype. The main objective of this study was to reduce the incidence of Olive Quick Decline Syndrome (OQDS, involving Xylella fastidiosasubsp.pauca) that afflicts the olive groves in Apulia (Italy). Non-inoculated control (C) plants were compared with Symbiotic (S) plants inoculated with 20 kg ha-1 of Micosat F ®, through a 15 cm deep scarification, in the groves of seven farms covering an area of 27 ha. In addition to a visual observation of 484 plants, to obtain a gradation of the disease severity, some objective rapid type methods were utilized to survey the plants and soil , namely leaf pH, NIR tomoscopy of the leaves, hay-litter-bag probes coupled with NIR spectroscopy and the prediction of soil induced respiration. The fingerprinting of the S and C types of leaves and litter-bags was ascertained by means of the use of a random forest algorithm in the classification matrices. The results on the symptoms appeared variable: they were significantly mitigated in two groves out of six, but they were aggravated in one. All the rapid measurements became essentials in a “holistic” model which was able to explain over 95% of the average mitigation / null / aggravation response to BF inoculation. The holistic model gathers differential and compositional analyses of the leaf (pH, crude protein, water) and of the soil (respiration), but depends mainly on the fingerprinting of the C and S leaves and litter-bags. Two keys were identified for a successful inoculation: a high degree of variability of the soil conditions permitting hospitality for the BF with enhancement of the microbial activity in the S soil (lowering the fingerprint of the control litter-bags) and homogeneity of the leaves (with increases in the fingerprint of the S leaves treated with BF). In short, the inoculation of diseased plants with one BF consortium is far from being the ultimate remedy to mitigate OQDS in all situations. Further studies are needed, at a field level, to clarify the soil hosting capacity and to define the mycorrhizal and / or endophytic * plant * pathogen interactions, even using rapid methods.
May 2019 DOI 10.14302/issn.2324-7339.jcrhap-19-2746
Khanam SabinaCorresponding author
Department of Biological Sciences, Yobe State University, Nigeria
Human immunodeficiency viruses causes HIV infection in humans belongs to two species of Lentivirus. It damages the cells of immune system which leads to weak immune system and the ability to fight from infections and diseases. This study was conducted to investigate the prevalence rate of HIV infection among pregnant women of different age groups attending Ajiko medical clinic, Damaturu, Nigeria. The prevalence rate was maximum (12.5%) in 36-45 age group and minimum (5%) in 26-35 age group but their was no HIV infection in 15-25 age group. The overall prevalence rate among pregnant women was 4%. General knowledge , training and campaigns of HIV prevention need to be tailored towards older women of age group 36-45 because of high prevalence rate.
Apr 2019 DOI 10.14302/issn.2641-5518.jcci-19-2700
S Lane AndrewCorresponding author
Cardiovascular Ultrasound Laboratory, Department of Intensive Care Medicine, Nepean Hospital, PO Box 63, Penrith NSW 2751
Rheumatic heart disease is becoming far less common in the developed world, and therefore expsoure to its complications are been seen less by clinicians. With the increasing ease of world travel, patients with less commonly seen medical conditions are increasingly presenting to Hospitals requiring management of their complications. We present a case of an elderly lady who was a tourist in Australia, who presented with complications of her rheumatic heart disease, and her subsequent radiological and echocardiographic investigations were a significant surpirse for her treating clinicians.
Feb 2019 DOI 10.14302/issn.2470-5020.jnrt-19-2618
Patel NaiyaCorresponding author
Graduate Research Assistant, Department of Public Health, Long Island University, Brooklyn, New York, United States, PMBA candidate, MPH, BDS.
Objective Testing a new drug, treatment, and medical device clinically is critically important before prescribing it to patient. Not determining the drug’s safety and efficacy through clinical trials might impose life threatening outcomes on its consumers. The research paper describes the critical factors associated for testing any new drugs clinically, as limited research is performed in this field of public health. Study Design A qualitative systematic literature review was performed by mining relevant original peer reviewed research papers as well as some online resources like MedlinePlus due to limited availability of studies on such critical topic. Methods The databases used were Web of Sciences core collection, PubMed, Google scholar. The keywords used to search research papers were “clinical trials”, “testing new drugs”, “history of testing drugs”, “evidence-based medicine”. Conclusion Drugs which are prescribed to critical target population like pregnant women and children should be more often clinically tested if possible as majority of them are available in the market without Food and Drug Administration (FDA) approval. The abusive potential of any new drug could end up taking lives of innocent individuals. More evidence-based medicine can help translate research results on a heterogeneous population efficiently.
Feb 2019 DOI 10.14302/issn.2324-7339.jcrhap-18-2533
M. Hussein Ahmed,Corresponding author
Assistant Professor, Shendi University, Faculty of Public Health, Head Department of Public Health,
This study was conducted in two (VCTs) at Elgenina town, the capital of West Darfur State in Sudan in period from November 2010 to February 2011, the study included all people attending VCTs in Elgeniena town for voluntary checking one hundred and fifty clients who visited the (VCT) centers and volunteered were included in this study, nonprobability sample, 150 volunteers was taken and covered all ages, One ml of blood was taken from each of the study sample and tested by rapid Immune Chromatographic (ICT) for HIV, a structured questionnaire was designed and the interviewed after a written consent to participate in the study was signed, data was analyzed using the SPSS statistical programmer and for possible association between study variables, the Chi square test was used, the study showed that 35 volunteers (23.33%) were positives, of whom 54.3% 19 were males. People having more than one sex partner were high 63.6% with statistically significant factor of getting infection (P.value = 0.00). Also, practicing unsafe sex were 5.2% another major risky (P.value = 0.00). Among the HIV positive cases 34.3% were drug users, compared to 20.9% from the HIV negatives (p. value = 0.10). There is no relation between education level and infection with HIV (p .value = 0.154). Forty two percent of the participants were single, 30% married, 10% divorced, 7.3% widows and 10.7% were separate
Jan 2019 DOI 10.14302/issn.2641-5518.jcci-18-2552
T KaraCorresponding author
Department of Pathology, Mersin University Medical School, Mersin, Turkey
This report presents a case of collision tumors of low-grade B-cell lymphoma and poorly differentiated adenocarcinoma in the caceum of a 63-year-old woman. Lymphoma was diagnosed incidentally after appendectomy for a clinical presentation of acute appendicitis. Imaging follow-up demonstrated mesenteric lymphadenopathy and liver lesions, and all surgically resected regional mesenteric lymph nodes and liver biopsy were found to be infiltrated by both mucosa-associated lymphoid tissue (MALT) lymphoma and adenocarcinoma. Systemic chemotherapy was administered for advanced colonic adenocarcinoma with liver metastases. The occurrence of synchronous lymphoma and adenocarcinoma of the colorectal region is rare, and this is a previously unreported case of a patient that was diagnosed during management of acute appendicitis.
Dec 2018 DOI 10.14302/issn.2641-5526.jmid-18-2488
Luis Fernández-Martínez JuanCorresponding author
Group of Inverse Problems, Optimization and Machine Learning. Department of Mathematics, Universidad de Oviedo, Oviedo, Asturias, Spain
Background: Triple Negative Breast Cancer (TNBC) is a type of breast cancer with very bad prognosis. Predicting the histological grade (HG) and the lymph nodes metastasis is crucial for developing more suitable treatment strategies. Methods: We present the main clinical and pathological variables to predict the histological grade and lymph nodes metastasis via novel machine learning techniques. These variables are currently being used for prognosis and treatment in medical practice. This analysis was performed using a database of 102 Caucasian women diagnosed with TNBC. The results were cross-validated using random simulations of this dataset. Results: HG was predicted with an accuracy of 93.8% using a list of 6 prognostic variables with significant implications: Ki67 expression, use of Oral contraceptives, Col11A1 expression, Col11A1 score, E-cad truncated and Tumor size. The lymph nodes metastasis was predicted with an accuracy of almost 85% using only 6 prognostic variables: Vascular invasion, Tumor size, Perineural invasion, Age at diagnosis, Ki67 expression, and Col11A1 score. This analysis also served to establish the median signatures of the groups with and without lymph node metastasis, and proved the existence of a kind of small-size tumors (around 2.15 cm) with lymph node metastasis but not showing vascular and perineural invasions and higher protein Col11A1 score. Besides, these signatures proved to be very stable. Conclusions: The additional information conveyed by the prognostic variables found in these two classification problems provides new insight about the genesis and progression of this disease and can be used in medical practice to improve decisions in patient diagnosis and further treatment.
Nov 2018 DOI 10.14302/issn.2578-8590.ipj-18-2490
Hinzpeter JaimeCorresponding author
Medical Doctor, University of Chile, Clinical Hospital, Santiago Chile
A short editorial underscores the bridge between basic sciences and clinical medicine. It emphasizes how mechanistic knowledge informs diagnostics and therapy, and calls for curricula that strengthen this continuum.
Oct 2018 DOI 10.14302/issn.2578-2371.jslr-18-2213
Meriam SabbahCorresponding author
Department of gastroenterology, Habib Thameur Hospital, Tunis, Tunisia.
Introduction: Granulomas in gastric biopsy specimens are extremely rare. The final diagnosis of granulomatous gastritis is based on morphological findings, clinical and laboratory data. The aim of our study is to evaluate the clinical fields and to determine the etiology of gastric granulomatosis in our experience Patients and Methods: Thirty nine patients were reviewed retrospectively in the department of pathology of Habib Thameur between 2000 and 2018. Slides from all cases were stained by hematoxylin and eosin. The clinic-pathologic findings and the associated lesions were analyzed and the final etiology of the gastric granulomatosis was noted. Results: Biopsies from the 39 patients diagnosed as having granulomatous gastritis were reviewed. Mean age was 49 years (24 – 96) and sex ratio was 0,25 (M/F=8/31). Indication of endoscopy was gastric pain in 12 cases, chronic diarrhea in 6 cases, anemia in 2 cases, vomiting in 4 cases. Other symptoms were rare. Upper endoscopy was normal in 8 cases, showed antral gastropathy in 20 cases (erythematous in 6 cases, nodular in 8 cases and ulcerated in 6 cases). In four cases, fundic lesions were observed. Granuloma was unique in 14 cases and multiple in 25 cases. Localisation of granuloma was the antrum in 25 cases, the fundus in 7 cases, and both of them in 7 cases. An associated chronic gastritis was noted in 25 cases. Concerning the etiology, 10 of our patients had Crohn's disease while 6 of them had gastric tuberculosis. In five cases, H Pylori was the retained cause of gastric granulomatosis. In the other patients, the final diagnosis was sarcoidosis (n=3), foreign body reaction (n=1), yersiniosis (n=1). In our series, thirteen cases were unclassifiable. Conclusion: Although many cases remain unclassified, in most cases of granulomatous gastritis, a diagnosis of Crohn's disease or tuberculosis could be established. If this cases are excluded, an association between H. pylori and granulomatous gastritis cannot be ruled out. The others causes are extremely rare.
Oct 2018 DOI 10.14302/issn.2474-3585.jpmc-18-2405
Zhang ChunyuCorresponding author
Department of Health Reform & Development, China-Japan Friendship Hospital, Beijing, PR China.
Excessive overtime work, which is a serious problem among Chinese physicians, is the primary reason for night clinic closure policies. The aim of this study was to evaluate the effects of such policies on physicians’ workload and satisfaction. Physicians at the hospital, which closed its night clinic in 2017, were selected as the intervention group, and those at another hospital, which still operates a night clinic, were chosen as the control group. In total, 829 participating physicians self-reported their characteristics and responded to questions on three effect indicators: weekly hours worked, work–family balance, and job satisfaction; the index years were for 2016 and 2017. A pre–post-with-control-group study design and the difference-in-difference (DID) methodology were employed to evaluate the effect of night clinic closure. After adjusting for physicians’ characteristics, the effect of all variables, except hours worked per week, on work–family balance and job satisfaction remained significant. Although the adjusted effect on hours worked per week was not significant, our results suggest that minor policy changes that reduce the workload of physicians may nonetheless benefit this group. However, as the satisfaction scores remained low, other policies should be implemented to relieve the workload and improve satisfaction among physicians.
Oct 2018 DOI 10.14302/issn.2379-7835.ijn-18-2228
Kishan Gupta BalCorresponding author
Senior Professor, In-charge Medical ICU, Department. of Medicine, S.P. Medical College, Bikaner.
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.2328-0182.japst-18-2281
Ali Arain AshiqueCorresponding author
Assistant Professor of Pharmacology.
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.2577-2279.ijha-18-2221
Ahmed Abdelrahman NuggedAlla MotazCorresponding author
Faculty of Medicine and Health Sciences, Head of Department of Anatomy, University of Kassala.
Background: Faculty of Medicine and Health sciences at University of Kassala, Sudan was established 1990. It adopts the traditional curricula, which implemented in preclinical (basic sciences) and clinical phases. This study was held to explore students' perception and attitudes towards the basic sciences. Methods: A descriptive cross-sectional study was conducted during April- August 2017 among 251 medical students. Self-administered questionnaire was used to collect data. It was collected and analyzed using SPSS 16.0. Results: A total of 251 of participants in different phases of education in faculty of medicine and health sciences were included in the study; preclinical 116 (46.2%), 113 clinical (45.0%), and 22 (8.8%) were in internship. 95 (37.8 %) were males and 156 (62.2%) were females. The study revealed that physiology was the most preferable subject. Students' satisfaction to syllabus for anatomy, physiology and biochemistry was 61.4%, 43%, and 28.7% respectively. However, 46.6% of students spent a long time to understand biochemistry and 33.1% considered it as overloaded syllabus. Participants showed poor ability to link between theoretical and practical work in case of biochemistry (26.7%), where as anatomy and physiology were represented by 76.9% and 42.2% respectively. Less than half of students were able to integrate the subjects of basic sciences and basic with clinical sciences. Conclusion: In this study, the students determined the difficulties of recalling of information, poor integration between basic and clinical sciences and even integration within the subject. Development of integrated curriculum is necessary to improve the quality of education.
Jul 2018 DOI 10.14302/issn.2577-2279.ijha-18-2179
A. Hegazy AbdelmonemCorresponding author
Human Anatomy and Embryology department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt
Cranial vault is the case surrounding the brain. Its structure differs in newborns than in adults in some aspects. Such differences should be clear for both health and family members. Moreover, the anatomy and embryology of fetal skull take a little attention in the previous literature and textbooks. Therefore, this short review aimed to clarify some aspects of anatomy and clinical importance of cranial vault features in newborns. The newborn vault is formed of multiple separate flat bones connected by fibrous tissues with wide soft gaps called fontanelles. Development of bones of skull vault is closely correlated with the expanding growth of the underlying brain. Such brain shouldn't be struggled by continuous tightening of the newborns' vault. Also, the newborn skull could be affected even by a fixed sleeping position.
Jun 2018 DOI 10.14302/issn.2372-6601.jhor-18-2139
S. Afriyie-Mensah JaneCorresponding author
Department of Medicine and therapeutics, School of Medicine and Dentistry, College of Health Sciences university of Ghana, Accra, Ghana.
Pulmonary hypertension (PH) has become an increasingly recognized complication in sickle cell anaemia (SCA) and is a major cause of morbidity and mortality. Though the burden of SCA in sub-Saharan Africa is high, there is paucity of data on SCA-associated PH with little or no attention given to it in routine patient care. The current study therefore sought to determine the prevalence of PH and its associated risk factors among adult patients with SCA. This was a cross-sectional study involving 76 clinically stable, hydroxyurea-naive participants. We obtained socio-demographic and clinical history. Measurement of Tricuspid Regurgitant jet Velocity (TRV) was obtained via transthoracic echocardiography and lung function was assessed using spirometry and pulse oximetry. Other investigations were complete blood counts, free plasma haemoglobin, serum urea and creatinine. Twenty-five (32.9%) of study participants had elevated TRV (≥ 2.5m/s) on Doppler echocardiography, which was suggestive of raised pulmonary artery systolic pressure. There were significant associations between elevated TRV and steady-state haemoglobin (p < 0.001), blood urea level (p = 0.030), presence of chronic leg ulcers (p = 0.043) and oxygen saturation (p < 0.001) and these may be identifiable and modifiable risk factors for selective screening with echocardiography in a resource poor setting.
Jun 2018 DOI 10.14302/issn.2575-1212.jvhc-18-2146
A Elmetwally MohammedCorresponding author
Department of Theriogenology, Veterinary Medicine Faculty, Mansoura University, Mansoura 36615, Egypt
Retained fetal membrane (RFM) is a crucial calving related disorder that affects economic for the farmer and herd health. Retention of Placenta (ROP) is the condition in which the fetal membranes are not expelled within a period of 12 hours after parturition. Buffalo cows (n=34) aged 4-9 years old with 2-6 lactation season were used in the present study. The Experimental buffaloes were divided into either with (n=25) or without (n=9) fetal membrane retention. The objective of this study was to evaluate the effect of oxytetracycline treatment on reproductive performance of buffalo-cows with retained fetal membranes. All buffaloes in treated group received systemic infusion of oxytetracyclin Hcl injection 5% and 10 mg/kg oxytetracycline for 3 days intrauterine. Reproductive performance parameters for all experimental buffaloes were days to first estrous, number of service per conception, days open and pregnancy diagnosis. All reproductive parameters demonstrated significant changes between treated and non-treated animals (P < 0.05). Altogether, the obtained results indicated that retained placenta in buffaloes could be treated successfully by intrauterine infusion of oxytetracycline
Apr 2018 DOI 10.14302/issn.2473-1005.jdoi-18-1968
Mauricio Ferraz da Silva JoaoCorresponding author
Av Eng Francisco Jose Longo ,77 12245000, Brazil.
Currently, patients seeking dental treatment are increasingly concerned with the esthetics. Accordingly, the professional must be able to indicate treatment approaches that often include more than one specialty. This concept of integrated dentistry allows achieving excellence in results, which may not be reached one single Dentistry specialty. In addition, the multidisciplinary dentistry enables the solution of cases more conservatively, especially cases where aesthetics is a relevant factor. This study aimed to report a clinical case showing esthetic disharmony of the anterior teeth even after the ending of the orthodontic treatment, causing dissatisfaction for both the patient and the dentist. From a functional point of view, the occlusion was adequate. However, the esthetics prevented a satisfactory outcome. To solve this issue, the case was treated through minimally-invasive ceramic laminates, then reaching the expected result.
Dec 2017 DOI 10.14302/issn.2576-9383.jhhr-17-1811
JM Lemmens RyanneCorresponding author
Department of Healthcare, Centre of Expertise PXL Innovation Care, PXL University College, Hasselt, Belgium
Homecare is very important in oncology care since cancer patients are discharged more and more earlier from the hospital and receiving ambulatory treatments. Homecare nurses have a more general broad educational background, with less specialization regarding specific care, like oncology care. The aim of this study is to develop and test a cross-platform application (named Oncopunt) for homecare nurses involved in oncology care to provide specific nurse-centred information via digital media about skill guidelines specific for oncology care. This study was set-up as a non-experimental feasibility and satisfaction study with one measurement moment to collect information about usability, user-experience and added value of Oncopunt using the System Usability Scale (SUS) and an additional questionnaire. The cross-platform application Oncopunt was build using Drupal and Vimeo and consists of a homescreen, filter/search function and watch-function (full video panel, chapter panel and FAQ). Seventeen homecare nurses completed all questionnaires. The mean SUS score was 83,8 (stdev 11,6) and Oncopunt was rated positively regarding video content, technical issues, website layout, quality of care and user satisfaction. Oncopunt is developed to provide homecare nurses specific nurse-centred information about skills specific for oncology care via digital media . It was rated good on usability, user-experiences and added value for clinical practice.
Nov 2017 DOI 10.14302/issn.2641-5518.jcci-17-1806
Ralapanawa UdayaCorresponding author
Consultant Physician and Senior Lecturer in Medicine, Professorial Medical Unit, Teaching Hospital, Peradeniya, Sri Lanka.
Background Hypertension is one of the most prevalent risk factors for myocardial infarction, strokes, congestive cardiac failure and chronic kidney disease (CKD)and its prevalence is significantly higher inthe elderly population. Objectives To assess the demography, various presentations and the prevalence of risk factors among elderly hypertensive patients followed up in a tertiary care hospital in Sri Lanka. Materials and Methods This was a cross sectional descriptive study involving 250 patients whoseage was 60 years or above onantihypertensives for at least 6 months. Results Approximately 65.2% of the study population was female. The mean age was 70.17.Dizziness and chest pain were the most prevalent symptoms.The mean age at first detection was 58.17 years.Mean SBP and DBP were 128.5mmHg and 81.14mmHg respectively. The prevalence of alcohol consumption and smoking among men were 70.1% and 72.4% respectively. Approximately 54.7% were either overweight or obese.Approximately 81.6% females and 41.4% males had a waist circumference ofmore than therisk level with p-value<0.05. Approximately 36% had diabetes mellitus and 27.6% of the patients had at least one parent and 36.8% had at least one sibling diagnosed with hypertension. Approximately 61.3% of the patients hadadequate levels of physical activity while 31.8% had IHD,11.5% had stroke and 3.8% had CKD. Conclusion Dizziness and chest pain were the most disturbing symptoms while abdominal obesity among females,and alcohol consumption and smoking among males were the major risk factors in elderly hypertensive patients
Sep 2017 DOI 10.14302/issn.2577-137X.ji-17-1736
Ahmed Kamal SamiaCorresponding author
Animal Health Research Institute, Dokki, Giza, Egypt
Some strains of Foot and mouth disease virus (FMDV) are endemic in Egypt. The present study was performed on cattle and buffaloes (ages: 3 months up to 1.5 years old, of years 2015 and 2016), which were suffering foot and mouth disease (FMD). Sera and tissues samples were tested by different techniques including serum and virus neutralization tests (SNT, VNT), virus isolation and identification by tissue culture methods, Enzyme linked immune-Sorbent Assays (ELISA); and by the pathological and hematology techniques. The results showed the predominance of FMDV serotype O with the presence of serotypes SAT2 and A. The results showed the pathologic picture of FMD was similar regardless its specific subtypes, as apparently the studied strains produces same pathological and hematological changes. Microscopic examination reveals severe hydropic degenerations and necrosis in most affected organs, accompanied by significant changes in blood parameters which indicate severity and direct effects of FMDV on the hematopoietic system. These findings indicates the mode of pathogenesis of FMD virus in its way to exhibits the characteristic symptoms of illness. However, the investigation showed the presence of FMDV type O, A and SAT2 in the studied areas of delta governorates. It is important to focus on producing of vaccines which have only these serotypes as solution to get rid of the endemic behavior of FMDV in delta of Egypt.
Aug 2017
Oluyinka AKINTAYO RichardCorresponding author
Department of Medicine, Rheumatology Unit, Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
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.2377-2549.jndc-17-1645
Manivarman S.Corresponding author
Assistant Professor, Post Graduate and Research Department of Chemistry, Government Arts College, C-Mutlur, Chidambaram, Tamil Nadu, India.
The structure of the newly synthesized hydrazone derivative 2 - 6 – oxo - 2-thioxotetrahydropyrimidin – 4 1H - ylidene hydrazine carbothioamide (OTTHPYHCT)compound is determined by using spectral information and elemental study. Density functional theory (DFT) studies were performed using the B3LYP/6-31G (d, p) basis set to expand imminent into their structural properties. Frontier molecular orbital (FMO’s) analysis of title compoundwas computed at the same level of theory to get knowledge about their kinetic stability of the molecule by the energy gap value obtained. Global reactivity descriptors are determined to explain the biological activity of the molecule. NBO analysis provides information about charge transfer, delocalization effect, hyperconjugative interactions and the energy responsible for the stabilization of the compound. First hyperpolarizability analysis nonlinear optical response was simulated at the B3LYP/6-31G d, p level of theory as well. Thermodynamic parameters explain vibrational intensity of the molecule.
Jul 2017 DOI 10.14302/issn.2574-4372.jesr-17-1705
Varma VijayalakshmiCorresponding author
Biomarkers and Alternative Models Branch, Division of Systems Biology, National Center for Toxicological Studies, Jefferson, AR
Drug-induced cardiotoxicity is one of the predominant reasons for drug attrition and withdrawals. This is of critical concern when potentially cardiotoxic drugs are administered to individuals with inherited arrhythmogenic cardiac diseases or with metabolic diseases such as obesity and diabetes, which are key risk factors for cardiovascular diseases. Pathophysiological alteration prevalent under such conditions can alter or exacerbate cardiotoxic responses. The growing incidence of obesity, diabetes and metabolic syndrome subject a significant percentage of the population to drug treatments, thereby augmenting their risk for drug-induced cardiovascular toxicity. Hence, screening for drug-induced cardiotoxicity early in the preclinical stages of drug development, by using appropriate human disease models, can be effective in ensuring safety in clinical trials and preventing late stage and post-marketing drug withdrawals owing to cardiotoxicity. The advent of human pluripotent stem cells (hPSC) and induced pluripotent stem cell (iPSC)-derived cardiomyocytes are revolutionizing safety/toxicity screening in human cells by providing relevant human-specific, renewable model systems to explore human drug toxicity. The ability to generate patient-specific iPSCs that can model cardiac diseases, now offers a valuable option that can further improve drug safety assessments and enable a more accurate prediction of toxicity that occurs in the representative population that are prescribed the drugs. Use of appropriate disease models will not only provide cost savings by decreasing potential drug attrition and withdrawals, seen with many drugs, but will also be a promising option to advance precision medicine
May 2017 DOI 10.14302/issn.2576-2818.jfb-17-1435
Wiesak TeresaCorresponding author
Abington Reproductive Medicine, Toll Center for Reproductive Science, Abington, PA, USA;
The objective of this study was to investigate whether percentage of mature oocytes retrieved from ovaries stimulated with long agonist or multi-dose antagonist protocols affect the implantation, clinical pregnancy and live birth of ICSI (Intracytoplasmic sperm injection) cycles. The 654 cycles of agonist (long lupron) and 610 cycles of multi-dose flexible antagonist (antagon) were analyzed after stratification according to the percentage of the mature oocytes retrieved. The clinical pregnancy of the groups with less than 30 % mature oocytes retrieved, both antagonist and agonist protocol was statistically lower (at least p< 0.05) compared to the groups with more than 30% mature oocytes retrieved. In the agonist protocol, the implantation and live births for this group were significantly (p<0.009) lower than in the group with ≥70% mature oocytes retrieved. The live births in groups with more mature oocytes retrieved (30-69% and ≥70 %) of the antagonist protocol were lower (22.2% vs. 35.9% and 23.9% vs. 41.5%, p<0.0001, respectively) compare to the agonist protocol. The results of our study showed that a very low percentage of mature oocytes retrieved impacts the clinical outcome of antagonist and long agonist protocols.
Mar 2017 DOI 10.14302/issn.2474-3585.jpmc-16-1161
Johansson GunnarCorresponding author
Professor of Health Sciences, School of Health and Welfare, Halmstad University
There Is A Gap Between What We Know And What We Do, Such As Knowing What We Should Eat And What We Actually Eat, A So-Called “Attitude/Behavior Gap”. It Is Not Necessary To Go From A Change In Attitude To A Change In Behavior. It Is Possible To Do The Opposite; In Other Words, It Is Possible To Go From A Change In Behavior To A Change In Attitude. The Objective Of This Paper Is To Describe And Explain The Concept Of Dietary Advice On Prescription (DAP) And Present The Reasons And Evidences For The DAP Messages. Dietary Advice On Prescription (DAP) Starts With Discussing Behaviors Related To Dietary Habits And Then Goes From Behaviors Towards Attitudes. DAP Is A Theory-Based Pedagogical Model That Deals With Behaviors Related To Why, How And When We Eat, Rather Then What We Eat. The DAP Model Is A Method That Quickly Leads The Client Onto A Track That Yields Autonomy, Respects The Client’s Integrity, Gives Confirmation, Emphasizes The Delight And Pleasure Of Eating, Stimulates Discussions And Gives The Client The Initiative In These Discussions. In A Clinical Situation, The Counsellor Lays Out The DAP Postcards On A Table And The Client Picks One Card (Or Several) That Feels Relevant And Interesting For The Client To Discuss. Together They Make An Agenda For The Discussion Such As, For Instance, In What Order To Discuss The DAP Postcards. The Counsellor Asks In An Open Manner With A Motivational Interview (MI) Spirit Why The Client Has Chosen The Particular Card(S). The Client Explains, Elaborates, Turns And Twist About The Choices He/She Has Made. The Results Of The First Published Qualitative Study Of This Two-Year Randomized Controlled Trial Demonstrate That The Participants Found The Concept Valuable.
Mar 2017 DOI 10.14302/issn.2324-7339.jcrhap-17-1468
Gibb JeanCorresponding author
University of California, Los Angeles Medical Center
Successful viral load programs rely on the presence of data systems and high quality of patient data. Using a cohort of 49 patients at Partners in Hope, a large, urban HIV clinic in Malawi, we performed a quality improvement assessment of a new viral load program with a focus on accuracy of data collected from patients as well as adherence to Malawi HIV Guidelines in regard to response to elevated viral loads (≥1,000 copies/mL). Data were obtained from three parallel medical record systems to investigate the proportion of patients with a repeat viral load and whether the three data systems agreed in regard to sociodemographic and clinical data. Fewer than 30% of patients had a repeat viral load within six months, as recommended in the Malawi HIV Guidelines. There were significant problems with data agreement across the three parallel databases used for care. Date of birth was consistent for 55.1% (N=27) of patients, while a different date of birth was noted in all three sources for 10.2% of patients (N=5). Viral load data from all three sources agreed for only 2.0% of patients (N=1). For 65.3% (N=32), the viral load from the laboratory did not match the recorded viral load in the electronic or paper record. Scale-up of viral load monitoring must be accompanied by the development of data systems that support workflow from sample collection to lab and back to provider. Education of providers and strategies for data collection with minimal errors can facilitate scale-up of high quality programs.
Jan 2017 DOI 10.14302/issn.2572-3030.jcgb-16-1307
Morales RafaelCorresponding author
Genetic Counselling Unit, Medical Oncology Department, Hospital La Mancha Centro, Av La Constitución, Nº 3, 13600, Alcázar de San Juan, Ciudad Real (Spain)
Interpreting variants of uncertain significance (VUS) for their effect on protein function, and therefore for the risk of developing cancer, has become a challenge in clinical practice for genetic counselling services. The present work combines structural bioinformatics and systems biology based mathematical modelling approaches with the aim of determining the pathogenicity of the mutation c.5434C->G (p.Pro1812Ala) in the BRCA1 gene (detected in a patient from a high risk family) and also to mechanistically understand the effect of this mutation in DNA damage response, a key process in cancer development. The results obtained showed that this mutation prevents the interaction of BRCA1 with key proteins of the cell cycle, subsequently impairing BRCA1-dependent induction of cell cycle arrest. The comparison of the molecular mechanisms associated with the native BRCA1 protein and the mutated variant function in DNA damage response showed that the latter undergoes a reduction in its ability to modulate pathways that are critical for DNA repair and cell cycle control. Therefore, this variant will not be able to exert its tumor suppressive action. Interestingly, these conclusions can be extrapolated to all mutations that, like c.5434C>G (p.Pro1812Ala) BRCA1, cause loss of BRCT domain activity.
Dec 2016 DOI 10.14302/issn.2379-7835.ijn-16-1381
Kishan Gupta BalCorresponding author
Senior Professor, In-charge Medical ICU, Department. of Medicine, S.P.Medical College, Bikaner.
Introduction: Vitamin D deficiency has been reported highly prevalent in Chronic liver disease (CLD) and there is an emerging interest to explore the relationship of vitamin D deficiency and severity of various types of CLD. Aim: To evaluate vitamin D level in patients with various type of CLD and clinical significance of its deficiency. Materials and Methods: Serum vitamin D levels were measured by ELFA in 100 patients (91 male and 9 female) suffering from CLD. The degree of liver dysfunction was estimated by Child Pugh criteria and Model for End stage Liver Disease (MELD) score. Results: Prevalence of vitamin D deficiency and insufficiency were 43% and 42% respectively among CLD patients. Low levels of vitamin D were associated with leucopenia or leucocytosis indicating increased risk of infection. On Linear regression vitamin D level showed significant negative correlation with Child Pugh score (r = – 0.7382, p<0.0001) and MELD score (r = – 0.6673, p<0.0001). Our study shows low vitamin D level was associated with poor outcome (mean vitamin D level 10.38 ± 2.35 who died vs 23.14 ± 6.68 who survived and discharged). Conclusion: CLD is associated with a significantly low level of vitamin D which was independent to patient’s gender, BMI, residence and education level. The lower level of vitamin D is associated with severity of CLD, mortality and increased risk for infections. Awareness of serum vitamin D level in patients with CLD is important to improve outcome.
Dec 2016 DOI 10.14302/issn.2474-3585.jpmc-16-1281
H. Alghamdi AhmedCorresponding author
Faculty of Medicine, Albaha University, Kingdom of Saudi Arabia.
Objectives This study describes and compares the epidemiological criteria of children with diabetes from 2007 to 2014. Methods A prospective study conducted with 372 children with diabetes mellitus. An access program was used for data collection, and SPSS 17 was used to analyses the results. Results A total of 372 cases with diabetes were studied and were divided into three groups according age. The first age group was between one day and six years and comprised 128 (34.4%) patients. The second group aged 7- 12 years of age comprised 174 (46.7%) patients. The third group aged 13-18 years of age comprised 58 (15.59%) patients. The average age was 8.32 years. Females constituted 52 % (194 cases) of all cases. T1DM constituted 95.4%, equal to 355 patients, T2DM constituted 1.88%, equal to seven cases. Monogenic diabetes affected three patients or 0.79%, with one case of monogenic neonatal diabetes confirmed by genetic study, and two other cases suspected to be MODY. The highest incidence was observed in the autumn months, with 105 children affected, constituting 27.8 % cases. The year 2012 had the highest incidence rate, with 59 children and adolescents affected at an incidence rate of 25.48 / 100000.Al-Baha region had the highest number of cases constituting 37.7 % of cases. Diabetic ketoacidosis was the first presentation and constituted 44.2% of cases. Conclusion. Diabetes in children is increasing significantly in recent years, requiring more detailed analysis of its epidemiological factors to find out any significant correlations which may help in its prevention.
Dec 2016 DOI 10.14302/issn.2329-9487.jhc-16-1244
Ide TomomiCorresponding author
Department of Cardiovascular Medicine, Kyushu University, Fukuoka, Japan
Objective: The prospective intervention study was conducted to investigate the effects of kale powder (Kale juice mixed with water or milk) consumption on metabolic syndrome in subjects with potential metabolic syndrome. Method: In Arita-cho, 149 male and female subjects with potential metabolic syndrome were instructed to consume kale powder for 8 weeks, and its effects on blood pressure, HbA1c, BMI, abdominal circumference, and blood triglycerides, LDL-C, HDL-C, and fasting blood sugar levels were assessed. Additionally, the safety of kale powder was examined. Results: After the 8-week long intake of kale powder, a significant decrease was observed in laboratory and home test-based blood pressure, abdominal circumference, and levels of LDL-C, HDL-C, and fasting blood sugar. Additionally, a hypotensive effect was observed on conducting stratified analysis, in which patients with blood pressure-related diseases were excluded. Furthermore, no safety concerns were identified regarding kale powder. Conclusion: Kale powder had a beneficial effect to maintain optimal blood pressure, blood sugar, and abdominal circumference in subjects with potential metabolic syndrome. Additionally, a hypotensive effect was observed within the normal range in subjects without blood pressure-related diseases.
Jul 2016 DOI 10.14302/issn.2474-3585.jpmc-16-1114
Okwundu Nwankwo InnocentCorresponding author
Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, Usmanu Danfodiyo University Sokoto, Nigeria.
Campylobacter infection has been detected in poultry processors at live bird markets in Sokoto, however the prevalence of Campylobacter species in more diverse group of the population is uncertain. For this purpose, 292 human fecal swabs from patients in four Government Hospitals in Sokoto State were analyzed for Campylobacter species using culture and phenotypic typing method. The prevalence rate of 55% was revealed in the tested samples while 56% and 55% were for males and females respectively. Campylobacter jejuni, C. coli and C. lari had 20%, 40% and 40% in males and 38%, 35% and 27% in females respectively. The prevalence rates of 60%, 52%, 45%, 41% and 80%,were revealed in age range of (less than 1-6, 7-13, 14-20, 21-55 and 56-76) yrs respectively. Furthermore, 70% and 43% prevalence rates were recorded in pregnant and non-pregnant women of reproductive age respectively. There was no statistical significant association (P>0.05) between Campylobacter infection and age range and sex, but the statistical association between infection and pregnancy was significant (P<0.05). The prevalence of Campylobacter species in patients as found in the various hospitals has revealed the level of environmental contamination in different homes in the state and the need to include Campylobacter in screening routine laboratory diagnosis of gastroenteritis in humans for appropriate treatment and management especially in young children, old adult and pregnant women.
Apr 2016 DOI 10.14302/issn.2474-7785.jarh-15-699
Coronado-Vázquez ValleCorresponding author
Healthcare Director, Hospital of Riotinto, Mines of Riotinto, Huelva
Purpose Hospital readmission of patients with pluripathologies is frequent and costly. This study describes the impact of patients’ pluripathologies, functional capacity and social complexity on readmissions during a 12-month period following hospital discharge. Methods A prospective cohort study. Monthly monitoring of 111 patients over 12 months in Hospital of Riotinto. The primary endpoint was readmission rate. Predictive variables: age, gender, hospitalizations the year before, illnesses that define the pluripathology, medication prescribed on discharge, social situation (Gijón Scale), functional state (Barthel) and cognitive impairment (Pfeiffer). Results Readmissions accounted for 21.6% of the patients surveyed. Of those readmitted, the mean age was lower than those who did not return to hospital (75.4 vs.79.6) (p=0.031), the average amount of medication prescribed greater (10.5 vs.8.7) (p=0.014), the Barthel score higher (52.5 vs.50.6) and the Gijón value lower (13.8 vs.14.6), but no results was significant. The mean survival time (without readmission) was 310.9 days (95% CI, 289.4-332.5). Category B (chronic renal disease and vasculitis) and F (diabetes with microangiopathy and artery disease) had a lower average survival time (X2=7.02; p=0.008) (X2=7.07; p=0.008). The readmission risk was hazard ratio (HR) = 3.13 (95% CI, 1.37-7.14) for category B, and HR = 3.38 (95% CI, 1.37-8.36) for category F. Conclusions There is a high proportion of readmissions among patients with pluripathologies in the year following discharge from hospital. The greater risk occurs in patients with chronic renal insufficiency and diabetes with microvascular complications. Factors that can be modified are polymedication and the proper control of patients’ diabetes.
Mar 2016 DOI 10.14302/issn.2577-137X.ji-15-834
Z Kompithra RajeevCorresponding author
Department of Child Health, Christian Medical College, Vellore, Tamil Nadu, 632004, India
The Expanded Program on Immunization (EPI) in India delivers vaccines under its policy, through government hospitals, health centers and outreach clinics. However, the national average full immunization coverage is stagnating at about 70%. The days and times of clinics are not always convenient for mothers working at home or employed outside. Moreover, vaccines not under EPI, but recommended by the Indian Academy of Pediatrics (IAP), are unavailable there, forcing mothers to go to private sector immunization clinics to get them. Recognizing the local need for user-friendly immunization clinic, we designed one in the Department of Child Health. The impetus came from local demand by a civil society organization (Rotary Club of Vellore). Our immunization clinic is open every working day (8.30 am to 4.00 pm) offering both groups of vaccines. Its success is illustrated by the fact that over 7000 children per month receive immunization in this clinic. We describe its design and operation so that this model may be replicated in other urban hospitals with pediatric sections.
Jan 2016 DOI 10.14302/issn.2470-5020.jnrt-15-803
B. Jensen MatthewCorresponding author
University of Wisconsin Department of Neurology
We sought to identify early uses of blinding in therapeutic clinical trials of neurological disorders by multiple search methods. A 1784 report by Benjamin Franklin and others described the evaluation of the use of Mesmerism to treat neurological and other syndromes including headache and epilepsy, using blindfolds and screens. This report demonstrated the usefulness of blinding to reduce bias in clinical research, yet despite this early discovery, blinding was not widely accepted or routinely used until the 20th century. Blinded clinical trials began to be used for various neurological syndromes in the 1950s, sporadically at first and then increasing in frequency in subsequent years. The reason for this delay is unclear, but we propose several hypotheses.
Dec 2015 DOI 10.14302/issn.2324-7339.jcrhap-13-264
J. R WernikCorresponding author
Facultad de Medicina, UDELAR, Montevideo, Uruguay;
Phytochemicals (PHT) are a large group of biologically active plant chemicals that may have positive effects on human health such as immune system stimulation, down regulation of inflammatory responses, radical scavenging activities, cell repair function, and antibacterial and antiviral activity. In this proof of principle 6 months study, the effects of supplementing a PHT mix, Phyto V7, to HIV-1 seropositive individuals and AIDS patients were examined. Individuals with CD4+ T-cells below 350 counts/mm3were assigned to one of the following treatments: CG1 - no treatment, CG2 - only highly active antiretroviral treatment (HAART), TG1 - only Phyto V7, and TG2- both Phyto V7 and HAART. After 3 months of treatment there were approximately (-)1%, 1%, 2% and 4% increase in the mean weight of the CG1, CG2, TG1 and TG2 groups, respectively. The tendency for the body mass index (BMI) was similar. The CD4+ counts increased by 13%, 39%, 53% and 35%, respectively. Similar trends were noted after 6 months with 2%, 79%, 53% and 69% increases in the CD4+ counts, respectively. There was a significant reduction in viremia only in groups receiving HAART. Overall better results were obtained in the group of patients receiving both HAART and Phyto V7, in which the mean weight increased by 5.7% and the CD4+ T-cell counts increased by 69% after 6 months. This study indicates that providing Phyto V7 to HIV-1 seropositive individuals and AIDS patients, receiving or not receiving HAART, improves their physical wellbeing and CD4+ counts, enabling them to cope better with the viral infection.
May 2015 DOI 10.14302/issn.2574-4518.jsdr-14-554
Latzer YaelCorresponding author
Faculty of Social Welfare and Health Sciences, Haifa University, Haifa, Israel.
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.
May 2015 DOI 10.14302/issn.2574-4488.jna-14-601
Andreucci MicheleCorresponding author
Nephrology Unit, Department of “Health Sciences”, Campus “Salvatore Venuta”, “Magna Graecia” University, Viale Europa, loc. Germaneto, I-88100 Catanzaro, Italy ([email protected])
Iodinated radiographic contrast agents (IRCA) are pharmaceutical agents used to improve the visibility of internal organs and structures in X-ray based imaging techniques. However, IRCA may have adverse unwanted effects, ranging from a mild inconvenience, such as itching, to a life-threatening emergency. The adverse effects of IRCA include delayed allergic reactions, anaphylactic reactions, and/or cutaneous reactions. But exposure to IRCA may be associated also with the development of either hyperthyroidism or hypothyroidism, presumably due to the effect of free, biologically active elemental iodine ions present in these agents. Among the side effects associated with the use of intravascular injection of IRCA, Contrast-induced nephropathy (CIN) is undoubtedly their most important and frequent well known adverse reaction. The pathogenesis of CIN is discussed in detail including the factors that increase the incidence of CIN, the main ones being pre-existing renal impairment, particularly when associated with diabetes mellitus. Finally, the measures to reduce the nephrotoxicity of IRCA are suggested beginning with monitoring renal function, discontinuation of potentially nephrotoxic drugs, use of either iodixanol or iopamidol at the lowest dosage possible. The main procedure for prevention of CIN is an adequate hydration of the patient with either isotonic sodium chloride or sodium bicarbonate solutions. A long list of references is provided that will enable readers a deep appreciation of the topic.
Mar 2015 DOI 10.14302/issn.2379-8572.joa-14-611
Shiba TravisCorresponding author
Department of Head and Neck Surgery, University of California- Los Angeles, Los Angeles, California, U.S.A
Vocal fold scarring is a clinical problem without reliable treatment. Tissue engineering of a vocal fold replacement is an exciting potential treatment for vocal fold scars that involve multiple layers of the vocal fold. Human adipose-derived stem cells (ASC) were previously used to produce a promising vocal fold cover layer replacement. However, relevant in vivo studies are needed before human application, and implanting the human cells in animal larynges would introduce significant risk and data confounding. We therefore report here the development of a construct based on rabbit ASC with the potential for use in pre-clinical implantation studies. Rabbit ASC were isolated and cultured in a three-dimensional fibrin matrix to create an implantable construct resembling the vocal fold mucosa. Key differences between the human cell and the rabbit cell models are highlighted.
Feb 2014 DOI 10.14302/issn.2324-7339.jcrhap-13-211
Gust D.Corresponding author
Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States
Recruitment of couples is important for study success. The multi-centered HPTN 052 clinical trial was designed to evaluate whether immediate versus delayed use of ART by HIV-infected individuals would reduce transmission of HIV to their HIV-uninfected partners. The objective of this study was to retrospectively compare several approaches for community recruitment at our site in Kisumu, Kenya based on a) feedback from recruitment staff, b) associated cost, and c) number of eligible couples enrolled. A secondary objective was to assess the discordant couples’ acceptability of the community recruitment approaches relative to the a) main recruitment venues, b) educational materials, and c) local language best suited for explaining the trial. 241 couples were screened for eligibility using nine recruitment approaches. We compared the approaches used for the 60 couples found to be eligible to those used for the 56 ineligible couples for whom that information was available. Analyses for association were carried out. In-depth interviews were conducted with 20 staff and 29 discordant couples. Records were kept of the costs associated with each approach. Overall, staff interviews revealed that acceptability of the approaches was high. Challenges were present with all approaches ranging from one member of the couple not wanting to reveal their positive HIV status to their partner (Patient Support Center or PSC approach), to not finding people at home (home based counseling and testing or HBCT approach). The PSC and the HBCT recruitment approaches were the most effective in terms of recruiting eligible participants. There was an overall significant difference between the proportion of eligible and ineligible participants among the 9 approaches (χ2 (8) =33.5; p<0.0001). Analyses for association showed that the PSC approach resulted in attracting a greater proportion of couples who were eligible than ineligible (χ2 (1) =6.6; p=0.016). The cost for the PSC approach was less than one-third that of the HBCT approach. All discordant couples interviewed found the two main recruitment venues (PSC and their home) acceptable. Among couples who saw the educational materials, the majority found them useful (poster 72.7%; pamphlet 90.9%; flyer 88.9%). All couples found the language they were told about the study acceptable. The evaluation of recruitment approaches indicated that working with local partners, specifically the PSC staff and HBCT staff, was the most effective way to recruit eligible discordant couples. A focus on collaborations and partnerships between research and clinical organizations will help study recruitment efforts. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of their respective institutions. Funding for this substudy was provided by the Kenya Medical Research Institute (KEMRI) through a cooperative agreement with the U.S. Centers for Disease Control and Prevention.
May 2013 DOI 10.14302/issn.2324-7339.jcrhap-12-137
Kumar AlokCorresponding author
Ladymeade Reference Unit, Ministry of Health, Government of Barbados; School of Clinical Medicine and Research, University of the West Indies and Queen Elizabeth Hospital, Barbados.
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.
Dec 2012 DOI 10.14302/issn.2324-7339.jcrhap-12-68
Tumwine ChristopherCorresponding author
Infectious Diseases Institute, Makerere University, P.O. Box 22418, Kampala-Uganda
New research suggests that people living with HIV have the potential to be strong advocates for HIV prevention by passing on HIV prevention messages within their social networks. However, there is a paucity of research into the nature and prevalence of HIV prevention behaviours engaged in by HIV clients, and the psychosocial correlates of such advocacy, which are the goals of this analysis. We examined engagement in HIV prevention advocacy among 602 new HIV clients at two clinics in Uganda. Eighty nine percent reported encouraging others to get tested for HIV, 79% told people they know to use condoms when they have sex, and 61% reported discussing HIV more generally with friends and family. A client was classified as fully engaged in HIV prevention advocacy if they reported engaging in all three of the measured HIV prevention advocacy behaviors. In the bivariate analysis, being from the rural study site (p<0.001), higher levels of HIV disclosure to friends (p<0.001), greater hopefulness (p<0.001), and lower levels of depression (p<0.001) and internalized HIV stigma (p<0.001) were associated with full engagement in HIV prevention advocacy. In the multivariate analysis, being from the rural study site (OR=5.461, 95% CI=3.11-9.61), lower levels of internalized HIV stigma (OR=0.524, 95% CI=0.39-0.70) and higher levels of HIV status disclosure to friends (OR=2.040, 95% CI=1.23-3.38) remained significantly associated with full engagement in prevention advocacy. These data suggest that psychosocial adjustment and functioning may play a key role in empowering HIV clients to be advocates for prevention.
Jun 2026 DOI 10.14302/issn.2642-9241.jrd-26-6332
de Melo PhilipCorresponding author
Respiratory diseases remain a major contributor to hospital morbidity and mortality worldwide, particularly among elderly patients and individuals with severe pulmonary compromise. Accurate prediction of respiratory mortality is clinically important for triage, resource allocation, ICU utilization, and early intervention. Traditional statistical models frequently demonstrate limited predictive sensitivity because respiratory mortality is influenced by complex interactions among demographic, diagnostic, physiologic, and severity-related variables. In this study, a machine learning framework was developed to predict in-hospital mortality among patients with respiratory disease using administrative and clinically derived variables, including age, sex, length of stay (LOS), diagnostic descriptions, risk of mortality and severity scores. A Random Forest classifier with balanced class weighting was developed and implemented to address nonlinear relationships and class imbalance within the dataset. Initial modeling demonstrated good overall discrimination performance, with receiver operating characteristic area under the curve (ROC-AUC) values approaching 0.84; however, mortality recall remained limited because deceased patients represented a minority class within the original dataset. To improve mortality detection, a physiologically informed synthetic augmentation strategy was developed. Synthetic clinical variables included oxygen saturation, ICU status, ventilator support, sepsis status, systolic blood pressure, creatinine, and lactate levels. Conditional physiologic consistency rules were incorporated during augmentation to preserve clinically plausible relationships among respiratory failure, hemodynamic instability, and organ dysfunction. The augmented dataset substantially improved model sensitivity and balanced mortality classification performance. Final model evaluation demonstrated strong predictive capability, achieving approximately 97% classification accuracy with balanced precision and recall across mortality classes. Confusion matrix analysis revealed marked reduction in false-negative mortality predictions compared with baseline modeling approaches. Feature importance analysis identified physiologic instability markers, respiratory severity classifications, LOS, and diagnostic respiratory categories as dominant predictors of mortality. These findings suggest that hybrid simulation-augmented machine learning frameworks may provide a valuable strategy for respiratory mortality analytics, particularly in datasets with limited real-world mortality prevalence and incomplete physiologic representation.
Jun 2026 DOI 10.14302/issn.2574-4496.jtc-26-6304
Elshafie OmaymaCorresponding author
Objective To evaluate the treatment outcomes of patients with Differentiated thyroid cancer (DTC) who underwent total thyroidectomy followed by RAI therapy at the Sultan Qaboos Comprehensive Cancer Care and Research Centre (SQCCCRC) in Oman. Methods This is a retrospective observational clinical study conducted at SQCCCRC. The study included all patients diagnosed with DTC who were admitted to SQCCCRC between June 2021 and November 2023. A total of 255 patients were identified and met the inclusion criteria for this study. Results The mean age at diagnosis was 39.9 ± 12.4 years (range: 14–79), with 78% of patients being female. The mean BMI was 30.3 ± 6.4 kg/m², with nearly half of the cohort (48.2%) classified as obese (BMI ≥ 30). Most patients had papillary thyroid carcinoma (92.9%), while follicular and Hürthle cell carcinoma accounted for 5.9% and 0.8% of cases, respectively. Based on the American Joint Committee on Cancer (AJCC) staging, 86.3% of the patients were classified as stage I and 3.9% as stage II. Six patients (2.4%) had stage IVB disease. According to American Thyroid Association (ATA) risk stratification the majority were low-risk. Patient age was strongly associated with disease stage. The distribution of metastatic cases varied by region, with the highest proportion observed in Dhofar. Most patients (87.1%) received a single dose of radioactive iodine (RAI), with a median cumulative dose of 3.7 mCi). At six months post-treatment, 70.2% of patients had a TG level < 0.2 ng/mL. Conclusion The outcome of therapy in majority of our patients is favorable with 72% having excellent biochemical response at last follow up. None of the patients with distant metastasis achieved excellent response and a high proportion of them came from the Dhofar governorate, a targeted intervention would be of benefit. Low risk patients require special attention and may need radioactive iodine during follow up, unlike other regions and hence warrant very close follow up and further review to establish the best practice guidelines in our region.
Jun 2026 DOI 10.14302/issn.2474-7785.jarh-26-6358
Marks RayCorresponding author
Hip fractures, which remain an immense public health concern, have been subject to study and prevention efforts for many decades, but with limited success in averting either incident, second or subsequent hip fractures, commonly attributed to a combination of age related proclivity to fall, low bone and muscle mass. This review examines second hip fracture incidence rates and determinants of this serious functionally debilitating injury as observed over time remains a current 2026 public health concern. It specifically explores if more preventive efforts are currently warranted in this regard, and in what respect, if indeed, more frail older adults are living longer, but may be in excessively poor health, fearful of moving or falling, malnourished, weak with poor balance, or depressed. Based on what is published, it is concluded 1) second hip fracture incidence rates remain considerable, especially among those who are frail with osteoporotic bone disease, poor vision, heart/or cognitive conditions, plus those with muscle deficits of the lower limb, live alone and have a falls history; 2) studies to identify possible mitigation approaches appear promising in this regard, along with more routine efforts to minimize falls risk and bone attrition.
Jun 2026 DOI 10.14302/issn.2694-2283.jsem-26-6247
Quintero GabrielCorresponding author
Background Ankle sprains are among the most common injuries in sports, often characterized by high recurrence rates despite appropriate local treatment. Traditional approaches primarily focus on the injured joint, with limited attention to proximal biomechanical factors that may predispose athletes to injury. Objective To propose a functional, longitudinal kinetic chain model in which sacroiliac joint dysfunction may act as a predisposing factor for ankle sprain/strain injuries in athletes. Methods This paper presents a clinical hypothesis based on biomechanical reasoning and observational findings. The proposed model describes how sacroiliac joint dysfunction, particularly posterior innominate rotation (PI), may lead to pelvic obliquity and functional leg length discrepancy. These changes may induce compensatory femoral external rotation and foot toe-out, altering ground contact mechanics during gait and running. Results (Hypothesis) The altered alignment and loading pattern may increase the vertical impact force and modify the ground reaction vector on the functionally shorter limb, resulting in reduced mechanical stability at the ankle during heel strike or foot contact. Over time, this may increase susceptibility to inversion or eversion injuries, manifesting clinically as recurrent sprain/strain. Conclusion Ankle sprains in athletes may, in some cases, represent the distal expression of a proximal biomechanical imbalance. Incorporating assessment of the sacroiliac joint and the longitudinal kinetic chain into routine clinical evaluation may improve injury risk identification and contribute to more effective prevention strategies. Further research is needed to investigate this proposed relationship.
May 2026 DOI 10.14302/issn.2641-4538.jphi-26-6161
J GonzalezCorresponding author
Objectives Motor fluctuations and non-motor disorders not manageable by first-line treatments in advanced Parkinson's disease require continuous dopaminergic stimulation strategies such as subcutaneous infusions of apomorphine (APO) or foslevodopa/foscarbidopa (FLD/FCD). A Budget Impact Analysis (BIA) was performed to estimate the cost difference between both treatments assuming equivalent clinical efficacy and safety. Material and methods The efficacy results of pivotal clinical trials at 12 and 52 weeks of treatment and the safety profile of APO vs FLD/FCD were compared, based on latest scientific publications and other available clinical data. A comparative BIA was performed, based on estimated annual drug treatment costs at Spanish published prices. Results The efficacy of APO (16 h/day) and FLD/FCD (24 h/day) in reduction of OFF hours (2.47 vs 2.75, 12 weeks; 3.66 vs 3.50, 52 weeks; respectively) and increase of ON hours without disabling dyskinesias (2.77 vs 2.72, 12 weeks; 3.31 vs 3.80, 52 weeks; respectively) could be considered clinically equivalent, as well as their safety profiles. However, a significant discrepancy is observed in the costs of the aforementioned alternatives. Considering published prices and the average dose reported in the literature, in Spain the annual cost of APO would be €13,980 compared to €55,198 for FLD/FCD. Consequently, the financial resources required for the treatment of FLD/FCD would enable the treatment of approximately three to four patients with APO. The BIA indicated the potential for annual savings in more than €2,500 million, considering a total target population of over 60,000 patients per year. Finally, an univariant sensitivity analysis was performed, considering a scenario in which the hospital acquisition cost of FLD/FCD decreased between 20%-30% (€44,159- €38,638/year). In this scenario, the total annual savings range between €1,875-€1,532 million per year. Conclusions Overall APO is more efficient than FLD/FCD, as it provides similar clinical efficacy at a lower treatment cost. The selection of an appropriate treatment option is to be determined by clinical criteria and patient characteristics, but cost evaluation should be considered to select the most cost-effective therapeutic option.
May 2026 DOI 10.14302/issn.2642-3146.jec-26-6199
Chung Kung-MingCorresponding author
Solar thermal heating is a mature technology for producing hot water in the domestic sector. Industrial processes require significant heat, so solar water heaters can be used for pre-heating. A forced- circulation solar water heater is installed in a feed plant that is located south of the Tropic of Cancer. The thermal efficiency of the system is closely related to the incident solar radiation. This study uses a two-stage setting for a thermostat to collect more solar energy if incident solar radiation is less intense. When the temperature difference between the water storage tank and the water outlet for the solar collectors (setting of a thermostat from 6° to 8°C) increases, there are more energy savings. The simple payback period for the system is 2.05 years, so it is financially viable to use a solar water heater for industrial heat processes. Excessive carbon emissions resulting from industry processes are a main cause of global warming. Carbon tax can be used as a central climate policy instrument for carbon reduction. The government of Taiwan stipulates the legal foundation for levying carbon fees in 2025. The carbon emissions and carbon tax for the feed plant are described to prompt the case for sustainability.