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Feb 2024 DOI 10.14302/issn.2329-9487.jhc-24-4910
Ebstein’s anomaly is a rare congenital heart disease. It is usually associated with other congenital defects, particularly atrial septal defect/patent foramen ovale (PFO). We report here the case of Ebstein's disease revealed in a 23-year-old adult admitted for palpitations and exertional dyspnoea. He was in heart failure. The EKG showed atrial flutter . Cardiomegaly was present with a cardiothoracic index of 0.7. On echocardiography, the apical displacement of the tricuspid septal leaflet was 15 mm/m2 , the Celermajer index was Grade 3. There was a large thrombus floating in the right atrium. While awaiting surgical management, the patient was being treated with diuretics, digitalis and anticoagulants.
Mar 2022
Verruca vulgaris is a very common lesion, of viral etiology, benign clinical behavior and different types of simple treatments. Its epidemiological, morphological, histological and therapeutic study has been sufficiently reflected in the literature. We present a peculiar clinical case in which calcium deposits developed on a common wart without any alterations in its metabolism being observed in the analytical studies carried out (calcinosis cutis). A 9-year-old male patient attended the dermatology service due to an excrescent keratotic lesion of recent appearance and rapid growth. We have conducted an unsucessful bibliographic search of this relationship, possibly because these have not been communicated because it is simply a morphological finding with no clinical significance.
Feb 2020 DOI 10.14302/issn.2641-5518.jcci-20-3166
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.
Sep 2019 DOI 10.14302/issn.2474-3585.jpmc-19-3018
Radial Club Hand (RCH) is a rare and complex congenital disorder of the pre-axial border of the upper extremity. It is a congenital longitudinal radial ray deficiency which presents as radial deviation of the hand and distal forearm in the shape of a golf club 12. Radial ray deficiency (the most common type of longitudinal failure of formation) is a spectrum of malformations affecting the structures of the radial side of the forearm, including hypoplasia of the bones, joints, muscles, tendons, ligaments, nerves and blood vessels. The thumb dysfunction, wrist instability and short upper extremity that accompany this condition can cause significant functional impairment particularly in patients with bilateral involvement. Thus, the performance of activities of daily living such as accomplishing personal hygiene, fastening buttons and zippers becomes challenging 3.
Mar 2019 DOI 10.14302/issn.2470-5020.jnrt-19-2630
Patients suffering treatment resistant Parkinson´s disease (PD) are potential candidates for deep brain stimulation (DBS). Commonly most implanted electrodes have a cylindrical shape with quadripolar electrode contacts and generate a symmetrical stimulation field around the lead. To reduce side effects through activation of neighboring fibers a new electrode design with segmented contacts was developed and enables a better adaption of the field of stimulation as well as a multi-target stimulation to improve therapeutic benefits. We report about a 51-year-old male patient with a 15-year history of treatment-refractory PD, who was implanted with bilateral segmented electrodes in the subthalamic nucleus (STN) with St. Jude Medical Infinity™ DBS System (Abbott/St. Jude Medical, Saint Paul, Minnesota, USA). Despite a clear mood-enhancing effect, stimulation with ring electrodes caused motor side effects including rigor and speech disorder. With segmented electrodes an effective and gentle stimulation was achieved. The stimulation of the anterior segments in the central position of the electrode in the STN showed no side-effects and allowed a reduction of initial symptoms in an low stimulation amplitude. Despite precise preoperatively planning and intraoperative trial stimulation, side effects of STN stimulation are very common. The application of segmented electrodes permits more options to reduce side effects rather than using ring electrodes. Studies with larger sample sizes are needed to establish the optional DBS electrode.
Apr 2018 DOI 10.14302/issn.2578-8590.ipj-18-2018
Objective: The purpose of this study is to evaluate the use of paralytic shellfish poisoning toxin in a patient with arthrofibrosis of the knee. Arthrofibrosis is a common complication of knee surgery that tends to manifest itself as a limitation of the musculoskeletal ranges. Paralytic shellfish poisoning toxin has been proposed as an alternative treatment for painful musculoskeletal pathologies. Subjects: Use of paralytic shellfish poisoning toxin in arthroscopic menisectomy. Case report. Methods: Three doses of paralytic shellfish poisoning toxin were administered in an intra-articular manner on different days. Functionality, musculoskeletal ranges, pain at rest and pain during motion were evaluated. Results: The current alternatives for management of arthrofibrosis include the use of oral steroids, physiotherapy, mobilization under anesthesia and the liberation of arthroscopic debris. This case is the first report of the use of paralytic shellfish poisoning toxin. The adverse effects the patient presented coincided with those described in the literature but without the presence of severe reactions. Improvement in functional tests, progress in musculoskeletal ranges and a decrease in the level of pain were achieved. Adverse effects included parenthesia and a feeling of weightlessness.
Oct 2017 DOI 10.14302/issn.2576-182X.jbsc-17-1809
Rupture of an intracranial aneurysm may cover for a long time clinical and radiological signs of a coexistent tumor. We report the delayed diagnosis of glioblastoma in a 65-years old female with recent history of subarachnoid hemorrhage. In the literature are described few similar cases: we briefly discuss the management in the rare occurrence of a double neurosurgical disease.
Feb 2016 DOI 10.14302/issn.2473-1005.jdoi-15-912
A healthy 55-year-old man was referred to the Department of Endodontics, Oral and Dental Healthy Hospital, Eskişehir suffering from pain and paraesthesia in the left lower lip and chin.A panoramic radiograph revealed the presence of broken endodontic instrument beyond the apex of the mandibular left third molar. A cone beam computed tomography (CBCT) examination was undertaken, which revealed that the broken instrument was inside the mandibular canal. Damage to the inferior alveolar nerve (IAN) secondary to extrusion of a broken endodontic instrument was diagnosed. Extraction of the tooth was decided and the patient was prescribed with 1 mg/kg/day prednisone 2 times/day, once-daily regimen, and 150 mg/day pregabalin, two doses per day, monitoring the progress with periodic follow-up visits. One month after the incident, the signs and symptoms were gone. The complete resolution of the paraesthesia and the control of pain achieved in the present case suggest that surgical removal of broken endodontic instrument extruded into the mandibular canal with the use of prednisone and pregabalin is a good option in the management of inferior alveolar nerve injury.
Dec 2015 DOI 10.14302/issn.2473-1005.jdoi-15-742
This case report details reconstruction of a severely atrophic pre‑maxilla using rhBMP‑2 and a titanium mesh framework. Surgical technique, graft outcomes, and implant rehabilitation are described, with notes on indications and complications.
Nov 2013 DOI 10.14302/issn.2329-9487.jhc-12-155
We report the case of a 22 year-old-male patient affected by Sotos syndrome was preoperatively and urgently evaluated for tracheal stent implantation due to respiratory insufficiency caused by idiopathic tracheal stenosis. Rest electrocardiogram detected a ventricular pre excitation; a transthoracic echocardiography showed a classic pattern fulfilling criteria for isolated left ventricular non compaction. At the best of our knowledge this is the first report of a patient suffering from Sotos syndrome and simultaneously affected by isolated left ventricular non compaction and ventricular pre excitation.
Mar 2013 DOI 10.14302/issn.2329-9487.jhc-12-153
We describe a rare case of multiple coronary artery-left ventricular fistulas associated with apical hypertrophic cardiomyopathy in a 62 year asymptomatic old male admitted to our department for a perioperative evaluation of non cardiac surgery, already diagnosed for multiple coronary artery-left fistulae. He underwent transthoracic echocardiography and then to accelerated dipiridamole stress-echo.
Dec 2025 DOI 10.14302/issn.2997-1977.jd-25-5754
With more than 150,000 affected infants annually, Nigeria bears the largest burden worldwide of sickle cell disease (SCD), making it a significant public health concern. The management of SCD in Nigeria is challenging, despite advancements in medical research and increased knowledge. This review examines the numerous issues surrounding SCD in the nation, including the financial burden on affected families, the lack of specialized care facilities, the absence of newborn screening programs, the sociocultural stigmatization of SCD, and restricted access to high-quality healthcare. Additionally, inadequate public health education and a lack of coordinated national policies result in delayed diagnosis and suboptimal treatment outcomes. We also highlighted recent efforts and recommendations aimed at improving early detection, comprehensive care, and community support. Addressing these challenges through expanded health education and enhanced healthcare infrastructure is essential to reducing morbidity and mortality associated with SCD in Nigeria.
Oct 2025 DOI 10.14302/issn.2693-1176.ijgh-25-5729
Background In sub-Saharan Africa, where many countries continue to experience high burdens of vaccine-preventable diseases, increasing immunization access have been a priority for the governments and international organizations such as Gavi, the Vaccine Alliance. Over 40 Gavi-supported African countries have been impacted, with 364 million children reached and over US$5.7 billion disbursed, averting over 8.9 million child deaths. Despite this progress, the African region has struggled with immunization coverage due to various factors. Nevertheless, some African countries are transitioning out of Gavi support due to economic growth. However, many require strong political will to increase their expenditure on immunization. This study therefore aims to understand the factors influencing immunization performance and its relationship to public expenditure. Methods Data on 37 Gavi-eligible sub-Saharan African countries between 2006 and 2019 was obtained from the World Bank’s World Development Indicators, the WHO and UNICEF Joint Reporting Form and the Transparency International’s Corruption Perception Index. Descriptive immunization and health expenditure were analyzed using a panel regression of variables. DPT3 was used as an indicator of immunization uptake. The indicator for public expenditure on immunization per child was based on government spending on immunization divided by the number of children in the birth cohort. Results The average gross national income increased from US$639 to US$1,192 per capita, while government spending on immunization increased from US$1.7 to about US$4.5 per child. The findings show that there is a correlation between improved immunization financing, increased gross national income, reduced corruption, and improved immunization coverage. However, performance declines beyond a certain threshold when gross national income per capita increases. In addition, an English-speaking country effect was observed. Conclusions While improved immunization financing increases immunization coverage and constitutes an advocacy talking point, there is a need to understand why an increase in gross national income per capita does not translate into an improved immunization coverage. Key highlights Increasing national spending on immunization drives up the uptake of childhood vaccines. There is a threshold beyond which immunization coverage falls despite increased GNI. Controlling corruption increases immunization coverage tendency. French- and English-speaking countries’ immunization coverage differs. Immunization and health system financing have separate outcomes.
Sep 2025 DOI 10.14302/issn.2379-8572.joa-25-5687
Depending upon the species, the brainstem auditory evoked potential (BAEP) consists of four or five major high frequency components. According to longstanding doctrine, each wave represents the sequential activation of successively higher nuclei and tracts from the 8th (auditory) nerve to the midbrain (inferior colliculus). Although this conceptual framework has acquired the status of near dogma, surprisingly little evidence exists in support. In the present analysis, a new interpretation of the electrogenesis of the BAEP is proposed which is simpler although it retains skeletal elements of the older explanation. The revised model is mostly derived from two distinct sources. In the first, the timing of the BAEP waves is compared with that of cortical activity for a range of mammals including humans, monkeys, cats, rats and guinea pigs. It is demonstrated that for each of these, the conduction time of the acoustic signal to the cortex from the putative midbrain component (wave IV or V) is so unrealistically long that it implies that the entire waveform must arise in the peripheral pathways of the auditory system. In the second, a retrospective analysis is made of click repetition rates on the BAEP using extradural electrodes. It was shown that at high rates of stimulation (about 100/sec), the behavior of the waveform is almost totally at variance with the expectations of the conventional model. The essence of the revised conception is that all BAEP waves are just variations of the compound action potential of the 8th nerve, albeit generated or regenerated via separate routes and different methods. Such an explanation would thereby account for their near uniform sharp morphology as well as creating the impression of a composite neuronal response. More specifically, in the case of a four component BAEP, wave I is assumed to be generated by the normal air conduction route in an identical manner to the conventional explanation. In contrast, wave ll is assumed to be generated via bone conduction in the temporal skull thereby bypassing the transduction process in the middle ear. Wave lll is assumed to be generated by the first echo of the bone-conducted sound wave. Likewise, the second rebound within the temporal bone serves as the stimulation to evoke wave lV. As the energy of the auditory stimulus gradually dissipates, it may still continue to generate a train of lower amplitude potentials. It is concluded that the BAEP may contain little or no brainstem or midbrain activity and therefore the term BAEP may be a misnomer. A more appropriate epithet might therefore be the auditory nerve evoked potential or ANEP.
Jun 2025 DOI 10.14302/issn.2324-7339.jcrhap-25-5559
Background HIV status disclosure is a complex process influenced by multiple factors beyond health system support. Understanding these factors is essential for developing comprehensive interventions to promote disclosure and improve HIV prevention and care outcomes. Methods A descriptive cross-sectional study was conducted in 10 health facilities offering comprehensive HIV/AIDS care in Mukono district, Uganda. Data was collected from 317 clients through interview-guided questionnaires. Data was entered using EPI data and analyzed using SPSS version 16, including logistic regression to identify factors associated with disclosure. Results Multiple factors influenced HIV status disclosure. Individual factors included knowledge about HIV (OR=2.34, 95% CI: 1.45-3.78), self-efficacy (OR=3.12, 95% CI: 1.87-5.21), and psychological readiness (OR=2.89, 95% CI: 1.76-4.75). Relationship factors included relationship quality (OR=3.56, 95% CI: 2.13-5.94), communication patterns (OR=2.78, 95% CI: 1.65-4.69), and anticipated partner reaction (OR=4.23, 95% CI: 2.54-7.05). Community factors included perceived stigma (OR=0.34, 95% CI: 0.21-0.56), cultural norms (OR=0.45, 95% CI: 0.27-0.75), and religious beliefs (OR=1.87, 95% CI: 1.12-3.14). Structural factors included economic dependence (OR=0.38, 95% CI: 0.23-0.63) and access to support services (OR=2.45, 95% CI: 1.47-4.08). Conclusions HIV status disclosure is influenced by a complex interplay of individual, relationship, community, and structural factors. Effective interventions to promote disclosure must address these multiple levels of influence, going beyond health system support to create enabling environments for disclosure at the individual, relationship, community, and structural levels.
Jun 2025 DOI 10.14302/issn.2766-8681.jcsr-25-5555
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.
May 2025 DOI 10.14302/issn.2641-5518.jcci-25-5522
Background In adult males, non-communicating hydroceles are non fluctuant scrotal swellings that are formed when there is an imbalance of fluid secretion and absorption between the parietal and visceral layers of the tunica vaginalis. Giant hydroceles are a rare manifestation and have previously been classified as hydroceles that drain more than 1000 mL of fluid. In this report, we describe a case of a giant hydrocele requiring surgical management and highlight a review of the literature. Case Presentation A 34-year-old male presented with complaints of large right-sided scrotal swelling, accompanied by scrotal discomfort. Ultrasound of the right testicle revealed a large hypoechoic space with a complex collection and posterior displacement of the testicle, indicating a possible hydrocele. The patient was taken to the operating room for a right hydrocelectomy. Approximately 2 liters of fluid were drained from the sac. Discussion Hydroceles are defined as straw-colored fluid collections within the parietal and visceral layers of the tunica vaginalis. Giant hydroceles, defined as fluid collections within the tunica vaginalis exceeding 1000 mL, are rare and the management of such cases is sparsely documented in the literature. While most asymptomatic fluid collections resolve spontaneously, larger collections with inflammatory changes within the testicular wall may require surgical intervention, either laparoscopic or open.
Dec 2024 DOI 10.14302/issn.2474-3585.jpmc-24-5299
Objective Studies assessing the risk of developing CVD between different racial groups in the United States have reached varying conclusions. The purpose of this study was to identify risk for CVD using the Framingham Risk Score (FRS) between racial/ethnic groups. A secondary aim of this study was to compare risk for CVD based on SES status/poverty ratio. Methods A cross-sectional data analysis was conducted using the 2015-2020 NHANES datasets using individuals aged 18 to 79 years. Sample weights were assigned by NHANES researchers to each participant allowing researchers to generalize results to all non-institutionalized US civilians. Results Mexican Americans (MA) had the lowest average FRS and significantly lower CVD risk than all other racial groups, except NH Asian. NH Asians had the second lowest FRS and significantly lower risk than NH Blacks and NH Whites, but their risk was similar to other Hispanic or the other/multi-racial groups. NH Blacks showed no significant difference in FRS compared to NH Whites, other Hispanic, and other/multi-racial groups. NH Whites were not statistically different from other Hispanic or other/multi-racial groups. Other Hispanic and multi-racial groups did not exhibit statistically significant differences. Overall, Mexican Americans had the lowest FRS whereas NH Whites had the highest. Conclusions NH whites demonstrated the highest CVD risk according to FRS, as the oldest racial/ethnic group in the cohort. SES did not consistently predict FRS differences between racial/ethnic groups. These findings suggest a need to further explore FRS as a means of identifying individuals who are at high risk of developing CVD.
Jul 2024 DOI 10.14302/issn.2641-4538.jphi-24-5017
Background Frailty is an ageing-associated state linked to poor prognostic outcomes. Chronic inflammation due to HIV-infection, AIDS-related infections. and the adverse effects of antiretroviral therapy (ART) all contribute to frailty in people living with HIV/AIDS (PLHA). Frailty has been comprehensively studied in populations comprising predominantly of Caucasian PLHA. However, there remains a dearth of such data in Indian populations, especially in younger PLHA. Methodology This cross-sectional study aimed to estimate the prevalence of frailty in PLHA (18 - 50 years) who had been on ART for 24-60 months and identify markers linked to frailty. Frailty was assessed in 152 subjects using the Fried frailty-index. Parameters measured included the mid-upper arm and calf circumferences, pain-severity (using the Brief Pain Inventory), highly-sensitivity C-reactive protein, d-dimer, and interleukin-6. Results The prevalence of frailty and pre-frailty were 6.58% and 23.02%, respectively. Reduced grip strength and self-reported exhaustion were associated with frailty (15.79% and 13.16%, respectively). Low calf-circumference and mid-upper arm circumference were not significantly associated with frailty/pre-frailty. The prevalence of pain was 21.7% and both pain severity and pain interference were significantly associated with frailty/pre-frailty. CD-4 counts at the time of assessment showed an inverse association with frailty. Elevated C-reactive protein (CRP of 0.04 associated with 0.49 probability of frailty (95% CI 0.40 – 0.59), CRP of 0.12 associated with 0.63 probability of frailty (95% CI 0.47 – 0.76)). D-dimer levels were not significantly associated with frailty /pre-frailty. Conclusion In this first-of-its-kind study on frailty in young PLHA (mean age 37 years) from the Indian sub-continent, the prevalence of frailty and pre-frailty was 6.58% and 23.02%, respectively. Multivariate analysis showed a strong association of frailty with pain severity, CD4 count at time of assessment, hs-CRP levels and duration of ART.
Mar 2023
The visual presentation of the results of the analysis of cardio graphic information is an important element of the diagnostic process. The article discusses the issues of visualization of the state of the heart, notes the importance of a visual representation of the processes of the functioning of the heart for diagnosis. The Delaunay triangulation is considered and it is proved that on its basis it is possible to approximate an arbitrarily complex surface. An algorithm for constructing a surface model of the heart based on Delaunay triangulation has been developed. The issues of texture generation are covered in detail. The texture is a convenient tool for displaying the state ofthe heart, as it allows you to visually show the place of possible damage on the surface of the heart.
Sep 2022 DOI 10.14302/issn.2692-1537.ijcv-22-4328
Objectives To evaluate the diagnostic accuracy of chest CT for the diagnosis of COVID-19 associated with the clinical presentation and in relation to the PCR-RT. Sensitivity, specificity, positive predictive value and negative predictive value, gender, age group and degree of lung involvement will be evaluated. Methods We evaluated 1545 patients with chest CT, delineating the age range and degree of lung involvement, and 306 patients with chest CT and PCR-RT. Results Of the 1545 examinations, 53% were men and 47% were women, there was greater involvement in the 50-59 age group. In the pulmonary study, 55.05% were COVID-19. In the degree of lung involvement 37.70% were mild, 35.76% were moderate, and 26.54% were severe. In the distribution by age, there was a greater involvement between 50-59 years with 56% between moderate (27.6%) and severe (28.0%). Between tomography and PCR-RT, the sensitivity was 68.8%, specificity 59.5%, accuracy 91.3%, with prevalence 31.9%, positive predictive value 44.3% and negative predictive value 80.3%, in females, sensitivity 55.3%, positive predictive value 37.1%, negative predictive value 75.3%, in males, sensitivity 81.6%, positive predictive value 50, 6 and negative predictive value 86.6%.The sensitivities are different between the genders with p of 0.005 and specificity of 0.938, with age effect, starting at 45 years we have a p of 0.057 that decreases to 0.006 at 80 years for sensitivity and specificity. Conclusions The sensitivity and accuracy of CT scan in relation to PCR-RT was significant. Sensitivity increases with prevalence and in the older age group and in men.
Jun 2022 DOI 10.14302/issn.2575-1212.jvhc-22-4054
A cross-sectional study was conducted on bovine hydatidosis from May 2018 to November 2020 with the aims of finding its incidence and economic losses in bovine slaughtered for human consumption in Dalomana municipality abattoir. Usual ante mortem and post-mortem inspection was carried out on overall of 430 selected slaughtered cattle. From this total inspected, 82(19.1%) of them had harboured hydatid cyst (s) in one or more of their organ’s. Age and body condition as a risk factor were statistically significant as older zebus and medium were more infected (P<0.05, χ2= 14.597 and p value<0.05 χ2=9.68) respectively. Similarly, the geographical origin of the animals had significant contribution on hyadatid cyst distribution (P < 0.05, χ2 =12.724). Sex was statistically non-significant (P>0.05,χ2 =0.74) and have no difference. The single and multiple organs were infected by hydatid cysts. From the total of 282 hydatid cysts collected and characterized lung and livertook more percentage in harboring cysts, from this 137(48.58%) and 126(44.68%) cysts were observed in lung and liver respectively and 19(6.74%) are observed in other organ, such as spleen, kidney, and heart. The study indicated that annual economic failure due to direct organ condemnation and indirect carcass weight loss from the disease in Dalomana was estimated to be 105769.657 ETB. Hence, bovine hydatidosis is significantly a common disease in cattle, with severe public health fears and leads considerable servable and undetectable losses in bovine in Dalomana and its surroundings.
Mar 2022 DOI 10.14302/issn.2644-1101.jhp-22-4129
This essay discusses the practical aspects of mediation and arbitration. The article outlines effective steps to implement win-win, win-lose, lose-win, and lose-lose negotiation strategies. It is posited that with a win-win strategy, the job of a mediator or arbitrator is to find a win-win scenario that is acceptable to both sides. The role of a mediator or arbitrator when the parties are engaging in win-lose, lose-win, and lose-lose strategies is different in that at least one of the parties is not seeking a win for all sides. In particular, when the parties are not involved in a win-win, and court is an option, the parties need to gain as much information about the opposing party as possible to use it to their advantage in court. This is unfortunate but, at times, a necessary result of not participating in a win-win outcome.
Mar 2022 DOI 10.14302/issn.2576-9383.jhhr-22-4138
Medical science’s advancements depend on preserving its credibility and the public trust, though as a human institution it is fallible and liable to ethical breaches that can void public confidence and support. There is no more egregious ethical departure than deviations / violations of Human Research Subjects Protections (i.e., non-compliance), which is remarkable given they are fairly widespread and often repeated. Once uncovered, this generally should result in the research’s suspension or termination. Yet, there is a third option to preserve valuable and worthy research that went awry due to lapses in Human Research Subjects Protections, specifically, Remediation. Due to the sequestered nature of Remediation, little has been reported on its processes, and practically nothing, regarding practical considerations, recommendations, and implications for the remediation workers themselves—for this line of work is perilously risky. This commentary reports some of those best-practices, “first-hand grittier in-the-trenches” informed practical lessons learned. Implications are discussed in the interest of improving the reasonable, balanced, and competent ethical conduct of research, addressing / avoiding Human Subjects Protections ethical non-compliance, and avenues for further inquiry regarding Remediation.
Feb 2022 DOI 10.14302/issn.2329-9487.jhc-22-4067
Introduction Congenital Heart Defects (CHDs) are structural abnormalities of the heart and intra-thoracic great vessels that are present at birth and may be of functional significance. They are the most frequently occurring congenital anomalies and babies born with severe forms of these defects are likely to die in the neonatal period. Objectives The aim of this study was to determine the prevalence of CHDs among neonates delivered in Port Harcourt, Rivers State, Nigeria Methods Using a stratified sampling technique, 530 neonates were selected from three hospitals in Port Harcourt. The biodata of the parents and socio-demographic information were obtained through an interviewer-administered questionnaire to the mothers. Physical examination and echocardiograghy were performed on all the neonates. Results Five hundred and thirty (530) neonates aged 0-7days (5.2±1.8) participated in this study and the male to female ratio was 1.1:1. Forty-three neonates were found to have CHD giving a prevalence of 8.1% 95%CI: 6.0. Thirty-nine were acyanotic and four cyanotic. Congenital Heart Defects were found in 21 (48.8%) males and 22 (51.2%) females. The more common heart defects were isolated Atrial Septal Defect in 16(37.2%), isolated Patent Ductus Arteriosus in 11(25.6%) and isolated Ventricular Septal Defect in 6 (13.9%). The most common cyanotic CHD was Transposition of the Great Arteries in 2 neonates (4.7%). The clinical features identified in neonates with CHD were tachypnoea, dysmorphia, cyanosis, hypoxia and murmur Conclusion The prevalence of CHD is considerably high in Port Harcourt and further studies need to be carried out to ascertain the risk factors.
Jan 2022 DOI 10.14302/issn.2379-7835.ijn-21-4059
Aim There is limited published data describing the characteristics of the paediatric population prescribed semi elemental formulas. This retrospective observational audit aimed to describe the characteristics of the paediatric patients who have been prescribed a hydrolysed whey protein, medium chain triglycerides (MCT) based formula, Peptamen Junior® and the nutritional outcomes. Methods A retrospective observation audit was completed on a cohort of patients that was prescribed a semi elemental formula between 2016 and 2019 from a single tertiary paediatric medical centre. Data variables were collated such as patient characteristics, indications and modalities of administration, duration and tolerance to the formula. Results Data was collated on 375 patients with a median age of 6.2 years. The main underlying medical conditions were haematological/oncology (67%), gastrointestinal disorders (10.7%) and neurological conditions (9.4%). The most common indications for use were chemotherapy related side effects (36.2%), post bone marrow transplant (25.8%) and gastrointestinal symptoms (17.9%). The formula was rarely used as a sole source of nutrition, with 88% patients requiring accompanying forms of nutrition support. The majority of orders prescribed were of standard concentration (80.8%) and tolerance was recorded in 82.8% of patients. Conclusion The semi elemental formula Peptamen Junior® appears to be well tolerated in paediatric patients with a variety of medical conditions that have complex pathologies and may have wider scope of use in a more diverse group of medical conditions than currently indicated.
Nov 2021 DOI 10.14302/issn.2639-3166.jar-21-4004
Economic statistics concerning the quinquennial features of Agriculture employment (A), net Migration (M), Donor aid (D) and Personal remittances (P), available for over forty years from five West African countries have here been related to the GDP (G). The overall results of a multilinear regression (R2 0.84) have confirmed that the GD ratio, which is an index of aid efficiency, is significantly and positively driven by the PD ratio (high P and low D - favorable) and the PA ratio (high P and low A - favorable), but negatively driven by the PG ratio ( a higher D efficiency is obtained for constant G and lower P). A higher migration flux corresponds to a non-significant rise in the GD ratio. The five countries are clustered, by means of a principal component analysis, into three types. Partial least square regressions fitted to the GD ratio within each cluster provide a long-term polydromic function that highlights certain particular cluster features: reactive to forcing factors, such as Donor diminutions (SEN), active, as driven by Personal remittance (MLI), and mostly entropic for GMB, GNB and MRT. The learnt from the database is that Donor variations may follow different evolutions of the GD ratio in the three clusters.
Jun 2021 DOI 10.14302/issn.2692-1537.ijcv-21-3758
“Health Promoting Village” concept named as “Happy Villages” started in 2007 in Badulla District in Uva Province was a community mobilization process through which village communities have been empowered to look after their community health. The areas included were Early Childhood Care and Development (ECCD), Non-Communicable Diseases (NCD) prevention , Alcohol and drug abuse. Gender Based Violence. The programmed used many interactive tools as “Mood Chart” or “Happiness Calendar” which was giving a visualizing effect. Continuous assessments done from 2009 to 2013 showed that the Health promotion strategies used in the Happy Village concept in the Uva Province can effectively and efficiently be utilized for improvement of nutrition and achievement of milestones in children. From 2017 a National program is launched named “Happy Villages”. During the Covid 19 outbreak health promotion approaches were initiated to change in lay communities successfully. Villagers had actively engaged, collectively acted in responsible manner, and identified measures to prevent COVID-19 transmission in their households, neighbourhood and community. The use of village empowerment had become a fruitful source to face the Covid pandemic in Sri Lanka. Almost 300 “Happy Villages” around the country have made facing the Covid epidemic their chief task. Many innovative ideas and practices in facing Covid 19 pandemic at village level including a visualizing calendar to identify the risk behaviours of the family members as well as the Happiness calendar to identify the family stress levels are among them. Health promotion concept is getting rooted around the country with active participation of the villages with a multisectoral support. Continuous monitoring and evaluation and sharing best practices will show the world the effectiveness of Health Promotion and the ability of empowered people in facing pandemic situations
Apr 2021
Aim Community-based psychosocial support centers for cancer patients and their relatives (CBPSCs), developed in the Netherlands, offer easily accessible contacts with fellow patients and support by trained volunteers. We studied the characteristics of visitors of CBPSCs, which palliative support they need and receive, and how satisfied they are with this support. Methods The role of 20 CBPSCs was explored in semi-structured interviews among 34 visitors with regard to their contacts with CBPSCs on palliative care (study 1). Additionally, in 25 CBPSCs, 701 visitors filled out a web-based questionnaire about their experiences with the palliative care (study 2). Within this second study, 25 coordinators of CBPSCs also answered questions about the palliative care (study 3). Results The cancer patients and proxies stressed the view that palliative support should be a part of the support by CBPSCs. This belief was confirmed by the coordinators. Not only attention to the reduction of symptoms, but also emotional support and information supply should be offered when recovery is no longer possible. Talking about death and dying may be worrying for some visitors in a better condition. Education of the volunteers is needed, taking into account the conditions in the CBPSCs e.g., the already existing experience with the palliative care in the CBPSCs and participation in regional networks. Practical Implications Further development of the attention given to palliative support, training and research in that field is needed.
Dec 2020 DOI 10.14302/issn.2474-7785.jarh-20-3682
Background to the Issue Many older adults, including those already suffering from chronically painful disabling osteoarthritis of one or more joints remain more susceptible than healthy age and gender matched adults to the COVID-19 corona virus. Aims This report sought to examine what has been published in 2020 on this health condition from the perspective of the variable of widely imposed social isolation strategies designed to mitigate the spread of this highly infectious disease, and to especially keep older community dwelling adults ‘safe’ from infection. Methods Reviewed were all articles published in 2020 in PUBMED from January 1-December 24, 2020 on osteoarthritis and COVID-19 isolation impacts, plus relevant past osteoarthritis and isolation literature among older adults. The focus was on ascertaining how social isolation and distancing strategies might impact current community-dwelling adults diagnosed with osteoarthritis and whether more should be done specifically to mitigate any potentially preventable ‘socially’ induced negative health impact among this group, in spite of the laudable goals of this public health strategy. Results Older adults with osteoarthritis living in the community who are asked to self-isolate, may incur more osteoarthritis pain and disability than would otherwise be encountered if actions taken to counter this possibility are not forthcoming. Advocated over and above basic care approaches are several psychosocial strategies including the role of mobilizing various forms of social support. Conclusion Data indicate a need for concerted thoughtful and immediate attention to offset isolation, fear, and anxiety and depression effects as part of a carefully devised integrated plan of management to reduce excess osteoarthritis disability, as well as excess COVID-19 risk among otherwise free living older adults already compromised by osteoarthritis.
Dec 2020 DOI 10.14302/issn.2693-1176.ijgh-20-3613
Empathy has been described as a multi-dimensional construct with cognitive and emotional components, both of which are concerned about responsivity to others. It has been touted as a skill essential for medical practice and thus useful to all healthcare professionals. It has been assessed in several countries and among several healthcare cadres however, there is a yawning gap in Ghana about its level in medical students. This study utilised a cross-sectional design to assess empathy using the Multi-Dimensional Emotional Empathy Scale in medical students of the University in Ghana. The scale has an alpha reliability of 0.88. One hundred and eleven students, aged 24 years ±1.5 years completed the study. Overall, there were more males than females. The mean empathy score for the cohort was 101SD 13 and this was adjudged to be low. There was no statistical difference between age, gender and clinical year and empathy in this cohort. The authors recommend that empathy, especially its cognitive aspects, should be taught in medical school curriculum of the University of Ghana Medical School, Accra.
Jul 2020 DOI 10.14302/issn.2642-3146.jec-20-3389
Since the independence of South Sudan, Sudan lost 75% of its oil reserves, this led to major fuel shortages country wide, the fuel shortage raised the fuel prices and the overall transport prices. Scarcity led to black market trade of fuel specially in states away from the Capital City (Khartoum). Managing the available stock comes first before increasing the supply amount in order to solve the problem, one of the major fuel consumers to be managed is the transport sector specially the long haulage freight transport. Moving freight in Sudan is constrained by inadequate infrastructure and high costs. This paper covers specifically the long haulage freight transport between Khartoum State and Western side of the country (Darfur Region), Contributing to manage fuel consumption for trucks, taking into account trucks types used, roads, environmental impacts and mitigation measures applicable to save fuel . The results showed that the primary reason for the excessive fuel consumption is the usage of the rigid trucks (lorries) for transport specially the Hino700 series, this truck type, overload and absence of weight stations and control policies contributed significantly to deterioration of roads and transport efficiency decreasing. First step towards the solution would be in upgrading roads infrastructure assuring high quality along with enforced weight regulations and weight stations to protect roads from damages. High quality roads shall ease the usage of different truck types with different configurations. Then stablish a policy to force replacement of the low efficiency lorry truck types with high quality tractor semi-trailer combinations.
Jun 2020 DOI 10.14302/issn.2578-2371.jslr-20-3371
We hereby report a scrotal epidermoid cyst presenting as a scrotal mass which a rare entity in the absence of trauma. 36years old male presents with a complaint of left sided testicular swelling and discomfort. The workup included clinical examination, alpha-fetoprotein (αFP) and beta-human chorionic gonadotropin (β-hCG) analyses and scrotal ultrasound. Clinically confused as testicular malignancy. Complete surgical excision of the cyst was performed. Histopathology confirmed epidermoid cyst with no evidence of malignancy.
Mar 2020 DOI 10.14302/issn.2641-4538.jphi-19-2610
Background The relationship between predictors and the variable of interest was estimated using a structural equation model which is used to predict latent variables. The main advantage of the SEM is the ability to estimate the direct and indirect pathways of the effect of the primary independent variable on the outcome, given sufficient sample sizes. Despite not directly modeling the mediated pathways, GLMMs excluding mediating variables performed well with respect to power, bias and coverage probability in modeling the total effect of the primary independent variables on the outcome. In longitudinal studies, data are collected from subjects at several time points. The main purpose of longitudinal analysis is to detecting the trends or trajectories of the variables of interest. Methods A longitudinal study was conducted on 792 adults living with HIV/AIDS who commenced HAART. Structural equation modeling was used to construct a model to detecting predictors of CD4 cell count change. The procedure was illustrated by applying it to longitudinal health-related quality-of-life data on HIV/AIDS patients, collected from September 2008 to August 2012 monthly for the first six months and quarterly for remaining study period. Results The result of current investigation indicates that CD4 cell count change was highly influenced by certain socio-demographic and clinical variables. Out of all the participants, 141 (82%) have been considered 100% adherent to antiretroviral therapy. Structural equation modeling has confirmed the direct effect that personality (decision-making and tolerance of frustration) has on motives to behave, or act accordingly, which was in turn directly related to medication adherence behaviors. In addition, these behaviors have had a direct and significant effect on viral load, as well as an indirect effect on CD4 cell count. The final model demonstrates the congruence between theory and data (x2/df. = 1.480, goodness of fit index = 0.97, adjusted goodness of fit index = 0.94, comparative fit index = 0.98, root mean square error of approximation = 0.05), accounting for 55.7% of the variance. Conclusions The results of this study support our theoretical model as a conceptual framework for the prediction of medication adherence behaviors in persons living with HIV/AIDS. Implications for designing, implementing, and evaluating intervention programs based on the model are to be discussed.
Sep 2019 DOI 10.14302/issn.2470-0436.jos-19-2998
Purpose To report a rare case of Inverting Papilloma originating from the Lacrimal Sac in Tertiary Hospital. Method Case report. Results Inverting papilloma is uncommon in lacrimal sac. More often presents in Maxillary sinus, Ethmoid sinus and lateral wall of nasal cavity. This case of 69 years old, Filipino male, who presented with a two-year history of gradually enlarging left medial canthal mass, and tearing. There were no ophthalmoplegia, visual disturbances, proptosis or pain but there was globe displacement superolaterally. Other ophthalmologic examinations were unremarkable at that time of examination. Orbital CT-scan revealed: Heterogenously enhancing mass extending to ipsilateral nasolacrimal canal and nasal cavity causing mass effect. There was note of a suspicious area of hyperostosis. Patient was referred to the Department of Otolaryngology Head and Neck Surgery for co-management. Punch biopsy was done and histopathology revealed Inverting papilloma. Combined surgical management of anterior Maxillectomy via lateral Rhinotomy approach and Dacryocystectomy was done. Intraoperatively, there was note of adhesions to bone in the area of the Lacrimal Sac corresponding to the area of hyperostosis on CT-scan. Post-operative recovery was unremarkable with unchanged visual acuity and extraocular muscle movement. Conclusions This is a case of an inverting papilloma involving the lacrimal sac and nasolacrimal duct that was managed with combined anterior maxillectomy via Lateral Rhinotomy approach and dacryocystectomy for complete resection. We recommended complete resection of the tumor to minimize recurrence. Origin in the Lacrimal Sac area was confirmed by intraoperative findings which correlated with CT- scan findings.
Aug 2019 DOI 10.14302/issn.2470-5020.jnrt-19-2797
Background There is substantial evidence, from well-conducted epidemiological studies, that low vitamin D levels are correlated with increased risk for MS, and multiple case control studies have implicated the involvement of vitamin D deficiency in MS etiology. Narrow-band Ultraviolet B (NB-UVB; 300nm - 311 nm) induced vitamin D production has not previously been studied in a multiple sclerosis (MS) randomized placebo-controlled trial (RCT). Objectives To investigate NB-UVB induced vitamin D production, immunomodulation and MS symptomology following NB-UVB phototherapy in a MS cohort. Methods Using a blinded RCT study design, twelve individuals 18 years or older with MS were enrolled and assigned (1:1) into individualized NB-UVB dose (10-30kJ/m) phototherapy, or into placebo treatment, delivered 3 times per week, for 8-weeks. Serum vitamin D levels, walking performance, strength, cognitive function, mood and circulating progenitor cells (CPCs: CD34+CD45dim), monocyte populations (Intermediate CD14+CD16+, Classical CD14+CD16-), and T regulatory cell (CD4+/CD25+/FoxP3+Tregs) count were assesed. The data were analyzed by 2 x 3 mixed factor ANOVA. Results A statistically significant condition by time interaction on vitamin D levels (F=7.14, p<.005, partial η2=.42) was identified. NB-UVB phototherapy may provide immunomodulation in a select group of MS individuals. Conclusion UVB phototherapy corrects vitamin D deficiency. This study adds to the growing research investigating UVB treatment in MS.
Jun 2019 DOI 10.14302/issn.2474-3585.jpmc-19-2750
Purpose Foot injuries are common in low- and middle-income countries and continue to increase in incidence due to the surge in the use of motorcycles as means of transport.Yet, there is scanty data on the incidence and outcomes of treatment of open injuries to the foot in the developing world.We aimed to determine the incidence and functional outcomes of open foot injuries that are treated in a teaching hospital in Ghana. Methods We used a structured questionnaire to record the type of open foot injury, the mechanism of injury, any concomitant injuries, the time interval between injury and arrival at the hospital for treatment as well as the type of treatment instituted. Recruited patients were followed up for six months, complications resulting from the injury or its treatment were recorded for each patient. The function of the foot after healing of the injury was measured using a questionnaire-based visual analogue outcome scale of the American Foot and Ankle Society. Regression and chi-square analysis were used to evaluate potential associations. Results Over a four-month period, a total of 81 cases of open injuries to the foot were recorded. Out of this figure, 55 patients (67.9%) were males and 26 (32.1%) were females. It was found, that 66.7% aged between 19 and 49 years, 76.5% of the injuries occurred on the road and 29.7% was motor cycle related. Pedestrians are the most afflicted (61.7%). The treatment outcomes of traumatic amputations, open phalangeal fractures, dorsal skin degloving and lacerations were good. Gustillo-Anderson grade IIIB open fractures with associated plantar skin degloving had the worst outcomes with residual pain on weight bearing, bigger foot, inability to wear previous shoes and inability to tiptoe on the affected foot. Conclusions Open injuries to the foot are common in Ghana and exert a significant health burden, particularly on active young males. Long term disability may occur, even after adequate treatment of open fractures involving the foot.
May 2019 DOI 10.14302/issn.2574-4526.jddd-19-2770
Introduction In France 33% of patients didn’t take care of hepatitis C because there were no diagnosed. Drug injection was main contamination route of hepatitis C virus (HCV) in France. French guidelines were to treat all inmates and drug users, even fibrosis level. Access of HCV screening, care and treatment in drugs users, prisoners and homeless was low in France. They were considered as difficult to treat populations. All these patients need specific support. Hepatitis Mobile Team (HMT) was created in July 2013 to increase screening care and treatment of hepatitis B and C patients. HMT was composed of hepatologist, nurses, social workers and health care worker. Objective increase outreach screening care treatment access and cure of our target population. Patients and methods Target population was drugs users, prisoners, homeless, precarious people, migrants and psychiatric patients. We proposed part or all of our services to our 42 medical and social partners: HCV HBV screening by DBS (dried blood test); outside DBS and FIBROSCAN in converted van; Outreach open center; Drug users information and prevention, Free blood tests in primary care;, Staff training; Social screening and diagnosis; Mobile liver stiffness Fibroscan in site; Advanced on-site specialist consultation; Easy access to pre-treatment commission; Low cost mobile phones for patients; Individual psycho-educative intervention sessions; Collective educative workshops; Peer to peer educational program; Specific one day hospitalizations. All services were free for patients and for partners. Results from 2013 July to 2018 December, we did 8382 DBS for 5382 people (3053 HCV DBS) and 2302 Fibroscan*. HCV new positive rate was 21.3%. Our HCV active file was 651patients included these 24.8% new patients screened by DBS; 98% realized HCV genotype, HCV viral load and FIBROSCAN. DAA treatment was proposed to 96%; 95% started treatment, 4% were lost follow up or refused treatment. After treatment, there was 7 relapse and 3 reinfections by drug injection and cured rate of 94%. Sociological evaluation showed that 4 program qualities for patients: free access, closeness (outside hospital), speed (of the results) and availability (of nurse and social workers). Conclusions: Specific follow-up of drugs users and other HCV high-risk patients including screening, early detection, diagnosis and treatment increase rate of treated and cured patients, with low rate of relapse and reinfections.
May 2019 DOI 10.14302/issn.2644-0105.jbfb-19-2752
The proportion of mothers in the workforce has increased over the past 40 years. Examination of factors associated with a working/student mother’s milk expression is needed to provide effective lactation support. The purpose of this study was to examine the role of maternal assets in the relationships between the theory constructs, intention, and behavior of breast milk expression. Using a cross-sectional design framed under the theory of planned behavior, all female personnel associated with a higher education institute in northern New Jersey were invited to participate in the online survey, Milk Expression on Campus. Attitude toward breast milk expression, subjective norm, perceived behavioral control, intention, and behavior of breast milk expression on campus as well as maternal assets such as income, education, living status, and campus role were measured. Maternal assets had no moderation role but showed a significant and meaningful mediation effect on the relationship between perceived behavioral control and the intention to express breast milk on campus, with effect size R2=3.59%, 95% CI (-.1061, -.0047). There was no mediation effect of the asset on the relationship between intention and the behavior of breast milk expression, 95% CI (-.0984, .0232). Future breastfeeding support and promotion may direct its attention to provide systematic social and clinical support to enhance working/student maternal assets, e.g. family education, access to lactation services, or peer-based support programs, thereby helping mothers achieve their breastfeeding goals.
Apr 2019 DOI 10.14302/issn.2639-3166.jar-19-2732
The objectives of this study were to assess the Quality of Agricultural Graduates, employers’ perceptions of the employability and skills. A descriptive, analytical statistics, multistage random sampling method was adopted. Where two types of questionnaires were distributed to the Graduates and institutions associated with Sustainable agriculture (SA). The collected data was analyzed by Statistical Packages for Social Sciences (SPSS). The results revealed some respondents began higher education in Arabic (66.7%), while others in English (33.3%). The respondents faced with difficulties in understanding the courses due to teaching methods (36.7%), language (33.3%), and curriculum (30%). The result indicated some respondents (56.7%) do not have back ground about (SA). The respondents in the Ministries of Agriculture assessed the Graduates in regard to agricultural skills, and confidence to perform duties as fair (10%), and good (23.3%), but, for reliability, managerial skills, tactic and ability to participate in forums as fair (6.7%). Good (27.7%), fair (3.3%), and good (30%) respectively. Assessment of the Graduates at Research Centers, were assessed in relation to Research methodology, statistical analysis, and writing scientific papers as good (40 %,).While for Software skills as excellent (100%), and for Agricultural Technology Transfer as very good (80%). While; the respondents from Faculties of Agriculture, assessed the Graduated for practical skills, teaching ability, skills of writing scientific papers, participation in workshops and seminars as good (93.3%), very good (6.7%), fair (6.7) and very good (33.3%), respectively. The Graduates’ quality is below the expectations. Based on the above findings, the study recommends the review of the whole educational system, Faculties of Agriculture to include the concepts of sustainable agriculture in their curriculum and give high consideration to practical part. In the same context, further study is recommended including the whole Country.
Feb 2019 DOI 10.14302/issn.2643-6655.jcap-18-2570
Self-determination is a key concept to promote greater self-awareness in the subjects with disability, to build appropriate educational or professional projects and to evaluate the already active programs. Using PRISMA checklist, I selected articles from different databases (CINAHL, Medline, Psych INFO, Cochrane Library, ERIC, Scholar. The 9 evaluation measures identified are analyzed with respect to: choice of the points of view to be collected, domains, items and data collection methods. The results show that while some scales focus on autonomy, empowerment, self-realisation and self-regulation and others focus on knowledge, skills and abilities, attitudes and beliefs. Two instruments added also: opportunities and support. With respect to the choice of the points of view to be collected: in some cases the student’s opinion is collected but in other cases their point of view is integrated or replaced with that of teachers and parents. Only one tool is designed for all children and starts from the belief that self-determination is important for all people, including those with a disability. A third element of the analysis is the possibility of answering the questions posed by the various evaluation tools. A typical form is Likert scale while in other cases open questions are used. The analysis highlights two critical issues. The variety of definitions of self-determination is inevitably reflected in the choice of domains and items and therefore self-determination is only partially investigated. Secondly the opinion and people with disabilities are sometimes completed or replaced by that of third persons as parents and teachers. Starting from the analysis of existing instruments. the article closes with a reflection on the possibility of constructing a scale that considers all the aspects of self-determination offered in the literature (at the individual and environmental level) and collects the opinion of all the subjects involved in self-determination projects. This synthesis represents a first step in the construction of a possible universal scale starting from the analysis of the literature. A comparison would then be necessary with the students with intellectual disabilities, the family members and the other actors involved to understand which domains are really meaningful to them and to build indicators that correspond to the elements that are important to them. In this way we would have a tool capable of combining the point of view of literature with that of the people directly involved.
Jan 2019 DOI 10.14302/issn.2641-4538.jphi-18-1973
Introduction Adherence to ART is a challenge among pregnant women living with HIV/AIDS. This has an effect on the health of the mother and the unborn child. While studies have been done, it has shown that adherence during pregnancy is a challenge Virological and clinical success depend critically on high adherence to ART because with low adherence. The success of expanded ART coverage in improving health outcomes depends on adherence to treatment. During pregnancy, a compromised Virological response to ART also increases risk of mother-to-child transmission (MTCT) of HIV. This study was carried out to determine factors that influence adherence to antiretroviral therapy among HIV positive pregnant women in Lusaka district of Zambia. Methodology This was a qualitative study which used a case study approach. Data was collected through in-depth interviews. The collected data was analysed using a thematic analytical approach. Results 17 pregnant women living with HIV /AIDS in Lusaka had Challenges with adherence to ART. The study explored factors related to adherence to ART among pregnant women living with HIV/AIDS. ART adherence was found to be low. The findings call for the need to reduce on social stigma. The results confirmed that there is low adherence to ART among pregnant women living with HIV /AIDS in Lusaka. Conclusion Adherence to ART among pregnant women living with HIV/AIDS is a challenge for Zambian pregnant women. Improved levels of adherence to ART is hampered by fear of social stigma, and fear of being blamed by partners if they disclosed their status. Stigmatisation needs to be addressed because nearly all the participants expressed this factor. There is need to address the HIV/AIDS stigma very seriously in order for society to look at HIV/AIDS like any other illness.
Dec 2018 DOI 10.14302/issn.2377-2549.jndc-18-2430
Introduction: Analysis of 8-oxodG is usually conducted by either chromatography-based methods or by immunochemical methods commonly used based upon their low cost and high-throughput. However, concern regarding the accuracy of ELISA methods has complicated their use. We directly compare the levels of urinary 8-oxodG obtained by HPLC-MS/MS with three commercially available ELISA kits in this report. Methods: In the current study, a total of 9 human urine samples were analyzed by LC-MS/MS and three commonly used commercial available ELISA kits. Results: We found that urinary 8-oxodG levels analyzed by HPLC-MS/MS [1.4 ± 0.3 nmol/mmol creatinine) were 7.6- to 23.5-fold lower than those detected by ELISA. Overall, the correlations between ELISA and HPLC-MS/MS were poor but were improved after SPE purification for kits from ENZO (P = 0.2817 without SPE; P = 0.0086 with SPE) and Abcam (P = 0.0596 without SPE; P = 0.0473 with SPE). Discussion and Conclusion: While we confirmed that SPE purification can improve the correlation between the selected ELISA kits and HPLC-MS/MS, HPLC-MS/MS is still the method of choice to accurately assess the levels of 8-oxodG in human urine.
Aug 2018 DOI 10.14302/issn.2379-7835.ijn-18-2262
Objective: To analyse safety, tolerability, efficacy and logistic issues related to administration of 3 types of therapeutic feeds to children with severe acute malnutrition (SAM) from tribal district of Nandurbar, Maharashtra. Design: A three arm open label, block randomized trial using 3 therapeutic feeds i.e. commercially available ready to use therapeutic feed (C-RUTF), locally prepared ready to use therapeutic feed ( L-RUTF) & amylase rich food(ARF) was given to 1092 tribal children of SAM in Nandurbar District, Maharashtra, India during 2014-2015. Setting: Tribal district of Nandurbar, Maharashtra. Participants: 1092 children of SAM, 766 on C-RUTF, 184 on L-RUTF & 143 on ARF followed on treatment for 8 weeks. Outcomes: The recovery rates in the three groups, any untoward effects during treatment and logistic aspects of procurement, delivery, storage & administration of therapeutic feeds. Results: Total number of children with SAM were 1092. Gr 1 – Out of 765 children of SAM, 404 (52.8%) recovered on C-RUTF. Gr 2 – 80 (43.5%) recovered out of 184 on L-RUTF. Gr 3 – 64 (44.8%) recovered on ARF at the end of 8 weeks of treatment, the difference being statistically significant between C-RUTF & others. Out of 38 children on C-RUTF, it was observed that 1 had diarrhoea, 1 had vomiting, 1 had fever, 4 children reported more activity in terms of playfulness, more speaking & smiling. 31 children had nothing specific to report. Out of 34 children on L-RUTF, 6 children reported diarrhoea, 1 had vomiting & 4 children reported fever. 3 children reported more activity. 23 children had nothing specific to report. Out of 19 children on ARF, 1 had diarrhoea, 1 had vomiting, 1 had fever, 3 reported more activity. 13 had nothing specific to report. Untoward effects were noted in 3 out of 38 (7.89%) in C-RUTF group, 11 out of 34 (32.35%) in L-RUTF group and 3 out of 19 (15.7%) in ARF group. Conclusion: C-RUTF was found to be more efficacious, with least untoward effects, easy to administer and was more palatable when compared to L-RUTF & ARF.
Jul 2018 DOI 10.14302/issn.2690-4837.ijip-18-2238
Background Colonization with methicillin-resistant Staphylococcus aureus (MRSA) is recognized as an association towards development of infections that may cause of morbidity among people living with Human Immunodeficiency Virus (PLWHIV). We report on the prevalence, antibiotic susceptibility pattern and risk factors associated with MRSA carriage among PLWHIV at Nyenga hospital, Buikwe district in central Uganda. Materials and Methods We conducted a cross-sectional study among PLWHIV attending Nyenga hospital anti-retroviral therapy (ART) clinic. Nasopharyngeal swab was collected from each participant, cultured to isolate Staphylococcus aureus, and drug susceptibility testing (DST) performed. Sociodemographic data and medical history was recorded. Results We enrolled 219 PLWHIV; of these, 58.4% (N=128) were females. The majority of participants (95.0%) were on ART. Ninety-eight (44.75%) of the nasopharyngeal swabs had growth, of which 41 (41.84%) were S. aureus. Of these, 11 (5.02%, 95% confidence interval: 3.67-7.02) were MRSA. Of 41 isolated S. aureus strains, only 8 (19.51%) were susceptible to all antibiotics tested. A total of three (7.32%) were multi-drug resistant (MDR), while one1 (2.43%) was a possible extensively drug resistant (XDR) strain. Deteriorating immunologic state as indicated by a low CD4 count showed a significant association with the MRSA colonization. Conclusion These results are reassuring that MRSA colonization is high among PLWHIV. As most of the antibiotics in use were resistant, it raises concerns of intricate clinical management in a low resource set up.
Apr 2018
A clinical perspective on renal function in acute myocardial infarction reviews pathophysiology, prognostic markers, and management implications, including contrast nephropathy prevention and hemodynamic support.
Mar 2018 DOI 10.14302/issn.2578-8590.ipj-18-1952
Objective To evaluate the effect of a single intraarticular dose of Gonyautoxins for pain control after Total Knee Arthroplasty (TKA). Subjects 30 consecutive patients with osteoarthritis with Kellgren & Lawrence level of two or more, who required TKA, were enrolled. Methods Subjects receive a single intra-articular infiltration of 40 µg dose of Gonyautoxins, immediately after TKA wound closure. The pain was measured with the Visual Analog Scale (VAS). Additionally, the range of motion at 12, 36, and 60 hours and hospital stay length were recorded. Results were compared to the 2014 TKA cohort. Results 25 patients (83.33%) achieved successful pain management. All patients achieved complete flexion ≥90° 60 hours after surgery and 24 patients achieved full extension before hospital discharge. The median VAS pain score for each evaluation period was ≥2. The 25 Gonyautoxins treated patients who achieved successful pain management had a median VAS pain score of 0 after 36 and 60 hours. Conclusions Gonyautoxins are safe and effective in pain management after TKA when used as a single intra-articular dose. This protocol shows adequate pain control in TKA, reducing discharge to 3 days and greater range of motion, improving the post-operated patient experience.
Dec 2017 DOI 10.14302/issn.2381-862X.jwrh-17-1822
Objective Because of the increased demand for the availability of independent information regarding the efficacy, the lack of efficacy and the possible harm of medical interventions, the study aims to evaluate the information package „Menopause", published by the German Institute for Quality in Healthcare (IQWiG). Methods: Qualitative, guideline-based interviews, carried out in n=41 women (40-63 years). The analysis of transcripts was carried out according to Mayring. Results Information perception of women who could use the material could be summarized into the following: (1) Information were perceived as independent and deemed trustworthy. (2) Scientific study results were unknown but welcomed. (3) Decision aids are useful but need further communicative support. (4) Women requested suggestions for empowerment and self-help. (5) Some women are better accessible through experiences. (6) Women who did not take on any information presented in the material. Conclusions: Through evidence-based health information (EBHI) and decision aids interviewed women can be enabled to make informed decisions concerning their health care. Health information should include the relevant context factors. However, not all women could be reached. Practice implications Not only the implementation of independent EBHI into the structure of healthcare but also communicative services including biographical aspects and self-help strategies are needed.
Oct 2017 DOI 10.14302/issn.2476-1710.jdt-17-1582
Depression in the general population has been associated with inadequate or lack of social support. Evidence from the disability field has been limited. This study investigated the relationship of perceived social support to depression in Persons with Disability (PWDs) using a descriptive survey design. Data was collected from 317 PWDs using the Beck Depression Inventory Scale (BDI) and Multidimensional Scale of Perceived Social Support (MSPSS) and analyzed with Statistical Package for the Social Sciences (SPSS) version 16 software. Findings revealed significant relationship between perceived social support and depression in PWDs and meaningful social support ameliorated severity of depressive symptoms. Though etiology of acquisition of the disability, either by birth or later in life, had less likelihood on being depressed, respondents who acquired their disability later in life had significant depression levels than those who were born disabled. Implications of findings for the treatment of depression in PWDs are discussed.
Sep 2017 DOI 10.14302/issn.2574-612X.ijpr-17-1746
Objective: Aim of this study was to assess appraisal and utilization of psycho-oncological care of Turkish female breast cancer patients in Germany. The presented results are part of a larger study about care of female German and Turkish cancer patients in Germany (4B-study). Methods: In this qualitative study semi-structured face to face interviews were conducted with Turkish breast cancer patients in Germany. Interviews were transcribed and analyzed in Turkish by two Turkish speaking researchers via content analysis using MAXQDA qualitative analysis software (version 11). Results were discussed among a bilingual research team. Selected citations were translated. Results: Turkish patients showed a great need for support, particularly emotional and informational support. However, the available psycho-oncological care was rarely used due to lack of information, prejudice, language and cultural barriers. A missing belief in effectiveness of psycho-oncological care was also noted. Conclusions: According to this study, psycho-oncological services do not adequately correspond to the needs of Turkish breast cancer patients. If confirmed in more extensive studies, these findings call for the development of migrant-sensitive approaches and therapeutic action to provide ease to cancer patients. Additionally, prejudice against psycho-oncological care needs to be reduced in the Turkish community.
Aug 2017 DOI 10.14302/issn.2470-5020.jnrt-17-1487
The global popularity of soccer has led to widespread tendency towards this sport. Because of the convenience of using artificial surfaces, the rapid growth of using these surfaces led to concerns about the declining performance of the players. The aim of this comprehensive review is to study the difference between the performance of players on different playing surfaces and the risk factors for use of artificial turf compared to natural grass. A literature search of valid scientific databases such as Science Direct, PubMed and Jstor by searching keywords was performed. In total, more than 6,000 articles were retrieved. After the preliminary selection process, the final analysis was performed on a total of 76 articles. Results: Mechanical properties of artificial grass have a significant effect on the average time of sprinting, the best time of sprinting and maximum speed. The numbers of sliding tackles on artificial turf were lower compared to natural grass. Artificial turfs exposed hardness, elasticity and high friction. The characteristics of artificial grass have changed over time and increased the probability of injuries. There was no significant difference between the overall risks of acute injuries in soccer players performing on artificial turf compared to natural grass. The amateur, young and female soccer players had rated lower injuries on artificial grass. But the rate of injuries in elite soccer players were higher on artificial grass and hence they are not found of playing on such playing surfaces.
Aug 2017 DOI 10.14302/issn.2576-2818.jfb-14-553
All independent experimental data on epithelial and glandular cells lines of human endometrium support the evidence for a rapid production of eicosanoids from the LH/hCG receptors when exposed to the hCG hormone. Prostaglandins rapidly act on the surrounding endometrial stromal cells throughout the adenylyl cyclase enzyme leading to very large amounts of cAMP and angiogenic factors (VEGF) production. The cAMP is the most important intracellular second messenger and along with progesterone accomplishes the full process of decidualization and acquisition of receptivity after estrogenic priming of the endometrium. The status of uterine receptivity lasts few days only and timing for successful embryo-signal transduction system activation by the endometrium is probably short. In absence of in vivo embryonic signals it is impossible to predict, on individual bases, how the intensity of all the complex interlinked molecular changes of decidualization might ever be in case of exposure to native hCG. In other terms, amount of prostaglandins and cAMP produced in response to variably glycosylated hCG are all, in vivo, not measurable variables and should be viewed as a “wave” of biochemical chain reactions. Embryonic hCG is secreted in form of multiple isomers having an unpredictable variable level of glycosylation and control of this variable remains elusive. During cycles of ovarian stimulation many drugs (FSH, LH, HCG) interact with different G-protein coupled receptors (GPCRs) making it possible to alter the prostaglandins-mediated decidualization process ready to be elicited only by hCG of pregnancy. Since the molecules (cAMP and progesterone) controlling endometrial stromal cells differentiation into decidual cells are critical for successful implantation and placenta formation, the evidence of fast eicosanoids production associated with endometrial LH/hCG receptors exposure to hCG and the potential by human endometrium to produce, in response, very large amounts of cAMP has biological and clinical relevance.
Aug 2016 DOI 10.14302/issn.2474-9273.jbtm-16-1105
An often neglected factor in the examination of the mental quality of life of survivors of colorectal cancer is the role of family and community level resources and support. The aim of this study was to develop a deeper understanding of the influence of family and community level resources over and above previously examined mental health variables. A survey-based pilot study was conducted with 101 colorectal cancer survivors. Four multiple linear regression models were developed to examine the associations between demographic, health-related, individual psychosocial, family and community level factors, and specific dimensions of mental quality of life (measured using the mental health subscales of the SF-12). In addition to examining all of the correlates of mental quality of life, the unique role of family and community level factors over and above previously examined factors was examined. Analyses found that family and community level factors, as a whole, explained a significant portion of the variance in role emotional health, mental health, and social functioning over and above demographic, health-related, and individual psychosocial factors. Family cohesion was a significant, unique predictor of role limitations due to mental health, and family and community social support was a significant, unique predictor of role limitations due to mental health and overall mental health. These results suggest the potential importance of considering family and community level resources when conducting research and designing interventions to improve mental quality of life in colorectal cancer survivors.
Aug 2016 DOI 10.14302/issn.2474-3585.jpmc-16-1115
Purpose: To determine an appropriate time interval for conducting mass screening for glaucoma, it is important to gather information on the annual incidence rate. Thus, a retrospective cohort study was conducted to determine the annual incidence rate of visual field abnormalities (VFA) among a workplace cohort. Methods: In an initial visual field test using frequency doubling technology (FDT) perimetry conducted on 3443 employees (mean age 47.4 ± 8.9, men/women = 2967/476), no abnormalities were observed. Subjects were followed-up with annual perimetric testing for seven years, with VFA being determined using FDT test (FDT-VFA). Results: Using theKaplan–Meier method (log rank test, p < 0.001), cumulative FDT-VFA rates (SE) at seven years for subjects in their 30s, 40s, 50s, and 60s or older were found to be 3.0% (0.6), 4.2 % (0.6), 4.8 (0.8), and 11.3% (0.2), respectively. A linear fit to the Kaplan–Meier results yielded an annual incidence rate of 0.42%, 0.60%, 0.77%, and 1.60% for the 30s, 40s, 50s, and ≥60s age groups, respectively. Conclusion: Our data suggest that the annual incidence rate of VFA is <0.7% per year in subjects younger than 60 years of age; however, it increases to 1.6% per year in older subjects, thus suggesting that the monitoring frequency of glaucoma patients may need to be adjusted as a function of their age and be performed more frequently after the age of 60 years
Feb 2016 DOI 10.14302/issn.2381-862X.jwrh-15-672
The study was conducted in four selected hospitals in the Southern part of India with an aim to determine the support needs of women in early labour as perceived by women. A descriptive design was used to determine the support needs of women in early labour. Following ethical approval, sixty women between 29-40 weeks of gestation with singleton pregnancy were interviewed in early labour, using a validated Labour Support Need Assessment Tool to gather data on background information and perception of women related to need and support needs (physical, emotional and informational support). Results indicated that women perceived all types of support such as physical, emotional and informational as significant factors in their care during labour, regardless of their parity and gestation. The major findings of the study suggested that there was a slightly higher need for support among women for informational (90.33%) and emotional support (88.78%) compared to physical support (80.19%). For primigravid women, and multiparous women who were experiencing labour for the first time (previous birth by caesarean section), the ‘need for support’ was greater than for women who had previous experience of labour. Early labour is the time when most women use their own coping skills and seek support. Determining the quantity and quality of support women need at this phase of labour can help care providers to provide the best comprehensive care to women in early labour. The findings of the study provide a guide on what women feel is helpful in early labour.
Dec 2015 DOI 10.14302/issn.2324-7339.jcrhap-13-264
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.2470-0436.jos-14-441
Purpose: To describe a new intraocular lens that can be implanted in case of rupture of the posterior capsule and lack of capsular support. Methods: This experimental study was carried out on ten Flanders rabbits. The right eye of each rabbit underwent intra capsular lens extraction and two peripheral iridectomies, and the new lens was implanted with an optic rest in the posterior chamber. Additionally, the haptics rest in the angle of the anterior chamber through peripheral iridectomies. Main outcome measures were lens stability inside the eye and complications regarding this technique. Results: Intraocular lenses remained in a stable position with only a mild inflammatory reaction; four eyes developed hyphema that disappeared 10 days after surgery. Conclusion: The new lens design has good intraocular stability when posterior capsular support is absent and only produced minimal inflammation inside the eye.
Nov 2014 DOI 10.14302/issn.2377-2549.jndc-14-391
Oxidation of 1-Proponol, 1-butanol 1-Hexanol and benzyl alcohol using chloromethylated polystyrene (6% Cross link) DMG (Dimethylglyoxime) copper complex or Poly(S-DVB)-DMG-M Where M= Cu) as catalyst and tert.butylhydroperoxide(TBHP) as oxidant, was studied. The polymer supported Cu Complex was characterized by some physicochemical and spectroscopic methods like elemental analysis IR Scanning electron micrographs (SEM). In the oxidation of 1-propanol, 1-butanol, 1-hexanol and benzyl alcohol. It was found that Product yield of these alcohols corresponding the order 1-Butanal >1-hexanone >Benzyldehyde > 1-Propanone. Kinetic data indicates that catalyst could be recycled without significant degradation of polymer
Mar 2014 DOI 10.14302/issn.2372-6601.jhor-13-352
Variation in the lower and upper limits of haemoglobin (Hb) ranges will alter diagnosis and referral rates of anaemia or erythrocytosis. The haemoglobin ranges for adults in Irish laboratories were applied in the context of haemoglobin levels of a representative sample of Irish adults (SLAN). Between 2.8% and 8.5% of men would be diagnosed with anaemia in different laboratories for lower limit between 130-140g/L. For women, diagnosis of anaemia would range from 0.7% to 7.3% for the lower limit between 110-125g/L. Similar reference range variations occur in UK laboratories. A suggested “normal reference range” is extrapolated from the SLAN cohort.
Jun 2013 DOI 10.14302/issn.2324-7339.jcrhap-12-174
Background: In India, Human immunodeficiency (HIV) infected patients with highly active antiretroviral therapy (HAART) are at higher risk of developing adverse drug reactions (ADRs). Objectives: The aim of this study was to characterize the pattern of use of HAART, occurrence, incidence, severity and causality of ADRs to HAART in Indian HIV positive patients. Methods: This was a prospective observational study conducted between August 2009 and May 2012. Enrolled HIV positive patients were intensively monitored for ADRs with fixed dose antiretroviral therapy as per National AIDS Control organization (NACO).World Health Organization (WHO) definition of ADR was adopted to detect ADRs to HAART and classified based on WHO adverse reaction terminologies. Naranjo’s scale was used for causality assessment of ADRs. Preventability was assessed using Thornton and Schuman criteria and severity was assessed using the modified Hart wig and Siegel scale. Pattern of ADRs was assessed with patient demographics, ADRs characteristics, and pattern of drug and reaction characteristics. P-value <0.05 was considered as statistically significant. Results: A total of 426 ADRs to HAART were evaluated from 1982 HIV positive patients during the study period. The overall incidence of ADRs to HAART was 21.4%. Significant difference was seen in the incidence of ADRs in the age group of 41-60 years (p <0.001), CD4+T-cell counts of 350-500 cells/µl (p <0.001), females (p <0.001). Three fatal ADRs of with cutaneous drug eruptions of Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) was 1.1%. Anemia (31.7%) accounted for majority of the reports followed by vomiting (15.5%), skin rash (12.9%) and peripheral neuropathy (10.7%). The suspected drug was withdrawn for the management of the ADRs in majority (27.9%) of the reports. Higher incidence rate of ADRs was noted with lamivudine (3TC) + nevirapine (NVP) + stavudine (D4T) (22.9%). In, naranjo's causality assessment, majority of the ADR reports were rated as possible (69%). Symptomatic treatment for ADRs was given in 91.8% of the reports and 86.4% of the reports the patient recovered from the suspected adverse reaction at the time of evaluation. Conclusion: In India, occurrence of ADRs to HAART in HIV infected patients was found to be higher with zidovudine induced anemia (31.7%). The higher percentage of ADRs to HAART was seen with female patients, age 41-60 years; CD4+ T-cell counts 350-500 cells/µl. Physician must focus for monitoring all lab investigations for early detection and prevention of adverse effects associated with HAART.
Jun 2013 DOI 10.14302/issn.2324-7339.jcrhap-12-74
HIV infected children who started antiretroviral therapy (ART) in public health facilities in South Africa have survived to older age and disclosure has become an essential part of their care. Available data on HIV disclosure to children were collected much earlier in the provision of ART in South Africa. The aim of the study was to (a) determine the characteristics of caregivers of pediatric HIV patients in Gauteng, South Africa, (b) estimate the prevalence and timing of HIV disclosure among these patients, and (c) assess the factors associated with disclosure status. A cross-sectional study was conducted among 286 caregivers of paediatric ART children aged 4–17 in two centres in Gauteng, South Africa. Bivariate and multivariate logistic regression analyses were carried out. The highest proportion of care givers were biological mothers (n=140, 49.3%). The mean age of the children was 8.5 years, (range 4-17 years). More than a third (n=99, 34%) were disclosed their HIV status, and the mean age at disclosure was 9.3 years, (SD = 2.7). Child’s age older than 10 years (OR =1.63; 95% CI: 1.44–1.85), having a nonbiological caregiver (OR=1.75; 95% CI: 1.06-2.89), caregiver educational level (OR =0.64; 95% CI: 0.47–0.87), and caregiver’s age older than 60 years (OR=1.02; 95% CI: 1.01-1.04), were significantly associated with HIV disclosure to infected children. The relatively higher prevalence of disclosure is attributed to increasing access to paediatric ART. Training healthcare providers to support caregivers in disclosure will increase the rate of disclosure to HIV infected children receiving ART in public health facilities.
May 2013 DOI 10.14302/issn.2324-7339.jcrhap-12-137
Background: HAART has resulted in significant decline in morbidity and mortality from HIV. However, it is unclear if the trends have continued in the current HAART era. An understanding of healthcare utilization patterns is important for optimization of care and resource allocation. We examined the diagnoses for hospitalizations of patients with HIV and their clinical and demographic profile years after the introduction of HAART. Methods: A retrospective audit of the HIV admissions from July 2009 through June 2010. The case notes of all the adult admissions where one of the discharge diagnoses was HIV infection was reviewed. Data including the demographics, date of diagnosis, treatment and the follow up details, admission outcome and the final diagnosis were extracted from the case notes. Results: Over the 12 months period there were 154 admissions where one of the discharge diagnosis was HIV infection, and this accounted for 2.9% of all medical admissions in adults. 103(67%) admissions were in persons who were known to be HIV infected prior to the current admission. HIV infection was diagnosed for the first time during the current admission in 51(33%) cases. Nearly two-thirds of those hospitalized, had a CD 4 cell counts of < 200/µL and 63 (66%) had a viral load greater than 50,000 copies/ml. Over all, opportunistic infection was the commonest (47%) discharge diagnosis, followed by serious bacterial infections and HIV nephropathy. The median duration of hospitalization was 6 days (Range 2 to 71 days). There were 49 (32%) deaths. Conclusions: A significant proportion of patients admitted with HIV infection were still diagnosed on admission and were found to be severely immunosuppressed. An opportunistic infection continues to be the commonest discharge diagnosis in HIV infected patients.
Dec 2012 DOI 10.14302/issn.2324-7339.jcrhap-12-71
In India, interruptions to highly active antiretroviral therapy (HAART) are due to adverse drug reactions (ADRs) and no reports on the direct cost incurred in the management of ADRs to HAART are available. There is a need to study direct cost incurred with ADRs to HAART to explore the high economic cost burden imposed by ADRs to HAART in HIV/AIDS patients. This study was aimed to evaluate the direct cost incurred in the management of ADRs to HAART in Indian HIV positive patients. This prospective study was conducted at a Medicine department in a South Indian tertiary care teaching hospitals were ADRs reporting system exist. HIV-positive hospitalized in-patients were identified and intensively monitored for ADRs to HAART. The World Health Organization (WHO) probability scale was used for causality assessment of ADRs. Modified Hart wig and Siegel scale was used for severity assessment of ADRs.Pearson chi-square test identified association of mean direct cost between ADRs and without ADRs by investigating total mean direct cost. The overall direct cost per ADRs to HAART was found to be higher in the context of expenditure on health care cost in India.