African Health Sciences

Editor’s choice: Sexual reproductive health, child issues, NCDs, surgery, infections and health systems - a salad of sorts

James K Tumwine — 2023-10-11

NIL

Editorial: Reducing the risks of nuclear war: the role of health professionals

Kamran Abbasi — 2023-10-11

NIL

Preliminary efficacy, feasibility and safety of intra-umbilical oxytocin to reduce the time to placental delivery at caesarean section: an exploratory randomized trial

Katrin Middleton — 2023-10-11

Background: Delayed placental separation either after vaginal birth or caesarean birth is an important cause of postpartum haemorrhage, among other causes such as uterine atony. Intra-umbilical oxytocin has been shown to reduce the time to placental delivery after vaginal birth. However, the efficacy of intra-umbilical oxytocin to reduce the time to placental delivery following caesarean section birth is not known.

Objectives: To explore the preliminary efficacy, feasibility and safety of intra-umbilical oxytocin to reduce the time to placental delivery at caesarean section.

Methods: A double-blind, placebo-controlled, exploratory randomized clinical trial was conducted at a tertiary hospital in the Eastern Cape Province, South Africa. A total of 66 women undergoing elective caesarean section were enrolled in the study and randomized into oxytocin group (n = 33) receiving an intra-umbilical infusion of 20 units of oxytocin in 30ml saline, and placebo group (n = 33) receiving an intra-umbilical infusion of 30ml saline. Data were analysed using Epi Info and RevMan software. Preliminary efficacy was assessed by examining the time elapsed from birth of the baby to complete delivery of the placenta; blood loss more than 500 ml; the need for manual removal of the placenta; and the completeness of the placenta. Feasibility was determined by observing the successful insertion of the catheter and injection of the solution. Safety was evaluated by investigating adverse effects of the procedure.

Results: Four women (12%) in the placebo group had a delayed placental delivery compared to one (3%) in the oxytocin group. The mean time from birth to placental delivery was 159 (SD 61) seconds in the placebo group and 143 (SD 45) seconds in the oxytocin group. There was no statistically significant difference between the two groups. Feasibility of the procedure was confirmed by successful insertion of the catheter and injection of the majority of the solution in all 66 cases. No adverse effects of the procedure were identified.

Conclusion: Administration of intra-umbilical oxytocin is feasible, safe and has potential to reduce the time of placental delivery at caesarean section. Further studies involving larger sample sizes are justified.

Keywords: Caesarean section; intra-umbilical oxytocin; postpartum haemorrhage.

A comparative study on the effectiveness of paracervical block and parenteral diclofenac for pain relief during manual vacuum aspiration

Iyke F Osinachi — 2023-10-11

Objective: To compare the effectiveness of paracervical block with intramuscular Diclofenac for pain relief during manual vacuum aspiration (MVA) for early pregnancy losses.

Methodology: This was an open label randomized controlled trial. Participants were randomized into two therapeutic groups (A and B) using computer generated numbers. Group A received intramuscular Diclofenac 75 mg. Group B received paracervical block using 1% Lidocaine. Participants were asked to rate their pain level on a continuous 10 cm visual analogue scale (VAS) from 0 (no pain) to 10 (the worst pain ever) within 5 minutes of completing the procedure. Participants’ level of satisfaction was assessed within 30 minutes of completing the MVA using Likert scale. Data was analysed using the Statistical Package for Social Sciences (SPSS), Version 20. Test of statistical significance was set at 95% confidence level (P < 0.05). The primary outcome was the level of pain felt by the patient during the procedure (10 cm VAS). Secondary outcomes included patient’s satisfaction and adverse events.

Results: There was significant difference in the mean pain level between the intramuscular diclofenac group; 6.5±1.5 (moderate) and those that received paracervical block; 2.3±1.5 (mild), (p-value=0.005). Patients’ satisfaction was also better in paracervical block group compared to intramuscular diclofenac group, (p-value=0.005). Both groups were comparable in terms of complications and drug side effects.

Conclusion: Findings from the study suggest that the use of paracervical block compared to intramuscular Diclofenac for pain relief during MVA for incomplete miscarriage significantly reduced pain, improved patients’ satisfaction and was comparably safe.

Keywords: Paracervical block; Diclofenac; Pain relief; Manual vacuum aspiration.

Decision to delivery interval, maternal and fetal outcomes in emergency caesarean sections in a tertiary teaching hospital, Dar es salaam, Tanzania

Peter Wangwe — 2023-10-11

Background: Emergency caesarean section (CS) answers the question on how soon the procedure should be performed. Maternal and fetal outcomes deteriorate when decision to delivery interval (DDI) exceeds 75 min. This study aimed at determining the DDI, Maternal and fetal outcomes in CS categories at Muhimbili National Hospital (MNH).

Methodology: A descriptive cross-sectional study involving 427 emergency CS at MNH was conducted from September to November, 2017. Data was extracted and analysed using SPSS version 23.0 where frequency, means, chi-square test and DDI were calculated to determine its association with categories of CS.

Results: The mean DDI for category one, two and three CS were 126.73, 133.57 and 160.08 min respectively. Only two (0.5%) and 54 (12.6%) of category one and two emergency CS met the recommended DDI of 30 and 75 min respectively. Maternal and fetal adverse outcome were increasing with increase in DDI. There was no significant association between DDI and adverse maternal outcome (OR: 1.2; 95% CI 0.49-2.83) and fetal outcome (OR: 1.7; 95% CI 0.91-3.38).

Conclusion: The proportions of adverse maternal and fetal outcome were high when DDI was ≥ 75 min. Improving triage of the patients according to their urgency is crucial in reducing prolonged DDI.

Keywords: Caesarean section category; maternal and fetal outcome; decision to delivery interval.

Postpartum resolution of hypertension, proteinuria and acute kidney injury among women with preeclampsia and severe features at Mulago National Referral Hospital, Uganda: a cohort study

Kasereka Muteke — 2023-10-11

Background: The resolution of hypertension, proteinuria and AKI postpartum among women with preeclampsia is not well documented in Uganda.

Objective: To determine the time to resolution of hypertension, proteinuria and AKI postpartum until 6 weeks among women with preeclampsia in Mulago Hospital, Uganda.

Methods: Between August 2017 and April 2018, we measured blood pressure, urine protein and serum creatinine on days 1,7,21 and 42 postpartum among 86 women with preeclampsia. The primary outcomes were time to the resolution of hypertension, proteinuria and AKI. We fitted accelerated failure models using Stata 17’s stintreg. command with a log normal distribution and obtained time ratios of selected exposures on time to resolution of hypertension, proteinuria and AKI intervals.

Results: The median time to resolution of hypertension, proteinuria and AKI was seven (7) days (Inter quartile range, IQR 1-21). The time to resolution of hypertension among primiparous women was 3.5 times that of multiparous women [TR 3.5, 95%CI 1.1, 11.3]. No differences were observed in resolution of hypertension, proteinuria and acute kidney injury.

Conclusion: The time to resolution of hypertension, proteinuria and AKI was seven days. We recommend larger studies with longer follow-up beyond six-weeks postpartum to inform revision of our guidelines.

Keywords: Acute kidney injury; preeclampsia with severe features.

Perception and level of satisfaction with the quality of antenatal care services among pregnant women attending antenatal clinic at plateau state specialist hospital, Jos, Nigeria

Olaoye Titilayo — 2023-10-11

Objective: This study evaluated pregnant women’s perception and level of satisfaction with quality of antenatal care received
at Plateau State Specialist Hospital.

Materials and Methods: The study employed a hospital-based cross-sectional design. Convenience sampling was used to
select two hundred and thirty-eight (238) women attending antenatal clinic at the Plateau State Specialist Hospital. A validated
semi-structured interviewer-administered questionnaire with a Cronbach’s Alpha score of 0.83 was used for data collection. Respondent’s perception was measured on a 36-point rating scale and the level of satisfaction on a 9-point rating scale. Data was
subjected to descriptive analysis and Pearson’s correlation was used to test for hypothesis.

Results: The mean age was 28.79 years. Most of the respondents were married (81.9%), twenty-eight percent of the respondents
had two children. The respondent’s perception of quality of antenatal care shows a mean score of 25.0± 4.61 which
indicates that the respondents had positive perception of the quality of antenatal care (69.4%). Also, the respondent’s level of
satisfaction with the quality of antenatal care received shows a mean score of 6.50 ± 1.8 indicating that they were very satisfied
(72.2%) with quality of antenatal care. There was a significant relationship between the respondent’s perception of the quality
of antenatal care and level of satisfaction of the quality of antenatal care service (r= 0.43; p< 0.003).

Conclusion: The respondents had positive perception and are satisfied with the quality of antenatal care services received. A
Periodic patient satisfaction survey should be established as part of the antenatal evaluation to provide feedback for continuous
quality improvement.

Keywords: Antenatal care; perception; level of satisfaction; Plateau.

Prevalence and predictors of hepatitis C infection among antenatal attendees in a tertiary hospital in Southern Nigeria

Ganiyu Oluwedolapo Shittu — 2023-10-11

Background: Hepatitis C virus infection as it specifically relates to pregnancy has been a neglected condition, thus its recognition
and treatment in pregnancy is relevant because of the risks of the long-term complications of the infection in the mother,
potential effects of the infection on the pregnancy and risk of vertical transmission to the newborn.

Objectives: To determine the proportion of pregnant women with serologic markers of hepatitis C infection, identify risk factors
as well as factors that predict the occurrence of the infection in them.

Methodology: Over a 3-week period, blood samples from 456 pregnant women were assessed for antibodies to hepatitis C
virus, while a pre-tested questionnaire was used to obtain socio-demographic data and the presence of risk factors in the University
of Uyo Teaching Hospital, Nigeria.

Results: The prevalence of HCV infection in pregnancy was 4.6%. No known risk factors for HCV infection in pregnancy were
identified. Only increasing gestational age was a predictor of HCV infection in pregnancy in the study.

Conclusion: The prevalence of hepatitis virus infection among the study population was high. Second trimester and increasing
gravidity were protective of the infection in pregnancy. There is therefore need for introduction of general routine screening of
all pregnant women presenting for antenatal care.

Keywords: Hepatitis C virus infection; pregnant women; Uyo; prevalence of hepatitis C.

Service delivery inaccessibility as a predictor of teenage pregnancy in South Africa

Mkwanazi Sibusiso — 2023-10-11

Background: With the onset of the South African democracy in 1994 it was hoped that many social inequalities would be
addressed urgently. However, studies have shown that service delivery inaccessibility remains a challenge and investigating the
social implications of such injustices remains important.

Objective: This study determined to establish the association between service delivery inaccessibility and adolescent pregnancy
in South Africa.

Methods: Using data from 2019 and 2021 general household surveys, 7 737 teenage females were included. The study applied
descriptive statistics, chi-squared testing as well as multilevel binary logistic regression.

Results: Random-intercept multilevel binary logistic regression revealed that the risk of adolescent pregnancy independently increased as the level of service inaccessibility increased at household level (no services: OR=1.73, 1 service: OR=1.40, 2 services:
OR=1.28) and community level (medium: OR=1.22, high: OR=1.38) at a P-value of 0.05.

Conclusion: Findings highlight the need to guarantee universal service delivery urgently not only for development, but also to
prevent adolescent pregnancy. Furthermore, the findings present evidence of structural factors driving adolescent pregnancy in
South Africa, which renders continued cycles of poverty, injustice and early pregnancy amongst the majority of Blacks.

Keywords: Teenage pregnancy; service inaccessibility; multilevel modelling; South Africa; structural inequality; teenagers.

Contraceptive use and sexual quality of life of patients with thalassemia in Northern Cyprus: a descriptive cross-sectional study

Sevinc Tastan — 2023-10-11

Objective: Although contraception methods are an important factor affecting sexual life, no literature has been recorded about
the contraceptive methods used and the sexual life of thalassemia patients. The aim of this study is to document the effects of
and preferences of contraception methods used in the sexual lives of patients with thalassemia.

Methods: The descriptive and cross-sectional study took place in Northern Cyprus at a Thalassemia Center in a State Hospital.
The study sample consisted of 100 thalassemia major or intermedia patients. The data includes descriptive characteristics, the
preference of contraception methods used by men and women and Sexual Quality of Life Questionnaires.

Results: Participants learned about contraception methods mostly from social media/internet, and 58.3% of the women and
46.2% of the men did not use any contraception method within the last year. Women’s sexual quality of life score was 70.3±19.9
and men’s Sexual Quality of Life score was 78.9±20.6. Women having knowledge of contraception methods had higher scores
than man (p<0.05). Male patients not having physical exercise had sexual quality of life scores significantly lower than those who
followed exercise programs (p<0.05).

Conclusions: Results indicate a significant need to include family planning and sexual health subjects that specifically address
thalassemia patients.

Keywords: Thalassemia; contraceptive; sexual quality of life.

Predictors of fertility awareness among selected married women of childbearing age in Nigeria: a cross-sectional survey

Adaobi Uchenna Mosanya — 2023-10-11

Background: Increased fertility awareness can help infertile couples to achieve pregnancy.

Objectives: This study aimed to determine both the predictors and levels of fertility awareness among married Nigerian women of childbearing age.

Methods: A nationwide cross-sectional survey. Data were collected via online and face to face questionnaires. Descriptive and inferential analysis were done with SPSS 25.

Results: Most respondents married between ages 24-29 years old (40%) and just over half had good fertility awareness (53%). The associated factors were age at menarche (X2 = 9.962, p = 0.007), geopolitical zone of residence (X2 = 17.301, p = 0.008), level of education (X2 = 64.843, p < 0.001), employment status (X2 = 9.319 p = 0.025) menstrual cycle charting (X2 = 66.392, p < 0.001), use of internet to increase awareness (X2 = 39.849, p < 0.001) and books (X2 = 58.855, p < 0.001). Fertility awareness was lower for those with secondary education than postgraduates (AOR=0.213, 95% CI 0.116-0.390, p < 0.001). Moreover, the odds of having good fertility awareness were less in those who did not chart their menstrual cycle (AOR=0.363, 95% CI 0.245-0.538, p < 0.001).

Conclusion: Menstrual cycle charting and level of education were predictors of fertility awareness.

Keywords: Nigeria; fertility; educational status; menstrual cycle; internet.

Abdominal obesity, serum estradiol and cardiovascular risk among Nigerian postmenopausal women: a cross-sectional study

Omolara T Lewechi-Uke — 2023-10-11

Background: Rates of cardiovascular (CV) disease mortality is usually higher in men but this equalizes with that of women following menopause.

Objectives: This was to determine the contribution of abdominal obesity and estradiol to cardiovascular risk in postmenopausal women (PMW) as well as estimate their CV risk profile.

Methods: 271 consenting PMW were recruited consecutively into this cross-sectional hospital-based study. Data relating to their socio-demography, blood pressure and anthropometry was obtained and laboratory analysis of lipid profile and serum estradiol was done. Cardiovascular risk of participants was estimated using standardized calculators.

Results: Mean age of participants was 57.8±5.5 years. Significant correlation existed between each of triglyceride (Positive), High Density Lipoprotein (negative) and Waist-Hip-Ratio (WHR) (p=0.001 and 0.000 respectively). Hypertension and dyslipidaemia were significantly associated with WHR (p=0.01 and 0.031 respectively). Significant negative correlation existed between CV risk profile and serum estradiol (rs = -0.140, p = 0.028). Ten-unit increase in WHR was associated with two-fold risk of hypertension (OR> 1.73, C.I.= 1.13-2.66). A unit change in age was associated with 0.61 increase in TC.

Conclusion: Abdominal obesity and serum estradiol significantly influence cardio-metabolic risk. Newer risk calculator which incorporates factors peculiar to women such as serum E2 is hereby recommended.

Keywords: Cardiovascular risk; postmenopausal women; abdominal obesity.

Effects of metabolic syndrome on bone mineral density in postmenopausal Turkish women

Zeynep T Bahtiyarca — 2023-10-11

Objective: In this study, we aimed to determine the potential effects of metabolic syndrome (MetS) and its components on bone mineral density (BMD) in the lumbar spine and femoral neck in postmenopausal Turkish women.

Patients and methods: 193 postmenopausal women were included in this study. Anthropometric measurements, biochemical blood tests, and T-scores of BMD in the lumbar spine (L1–L4) and femoral neck were recorded. The participants were divided into two groups according to the bone mineral density (BMD) results as osteoporosis group (Group 1, n=109) who had a T-score>−2.5 at the spine or/and femoral neck, and the control group (Group 2, n=84) who had T-score>−2.5 at the spine or/and femoral neck. MetS and its components were screened using the criteria of the Adult Treatment Panel III (ATP III) and National Cholesterol Education Program (NCEP). The effects of the MetS components on T-scores of BMD at the femoral neck and lumbar spine were evaluated by partial correlation test and multiple regression analysis.

Results: MetS was detected in 58 (30.1%) participants. The prevalence of MetS was significantly higher in Group 2 compared to Group 1 (39.3% vs 22.9%, p=0,014). Among the MetS components, especially abdominal obesity showed a significant positive correlation with T-scores of BMD at the femoral neck and spine. A weak but significant correlation was also observed with systolic and diastolic blood pressure, serum triglyceride levels, and fasting blood glucose (FBG). Multiple regression analysis revealed an association between waist circumference and BMD at both femoral neck and spine, and also between serum triglycerides, systolic and diastolic blood pressure, and spine BMD.

Conclusion: Our findings support that MetS is associated with increased BMD at the femoral neck and spine in postmenopausal women. A significant positive association was observed among the MetS components, especially with abdominal obesity, and also a weak positive association with serum triglycerides, and systolic and diastolic blood pressure.

Keywords: Postmenopausal women; bone mineral density; metabolic syndrome; osteoporosis.

A cross-sectional study of prevalence and predictors of risky sexual behavior among school-going adolescents in Mbarara municipality, Uganda

Michael U Anyanwu — 2023-10-11

Background: Adolescents in Sub-Saharan Africa are at a greater risk of experiencing the adverse consequences of risky sexual behavior such as unwanted pregnancy and school drop-out than adolescents from other regions.

Objectives: This study determined the prevalence and identified the demographic, school and social factors associated with risky sexual behavior among secondary school students in Uganda.

Methods: This was a quantitative cross-sectional study conducted in 12 secondary schools in Mbarara Municipality, Uganda. A self-reported questionnaire was used to estimate the prevalence and predictors of risky sexual behavior among the students.

Results: Out of the 910 students, 314 (34.6%) were sexually active and almost two in every ten adolescents had engaged in risky sexual behavior 171 (18.8%). About 27 (8.7%) had been pregnant or impregnated their sexual partner while 143 (45.6%) used condoms consistently. Risky sexual behavior was associated with age, gender of the student as well as alcohol consumption, smoking and substance use.

Conclusion: Most of the participants were not sexually active, however, among the sexually active students, more than half engaged in risky sexual behavior. This finding suggests the need to introduce comprehensive sex education with a focus on safe sex practices in secondary schools in Uganda.

Keywords: Prevalence; risk factors; sexual behavior.

The prevalence of sexual violence against African women: a systematic review and meta-analysis

Qu Xianguo — 2023-10-11

Background: High rates of sexual violence ratios in low-income countries are recognized as a global public health problem. The incidence of violence against African women has been increasing. However, no study has systematically summarized the global prevalence of sexual violence against African woman.

Methods: We conducted a comprehensive search of PubMed, Embase and Web of Science, databases from their inception through January 2021 for pertinent studies on reporting the prevalence of sexual violence against African women. We included observational studies. The prevalence rate was estimated using a random-effects meta-analysis. The heterogeneity was evaluated using I2 statistic. Differences by study level characteristics were estimated through subgroup analysis and meta-regression.

Results: A total of 9 cross-sectional studies were included (a total of 9,030 participants). The pooled sexual violence rate was 0.33 (95% CI = 0.23–0.42). Subgroup analyses found that there was a higher rates of sexual violence against pregnant woman in east Africa (0.41, 95% CI = 0.24–0.58), pregnant (0.42, 95% CI = 0.05–0.80), and interview (0.40, 95% CI = 0.01–0.78). The analysis found that the major sexual violence types were the physical violence (0.19, 95% CI = 0.07–0.31), psychological violence (0.36, 95% CI = 0.11–0.61), sexual assault (0.25, 95% CI = 0.02–0.47).

Conclusions: Nearly one out of every three (33%) African woman around the world has been a victim of sexual violence in their life. This current study investigated the status and characteristics of sexual violence against women, which could provide an important reference for the African health care provider. Assessing this problem against African women helps government officials, policy makers, program designers and non-governmental organizations to design prevention and controlling strategies.

Keywords: Sexual violence; African women; Meta-analysis.

Reproductive health challenges of an African school girl: a case report on non-bulging imperforate hymen with haematocolpometra during Covid-19 pandemic

Raymond Bvumbi — 2023-10-11

Background: Several schoolgirls attain reproductive age with undiagnosed gynaecological problems which pose challenges in their livelihood. These conditions include precocious puberty, congenital reproductive tract abnormalities, and delayed sexual development. Many children with these conditions face additional challenges including physical pain, psychological trauma and delayed diagnosis.

Methods: A 14-year-old girl presented with acute on chronic pelvic pain and haematocolpometra due to imperforate hymen during COVID-19 pandemic. She has not undergone cultural virginity test in her community. The hymenal membrane was unusually non-bulging despite the haematocolpometra. A partial hymenotomy with a narrow margin of excision was performed.

Results: The hymenal orifice later obliterated and resulted in a repeat partial hymenectomy where a wide surgical margin of the hymen was excised.

Conclusions: A wide rather than narrow partial hymenectomy prevents obliteration of the hymenal orifice after surgery for imperforate hymen. There is a need for timely interventions such as counselling and community awareness that prevent undue consequences of an imperforate hymen and its treatment including pain and possible inability to pass cultural virginity test in some African communities.

Keywords: African schoolgirl; cryptomenorrhea; haematocolpometra; hydrometrocolpos; impact of COVID-19; non-bulging imperforate hymen.

Birth asphyxia and its associated factors among newborns at a tertiary hospital: evidence from Southern Ethiopia

Mulugeta Demisse — 2023-10-11

Background: Globally, 45% of under-five children death occurs during the neonatal period and about 25% of all neonatal deaths are caused by birth asphyxia. In Ethiopia, in 2015, it was the first cause of neonatal deaths followed by prematurity and sepsis. The study aims to assess prevalence of Birth asphyxia and associated factors.

Methods: Institution-based cross-sectional study was conducted among neonates admitted to Neonatal intensive care unit of Hawassa University Specialized comprehensive hospital from December 1 to December 30, 2020. Systematic random sampling technique was employed to select samples. Logistic regression analysis using Statistical Package for Social sciences version 24was employed.

Results: The prevalence of neonatal asphyxia in this study was17.9%. Prolonged labor [AOR (Adjusted odds ration) = 2.909; (95% CI (Confidence Interval): 1.184 – 7.151)], presence of meconium [AOR= 2.137; 95% CI 1.028 – 4.683)], premature rapture of membrane [AOR = 2.459; 95% CI: 1.021 – 6.076)] and complication during labor [AOR= 3.351; 95% CI: 2.142 – 5.871))], were factors associated with neonatal asphyxia.

Conclusion and Recommendations: Nearly two in every ten newborns faced perinatal asphyxia in the study area. Early identification of high-risk women, intervening on delay in referral, and early and vigorous management of abnormal labor and complicated labor is essential to halt the problem.

Keywords: Birth asphyxia; neonates; neonatal intensive care unit.

Neonatal factors associated with immediate low Apgar score in newborn babies in an intermediate hospital in Namibia: a case control study

Justina Lungameni — 2023-10-11

Introduction: Apgar score is conducted to a baby immediately after birth checking how the baby tolerated the birth process
and outside the uterus.

Objectives: To describe the neonatal factors associated with immediate low Apgar score and analysing the associations among
factors associated with low Apgar score in new-born babies.

Methods: A quantitative, case-control, descriptive research design was used. Study population were all maternal records of
deliveries conducted between 01 January 2019 and 31 December 2019. Simple random sampling was used to select the sample
size for 194 cases and 194 controls using a 1:1 case-control ratio. Records indicating low Apgar scores were the cases while normal
Apgar scores were the controls. A total of 388 maternal files were reviewed. Data were collected using a document review
checklist and analysed using SPSS version 26.

Results: The study found that, neonatal factors associated with immediate low Apgar score are; gestational age, foetal presentation,
cord prolapse, cord around the neck and the importance of cardiotocography interpretation as they had a P-value > 0.005.

Conclusion: Gestational age, birth weight, foetal presentation, cord around the neck and lack of cardiotocography assessment
were found to be associated with immediate low Apgar score.

Keywords: Neonatal; factors; immediate low Apgar score; newborn; babies.

Prevalence and factors associated with low birth weight among newborns in South Sudan

Chol Lat — 2023-10-11

Background: WHO estimates that that 13% of babies are delivered low birth weight in Sub-Saharan Africa. Infants with LBW
have a twenty times greater risk of dying than infants weighing more than 2500 grams. The neonatal mortality rates in South
Sudan is 40 per 1000 live births. LBW significantly contributes to neonatal mortality rates.

Objectives: The study aimed at determining the prevalence and factors associated with LBW among newborns.

Methods: This was a cross-sectional descriptive study conducted at three hospitals. Completed data on all live births was collected
using a structured questionnaire. Univariate and multivariate logistic regression analysis was applied for factors associated with
LBW. Adjusted odds ratio with 95% confidence interval was applied and a P value < 0.05 was considered statistically significant.

Results: We retrieved records of 11845 birth cohorts. The prevalence of LBW among newborns was 11.4%. The prevalence
of LBW at Aweil, Juba and Bor was 13.3%, 9.8% and 8.8% respectively. Maternal age less than 20 years and 35 years and above,
multigravidity, GA < 37 weeks, male sex and multiple pregnancy were significantly associated with LBW.

Conclusion: The prevalence of LBW in infants was 11.4%. Associated factors were, maternal age, GA < 37 weeks, multigravidity,
male sex and multiple pregnancy.

Keywords: Low birth weight; improve birth outcomes; multivariate logistic regression analysis.

Prevalence and factors associated with neonatal acute respiratory distress syndrome among neonates admitted to the neonatal intensive care units of Gurage zone public hospital, South West Ethiopia

Bogale Chekole — 2023-10-11

Background: Respiratory distress syndrome (RDS) is the leading cause of respiratory failure and death of a neonate in today's world, especially in developing countries like Ethiopia.

Methods: We used an institutional-based cross-sectional study in the selected hospitals of the Gurage zone admitted from June 2019 to June 2021. The data were collected using a structured questionnaire. Data were entered into Epi data 3.1 and exported to SPSS version 25 for analysis.

Result: The prevalence of respiratory distress syndrome (RDS) in the study area was 45.1%. The odds of RDS in neonates from mothers with gestational age between 35 &37 were 3.99 times higher compared to term gestation. The odds of RDS among neonates with jaundice and sepsis are 4.33- and 1.92-times higher odds compared to their counterparts. The odds of RDS in neonates born via Caesarean section were 1.7 times higher compared with those delivered via spontaneous and instrumental delivery. RDS was also higher in neonates born to mothers <20 years of age and >=35 years old.

Conclusion: the prevalence of RDS in the study area was high. Thus, healthcare providers should act on those factors with appropriate follow-up for early detection of the problem and prevent the risk.

Keywords: Respiratory distress syndrome; neonate.

Spatio-temporal modelling of under-five mortality in Lesotho using demographic and health survey data

Mthobisi Mxolisi Zondi — 2023-10-11

Background: Lesotho is in the Sustainable Development Goal (SDG) region which aims to reduce the under-five mortality (U5M) to the average of 25 deaths per 1000 live births by the end of 2030 under the sustainable development goals (SDGs) initiative by the United Nations

Methodology: This paper makes use of the Lesotho Demographic and Health Survey (LDHS dataset, which focuses on female reproductive ages 15-49 and male reproductive ages 15-54 The spatio-temporal models were used in this study to investigate how the proposed covariates change over time.

Results: The results showed that children who were breastfed had a lower odd of death compared to children who were not breastfed, children from more educated mothers had significantly lower odds of U5M compared to those from less educated mothers. Having a larger number of children under the age of five also contributed significantly to an increased risk of U5M. The likelihood of U5M increased with age.

Conclusion: The study recommends that mothers of under-five children be educated about breastfeeding and encouraged to use contraception in order to postpone birth and reduce parity. Rural development should be prioritized through improved primary health care; and public health services should be made more accessible to rural residents.

Keywords: Spatio-temporal modelling; under-five mortality; Integrated Laplace nested approximation; Lesotho demographic and health survey data.

Digestive manifestations of Covid-19 in children: a retrospective study

Abderrahmane Jallouli — 2023-10-11

Background: The world is currently facing a pandemic due to a new species of the Coronaviridae family called SARS-CoV-2,
discovered in the city of Wuhan in China in December 2019. The WHO has named the resulting disease COVID-19 (Coronavirus
Disease 2019). It has been a global health problem due to its major socio-economic damage. The aim of this study was to
show the prevalence of gastrointestinal and hepatic manifestations in symptomatic children with COVID-19.

Methods: We performed a retrospective study, including 36 symptomatic children infected by SARS-CoV-2 hospitalized at the
mother and child hospital of university hospital of Mohammed VI, Marrakech in Morocco, over a period of 7 months. Clinical
and biological manifestations of the digestive system were evaluated for all patients.

Results: The digestive symptomatology came in second place after the respiratory manifestations. 14 patients (38.89 % of
symptomatic patients) in our study had digestive symptoms on admission: 12 (33.33%) presented with diarrhea, 4 (11.11%) had
abdominal pain and only one child (2.78%) had vomiting. Aspartate aminotransferase (AST) was elevated in one patient, while
alanine transaminase (ALT) was elevated in 6 patients. The prothrombin level was normal in all patients. All patients were discharged
with good general condition without morbidity and mortality.

Conclusion: This study concludes with the high prevalence of digestive manifestations of COVID-19 in symptomatic children.
There were no severe clinical or biological abnormalities in our study. Digestive manifestations during COVID-19 in children
are frequent, which requires the awareness of health professionals

Keywords: COVID-19; digestive manifestations; children.

The road to a polio-free Uganda; contribution of the Expanded Program on Immunization Laboratory (EPI-LAB) at Uganda Virus Research Institute

Mary B Nanteza — 2023-10-06

Background: The control of poliomyelitis in Uganda dates back as far as 1950 and acute flaccid paralysis (AFP) surveillance has since been used as a criterion for identifying wild polioviruses. Poliovirus isolation was initially pursued through collaborative research however, in 1993, the Expanded Program on Immunization Laboratory (EPI-LAB) was established as a member of the Global Poliovirus Laboratory Network (GPLN) and spearheaded this activity at Uganda Virus Research Institute.

Objectives: The aim of this report is to document the progress and impact of the EPI-LAB on poliovirus eradication in Uganda.

Methods: Poliovirus detection and identification were achieved fundamentally through tissue culture and intra-typic differentiation of the poliovirus based on the real-time reverse transcriptase polymerase chain reaction (rRT PCR). The data obtained was entered into the national AFP database and analysed using EpiInfoTM statistical software.

Results: Quantitative and qualitative detection of wild and Sabin polioviruses corresponded with the polio campaigns. The WHO target indicators for AFP surveillance were achieved essentially throughout the study period.

Conclusion: Virological tracking coupled with attaining standard AFP surveillance indicators has been pivotal in achieving and maintaining the national wild polio-free status. Laboratory surveillance remains key in informing the certification process of polio eradication.

Keywords: Poliovirus; eradication; acute flaccid paralysis; laboratory surveillance; Uganda.

mHealth app usage amongst paediatric department doctors in South Africa

Shahid Mahmood — 2023-10-11

Background: Smartphone and mobile health (mHealth) applications (apps) have become an integral part of the day-to-day function of healthcare professionals, allowing quick, comprehensive, and up-to-date access to current clinical guidelines and other reference material.

Objective: To evaluate the extent and nature of use of mHealth apps by paediatric department doctors in South Africa.

Methods: E-mails requesting study participation were sent out to 285 paediatric department doctors employed at six hospitals affiliated to the University of the Witwatersrand. Willing participants were directed to complete the online study questionnaire.

Results: A total of 150 respondents completed the questionnaire. All respondents owned a mobile device and already had one or more mHealth apps, 95.3% were unaware of any regulatory body responsible for regulating the use of mHealth apps, 86.0% did not have access to free Wi-Fi at work and 87.3% used an mHealth app at least once daily. Drug dosing (81.3%), diagnostic (59.3%) and clinical decision-making (44.7%) apps were the most common app categories with Medscape® (62.0%) and EMGuidance® (41.3%) being the most frequently used apps. Peer recommendation (76.0%), app credibility (74.0%) and app functionality (66.0%) were the most common factors that were considered by respondents prior to downloading or using an mHealth app.

Conclusion: Medical apps are frequently used among paediatric medical doctors of all ranks. Drug dosing, diagnostic and clinical decision-making apps are the most common app categories in use. Improved awareness of the regulations pertaining to the use of mHealth apps amongst doctors is required.

Keywords: Medical apps; mHealth; mobile health; smartphone health; information technology; drug dosing app; medical diagnostic app.

Comparison of iron isomaltoside ferumoxytol with iron sucrose for iron deficiency anemia: a meta-analysis of randomized controlled trials

Lunbo Shi — 2023-10-11

Introduction: The efficacy of iron isomaltoside ferumoxytol versus iron sucrose to treat iron deficiency anemia remains controversial. We conduct this meta-analysis to explore the influence of iron isomaltoside ferumoxytol versus iron sucrose on iron deficiency anemia.

Methods: We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through March 2021 for randomized controlled trials (RCTs) assessing the effect of iron isomaltoside ferumoxytol versus iron sucrose on iron deficiency anemia. Meta-analysis was performed using the random-effect model.

Results: Four RCTs involving 3892 patients were included in the meta-analysis. Overall, compared with iron sucrose for iron deficiency anemia, iron isomaltoside showed similar change of Hb (SMD=0.14; 95% CI=-0.07 to 0.35; P=0.18), Hb responder (SMD=1.41; 95% CI=0.71 to 2.81; P=0.33), serum ferritin (SMD=15.13; 95% CI=-23.45 to 53.71; P=0.44), and transferrin saturation (SMD=1.20; 95% CI=-1.08 to 3.47; P=0.30). However, iron isomaltoside further improved serum-ferritin at week 2 than iron sucrose (SMD=204.79; 95% CI=38.23 to 371.35; P=0.02).

Conclusions: Iron isomaltoside ferumoxytol showed comparable efficacy to iron sucrose for the treatment of iron deficiency anemia.

Keywords: Iron isomaltoside ferumoxytol; iron sucrose; iron deficiency anemia; randomized controlled trials.

Epidemiological and clinical characteristics of 66 Tunisian Sickle cell syndrome patients

Ahlem Sahli — 2023-10-11

Introduction: Sickle cell syndrome (SCS) represent a real health problem. In this work, we propose to study the epidemiological and clinical features of 66 patients with SCS.

Methods: This is a retrospective descriptive cross-sectional study carried out on a population of 66 patients with SCS, (36 S/S, 18 S/β-thalassemia, seven S/C and five S/OArab), over a period of two years.

Results: The average age of our population is 15.5 years ± 8.4. 36 patients (55%) were born to a consanguineous marriage and 35 (53%) had siblings with SCS. The average baseline hemoglobin in our patients is 9.1g/dL±1.51. S/C patients have significantly higher baseline hemoglobin than S/S, S/β-thalassemia and S/OArab with p <0.05. Jaundice, mucosal skin pallor and hepatomegaly have been observed only in S/S, S/β-thalassemia and S/OArab patients. The persistence of splenomegaly is more frequent in S/C than in S/S, and in S/-thalassemia than in S/S. The most common acute complications were vaso-occlusive attacks (69.7%) and worsening of anemia (54.54%). The most common chronic complication was cholelithiasis (36.36%).

Conclusion: S/C patients present the best tolerated form and were the least affected by chronic complications and therefore can lead an almost normal life.

Keywords: Acute complications; chronic complications; sickle cell syndrome; steady state.

Endoscopic esophageal foreign body removal among children at Lubaga Hospital, Kampala, Uganda

Michael Okello — 2023-10-11

Background: Diagnostic upper gastrointestinal endoscopy involves examination of the lining of the esophagus, stomach and part of the duodenum. Interventional endoscopy in addition to evaluating the upper gastrointestinal tract to make a diagnosis, also offers a treatment benefit. Traditionally, esophageal foreign bodies (FBs) in Uganda were removed using rigid endoscopy. We therefore report an emerging trend of using flexible endoscopy to remove these FBs.

Objective: To describe participant characteristics and endoscopic findings among children who underwent esophageal FB removal in Lubaga Hospital in Kampala.

Methods: This was a retrospective review of endoscopy reports for children who underwent endoscopic esophageal FB removal at Lubaga Hospital from December 2014 to March 2022.

Results: Overall, 61 symptomatic children underwent this procedure. The majority of the FBs were removed by flexible endoscopy (n=55, 90.16%). The mean age of the participants was 7.88 (SD=2.12) years old. The majority of the children were females (72.13%) and coins were the most ingested FBs (84%), others included steel crucifix, nails etc. The upper esophageal sphincter was the commonest site for FB impaction (74%).

Conclusion: We report high success rates of 90.16% for endoscopic removal of impacted esophageal foreign bodies among Ugandan children using the now widely available flexible endoscopy.

Keywords: Endoscopy; esophagus; foreign body.

Clinicopathological pattern of breast lesions in children and adolescents

Chukwuemeka Charles Nwafor — 2023-10-11

Background: Breast lesions are not common in children and adolescents. The aim of this study is to retrospectively survey the clinicopathological pattern of breast lesions in children and adolescents in our setting.

Materials and method: This is a retrospective study of all breast specimens from children and adolescents that were histopathologically diagnosed in University of Uyo Teaching Hospital.

Results: The youngest patients seen were 11 years old, with mean age of 17.1 ± 1.91. The commonest clinical diagnoses were fibroadenoma (n=134, 72.4%). Thirty-five-point seven percent of the patients presented within 6 months of noticing the lump. The mean size of the lumps was 6.2cm ± 3.9. Fibroadenoma was the most common benign diagnosis and the most common histopathologic diagnosis in this study. The mean age of patients with fibroadenoma was 17.15±1.83.

Conclusion: The pattern of breast lesions in adolescents in Uyo is similar to that from other parts of Nigeria.

Keywords: Adolescents; benign; breast lesions; fibroadenoma.

Clinicopathological pattern of oestrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 over-expression of epithelial ovarian carcinomas in Nigeria

Mustapha Akanji Ajani — 2023-10-11

Background: Ovarian cancer is the leading cause of death from all gynaecological malignancies. Only few biomarkers of epithelial ovarian cancer (EOC) prognosis have been studied so far among Nigerian patients.

Objective: To determine the pattern of oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER-2) expression in patients with EOC seen in Nigeria

Materials and Methods: This was a retrospective multicentre study of 102 cases of epithelial ovarian cancers. Relevant clinical information was obtained from hospital-based records in the 3 participating centres. Tissue microarrays were constructed using representative tumour tissue and the ER, PR and HER2 immunohistochemical staining was carried out at the University of Chicago, United States of America.

Results: Serous carcinomas predominated (71% of cases). ER positivity was observed in 31.4%, PR positivity in 21.5% and HER2/neu in 16.7% of tumours. Fifty-two percent of tumours were triple negative. Serous tumours were significantly associated with ER positivity (p=0.001). Mean patient age for EOC was 52.6 ± 13.1 years. There were no statistically significant associations between hormone receptor status and histological grade, FIGO staging or survival.

Conclusion: Serous tumours were significantly associated with ER expression while non-serous tumours tended to be triple negative.

Keywords: Oestrogen receptor; Progesterone receptor; HER-2 over-expression; Epithelial ovarian cancer.

Malignancy-related mir-210, mir-373 and let-7 levels are affected in iron deficiency anemia

Ruveyda Sak — 2023-10-11

Background: Hypoxia is the hallmark of iron deficiency anemia (IDA) and in hypoxic environment, significant changes are observed in malignancy-related microRNAs (miRNA). Our aim is to examine whether there is any difference in the levels of miR-210, miR-373 and let-7, which are directly related to malignancies in patients with IDA.

Methods: Thirty-five female patients with IDA between the ages of 18-65 and 10 healthy controls were included in the study. Patients who received oral iron therapy, who had inflammatory disease, and who were pregnant were excluded from the study. Student t Test was used for comparing variables with normal distribution in two independent groups, and Mann-Whitney U Test was used for variables without normal distribution. Comparison of categorical data was made using the chi-square test.

Results: The mean hemoglobin and ferritin level were 10,78±0,93 and 6.28±5,76 respectively. Plasma miR-210 expression were found as -7.27±2.23 and -6.15±0,88 in IDA and control group respectively (p = 0.022). Plasma miRNA-373 were -7.36±2,58 and -6,96±1,93 and let-7 expression were 2.14±2,15 and 3,57±2,21 in IDA and control group. (p = 0.65 and p = 0.20, respectively).

Conclusions: Plasma miR-210 expression was significantly up-regulated and miR-373 and let-7 expression was down-regulated, though insignificantly, in IDA group.

Keywords: miRNA; iron deficiency anemia; malignancy.

Imaging classification and BIRADS assessment of cystic breast lesions with pathologic correlates. a 5-year experience in Zaria, North West Nigeria

Sefiya Adebanke Olarinoye-Akorede — 2023-10-11

Background: Breast cysts encompass a variety of pathologies, both benign and malignant. Therefore, classifying cysts into different categories is needful to develop a management algorithm. This study aimed to describe and distinguish between simple, complicated and complex cysts; and compare the final BIRADS assessment with pathologic findings.

Materials and methods: A 5-year retrospective review of our ultrasound database identified two hundred and seventy patients with cystic breast lesions. They were divided into simple, complicated and complex cysts according to ultrasound characteristics based on shape, orientation, margin, wall thickness, internal features (echogenicity, septa, mass) posterior acoustic features, surrounding tissue vascularity. The final BIRADS assessment was correlated with histological findings.

Results: There were two hundred and sixty-six (98.5%) females and four (1.5%) males with a mean age 34.9 ± 11.8 years. The commonest presentation was a palpable mass, in 70% of the patients. There were 89 (33.0%) simple cysts, 61 (22.6%) complicated cysts and 120 (44.4%) complex cysts.

Conclusion: Majority of the breast cysts (83%) were benign with overall 17% incidence of malignancy. Complex cysts were the most frequent cyst type in our study, it is also the category most frequently associated with breast cancer, obviating the need for histology.

Keywords: Breasts; Cysts; BIRADS; ultrasound; pathology.

Health-related quality of life associated with different cervical cancer therapies received by patients in two Nigerian tertiary hospitals

Aliyu Samaila — 2023-10-11

Background: There are important consequences from cervical cancer (CC) disease and its treatment among survivors, especially
the impact on quality of life (QoL).

Objective: To evaluate the health-related QoL associated with different CC therapies received by patients in two Nigerian tertiary
hospitals.

Methods: This study employed a prospective longitudinal design. It was conducted at Usmanu Danfodiyo University Teaching
Hospital, Sokoto and Ahmadu Bello University Teaching Hospital Zaria, North-Western Nigeria. Data of all the 157 eligible CC
patients were collected at baseline and after therapy. Data analysis was done with appropriate descriptive and inferential statistics
using SPSS V. 20 for windows. P<0.05 was considered statistically significant.

Results: Chemotherapy (CT) was the major therapy option received by 78(49.7%) of the patients. Patients who received chemoradiation therapy (CRT) and adjuvant chemotherapy (CTS) had the highest increase in mean overall health-related QoL of 0.138
(t=8.456, p<0.001) and 0.138 (t=6.489, p<0.001) higher than their respective baseline scores. Patients who received CT had the
least increase in mean overall health-related QoL of 0.095 (t=4.574, p<0.001) from baseline.

Conclusion: Chemoradiation therapy and adjuvant chemotherapy were associated with highest increase in mean overall
health-related QoL. Chemotherapy was associated with the least increase in mean overall health-related QoL.

Keywords: Cervical cancer; quality of life; therapies.

Cervical cancer awareness and risk factors among women residing in an urban slum in Lagos, Southwest Nigeria

Tope Olubodun — 2023-10-11

Background: Poor awareness of cervical cancer and high prevalence of its risk factors may be responsible for the large burden
of cervical cancer in low-income countries. This study assessed awareness of cervical cancer and prevalence of risk factors
among women residing in a slum in Lagos, Nigeria.

Methods: This was a descriptive cross-sectional study carried out amongst 305 women of reproductive age (15-49 years) in
Idi-Araba, a slum in Urban Lagos. Data were collected using interviewer administered questionnaires. Analysis was done with
SPSS 20 software.

Results: Mean age of respondents was 33.5(9.0) years. Only 12.8% of the respondents had heard of cervical cancer. Ninety-five
percent of respondents were sexually active and 56.2% had more than one lifetime sexual partner. Close to half (47.3%) of
respondents had their first sexual intercourse before the age of 20. One in five (22.2%) had 5 or more children. Half of the
respondents (54.8%) had had abnormal vaginal discharge.

Conclusion: Awareness of cervical cancer among the women was poor and prevalence of risk factors of cervical cancer was
high. Campaigns aimed at increasing awareness of cervical cancer, and screening should be carried out by governmental and
charitable organizations for women residing in slums.

Keywords: Cervical cancer; awareness; risk factors; slum; Nigeria.

Knowledge of breast cancer, willingness and barriers to mammography screening among rural women in Enugu State, Nigeria

Lawreta Ijeoma Abugu — 2023-10-11

Background: Breast cancer is a serious public health threat. Mammography is the most reliable screening method that detects
breast cancer early, enabling early onset of treatment which improves the prognosis of the disease.

Objectives: To determine women’s knowledge of breast cancer, as well as barriers and willingness of women to participate in
mammography screening.

Methods: Using the cross-sectional survey design, we sampled and studied two rural communities of Enugu State, Nigeria.
Two researcher-made questionnaires were used for the study. Frequencies, percentages, chi-square and regression analysis were
employed in data analysis.

Results: Only 11.4 percent of study participants had good knowledge of breast cancer. There were significant differences in
knowledge of breast cancer based on level of education (χ2 = 15.670; p =.001), monthly income (χ2 =6.954; p = .021) and ever
screened (χ2 =5.242; p =.015). Lack of money (48.0%) and lack of knowledge (30.4%) were the most reported barriers to breast
cancer screening. Women that had ever screened were 92.3% less likely willing to be screened than those never screened (aOR:
.077, 95%CI .011-.522, p=.009).

Conclusion: Health Education should be combined with improving women’s economic status and subsidizing the cost of
screening to increase breast cancer screening practice.

Keywords: Mammography; breast cancer; screening practice; knowledge.

Risk factors influencing chemotherapy compliance and survival of elderly patients with non-small cell lung cancer

Zhongxing Bing — 2023-10-11

Objective: Non-small cell lung cancer (NSCLC) has high degree of malignance and proneness to recurrence and metastasis. The aim of this study was to analyse the risk factors influencing the chemotherapy compliance and survival status of elderly NSCLC patients.

Methods: The clinical data of 110 patients admitted from January 2014 to March 2018 were retrospectively analysed. They were assigned to non-chemotherapy (n=25), partial chemotherapy (n=30) and complete chemotherapy (n=55) groups according to chemotherapy compliance, and followed up until March 2021. Their clinicopathological characteristics were investigated by univariate analysis and then multivariate Cox regression analysis. The survival rates were compared by Kaplan-Meier survival curve and log-rank test.

Results: Among the 110 NSCLC patients, 25 did not receive chemotherapy, 30 underwent partial chemotherapy and 55 received complete chemotherapy. Educational level, pathological tumor-node-metastasis (TNM) stage, pathological type, surgical approach, place of residence, payment mode and chemotherapy stage were independent risk factors influencing the chemotherapy compliance (P<0.05).

Conclusion: Particular attention should be paid to improving the chemotherapy compliance of patients with low educational level, late TNM stage, medical history of squamous cell carcinoma, history of thoracotomy, living in rural areas and no medical insurance, and those in the recurrence period or consolidation period of chemotherapy.

Keywords: Chemotherapy compliance; elderly; non-small cell lung cancer; risk factor; survival analysis.

Assessment of the relationship between miR-499C/T (rs3746444) polymorphism and lung carcinoma in Iranian population; a case-control study

Mehdi Torabi — 2023-10-11

Introduction: Lung carcinoma is characterized by uncontrollable division of respiratory system cells with detrimental and lethal
consequences on human health. Critical roles of microRNAs (miR) are scientifically approved in biological and pathological
pathways, such as the role of miR-499 (rs3746444) in lung carcinomas. Thus, in this case-control investigation, we aimed to
assess the probable relationship between miR-499C/T variant and the occurrence of lung carcinoma in Iranian population for
the first time.

Methods: Genotype of miR-499 polymorphism was described by the Polymerase Chain Reaction-Restriction Fragment Length
Polymorphism (PCR-RFLP) assay in patients and healthy individuals. Following definite diagnosis of lung carcinoma, the blood
samples were collected, and the DNA extraction was performed by Salting-Out method. Finally, data were analysed by SPSS (v.
20) and the significant level was considered p-value<0.05.

Results: Statistically, the frequency of combined genotypes of CC+CT were 83.33% and 35% and TT+CT were 100% and 92%
in case and control individuals, respectively. Also, individuals with genotypes of TC (OR: 3.08, CI95%: 3.03-3.17, p<0.0001),
TC+CC (OR: 0.10, CI95%: 0.05-0.23, p<0.0001), CC (OR: 0, CI95%: 0.00-0.60, p=0.0214), and TC (OR: 0.07, CI95%: 0.03-
0.15, p<0.0001) represented statistically significant (p<0.05) differences lung carcinoma than those with TT, TT, TT+TC, and
TT+CC genotypes, respectively. The frequency of miR-499C (78.5%) and miR-499T (21.5%) alleles were also statistically significantly
(p<0.05) difference associated with lung carcinoma in patients than controls.

Conclusion: In this study, a possible relationship among miR-499C/T polymorphism and lung carcinoma was detected in Iranian
population. Since this study was conducted for the first time, thus other supplementary assessments are needed for definite
conclusion.

Keywords: Lung, neoplasm; carcinoma; rs3746444; miR-499C/T; miR-499A/G; RFLP-PCR; Polymorphism; Iran.

Prevalence and predictors of type 2 diabetes complications: a single centre observation

Chinonyerem O Iheanacho — 2023-10-11

Background: Diabetes complications are a major burden on persons living with diabetes and the health care systems.

Objectives: The study assessed the glycemic control, prevalence and predictors of type 2 diabetes complications among patients
in a healthcare centre.

Methods: Two hundred adults who had type 2 diabetes in a general hospital were recruited for the study. Cross-sectional and
retrospective surveys were used to determine prevalence, number and types of complications in the patients. SPSS version 21
was used for descriptive analysis and Chi-square (p<0.05).

Results: A total of 200 (100%) respondents participated in the study and 97 (48.5%) had poor glycemic control. Mean number
of complications per patient was 2.48 ± 1.22. Number of complications per person and type of complications were significantly
associated with Age (p = 0.000 and p = 0.000, respectively), Gender (p = 0.008 and p = 0.031, respectively) and Occupation
(p=0.000 and p=0.006, respectively). Marital status (p = 0.032) and years of diagnosis (p=0.021) were also associated with type
of complications. The majority of patients 64 (32.0%) were admitted in the previous year for diabetes-related complications.
Majority 159 (79.5%) had ≥ 2 number of complications from the observed 497 complications.

Conclusions: Poor glycemic control and high prevalence of complications were observed. Also, socio-demographic characteristics
were likely predictors of number and type of complications. These findings are essential for improved planning and
prioritizing of diabetes care.

Keywords: Complications; Nigeria; prevalence; socio-demographics predictors; type 2 diabetes.

Physical inactivity and barriers to physical activity among Type-2 diabetics in Kumasi, Ghana

Linda Kumah Taylor — 2023-10-11

Background: Although the benefits of physical activity (PA) in diabetes management are well documented, there insufficient
data on physical activity levels and barriers to physical activity among Type-2 diabetics in Ghana. This study assessed physical
activity and barriers to physical activity among Type-2 diabetics at Manhyia Hospital in Kumasi, Ghana.

Methods: The study recruited 97 participants (32% men, 68% women). Physical activity was assessed using the Global physical
activity questionnaire and barriers to PA were assessed using the Barriers to being active Quiz. Anthropometry and sociodemographic
data were also collected.

Results: Prevalence of overweight/ obesity was 63.9%. About 60% of participants were inactive. Social influence (60.8%)
was the most prevalent PA barrier followed by lack of energy (59.8%) and lack of willpower (58.8%). Majority of participants
(57.7%) reported at least 4 barriers to being active. There was a significant negative correlation between age and number of PA
barriers (r = -0.214, p = 0.035). A significantly higher proportion of employed participants were active compared to the unemployed/
retired participants (p = 0.035).

Conclusion: This population of Type-2 diabetics needs urgent lifestyle interventions to improve physical activity and weight,
considering that the main physical activity barriers were personal motivation related.

Keywords: Physical activity barriers; Type 2 diabetics; Ghana; physical activity.

Influence of feedforward control-based health education intervention on compliance, visual function and self-perceived burden among patients with diabetic retinopathy

Jia Wang — 2023-10-11

Objective: To assess the influence of feedforward control-based health education intervention on the compliance, visual function
and self-perceived burden (SPB) among patients with diabetic retinopathy (DR).

Methods: Eighty-six DR patients were divided into feedforward control and control groups (n=43). The control group was
given routine nursing intervention, based on which the feedforward control group received feedforward control-based health
education intervention. The health behavior indices were compared after intervention. The correlations of QOL score with SPB
score and health behavior indices were analysed using Pearson’s and Spearman’s coefficients.

Results: After intervention, the total QOL score and scores of symptoms and visual function, physical function, social activity,
and mentality and psychology were significantly improved compared with those before intervention, which were significantly
higher in the feedforward control group (P<0.05). SPB score was significantly lower in the two groups after intervention than
that before intervention, particularly in the feedforward control group (P<0.05). The QOL score of DR patients was significantly
negatively correlated with SPB score but positively correlated with health behavior indices (P<0.05).

Conclusion: The feedforward control-based health education intervention mode is beneficial for guiding DR patients to promote
visual function recovery and to reduce SPB.

Keywords: Correlation; diabetic retinopathy; feedforward control; health education; self-perceived burden; visual function.

Assessment of gender differences in some inflammatory cytokines of tuberculosis patients before and during treatment

Chizoba Okeke — 2023-10-11

Background: Gender variation is a feature of many physiological parameters including inflammatory cytokines. Inflammation is an obvious feature of Tuberculosis (TB) infection with changes in pro and anti-inflammatory cytokines.

Objective: To compare the levels of inflammatory cytokines between male and female TB patients before treatment, after 2-months and after 6-months anti-tuberculosis treatment.

Materials and methods: A total of 35 males and 25 females TB subjects were enlisted before initiation of therapy and followed up after 2-months and 6 months treatment and samples collected and analysed. Tumour necrosis factor-alpha (TNF-α), Interleukin 10 (IL-10, Interleukin -6 (IL-6), Interleukin-2 (IL-2), transforming growth factor-beta (TGF-β) were assayed by ELISA method.

Results: Before treatment, the median level of IL-6 (pg/ml) was significantly higher in males compared to female TB patients (P=0.046). While after 2-months treatment, TNF-α (pg/ml) and IL-10 (pg/ml) was significantly higher in males compared with females (P=0.008 and 0.045 respectively). Conversely, the median IL-6 (pg/ml) was significantly higher in female TB patients compared to the males (P=0.042). No significant differences were observed after 6-months treatment.

Conclusion: Gender differences exist in IL-6 before treatment and in IL-6, TNF-α and IL-10 at two months treatment. Thus, TB treatment contributes differentially to levels of inflammatory cytokines in male and female TB patients.

Keywords: Tuberculosis; anti-tuberculosis drugs; cytokines; inflammation.

Assessment of risk factors associated with multi-drug resistant tuberculosis (MDR-TB) in Gulu regional referral hospital

Kizito Omona — 2023-10-11

Background: Multi-drug resistant tuberculosis (MDR-TB) is increasingly recognized as emerging infectious disease of public
health concern. Globally, 206030 people were diagnosed with MDR-TB in 2019, representing a 10% increase from 186883people
who had it in 2018. In Uganda, the prevalence of MDR among new TB cases is 4.4% and 17.7% among previously treated
TB cases.

Aim: To determine the risk factors associated with MDR-TB among tuberculosis patients in Gulu regional referral hospital.

Material and Methods: A cross-sectional analytical study using both quantitative and qualitative methods of data collection
and analysis was used. Data was collected from 384 TB patients using data extraction form and 6 Key informant interviews
conducted. Analysis using Pearson chi-square test was run.

Results: HIV positive patients were 2.6 times more likely to be infected with MDR-TB than HIV negative patients [AOR=2.6:
95% CI 1.34– 5.85: P=0.006]. Previously treated TB patients were 2.8 times more likely to be infected with MDR-TB than newly
diagnosed TB patients [AOR=2.8: 95% CI 1.33– 5.85: P=0.006]. Defaulting TB patients were 3.1 times more likely to be infected
with MDR-TB than the non-defaulting TB patients [AOR=3.1]

Conclusion: There is high prevalence of drug resistance among patients attending TB treatment at the facility.

Keywords: MDR-TB; tuberculosis; HIV; Gulu Regional Referral Hospital.

Evaluation of socio-demographic profile and basic risk factors of tuberculosis patients in South 24 Parganas district of West Bengal, India: a hospital-based study

Sujay Kumar Bhunia — 2023-10-11

Aim: To study and analyse the socio-demographic profile and basic risk factors of tuberculosis(TB) patients and their relation
with the current epidemiological status of TB registered under the RNTEP program in the study area.

Subjects and Methods: This prospective study was conducted on 1743 newly registered tuberculosis patients at TB-DOT center
of South 24 Parganas, West Bengal, India from 2011-2014. Socio-demographic variables and baseline characteristics of the
participants were noted by a semi-structured questionnaire.

Results: Our study results indicate that more than 95% of the TB patients were from lower socioeconomic class, and had
poor literacy status and tuberculosis was observed highest in non-agricultural labour and cultivators. Among the young adult’s
majority of the affected population were females from the lower/upper-lower socioeconomic class. Our analysis revealed that,
in successful tuberculosis therapy, men were more defaulters than women.

Conclusion: Our study provides a socioeconomic profile and the risk factors of tuberculosis in patients such as the status of
therapeutic intervention, involvement of other chronic diseases, age, sex and malnutrition. The findings of this study can be
used to plan future studies with specific risk factors of the region and also for implementing the intervention and evaluating its
effectiveness.
Keywords: Mycobacterium tuberculosis; socio-demographic factors; multi-drug resistance; pulmonary tuberculosis; extra-pulmonary
tuberculosis.

Epidemiological features of tuberculosis in the Middle East and North Africa from 1990 to 2019: results from the global burden of disease Study 2019

Mehdi Moradinazar — 2023-10-11

Introduction: Tuberculosis (TB) is a preventable and curable disease, although, it still causes more than one million deaths annually. Therefore, the aim of this study was to measure the epidemiological status and the burden of TB in the Middle East and North Africa (MENA) countries.

Methods: The study population included 21 countries in the MENA region, covering a population of about 400 million. The Global Burden of Disease (GBD) 2019 database was used. The case definition comprises all forms of TB, containing pulmonary and extra pulmonary TB, which are bacteriologically approved or clinically diagnosed. The prevalence, incidence, death, and the disability-adjusted life years (DALYs) rates per 100,000 people for all national locations by standardized age rates (ASR) were measured.

Results: In 2019, Afghanistan had the highest TB-related incidence 85.09 (95% UI, 73.69_98.46), death 21.91 (95% UI, 13.44_29.78), and DALYs rate 695.21 (95% UI, 454.34_939.49). The highest prevalence rates of TB were in Egypt 28935.42 (95% UI, 26125.54_32251.01). The highest TB-related DALYs rate was attributed to alcohol use, high fasting plasma glucose, and smoking were related to Tunisia, Qatar, and Lebanon, respectively. Between 1990 and 2019, TB- related incidence, prevalence, death, and DALYs rate have decreased by 53%, 42.19%, 76.20%, and 75.95% in MENA region, respectively.

Conclusion: TB has continued to decrease in prevalence, incidence, death, and DALYs rates in the MENA region, although, nowadays with the COVID-19 pandemic, societies may face more challenges for TB prevention, detection, treatment, and rehabilitation.

Keywords: Tuberculosis; disability; burden of disease; DALY; MENA.

The effect of the Covid-19 pandemic on Tuberculosis (TB) case notification in Ogun State, Nigeria

Olusoji J Daniel — 2023-10-11

Introduction: COVID-19 pandemic has resulted in disruptions in delivery of Tuberculosis services especially, in resource-limited settings. Provisional data by the WHO from 84 countries indicates that about 1.4 million fewer people received care for tuberculosis in 2020 than in 2019. This study assessed the effect of COVID-19 pandemic on tuberculosis case notification rates in Ogun state, Nigeria

Methods: A retrospective review of presumptive TB and diagnosed TB cases that were notified in 2019 and 2020. Analysis was done using Epi-info version 7.2.3.1. Level of statistical significance was p < 0.05

Results: A total of 3102 and 3326 confirmed cases were reported in 2019 and 2020 respectively with an increase of 7.2%. There was significant decline in total number of cases notified in Q2, 2020 compared to 2019 (p=0.001) with a significant increase in proportion of TB cases notified by private facilities from 11.65% in 2019 to 20.27% in 2020.

Conclusion: Total TB cases notified in Ogun state increased during the covid-19 pandemic. There was significant decline in TB cases during the lockdown but an increase in proportion of TB cases notified by private facilities demonstrating that private facilities can withstand disruptions to TB case notifications due to the Covid-19 pandemic.

Keywords: Tuberculosis; COVID-19; case notification; private-public mix; private sector.

Comparative genomics of spike, envelope, and nucleocapsid protein of severe acute respiratory syndrome coronavirus 2

Sufyan Sohail Khan — 2023-10-11

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) upsurge sprang up in Wuhan, China, in late December 2019.

Objectives: Due to the exceptionally high mutation frequency, comparative genomics of viruses isolated throughout time and in various geographical locations are crucial. To better understand how SARS-CoV-2 heterogeneity has changed around the globe, this research was conducted.

Methods: Nucleotide and protein sequences of SARS-CoV-2, SARS-CoV, and bat SARS-like CoV were extracted from the NCBI Virus database. The Wuhan SARS-CoV-2 variant was used as a reference. Molecular Evolutionary Genetics Study performed the phylogenetic analysis, while the Genome Detective Coronavirus Typing Tool performed the mutational analysis.

Results: The evolutionary research has revealed that bats are the primary host for coronavirus evolution and the origin of the formation of SARS-CoV and SARS-CoV-2. Numerous mutations have been discovered in the spike, envelope, and nucleocapsid protein.

Conclusions: The current research findings may have an implication that facilitates the development of prospective immunization candidates/small pharmacological compounds targeting COVID-19.

Keywords: SARS-CoV-2; COVID-19; pandemic; comparative genomics; spike protein; envelope protein; nucleocapsid protein.

Neutralising antibodies against SARS-CoV-2 give important information on Covid-19 epidemic evolution in Rabat, Morocco, March 2020-February 2021

Nadia Touil — 2023-10-11

Background: The SARS-CoV-2 is an extremely contagious and acute viral disease mainly affecting humans.

Objective: To estimate seroprevalence of SARS-CoV-2 neutralizing antibodies (NAbs) for illegible armed force individuals living in Rabat, Morocco

Method: A convenience sample (N = 2662) was conducted from May 2020 to February 2021. We used the standard neutralization assay to quantify the NAbs titers. A serum was positive when the titer was 1:4. High positive NAbs titers were defined when ≥ 1:32.

Results: Demographic and socioeconomic status did not affect seroprevalence data. An overall seroprevalence of 24,9% was found. Sera from blood donors, young recruits and auto-immune population had lower NAbs titers. However, titers were above 1:16 in 9% of the population with high risk of SARS-CoV-2 exposure. Seropositivity increased over time with values reaching peaks after the epidemic waves (2.4% in May 2020; 16.2% in August 2020; 22.7% in December 2020 and 37% in February 2021).

Conclusion: And increase of NAbs was observed over time and correlated with the post-epidemic waves of COVID-19 in Morocco.

Keywords: SARS-CoV-2; Serum neutralizing assay; Seroprevalence; Rabat; Morocco.

The practice of using repurposed medications as chemoprophylaxis for COVID-19 by healthcare workers in a tertiary hospital in Southern Nigeria

Sylvanus B Udoette — 2023-10-11

Background: Coronavirus disease 2019 (COVID-19) is a viral infection that has been reported in virtually every country. Healthcare workers (HCW) are more at risk of COVID-19 than the general population making them a priority group for vaccination. Before the roll out of COVID-19 vaccines in Nigeria, some HCW were using some repurposed, unapproved drugs to possibly prevent the disease. This study evaluated the frequency and pattern of drug use for COVID-19 prevention.

Methods: This was a prospective cross-sectional study of HCW conducted in Southern Nigeria. Data was obtained from the participants using a questionnaire and blood sample was obtained for SARS-CoV-2 antibody testing. Data was analysed using the statistical package for social sciences (SPSS) version 23.

Results: One hundred and sixty-six participants were enrolled in this study. Thirty-two (19.3%) of them had taken a repurposed medication as prophylaxis for COVID-19. The most used drugs were Vitamin C (9%), Azithromycin (8.4%) and Zinc (6.6%). History of contact with patient with confirmed COVID-19 and being a pharmacist were independent factors associated with the use of COVID-19 prophylaxis.

Conclusion: Several HCW in Nigeria take drugs to possibly prevent COVID-19. These medications may not offer significant protection against COVID-19. There is an urgent need to increase uptake of COVID-19 vaccines in HCW in Nigeria.

Keywords: COVID-19; Chemoprophylaxis; Healthcare workers.

Covid-19 and non-communicable diseases (NCDs) in Africa: a narrative review

Yusuff Azeez Olanrewaju — 2023-10-11

Coronavirus disease 2019 popularly known as COVID-19 is the current pandemic ravaging the world. It has disrupted so many aspects of humans’ life including the healthcare systems of all countries. While governments have instituted preventive measures such as social distancing, self-isolation and lockdown in a bid to control the spread of the virus, the absence of vaccine can lead to poor management of key risk factors (including unhealthy diets and physical inactivity) associated with NCDs and limited access to preventive health services can further contribute to development and progression of NCDs. This study provides a review of available evidences from PubMed, google scholar, online databases, and papers from other sources on the impact of COVID-19 pandemic on NCDs in Africa and emphasizes lessons from past pandemics that can be adopted to reduce the burden of the disease.

Keywords: COVID-19; Pandemics; Africa; Non-Communicable Diseases.

Impacts of Covid-19 & black fungus on diabetes patients in India

Anchana P Belmon — 2023-10-11

The Novel coronavirus disease Covid-19 is a highly acute respiratory, viral pathogenic and pandemic disease caused by the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus which leads to a heavy loss of mankind worldwide. The origin of the virus is not well known as it confirms the transfer of disease from person to person. As the disease is a novel clinical trial of antiviral drugs only seems to be better for emergency pathogenic Covid-19 impacts. The after all effect of Covid-19 results severely elevated glucose levels causing Diabetes Mellitus. The various symptoms of black fungus also report a heavy impact on diabetic patients. The analysis of Covid-19, mucormycosis and Covid vaccines with respect to diabetes is described in the paper.

Keywords: Diabetes mellitus; diabetes complications; diabetic patient.

Impacts of the Covid-19 pandemic on smoking cessation success

Pakize Ayşe Turan — 2023-10-11

Setting-objective: Current COVID-19 outbreak has led to many behavioural changes, including smoking behaviours. We aimed to investigate the success of quitting smoking of smoking cessation outpatients.

Design: Patients who applied to the smoking cessation outpatient clinic of a state hospital during the pandemic were retrospectively analysed. Smoking cessation success, personal views and experiences about COVID-19 were questioned. Hospital Anxiety and Depression (HAD) Scale was applied.

Results: The smoking cessation rate in the study population was 14.7%. The reasons for not being able to quit smoking were; stress (51.9%), drug discontinuation (28.4%) and reasons related to COVID-19 (12.3%). According to HADS scores; 35.8% of the participants were at risk for anxiety and 72.6% for depression. Those with pulmonary symptoms at the time of application (p=0.001), those who continued smoking cessation treatment (p=0.016), and those without depressive symptoms (p=0.040) were significantly more successful in quitting smoking. The rate of continuing smoking was significantly higher in patients with a history of COVID-19 <18.9% of participants>(p=0.013).

Conclusion: Intense stress and depressive symptoms, discontinuation of smoking cessation treatment and being infected with Coronavirus negatively affect the smoking cessation process in pandemic. These parameters should be considered during smoking cessation interviews and behavioural support should be obtained if necessary.

Keywords: Smoking; cessation; pandemics.

Comparison of knowledge, perception and willingness to receive covid-19 vaccines among tertiary students in Osun State, Nigeria

Wale Adeyemi Johnson — 2023-10-11

Background: Vaccination remains a potent way to curb the present covid-19 global pandemic.

Objectives: To assess knowledge, perception and willingness to receive covid-19 vaccines among tertiary students in Nigeria.

Methods: In the descriptive cross-sectional study, a sample size of 750 respondents was randomly selected from a university, polytechnic and college of education (COE) in Osun State, Nigeria. Independent sample T and Pearson correlation tests were used to analyse the responses.

Results: There was a significant increase in the percentage score of poor perception, relative to good perception among the university and polytechnic respondents. Among the COE respondents, significant increases in the percentage scores of poor knowledge, perception and willingness to receive covid-19 vaccines, relative to the good variables were observed. Weak positive correlations between knowledge and willingness & perception and willingness to receive covid-19 vaccines among all the respondents were noted. In addition, there was a significant increase in good perception to covid-19 vaccines among university and COE, relative to polytechnic respondents. Asides, a significant increase in good willingness to receive covid-19 vaccines was observed among the university, compared to COE respondents.

Conclusion: There is poor knowledge, perception and willingness to receive covid-19 vaccines among tertiary students in Osun State, Nigeria.

Keywords: Covid-19 vaccines; knowledge; perception; tertiary students; willingness.

Clinical value of CVP+VIVC in predicting fluid resuscitation in patients with septic shock

Haitao Zhang — 2023-10-11

Objective: To explore the clinical value of central venous pressure (CVP) + inferior vena cava respiratory variability (VIVC) in fluid resuscitation in spontaneously breathing patients with septic shock.

Methods: In retrospective observational study, during October 2019 to December 2021, 145 patients with septic shock treated in our hospital were enrolled by the method of observational study. According to the change rate of cardiac output (△ CO) ≥15% or △ CO<15% after 30 minutes, they were assigned into volume-responsive and volume-unresponsive group depending early fluid resuscitation in sepsis. The clinical value of combination of CVP and VIVC in predicting fluid resuscitation in patients with septic shock was compared.

Results: The CVP of the study group was higher at 12h and 24h after fluid resuscitation, and the VIVC level of the study group at 6h, 12h and 24h after fluid resuscitation was higher (P<0.05). Pearson correlation analysis indicated that CVP, and VIVC levels were noticeably correlated with fluid resuscitation in patients with septic shock (P<0.05). The area under curve (AUC) of receiver operating characteristic curve (ROC) of CVP for predicting fluid resuscitation in septic shock patients was 0.694 and the cut-off value was 0.932, the sensitivity was 46.9%, and the specificity was 87.5%. VIVC predicted fluid resuscitation in septic shock patients with an AUC of 0.776, which was a cut-off value of 0.688, a sensitivity of 50.0%, and a specificity of 90.0%. Combination of CVP and VIVC predicted fluid resuscitation in septic shock patients with an AUC of 0.948, which was a cut-off value of 1.420, a sensitivity of 90.6%, and a specificity of 87.5%.

Conclusion: Combination of CVP and VIVC may have a good effect on the evaluation of volume responsiveness in patients with septic shock, which is better than single CVP and VIVC. Combination of CVP and VIVC can be adopted to predict fluid responsiveness volume responsiveness in septic shock patients, which is of great significance for guiding clinical fluid responsiveness therapy.

Keywords: Septic shock; fluid resuscitation; CVP; VIVC.

Correlations of intestinal microorganisms with liver and immune functions of patients with human immunodeficiency virus and hepatitis B virus coinfection

Yong Deng — 2023-10-11

Objective: Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) coinfection has threatened the survival of
HIV-infected people. To explore the correlations of intestinal microorganisms with liver and immune functions of patients with
HIV/HBV coinfection.

Methods: Eighty-six patients positive for HIV antibody and HBV surface antigen diagnosed from January 2018 to June 2020
were selected as HIV/HBV coinfection group. Another 86 patients positive for HBV surface antigen and 86 healthy people were
selected as HBV infection and control groups, respectively. The correlations of intestinal flora with liver function, inflammatory
indices and immune cells were explored through Pearson’s analysis.

Results: Compared with control group, the proportions and numbers of T lymphocytes (CD3+), helper T lymphocytes (CD4+),
cytotoxic T lymphocytes (CD8+), CD4+/CD8+ and natural killer (NK) cells decreased in HIV/HBV coinfection group (P<0.05).
IL-2, IL-6, IL-17, ALT, AST, GGT, DBiL and TDBi levels were correlated negatively with Bifidobacterium, Lactobacillus and Bacteroides
numbers, but positively with Enterobacter and Enterococcus numbers (P<0.05). IL-10 level and proportions of CD3+, CD4+,
CD8+, CD4+/CD8+ and NK cells were correlated positively with Bifidobacterium, Lactobacillus and Bacteroides numbers, but negatively
with Enterobacter and Enterococcus numbers (P<0.05).

Conclusion: HIV aggravates the liver damage and immuno-inflammatory response in HBV patients.

Keywords: Intestinal flora; liver function; inflammatory factor; immune; human immunodeficiency virus; hepatitis B virus.

A retrospective study on side effects of first-line antiretroviral drugs on HIV patients based on 1A, 2A, and 5A regimen records at Zomba Central Hospital, Malawi

Ruth Sindie — 2023-10-11

AIDS is an incurable disease that is common in Africa. Patients with HIV/AIDS having a CD4 count of less than 240 are put on life prolonging ARV drugs. The ARVs have serious side effects on some patients which may be handled by treating them or switching patient’s drug to one with no or less serious side effects. However, before doing this, more understanding of the circumstances that lead to a side effect is vital. We use statistical analyses to link side effects of 1A, 2A, and 5A treatment regimens to the patient’s social and demographic characteristics based on hospital data records. A retrospective review of patients’ master cards (2011-2014) was done to assess adverse effects associated with different ARV regimens. Out of the 901 patients that showed side effects, 65.37% were females aged 31-40 and 34.63% were males. Comparatively, 1A regimen showed more side effects than 2A and 5A regimens. Age, gender and occupation correlated significantly with regimen symptoms (p< 0.05). Unlike men, women had the following extra side effects; cough, peripheral neuropathy and leg pains as compared to lipodystrophy. Our results show that old people (50years+) are less likely to get skin rash and other symptoms compared to lipodystrophy (RRR=0.973). Further, the probability of either having cough (0.0021, p< 0.05), or skin rash (0.0021, p< 0.05), as a side effect, on average, decreases as age increases with the same sex and weight. The probability of having peripheral neuropathy (0.0042, p< 0.01), however, increases with age. Knowledge of HIV patient’s socio-demographics and the patient’s regimen side effects can be utilised to appropriately manage severe ARV side effects. A therapy consideration that takes into account chemicals in ARV regimen responsible for specific side effects can be directed to patients with compatible socio-demographic characteristics.

Keywords: HIV/AIDS; ARV regimens; symptoms; side effects; socio-demographics; multinomial logistic regression.

Treatment of tibial traumatic osteomyelitis with negative pressure closure drainage combined with open bone grafting or bone migration and its effect on the levels of CRP, TNF-α and IL-6 in the serum

Xinqiang Wang — 2023-10-11

Objective: To observe the effect of negative pressure closure drainage combined with open bone grafting or bone migration in
the treatment of tibial traumatic osteomyelitis.

Methods: Eighty-six (86) cases of tibial traumatic osteomyelitis admitted to Hospital of the Chinese people's Liberation Army
from September 2017 to September 2018 were randomly divided into control group and observation group, forty-three (43)
cases each. Debridement, open bone grafting or bone migration was given to the control group.
The observation group was treated with negative pressure closed drainage on the basis of the control group. In addition, the serum
components such as CRP, TNF-α, IL-6 of the control group and observation group were detected respectively after surgery.

Results: Observation group granulation cover wound, fracture healing time was shorter than the control group, fracture healing
rate was better than the control group, the difference has statistical significance (P<0.05). By comparing serum CRP, TNF-α,
IL-6 levels before and after treatment in the two groups, it was found that the observation group was lower than the control
group (P<0.05, respectively). Serum CRP, TNF-α, IL-6 levels were significantly (P<0.05).

Conclusion: The treatment of tibial traumatic osteomyelitis with negative pressure closure drainage combined with open bone
grafting or bone displacement has a good effect on fracture healing and is worth popularizing.

Keywords: Bone removal; CRP; IL-6; Negative pressure closure drainage; Tibia; TNF-α; Traumatic osteomyelitis.

Relationship between antimicrobial resistance and virulence factors in uropathogenic Escherichia coli isolates from Ramadi, Iraq: phenotype and genotype identification

Ahmed Dhahir Abed — 2023-10-11

Background: Uropathogenic Escherichia coli (UPEC) is the most predominant pathogen that causes severe urinary tract infections (UTIs). Their therapeutic options are limited due to the rising of antibiotic resistance.

Objective: The aim of the study was to evaluate the level of antibiotic resistance profile, redundancy of virulence genes, and their correlation.

Methods: 41 UPEC isolates were collected from patients diagnosed with UTI, identified by the standard microbiological analysis, and tested for susceptibility to 12 antibiotic agents using the Kirby-Bauer method. The ability of UPEC isolates to produce biofilm, hemolyze and cause clumping of blood was determined. Virulence genes were detected by PCR analysis.

Results: The percentage of UPEC isolates was higher in females (78.1%) than in males (21.9%). UPEC isolates showed a high degree of resistance towards Ceftriaxone (90.2%), Cefepime (90.2%), Ciprofloxacin (82.9%), Levofloxacin (82.9%), and Trimethoprim-Sulfamethoxazole (80.4%). Biofilm formation (87.8%) and hemagglutinin activity (80.4%) were the most predominant virulence markers expressed in UPEC and showed a high degree of correlation with the antibiotic resistance profile. PCR analysis showed that fimH (85.3%) was the most prevalent gene detected in UPEC isolates, followed by aac3-II (80.4%) among the five genes tested, bla_TEM, aac3-II, sul2, hlyA, and fimH. The correlation between antibiotic resistant patterns and the presence aac3-II gene was significantly high. The resistance to the sulfonamides’ combined antibiotic was highly correlated with the presence of sulf2 gene.

Conclusion: Antimicrobial resistance was significantly linked to phenotypic and genotypic virulence factors. These results will aid in elucidating the pathogenicity of UTIs and guiding treatment decisions.

Keywords: UPEC resistance profile; virulence factor; Biofilm formation; hemagglutinin; hemolysin.

Molecular characterization of multidrug resistant (MDR) clinical isolates of Pseudomonas aeruginosa from Nsukka, South Eastern Nigeria

Martina C Agbo — 2023-10-11

Background: P. aeruginosa is an important nosocomial pathogen with increasing resistance to antibiotics. Objective: This study
was performed to evaluate the genetic relatedness of MDR clinical isolates of P. aeruginosa.

Method: A total of 1000 samples were analysed in the study. Antibiotic resistance profiles of the isolates were determined using
Kirby Bauer disk diffusion method. Polymerase chain reaction (PCR) and sequencing were simultaneously used to detect the
consensus region of 16S rRNA. Genetic relatedness of the isolates was determined using restriction patterns from ALU 1 digest
and random amplified polymorphic DNA.

Results: Out of the 192 P. aeruginosa isolates recovered, 136 (78.83%) were multidrug resistant. Sequence analysis of the confirmed
isolates (80.68%) revealed that all the isolates shared homology with each other and also showed sequence similarity to
known strains of P. aeruginosa (ATCC 27853; KT 315654; KU 321274 and KT894767). The PCR-Restriction fragment length
polymorphism (PCR-RFLP) analysis revealed that there was a lot of genetic relatedness among the isolates. The RFLP finger
printing technique detected seven distinct RFLP types among the isolates.

Conclusions: Thus, study shows that there is high prevalence of MDRPA and high degree of genetic relatedness among the
MDRPA isolates circulating in Nsukka area.

Keywords: MDRPA; PCR-RFLP; RAPD; Sequencing; 16S rRNA gene.

The occurrence of fungi from burn wound patients and antifungal susceptibility patterns: a cross-sectional study in Lusaka, Zambia

Kapembwa Sikwewa — 2023-10-11

Background: Fungal opportunistic infections in burn wound patients are among the leading cause of morbidity and mortality.
Attention remains focused on preventing bacterial infection at the expense of increasing fungal infection in burn wound patients.

Objective: To determine the occurrence of common fungi in admitted burn wound patients and their environment: and their
antifungal susceptibility patterns at the University Teaching Hospitals, Lusaka, Zambia.

Methods: This laboratory-based cross-sectional study enrolled a total 101 participants whose pus swab specimens were collected
from their burn wounds as well as 50 environmental swabs collected from strategic points. Wet mount, gram stain, culture on
Sabouraud dextrose agar, Corn meal agar and Germ tube were used to identify possible fungal isolates. Agar based disc susceptibility
test was carried out using fluconazole. Data was analysed using Excel and STAT version 14.

Results: Median age was 3 years and median burn % of TBSA was 18 in participants’ who had burn wound fungal infection
and consisted of 3 males and 6 females. Organisms isolated included Candida albicans from 8(7.9%) participants and 2(4%) from
50 environmental swabs. 1(1%) Candida spp was isolated from pus swabs. Out of the total 11 Candida isolates, 4 (36.4%) were
susceptible to fluconazole and 7 (63.6%) were resistant.

Conclusion: The isolation of Candida albicans and Candida spp from burn wound patients and the hospital ward environment
suggests presence of fungi in burn wound patients and hospital ward environments. Candida isolated showed varying susceptibility
patterns to fluconazole.

Keywords: Burns; Candida albicans; CLSI; fungal infection; Susceptibility patterns.

Comparison of the effects of different blood conservation techniques in elderly patients undergoing total hip arthroplasty

Yuanxing Cai — 2023-10-11

Background: To probe into the influences of different blood conservation techniques on the postoperative coagulation function and prognosis of elderly patients receiving Total Hip Arthroplasty (THA).

Methodology: A total of 60 patients were randomly divided into Autologous Blood Transfusion (ABT) group (n=30) and ANH group (n=30). For patients in the ABT group, an autologous blood recovery machine was used to recover, wash and filter the surgical field blood. For those in the Acute Isovolumic Hemodilution (ANH) group, blood was collected preoperatively from the central vein and stored in a citrate anticoagulant blood storage bag, while the same amount of hydroxyethyl starch was injected into the peripheral vein to dilute the blood. After Mai bleeding steps of the operation were completed, the autologous blood of patients was transfused back in both groups. The clinical indicators of patients in each group were observed.

Results: 48 h after operation, the ANH group obtained a higher level of hemoglobin (Hb), shorter Activated Partial Thromboplastin Time (APTT), and a lower expression rate of platelet activating factor CD62P than the ABT group.

Conclusion: The ANH group exhibits higher content of hemoglobin and fewer platelet (Plt)activating factors produced than the ABT group, while no significant difference in the shortened length of hospital stays is found.

Keywords: Hip arthroplasty; blood transfusion; autologous; hemodilution; transfusion of red blood cells; platelet activating factors.

Quality of life of patients with traumatic spinal cord injuries: a cross-sectional study at a tertiary hospital in Uganda

Rogers Mugisa — 2023-10-11

Background: The study aimed to assess the perceived quality of life of patients with traumatic spinal cord injuries.

Methodology: This was a cross sectional study conducted in the Spine Unit of a tertiary hospital in Uganda. The study population comprised of patients with spinal cord injuries. Data were collected using the WHO Quality of Life Brief questionnaire and Functional Independence Measure tool.

Results: 103 patients participated in the study, most were male (73.8%), and had a mean age of 37.7 years. Most participants were married (57.3%), unemployed (72.8%) and had no steady source of income (62.1%). Road traffic accidents accounted for most injuries (59.2%). The mean duration since injury was 20.5 months. Most participants (58.3%) had incomplete spinal cord injuries and 84.5% had complications. The perceived overall quality of life was poor in 87.4% of patients. Being employed (p= 0.02), the presence of complications (p= 0.03), and injury severity (p= 0.003) significantly affected quality of life. Functional independent measure scores were significantly better in individuals less severe injuries and those with lumbar level of injury with mean scores of 113.1±8.9 and 99.9±15.3 respectively.

Conclusion: The overall self-reported quality of life among patients with traumatic spinal cord injury was generally poor.

Keywords: Quality of life; traumatic injury; spinal cord.

Efficacy of arthroscopic internal fixation with countersunk screw in the treatment of talus fracture

Bo Sun — 2023-10-11

Objective: To explore clinical effects of arthroscopic internal fixation with countersunk screw in the treatment of talus fracture.

Methods: Forty-eight patients with talus fracture treated in hospital of Chengde Medical University from February 2015 to December 2019 were enrolled for present investigation. The patients with talus fracture were randomly assigned into two groups, with twenty-four patients per group. The patients with talus fracture in the observation group were treated with arthroscopic internal fixation with countersunk screw, while the traditional open reduction and internal fixation were applied for the ones in control group. The clinical efficacy of the patients was evaluated three months after the operation, and the preoperative and postoperative ankle joint functions, fracture-healing time, hospital stay, and complications were carefully compared between observation and control group.

Results: A total efficiency as high as 91.67% was showed in observation group, which is distinctly better than the effective rate of control group (66.67%, P<0.05). Before operation, ankle function scores (AOFAS) of control group and observation group is 42.08 ± 4.29 and 41.75±5.31 with no significantly difference (P>0.05); while after the surgery, AOFAS scores of control group is significantly lower than that of observation group: (66.28±7.51 vs. 53.0 ±6.79, P<0.05). Moreover, healing time and hospitalized duration of observation group are 3.19±1.04 months and 3.57±0.97 days, which are also significantly shorter than 4.18±1.25 months and 8.28±2.54 days in control group, respectively, (P < 0.05). And the total complication rate in control group is 20.83%, which is higher than 8.33% in observation group (P >0.05).

Conclusion: Arthroscopic internal fixation with countersunk screw can significantly improve the efficacy and ankle joint functions, shorten the fracture-healing time and hospital stays without increasing the incidence of complications.

Keywords: Arthroscopy; countersunk screw; curative effect; internal fixation; talar fracture.

Preoperative bowel preparation promotes intestinal functional recovery after esophagectomy

Junliang Ma — 2023-10-11

Background: Patients are prone to intestinal dysfunction after esophagectomy. The value of preoperative bowel preparation before esophagectomy is controversial. There is a lack of evidence as to whether preoperative bowel preparation can help patients improve bowel function and shorten the recovery time of bowel function.

Objectives: The objectives of this study were to explore whether preoperative bowel preparation can promote the recovery of intestinal function after esophagectomy.

Methods: We analysed 139 patients who underwent elective radical esophagectomy in the Department of Thoracic Surgery at the Second Affiliated Hospital of Xi'an Jiaotong University from May 2016 to December 2018. The enrolled patients were divided into the study group (bowel preparation group) and the control group (no bowel preparation group) of 71 cases and 68 cases. Patients in the study group were given dissolved polyethylene glycol electrolyte powder and a cleansing enema the day before surgery. Patients in the control group were neither given polyethylene glycol electrolyte powder nor cleansing enemas before surgery. The postoperative recovery of the two groups were compared.

Results: Postoperative bed rest time, bowel function recovery time and the time of first flatus and defecation after surgery were significantly shorter in patients with bowel preparation than in those without bowel preparation, and the differences were statistically significant. (P=0.038, P﹤0.001, P﹤0.001, P﹤0.001; respectively).

Conclusions: Preoperative bowel preparation can promote the recovery of patients with esophageal cancer, especially the recovery of bowel function, which can reduce the pain caused by abdominal distension and improve the quality of life of patients.

Keywords: Intestinal dysfunction; esophagectomy; retrospective cohort study.

Application value of high-frequency ultrasound combined with ultrasonography in the diagnosis of neonatal esophageal atresia

Yurong Ge — 2023-10-11

Objective: To explore the application value of high-frequency ultrasound combined with ultrasonography in the diagnosis of neonatal esophageal atresia (EA)

Methods: Seventy neonates with suspected EA who received healing in our hospital from August 2019 to April 2022 were retrospectively selected as the study subjects and their preoperative esophageal high-frequency ultrasound and ultrasound hydrography data were analysed. The diagnostic value of high-frequency ultrasound, ultrasound hydrography and combined detection in neonatal EA was analysed using intraoperative findings as the gold standard;

Results: (1) Among the 70 children with suspected EA, 62 were confirmed to be positive and 8 were negative; 59 were positive and 11 were negative by ultrasound hydrography alone; 61 were positive and 9 were negative by high-frequency ultrasound alone; 62 were positive and 8 were negative by combined detection.
(2) The accuracy of combined detection was 97.14%, which was notably different from 92.86% by high-frequency ultrasound and 84.29% by ultrasound hydrography (P < 0.05).
(3) The diagnostic AUC of ultrasound hydrography, high-frequency ultrasound, and combined detection for EA was 0.6125, 0.6500, and 0.6563, respectively (P < 0.05).
(4) There was no significant variation in the distance between preoperative high-frequency ultrasound, ultrasound hydrography, and intraoperative measurements of distal and proximal blind ends of type IIIA and IIIB EA esophagus (P > 0.05);

Conclusion: High frequency ultrasound and super fresh water injection angiography have good application value in the diagnosis of neonatal EA. There is no significant difference between the distance between the distal and proximal blind ends of the esophagus before and during the operation of type III EA and that during the operation of super fresh water injection angiography. However, in consideration of the risk of radiation and poisoning caused by esophagography, it is recommended that high-frequency ultrasound be selected first for diagnosis and if necessary, esophagography be supplemented for joint diagnosis.

Keywords: High frequency ultrasound; Ultrasound angiography; Neonatal esophageal atresia; Application value.

Clinical nursing application of parenteral nutrition combined with enteral nutrition support in neurosurgery

Meiying Huang — 2023-11-01

Background: To explore the clinical nursing effect of parenteral nutrition combined with enteral nutrition support in neurosurgery.

Methodology: 200 neurosurgical patients were randomly divided into two groups. The time of parenteral nutrition combined with enteral nutrition support in our hospital (January 2021) was used as the cut-off point, the PN group and the PN+EN group were divided according to the cut-off point. Nutritional status, immune status, occurrence of adverse events, prognosis-related indicators were compared between the two groups.

Results: Nutritional status and immune status at 7 days of nutritional support in the PN+EN group were higher than those in the PN group, The difference was statistically significant. The total incidence of adverse events in the PN+EN group (3.00%) was significantly lower than that in the PN group (11.00%), and the difference was statistically significant. The average ICU treatment time, average hospital stay and emerging infection rate in the PN+EN group were lower than those in the PN group, and the differences were statistically significant (P < 0.05).

Conclusion: Parenteral nutrition combined with enteral nutrition support in neurosurgery can achieve a more ideal intervention effect. It is beneficial to the prognosis of patients and has a certain value of promotion and application.

Keywords: Neurosurgery; parenteral nutrition support; enteral nutrition support; nursing effect.

Effects of interventional vascular embolization at different timing on prognosis and serum S100 calcium-binding protein B level of patients with aneurysmal subarachnoid hemorrhage

Peidong Yue — 2023-10-11

Objective: To evaluate the effects of interventional vascular embolization at different timing on the prognosis and serum S100
calcium-binding protein B (S100B) level of patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods: A total of 229 aSAH patients enrolled from January 2016 to January 2020 were divided into an early-stage group
(n=66), a middle-stage group (n=95) and a late-stage group (n=68. Their baseline data, serum indices and clinical outcomes were
compared. The factors affecting their prognosis were analysed. The value of serum S100B level for predicting the prognosis was
evaluated.

Results: The early-stage group had the highest GOS score, and the late-stage group had the lowest score (P<0.05). Older age,
large diameter of aneurysm, high Hunt-Hess grade upon admission, late surgical treatment and high S100B level were risk factors
for the poor prognosis of aSAH patients. The optimal cut-off value of S100B for predicting the prognosis was 2.785 μg/L.
The area under the receiver operator characteristic curve, sensitivity, specificity, Youden index and 95% confidence interval were
0.892, 84.3%, 86.3%, 0.706 and 0.844-0.940, respectively.

Conclusion: Early vascular interventional embolization is beneficial to the alleviation of brain injury and the reduction of serum
S100B level.

Keywords: Aneurysmal subarachnoid hemorrhage; interventional vascular embolization; prognosis; S100 calcium-binding protein
B; timing.

Effects of 0.15% ropivacaine alone and combination with sufentanil on epidural labor analgesia and adverse reactions

Huanhui Zhong — 2023-10-11

Objective: The aim of this study was to compare the impacts of 0.15% ropivacaine alone and 0.15% ropivacaine combined with
sufentanil on epidural labor analgesia.

Methods: A total of 297 eligible primiparae were randomly divided into group A (n=149, 0.15% ropivacaine + sufentanil) and
group B (n=148, 0.15% ropivacaine). Visual analogue scale (VAS) scores prior to analgesia and 20 min following epidural medication,
the maximum VAS score during labor, dosage of analgesic drugs, modified Bromage score, satisfaction degree, labor
duration, delivery mode, 1-min and 5-min Apgar scores of newborns, adverse reactions during analgesia, and fever during labor
were recorded.

Results: Group A and B had similar VAS scores 20 min following epidural medication and maximum score during labor
(P>0.05), which significantly fell compared with those before labor analgesia (P<0.05). The occurrence rates of nausea and
vomiting were of significant difference (P<0.05).

Conclusion: 0.15% ropivacaine alone achieves a comparable epidural labor analgesia effect to that of 0.15% ropivacaine + 0.05
μg/mL sufentanil on primiparae.

Keywords: Ropivacaine; sufentanil; epidural labor analgesia; adverse reaction.

Using a shortened uncuffed endotracheal tube as a nasopharyngeal airway: a useful adjunct during fiberoptic intubation training among anesthesia residents

Hosni A Salem — 2023-10-11

Background: Fiberoptic intubation (FOI) is considered a beneficial modality used to intubate life-threatening airway patients.
This study aims at assessing the effectiveness of shortened uncuffed endotracheal tube as a nasopharyngeal airway during FOI.

Methods: Between January 2019 and March 2021, this prospective randomized controlled trial has enrolled 62 adult patients
(56 males and 6 females) with normal airways scheduled for elective oral FOI classified American Society of Anesthesiologists
(ASA I-III), their age ranged 20-60 years. The patients were randomized into two equal groups (31 per each); in group I, FOI
was carried using lingual traction, and in group II, FOI was carried out with lingual traction plus a shortened uncuffed endotracheal
tube as a modified nasopharyngeal airway to maintain oxygenation. The time taken to successful tracheal intubation and
other technical parameters have been measured. The heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2),
end-tidal carbon dioxide (EtCO2), and any associated complications have been measured.

Results: During insertion of the scope, the SpO2 was significantly decreased in group I (92.55 ± 7.94) compared to group II
(97.42 ± 6.34), p=0.009. The heart rate, MAP, and EtCO2 were found to be insignificantly different in both groups (p>0.05).
The time needed for intubation in group I (2.78±0.98 min) was prolonged compared with group II (1.95±1.02 min) p =0.002.
The number of attempts was comparable in both groups, while the number of successful intubations from the 1st attempt was
12 (39%) compared to 18 (58%) in groups I and II respectively, p=0.36. The overall success rate by juniors was 71% in group I
compared to 84% in group II, p=0.66 with a lower incidence of using rescue oxygen and other facilitating maneuvers.

Conclusions: The modified nasopharyngeal airway is a useful modality to facilitate oral FOI by anesthesia resident trainees.

Keywords: Nasopharyngeal airway; Endotracheal tube; Training of FOI.

Risk factors of recurrent thyroid nodules after radiofrequency ablation

Yuke Xia — 2023-10-11

Objective: To investigate the risk factors of thyroid nodule recurrence after radiofrequency ablation (RFA).

Methods: The medical record information of 120 patients with thyroid nodules admitted to our hospital from June 2019 to April 2022 was retrospectively analysed. All participants received RFA treatment. According to the results of the postoperative thyroid ultrasound
examination (USG), the patients were divided into the recurrence group (R, N=16) and the non-recurrence group (NR,
N=104). Binary logistic regression analysis was performed to identify the independent risk factors of thyroid nodule recurrence
after RFA. The receiver operating characteristic (ROC) curve was used to analyse the value of the forecast of each independent
factor and combined model for thyroid nodule recurrence after RFA.

Results: During the follow-up period, 16 patients recurred, and the recurrence rate was 13.33%. Univariate regression analysis
showed that whether the nodules are solitary (WNS), nodule diameter (ND), the degree of risk of nodular location (DRN),
recurrent laryngeal nerve (RLN) injury were associated with thyroid nodule recurrence after RFA (P<0.05). Binary logistic
regression analysis showed that WNS, ND, DRN and RLN injury were independent risk factors for the recurrence of thyroid
nodules after RFA (P<0.05). ROC analysis of independent factors and combined model showed that solitary nodules, nodule
diameter and nodule location risk degree had diagnostic value, while RLN injury had no predictive value. The combined model
is more predictive than the independent factors.

Conclusions: The risk factors of recurrent thyroid nodules after radiofrequency ablation are related to WNS, ND, DRN and so on, which should be paid attention to and preventive measures should be taken.

Keywords: Thyroid nodules; radiofrequency ablation; recurrence; risk factors.

Values of serum neutrophil gelatinase-associated lipocalin and cystatin C after percutaneous coronary intervention for early diagnosis of contrast-induced nephropathy

Ping Luo — 2023-10-11

Objective: Serum creatinine (SCr) is not a sensitive and reliable index for the early diagnosis of acute kidney injury caused by
contrast-induced nephropathy (CIN). The aim of this study was to explore the values of serum neutrophil gelatinase-associated
lipocalin (NGAL) and cystatin C (Cys-C) after percutaneous coronary intervention (PCI) for the early diagnosis of CIN.

Methods: Three hundred patients receiving PCI from January 2018 to December 2020 were assigned to a CIN group (n=25)
and a non-CIN group (n=275), respectively. SCr, Cys-C and NGAL levels were measured, and their sensitivities for early CIN
diagnosis were evaluated by the area under the receiver operating characteristic curve (AUC) values.

Results: The NGAL and Cys-C levels of the CIN group began to rise 6 and 12 h after operation, respectively (P<0.05). The
CIN group had higher NGAL and Cys-C levels than those of the non-CIN group 12, 24 and 48 h after operation (P<0.05). The
AUC values of NGAL, Cys-C and SCr 24 h after operation were 0.885, 0.874 and 0.856, respectively.

Conclusion: The serum NGAL and Cys-C levels of patients after PCI reflect the early changes of renal function, which are
valuable for early CIN diagnosis.

Keywords: Contrast; cystatin C; nephropathy; neutrophil gelatinase-associated lipocalin; percutaneous coronary intervention.

A feasibility study of 70 kV double low-dose coronary imaging technique in abdomen-fatty patients using dual-source CT

Lei Chen — 2023-10-11

Objective: To investigate the aplication of low contrast agent concentration and low tube voltage in coronary CTA on patients
with high BMI (26kg/m2<BMI≤28kg/m2) and ultra-high BMI (BMI>28kg/m2).

Methods: 60 patients with high BMI (26kg/m2<BMI≤28kg/m2) and 60 patients with ultra-high BMI (BMI>28kg/m2) were
randomly divided into two groups: double low group A (n=30, tube voltage = 70 KV), double low group B (n=30, tube voltage
= 70 KV), processed by SAFIRE iterative reconstruction with 270 mgI/ml contrast agent. Conventional group a (n=30, tube
voltage = 120 KV), conventional group b (n=30, tube voltage = 120 KV), with filtered back projection (FBP) and 370 mg I/ml
contrast agent. the image excellent index (FOM), the effective radiation dose (ED), mean CT value, signal-to-noise ratio (SNR),
and contrast-to-noise ratio(CNR) between corresponding groups were compared.

Result: There was no significant difference in subjective scores of coronary artery image quality between the two high BMI
subgroups (P>0.05).The ED of group A (1.103±0.101 mSv) was significantly lower than that of group a (4.663±0.412 mSv)
(P<0.001).There was no significant difference in mean CT value, SNR and CNR between the two subgroups (P>0.05).The image
excellent index (FOM) of group A was higher than that of group a (P<0.05).The total iodine content and iodine injection
rate in group A were lower than those in group a (P<0.001).The difference of subjective scores of coronary artery image quality
between the two ultra-high subgroups was significant. The mean CT value, SNR and CNR of group B were lower than those of
group b (P<0.05). The images of 14 patients in group B could not meet the diagnosis demand.

Conclusion: It is feasible to reduce the tube voltage to 70KV in patients with abdominal BMI with high BMI (26Kg/m2<BMI≤
28Kg/m2). For patients with abdominal obesity with ultra-high BMI (BMI>28Kg/m2), under the same conditions, the
70KV can not meet the daily diagnosis requirement.

Keywords: Radiation dose; tomography; coronary artery; iterative reconstruction; contrast agent; abdominal obesity.

The balance between CD4+ T helper 17 and T-cell immunoglobulin and mucin domain 3 is involved in the pathogenesis and development of atrial fibrillation

Wenjing Dai — 2023-10-11

Background: To investigate the expression of Th17, T lymphocyte immunoglobulin mucin 3 (TIM-3+) cells and their related
cytokines in atrial fibrillation (AF) and their clinical significance.

Methodology: A total of 90 patients with AF were divided into paroxysmal group (n=45) and chronic group (n=45), and 45
healthy volunteers were selected as the control group. The proportion of Th17 cells and Tim-3 + cells in the peripheral blood
were detected. The concentrations of related cytokines in peripheral blood serum were determined. The correlation between
Th17 / Tim-3+ cells and related cytokines was analysed.

Results: Compared with the control group, the proportion of Th17 cells and the concentration of related cytokines (IL-17, IL-6
and Matrix metalloproteinase (MMP9)) in peripheral blood of patients with paroxysmal and chronic AF increased significantly,
while the proportion of tim3 + cells and the concentration of related cytokines decreased significantly. Compared with the
paroxysmal group, the proportion of Th17 cells and the concentration of related cytokines in the peripheral blood of patients
in the chronic group increased significantly, while the proportion of tim3 + cells and the concentration of related cytokines
decreased significantly.

Conclusion: Th17 / Tim-3 + cell balance is involved in AF, and can be used as a target for AF treatment.

Keywords: Atrial fibrillation; Th17 cells; Tim-3; Cytokines; IL-17; Gal-9.

Outcome of preventive nursing intervention, prophylactic anticoagulation and the use of the Caprini score on venous thromboembolism after varicose vein surgery

Ting Zheng — 2023-10-11

Objective: This research was devoted to estimate the outcome of preventive nursing intervention on venous thromboembolism (VTE) after varicose vein surgery in lower extremities.

Methods: A total of 516 subjects with varicose veins of lower extremities (from January 2020 to January 2022) treated in our hospital were separated into observation subgroup (n = 258) and control subgroup (n = 258) at random. The conventional nursing intervention was applied in the control subgroup, preventive nursing intervention, prophylactic anticoagulation and the use of Caprini score was applied in the observation subgroup. The levels of blood indexes [hemoglobin (Hb), platelet (PLT) and D-dimer (D-D)] were compared between the two subgroups before operation and 7 days postoperative, the occurrence of subcutaneous congestion, lower limb swelling and pain, VTE and nursing satisfaction of the subject 4 (four) weeks after discharge.

Results: After intervention, the levels of PLT and D-D in the observation subgroup were notably lower than those in the control subgroup. Four weeks after discharge, the incidence of subcutaneous congestion, lower limb swelling and pain, there had no notable difference in two subgroups Versus the control subgroup, VTE in the observation subgroup was notably lower and nursing satisfaction was higher.

Conclusion: Preventive nursing intervention can reduce the level of PLT and D-D, restrain in the incidence of VTE and improve the nursing satisfaction of subjects with varicose veins of lower extremities after varicose vein surgery of lower limb.

Keywords: Varicose vein surgery; nursing intervention; Caprini score.

Correlation between protein expression profiling of inflammation and bone metabolism in rheumatoid arthritis patients

Jie Wang — 2023-10-11

Objective: In patients with rheumatoid arthritis (RA), osteoarthrosis significantly reduces self-perception. However, the intrinsic
relationship between bone metabolism and SPP and cell activity at the molecular level remains unclear. The purpose of this
study was to understand the relationship between RA bone metabolic indicators and immune inflammation-related proteins.

Methods: A total of 30 patients with RA and 30 healthy controls were recruited. Four bone metabolism measures and nine
proteins expression measures were collected from RA patients and healthy controls. Spearman Correlation Analysis and Logistic-
regression Analysis were adopted for associations between bone metabolism and proteins.

Results: We screened and verified 3 key proteins, namely interleukin-11 (IL-11), interleukin-17 (IL-17) and programmed cell
death-2 (PD-L2) related to immunity and inflammation through microarray analysis. Levels of IL-2, IL-5, IL-11, IL-17, CTLA4,
TNF-β were higher in RA patients than in the control group (P<0.05), meanwhile, the levels of IL-8, PD-L2, TNF-β and B7-2
were low in RA patients (P>0.05).The results of Spearman Correlation Test suggested that sharp score was positively correlated
with age, CCP was positively correlated with RF, SDS score was positively correlated with RF, IL-17 was positively correlated
with CCP, BGP was positively correlated with BALP, RANKL was positively correlated with BALP, VAS score was negatively
correlated with CRP, TCM score was negatively correlated with SF-36 score.

Conclusion: BALP, BGP, OPG, RANKL were strongly associated with immune inflammation-related proteins and poor SPP
in RA patients, which can be used to predict poor SPP in RA patients, although the underlying mechanisms need to be further
explored.
Keywords: Rheumatoid arthritis; bone destruction; self-perception of patient; protein expression profiling.

Non-specialized care of skin disorders: a cross-sectional survey of new patients attending dermatology clinic in a tertiary hospital in Jos, Northcentral Nigeria

Ruth O Adah — 2023-10-11

Background: Given the paucity of skin health specialists in Nigeria and the low level of awareness amongst its populace, patients seek for care for skin related disorders from different sources and are given a variety of remedies before accessing specialist care.

Objectives: This study was aimed at describing outlets visited and medication received by patients with skin disorders prior to attending the dermatology outpatient clinic in JUTH.

Methods: This was a cross sectional study conducted over one year. Information on socio-demography, sources and medication received prior to presentation was obtained and analysed using SPSS 23.

Results: The male: female ratio among 166 consenting new patients was 1:1.4. Prior to presentation patients sought care most frequently from Health facilities (68.1%), Patent medicine vendors-PMV (30.7%) and Traditional healers (21.7%). Overall, different steroid preparations were the most commonly used medications (56.6%) across all age groups with fixed combination preparations most frequently used (32.5%). Unconventional substances reportedly used by patients for skin disorders were urine, toothpaste, tomatoes, salt, water in which a life catfish had been kept and fats from a dead dog. Only 21.1% of the patients did not use any medication prior to presentation.

Conclusion: There is need to increase capacity in the care of common skin diseases at all levels of the health care system to decrease patronage of unconventional providers. Raising awareness of the general public on the potential dangers of inappropriate treatment of skin diseases and strengthen referral system is imperative to reduce the burden of skin diseases in the country.

Keywords: Non-specialized; skin diseases; unorthodox; treatment; dermatology; clinic.

Lipid and nutritional profiles of Caribbean patients with chronic kidney disease

Saleh Idris — 2023-10-11

Aim: Chronic kidney disease (CKD) is marked by the deterioration of kidney function and derangement in lipid metabolism.
Thus, we aim at evaluating the lipid and nutritional parameters of Caribbean patients with CKD.

Methods: The study recruited 88 CKD patients and 105 apparently healthy subjects. Blood glucose, urea, creatinine, albumin,
uric acid, total cholesterol, triglycerides, HDL-cholesterol, VLDL, and LDL were measured in duplicate on the Vitros 4600
Multi-Channel Chemistry Auto-Analyzer (Johnson & Johnson Ortho-Clinical Diagnostics Inc., Rochester NY, USA) in our laboratory.
The Statistical Package for the Social Sciences (SPSS, version 20) was used for statistical analysis.

Results: Mean levels of diastolic blood pressure (p < 0.05), age, and systolic blood pressure between the patients and the
healthy controls (p < 0.001) were different. In addition, mean levels of BUN (p < 0.05), serum creatinine, and uric acid were
higher and eGFR lower in the patients compared with the healthy controls (p < 0.001). The mean levels of albumin, glucose,
triglycerides, HDL-cholesterol, and VLDL (p < 0.001) also differed between patients and healthy controls. Negative correlation
between eGFR and triglycerides and a positive correlation between eGFR and total cholesterol, HDL-c and LDL were observed.
The prevalence of hypoalbuminemia, hypercholesterolemia and underweight were 27.27%, 57.95% and 4.55% respectively in
patients, compared with 10.48%, 44.74% and 2.86% respectively in healthy controls.

Conclusion: Dyslipidemia is common in CKD patients and is therefore, imperative that, routine lipid profile analysis be detailed
in order to check any trend towards the development of CVD.

Keywords: Cardiovascular diseases; chronic kidney disease; dyslipidemia; estimated glomerular filtration rate; kidney; malnutrition;
parameter; risk factor.

Risk factors analysis of endoscopy and TIPS in the treatment of secondary esophagogastric varicose bleeding with cirrhosis

Xiaoyan Liu — 2023-10-11

Objective: To analyse the risk factors of secondary hemorrhage and survival rate in cirrhotic patients with esophagogastric variceal
rupture and to compare the efficacy and safety of endoscopic hemostasis and TIPS (transjugular intrahepatic portosystemic
shunt).

Methods: A total of 120 patients with secondary bleeding after endoscopic treatment of esophagogastric varicose bleeding with
cirrhosis in our hospital during the past 3 years were retrospectively analysed. There were 65 males and 55 females, ranging in
age from 49 to 74 years old, with an average of (59.5 ± 8.4) years old. The etiology, degree of varicose veins, bleeding location,
hemostasis method, Infection, ascites, portal vein thrombosis or cancer thrombus, albumin, platelets, prothrombin activity, Child
Pugh (Child-Pugh classification is a diagnostic criterion for liver reserve function) grade were compared in each group. The risk
factors of treatment failure and analyse the survival time was analysed.

Results: There were statistically significant differences in varicosis degree, infection, ascites, portal vein thrombosis or cancer
thrombus, child Pugh grade, albumin and prothrombin activity between the failed Endoscopy group and the successful hemostasis
group (P< 0.05). There were statistically significant differences in child Pugh grade, albumin and prothrombin activity between
the failed TIPS treatment group and successful hemostasis group (P< 0.05). There was no significant difference in 1-year
survival between the endoscopy group and the TIPS group.

Conclusion: Severe varicose veins, infection, ascites, portal vein thrombosis or cancer thrombus, child pugh classification, albumin,
and prothrombin activity were the major risk factors for failed secondary endoscopic therapy, child Pugh classification,
albumin and prothrombin activity were the main risk factors for failure TIPS treatment. There is no significant difference in
long-term survival between the two methods.

Keywords: Liver cirrhosis; esophagogastric varicose bleeding; Endoscopy; TIPS.

Relationship of body mass index to percent body fat determined by deuterium isotopic dilution and impedancemetry among Tunisian schoolchildren

Ben Jemaa Houda — 2023-10-11

Objectives: This study aims to evaluate the relation of body mass index (BMI) to fat mass among children by two techniques
impedancemetry and deuterium oxide dilution (D2O).

Methods: This study was carried out in 156 schoolchildren aged between 8 and 11 years. The children received interrogation
specifying lifestyle and food habits. Body composition was determined using the impedancemetry and D2O technique.

Results: The results showed a difference between the percentage of obese and overweight children according to BMIZ classification
(30.1%), bioelectrical impedance method (14.7%) and D2O technique (42.9%). Despite the difference between the last
two classifications, we found a significant correlation between body fat percentages determined by impedancemetry and D2O
technique (r = 0.695, p<0.01). Bioelectrical impedance analysis underestimated %BF by 78.02% in overall children, by 70.05%
in boys and by 84.73% in girls compared to D2O technique.

Conclusion: This study has demonstrated that the percentage of overweight and obesity varied according the methods used.
Further development of body composition methods is needed in children for the real determination of the obesity prevalence
and therefore a better monitoring of this public health problem.

Keywords: BMI; body fat; deuterium isotopic dilution; impedancemetry; obesity.

Factors associated with poor asthma symptom control in adult Angolan regularly seen at an outpatient respiratory clinic

Margarete L T Arrais — 2023-10-11

Background: Asthma is one of the most common chronic respiratory diseases and one of the most frequent causes of hospital
care.

Objectives: To describe the clinical characteristics of asthma and factors associated with its control.

Methods: A cross-sectional study was conducted at the Military Hospital in Luanda, from April 2018 to March 2019. Data collection
was performed using questionnaires on asthma symptoms and treatment, socio-demographic and environmental questions,
and a Global Initiative for Asthma (GINA) questionnaire to assess the level of asthma control. Ordinal logistic regression
analyses were performed. We estimated odds ratios, for higher categories of asthma control. P<0.05 was considered significant.

Results: The sample consisted of 305 asthmatics ≥18-years-old, 56% women, with a mean age of 41.3 years. About 28% of
patients had controlled asthma, 36% partially controlled and 35% uncontrolled. Poor asthma control was associated with frequent
use of short-acting beta-2 agonists [OR 5.70 (95%CI 2.37;13.7)], oral corticosteroids [OR 3.68 (95%CI 2.24;6.04)], and
incorrect inhaler technique [OR 4.08 (95%CI 1.25;13.3)].

Conclusions: A significant number of adults living in Luanda have uncontrolled asthma due to the under-use of inhaled corticosteroid
therapy. It is necessary to develop strategic management and prevention plans to improve Angolan asthmatics' medical
care.

Keywords: Asthma; Angola; symptom control; inhalers.

Prevalence, causes and associated factors of visual impairment and blindness among older population in outreach site, Northwest Ethiopia. A dual center cross-sectional study

Melkamu Temeselew Tegegn — 2023-10-11

Purpose: The study aimed to determine the prevalence, causes, and associated factors of visual impairment and blindness
among the older population in Outreach sites, Northwest Ethiopia.

Methods: A community-outreach-based cross-sectional study was conducted on 821 older population which were selected
using a systematic random sampling technique. Face-to-face interviews and ocular examinations were performed to collect the
data. A binary logistic regression was performed.

Result: A total of 821 participants were recruited for the study with a median age of 57 years, with a range of 40-91 years. Out
of 821 participants, 41.8% had visual impairment, and 11.7% were blind. Sixty-four and fifty seven percent of visual impairment
and blindness were caused by cataract. Age ≥70years (AOR=15.0; 95%CI: 8.4-26.9), rural residency (AOR=2.3; 95%CI: 1.5-3.6),
non-formal education (AOR=3.0; 95%CI: 1.6-5.6), unemployed (AOR=1.5;95%CI:1.05-2.4) and history of eye examination
(AOR=1.7;95%CI:1.1-2.8) were positively associated with visual impairment. Similarly, blindness was significantly associated
with age ≥ 70years (AOR=7.2; 95%CI: 3.1-16.6), rural residency (AOR=2.2;95%CI:1.2-4.2), and history of eye examination
(AOR=1.9; 95%CI: 1.1- 3.3).

Conclusion: The prevalence of visual impairment and blindness in this study was found to be high. Age, residency, educational
status, occupational status, and history of eye examination were significantly associated with visual impairment and blindness.

Keywords: Visual impairment; blindness; older population; Northwest Ethiopia.

The relationship between weight self-stigma, depression and loneliness in people with obesity

Aysel A Özdemir — 2023-10-11

The research was conducted to determine the level of weight self-stigma, depression loneliness and whether is there a relationship
between them. This was a descriptive correlational study. The study was conducted in a diet outpatient clinic of a
university hospital. Participants had moderate weight self-stigma, depression and loneliness. Weight self-stigma sub-dimensions
self-devaluation (β=0.28; p<0.001) and fear of enacted stigma (β=0.28; p<0.001) equally predicted depression. Fear of enacted
stigma predicted social loneliness negatively (β=-.44; p<0.001). Fear of enacted stigma (β =.16, p<.005) and depression (β =.44,
p<.001) predicted emotional loneliness positively. Weight self-stigma was positively correlated with depression and loneliness
(p<0.001).

Keywords: Obesity; weight self stigma; depression; loneliness.

Correlates of somatic symptom disorder among internally displaced persons in Ogoja displacement settlements, Nigeria: a cross-sectional study

Ugbe Maurice-Joel Ugbe — 2023-10-11

Background: Experiences of displacement have been associated with the prevalence of mental health disorders owing to certain
factors.

Objectives: This study aimed to identify the correlates of Somatic Symptom Disorder (SSD) among internally displaced adults
in Ogoja displacement settlements, Nigeria.

Methods: This was a cross-sectional study of 335 respondents. SSD was assessed using the SOM-SCL section of the Common
Mental Disorder Questionnaire while a semi-structured questionnaire was used to collect data on sociodemographic and displacement-related factors. Data were analysed using descriptive statistics, Chi-square, and multivariable logistic regression.

Result: The prevalence of somatoform disorder was 59.1%. Factors found to be significant in each bivariate Chi-square analysis
were modelled for the mental disorder. The multivariate analysis revealed that being married (AOR=2.80; p=0.020) prolonged
displacement (AOR=3.29; p=0.003), discrimination (AOR=2.25; p=0.010), disease outbreak (AOR=1.92; p=0.030), loss of
loved ones (AOR=1.34; p=0.028), overcrowded households (AOR=2.30; p=0.008), and fear of reprisals (AOR=2.05; p=0.026)
were significantly associated with somatoform disorder.

Conclusion: The findings suggest that the high prevalence of the studied outcome is related to several stressors and events
among Internally displaced persons. Evidence-based mental health support efforts by different bodies in creating and routinely
arranging mental health clinical interventions for this population is recommended.

Keywords: Somatoform; somatic symptom disorder; internally displaced adults.

Spectrum of substance use precipitating rehabilitative services among adult patients in the university of Port Harcourt teaching hospital

Chukwuma Ugochukwu Okeafor — 2023-10-11

Background: World Health Organization ranks substance abuse as one of the top twenty health risk factors. It poses a serious
public health crisis with a significant burden for affected individuals, families and health systems. This study aimed to identify
the spectrum and pattern of substance use among patients receiving rehabilitative services.

Methods: The study was a cross-sectional design involving 190 patients receiving rehabilitative care for substance use in the
University of Port Harcourt Teaching Hospital. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), a
validated and reliable tool was employed to obtain data on substance use. Statistical analyses were performed at P<0.05.

Results: The male to female ratio was 4:1. A higher proportion of the patients were within 18-35years category (81.6%; n=155).
The commonly used substances were alcohol (90.5%; n=172), cannabis/marijuana (43.7%; n=83), prescription opioids (28.9%;
n=55). cigarette (25.8%; n=49), and street opioids (15.8%; n=30). The prevalence of poly substance use was 68.4%(n=130).
Age(p=0.033) and sex (being male) (p=0.002) were predictors for number of substances used.

Conclusion: Almost all the patients receiving drug rehabilitative service used alcohol, and approximately 7 in 10 used more than
one substance. The need to inculcate harm reduction in the management protocol is therefore paramount.

Keywords: Substance use; alcohol; cannabis; substance use; rehabilitative care.

Factors influencing public and private healthcare utilisation in Uganda

Medard Turyamureba — 2023-10-11

Background: In Uganda, health care utilisation remains very low despite a number of government reforms that have been
implemented in the health sector since the 1990’s such as decentralization and removal of user fees in public health facilities
among others.

Objective: To examine the factors influencing public and private health care utilisation in Uganda.

Methods: The study used cross sectional data from the Uganda National Household Survey collected between July 2016 and
June 2017. Anderson’s conceptual framework was used to identify explanatory variables associated with choice of health care
providers and a multinomial logistic regression model was estimated.

Results: Out of the 17,912 individuals who sought care, 36% used a government facility, 60% used private facility while 4% had
self- care/treatment. The results show that out of pocket health expenditure, age, level of education, marital status, residence,
and type of illness significantly influenced choice of public healthcare providers. Similarly, utilisation of private healthcare providers
was associated with household welfare, level of education, residence, marital status, illness days, and type of illness.

Conclusion: The findings highlight the need for a national health insurance scheme to reduce out of pocket payments for health
care and enable the poor and vulnerable patients visit the modern health facilities.

Keywords: Utilisation; multinomial logit; health care provider, policy; Uganda.

Medical ethics and compliance amongst physician groups: a self-assessed survey in a hospital in Southeast Nigeria

Ogbonnia Godfrey Ochonma — 2023-10-11

Background: Being a doctor remains a moral enterprise as he is expected to make some medical decisions based on ethical principles during encounter with patients.

Objective: The objective of this study was to investigate the knowledge and application of medical ethical principles amongst physician groups in a Hospital in Enugu, Nigeria.

Methods: This was a cross-sectional self-assessed study conducted amongst medical doctors in five specialty groups in a teaching hospital in Enugu, Nigeria.
Descriptive and inferential statistics were used to summarize the items and determine whether significant differences on knowledge and application of medical ethics existed amongst the physician groups in the treatment of patients.

Findings: Observance and compliance with medical ethical conduct was highest among doctors that were aged 55 years and above. In sex, male doctors had higher ethical conduct compliance than female doctors. Comparing the doctors by rank, medical officers, consultants and senior registrars respectively had the highest ethical conduct.

Conclusions: Knowledge and practice of medical ethics were mostly deficient among younger Nigerian and female doctors. Remedying the situation will require better curricula both at the undergraduate and post-graduate medical school programmes for doctor trainees. Requiring certification in bioethics for license renewal will also help in resolving and improving the knowledge gap.

Keywords: Professional; ethical; conduct; doctors; patients; survey; Nigeria; hospital.

A 5-year review of research ethics applications in a tertiary health and educational institution in Nigeria

Dennis Amajuoyi Ndububa — 2023-10-11

Background: African contribution to global research output is said to be low. Poor funding and poor skills in grant writing have
been suggested as important factors for this situation.

Objectives: Applications for research ethics clearance in a hospital were reviewed to have an overview of the planned studies
and the proportion of them that attracted national and international funding.

Methods: A review of all applications for ethical clearance received by the institutional review board of a university teaching
hospital at Ile-Ife, Nigeria, from 2016 to 2020. They were analysed according to study nature, scope, purpose, and sponsorship
using descriptive statistics presented as frequency tables and charts.

Results: A total of 878 applications were reviewed. There were 803 (91.5%) applications for local, 45 (5.1%) for national multicentre,
and 30 (3.4%) for international multicentre studies. Applications for medical fellowship were 352 (40.0%) while 208
(23.8%) were from academic staff for non-degree research. There were 610 (69.5%) applications for self-sponsored studies.
Only 18 (2.0%) and 26 (3.0%) received sponsorship from national and international donor agencies, respectively.

Conclusions: Local studies formed the bulk of the submissions for ethics clearance. National and international donor funding
of research is abysmally low in this Nigerian tertiary institution studied.

Keywords: Research ethics applications; study sponsorship.

Problem gambling among secondary school adolescents in Enugu, Nigeria

Awoere T Chinawa — 2023-10-11

Background: Adolescent problem gambling is a common behavioural issue and could be associated with internet addiction.

Objectives: To determine the pattern of problem gambling and factors that predict gambling among adolescents that attended
secondary schools in southeast Nigeria.

Methodology: This is a cross-sectional study design. A three-stage sampling technique was used to select 796 secondary school
adolescents from eight secondary schools in Enugu State, Nigeria.

Results: The highest proportion of the respondents, 38.3% had problem gambling with negative consequences. There was a
weak positive correlation between gambling severity index and internet addiction. (n=796, r=0.254, p<0.001). There is a very
weak negative correlation between gambling severity index and age in years. (n=796, r= -0.034, p=0.331).
The male respondents were 1.5 times more likely to have problem gambling when compared with the females, (AOR=1.5;
(95%CI: 1.1-2.0). The respondents who have internet addiction were 3.5 times more likely to have problem gambling when
compared with those who do not have an internet addiction, (AOR=3.5; 95%CI: 2.6-4.8).

Conclusion: The prevalence of gambling among adolescents is high. Adolescents who had problem gambling also had internet
addiction. The male respondents were more likely to have problem gambling than their female folk.

Keywords: Problem gambling; secondary school; adolescents; internet addiction; gambling severity index.

Microbiological quality and proximate analysis of locally produced soymilk drinks sold in Calabar Metropolis; a public health assessment

John G E — 2023-10-11

Background: This study was aimed at evaluating the microbial quality and proximate analysis of soymilk produced and sold
within Calabar Metropolis.

Methodology: Soymilk samples were purchased in pairs from five locations in Calabar Metropolis. The samples collected were
subjected to microbiological and proximate analysis to ascertain the hygienic standards of the products and nutrient contents.

Results: The result showed that the highest heterotrophic bacterial count of 5.3 × 105 cfu/ml was recorded in soymilk sample
sold in Goldie market while the least (2.7 × 104 cfu/ml) was recorded at Watt market. The mean fungal count was highest in
Akim market samples (5.8 x 104 cfu/ml) and lowest in Atimbo market samples (2.4 x 103 cfu/ml). The probable bacterial and
fungal isolates were identified as: Pseudomonas aeruginosa, Bacillus sp, Escherichia coli, Klebsiella sp, Salmonella sp, Streptococcus sp,
Staphylococcus aureus, Aspergillus sp, Rhizopus sp, Penicillium sp and Mucor sp. All the isolated bacteria species were found to be resistant to more than 50% of the antibiotics used. Proximate composition analysis of the soymilk samples revealed high moisture,
carbohydrate and protein contents.

Conclusion: The microbial population detected in terms of number and types reflected poor hygienic standard of production.

Keywords: Soymilk; contamination; public health; hygiene; foodborne illnesses.

Restless legs syndrome in chronic renal failure patients on dialysis

Carin Behrens van Tonder — 2023-10-11

Background: Restless legs syndrome (RLS) occurs in patients with chronic renal failure (CRF).

Objectives: To determine the prevalence and morbidity of RLS in CRF patients on dialysis.

Methods: This cross-sectional questionnaire-based study included 100 dialysis patients (50 on haemodialysis [HD]; 50 on peritoneal
dialysis [PD]). A focused lower limb examination was done. Patients were classified with RLS when reporting uncomfortable
feelings in their legs that improved with movement and worsened when resting and at night.

Results: Gender distribution was equal. The median age was 43 (19–67) years. Six patients (HD and PD n=3 each) had international
criteria-confirmed RLS. Twenty-four patients reported symptoms suggestive of RLS. Fourteen and 16 patients with RLS
symptoms were on HD and PD, respectively. Sleep disturbances occurred in 43.3% (n=13) of patients with RLS symptoms,
compared to 20.0% (n=20) of the large cohort. Sleep disturbances, peripheral sensory loss, chronic disease-related anaemia,
increased urea and decreased albumin levels were more common among patients with RLS symptoms.

Conclusion: RLS symptoms occurred in 30.0% of the entire cohort, although only 6.0% met the international criteria. The type
of dialysis had no impact on the incidence of symptoms. Identifying RLS in patients with CRF on dialysis will allow for early
intervention.

Keywords: Restless legs syndrome; chronic renal failure; haemodialysis; peritoneal dialysis; symptoms.

Erratum to: colorectal cancer in a region of western of Algeria: results of 581 cases in 5 years

Bouchra Dahmani — 2023-10-11

NIL.