British Journal of Healthcare and Medical Research

Examining Prevalence and Risk Factors of Hepatitis B Virus Among Pregnant Women in the Context of Prevention of Mother-To-Child Transmission

Andrews Asamoah, Prosper Saho — Mon, 17 Jun 2024 00:00:00 +0100

Background: Hepatitis B. virus continues to pose threat to human by infecting millions of people globally through the liver and remains a public health problem even though there has been the availability of HB vaccine and antiviral agents over the years. It is estimated that 240 million people worldwide are chronically infected, particularly in low and middle-income countries (LMICs). The major well-established risk of harm associated with maternal HBV infection is perinatal transmission to the infant occurring most commonly through the process of delivery. Objective: The aim of this study is to estimate the prevalence of Hepatitis B and associated risk factors among pregnant women in Ejura-Sekyedumase Municipal. Method: The study adopted a cross sectional approach to research design among pregnant women attending antenatal care. Proportion sampling method was applied to each facility based on the number of pregnant women attending ANC clinic to determine the number of pregnant women to be interviewed from each facility. Statistical analysis was done using STATA and results were presented in frequencies and percentages while regression analysis results was report in odds ratio with its associated chi-square and p-values. Results: Three hundred and thirteen pregnant women participated in the study with a mean age of 30.3 +2.5. A total of 64 pregnant women tested positive for HB virus, giving a prevalence rate of 20.5%. Factors that were significantly associated with HB virus infection among pregnant women include age 18-24 and 45+ years, polygamous marriage, blood transfusion and multiple sexual partners. About 49% of the pregnant women had adequate knowledge on hepatitis B infection. Knowledge on hepatitis B infection was significantly associated with age, religion, place of residence and place of past deliveries. Conclusion: With the high prevalence of hepatitis B among pregnant women in the district, it is important urgent actions are taking to address the root causes of the high infection among the pregnant women. Screening and HBV vaccine introduction should be key on the agenda among policy-makers.

Effect of Chronic Melatonin Supplementation on Fitness Profile Parameters in Sedentary Young Men of Kolkata, India

Sohini Basu, Anindita Mandal Majee, Debasish Bandyopadhyay, Amit Bandyopadhyay — Sat, 22 Jun 2024 00:00:00 +0100

Purpose: Melatonin, a safe and pleotropic biomolecule might have ergogenic benefits beyond its antioxidant and chronobiotic properties to combat deleterious health consequences of sedentary lifestyle. Present study was aimed to investigate the comparative fitness profile analysis following chronic melatonin supplementation in young, untrained sedentary male subjects in contrast to placebo. Methods: A single blinded randomized controlled trial was conducted with the melatonin group (MG) (n=14) and placebo group (PG) (n=14). Melatonin at a dose of 3mg/day, 30-60 mins before bed time was administered nocturnally to the MG for 4 weeks. All the measurements were taken weekly in the morning. Fitness profile broadly consisted of a battery of standardized physical and physiological tests (aerobic, anaerobic and motor fitness parameters). Statistical analyses comprised of repeated measures ANOVA with the level of significance set at p<0.05. Results: In comparison to PG, a significant treatment effect was noted for vertical jump test (VJT) score and handgrip endurance, both higher in MG. Further, a significant time effect was observed with greater handgrip strengths (right and left hand), handgrip endurance, flexibility, VJT score, balance and lower blood pressure (systolic and diastolic) in MG. Conclusion: Chronic nocturnal melatonin administration is capable of improving certain fitness performances.

The Role of the Surgeon in Primary Immune Thrombocytopenia: Case Report

Fri, 31 May 2024 00:00:00 +0100

Idiopathic thrombocytopenic purpura (ITP) is important as it is one of the most common thrombocytopenias in adults. Despite their medical treatment, there is a percentage of refractory patients who persist with severe hemorrhages, requiring splenectomy; this is where the surgeon becomes involved in this condition. The objective of this work is to present our experience with this disease and laparoscopic splenectomy in the general surgery service of the General Hospital of Saltillo, Coahuila, Mexico. We present the case of a 40-year-old male with a diagnosis of ITP since he was 28 years old, who for the last 12 years presented recurrent symptoms of severe hemorrhagic events with partial and temporary improvement of the condition despite aggressive pharmacological treatment. We were requested to consult the general surgery service due to therapeutic failure of pharmacological treatment, and a protocol for laparoscopic splenectomy was initiated. The patient progressed adequately and was discharged after the procedure with follow-up by outpatient clinic with a biopsy negative for malignancy.

Case Report: Renal Tubular Acidosis As The Initial Presentation Of Sjogren's Syndrome

Sun, 30 Jun 2024 00:00:00 +0100

Sjögren's syndrome (SSjP) is a chronic multisystem autoimmune disorder characterized by inflammation of the lacrimal and salivary glands, with consequent dryness of the eyes and mouth and occasional glandular enlargement, it occurs in a primary form, not associated with other autoimmune rheumatic diseases. We present the case of a 36-year-old female patient with Sjögren's syndrome whose initial clinical manifestation was extraglandular, with the kidney as the main organ affected in the form of chronic hypokalemia and distal renal tubular acidosis, which led to immunological markers being performed. for Sjögren's syndrome, the diagnosis of this autoimmune exocrinopathy allowed, achieving clinical remission and stabilization of renal function with the use of steroids.

Clinical Report: Application of Jiao's Head Acupuncture in Cervical Spinal Cord Injury Treatment

Fri, 31 May 2024 00:00:00 +0100

Objective: This study investigated the efficacy of Jiao's head acupuncture in the treatment of a 46-year-old male who experienced quadriplegia due to cervical spinal cord injury after a head injury accident. Western medicine predicted that he would be unlikely to walk again, necessitating lifelong reliance on a wheelchair. Following three years of treatment and surgical interventions under conventional Western medical protocols, the patient showed no substantial improvement and continued to require assistance for daily activities. In this case, traditional western approaches did not yield the desired outcomes. Method: The treatment plan mainly used Jiao's Head Acupuncture for the Motor Zone, Sensory Zone, Foot Motor-Sensory Zone and Balance Zone. It also combined auricular stimulation with traditional acupuncture to target key points. Acupuncture sessions were conducted weekly for one hour. Results: The patient was able to stand up from the wheelchair during 2-3 sessions. The patient used a walker during sessions 7-8 and achieved independent walking under supervision by session 12. Noticeable improvement in muscle tone, range of motion, and mobility were observed within a two-month period. The patient's muscle strength in the quadriceps and anterior tibia muscles has notably improved from a scale of 1 to 4 out of 5. Discussion: This case study highlighted the efficacy of Jiao's head acupuncture in restoring motor function in patients with cervical spinal cord injury, helping to repair damaged nerves, especially in cases where western medicine treatment couldn’t see promising positive outcome and is worthy of further research and inclusion in clinical rehabilitation practice.

Anchor Points Our Imbedded Cultural Lifelines: Each To His Own Culture

Wendy Thomson — Sat, 18 May 2024 00:00:00 +0100

“We shall shortly be making our descent into London Heath Row; the temperature is 14 degrees. On behalf of the crew, we hope you have had a pleasant journey “The captain rounded off. The fact was I couldn’t have cared less what the temperature was, it could have been a raging hurricane or a blizzard for all I cared. I was just so pleased and relieved at the prospect of touch down: the bump when rubber and tarmac meet. To be back in my own country - England. I had missed my roots and everything English. I had accepted and respected that I was an interloper in South Africa, it wasn’t my country, it belonged to them - I had no rights - I had to conform. I was an alien. I had to toe the line it was the right thing to do. But I was homesick for my own people in my own country, where my family had lived for centuries — the English, a small island nation which had made its mark with a punch above its weight: Patriotic and willing to risk their lives for the country they loved, and their ancestors had helped to evolve and create. Albeit, rebellious, critical, and disagreeable when England was being mismanaged. But inventive resolute stoical when it mattered most.

Non-Vital Bleaching for a Single Dark Anterior Tooth: A Case Report

Daij Aldaiji — Sun, 30 Jun 2024 00:00:00 +0100

Restorative dentistry is a mixture of art and science, dental bleaching is a conservative, less expensive option to restore the color of endodontically treated discolored teeth. Purpose: the aim of this study is to report a case of a non-vital endodontically treated single dark anterior tooth by using a combination of bleaching techniques. Case: 35 years old man complained about a single dark upper anterior tooth which was Re-endodontically treated 4 months ago. case management: A combination of closed internal and external bleaching treatment was taken, and the result was satisfactory for the patient. Conclusion: bleaching using a combination of closed internal& external methods for a single dark tooth that has received an endodontics treatment shown to be effective. Safe and return teeth to their desired color.

Physiology of High-Altitude Acclimatization: Review Article

Bahaeldean E. Elawad — Sat, 01 Jun 2024 00:00:00 +0100

As the barometric pressure decreases exponentially within the troposphere, the partial pressure of oxygen decreases proportionally in ambient air, inspired air, alveolar air, and arterial blood. The primary physiologic challenge with altitude is reduced partial pressure of oxygen (hypobaric hypoxia). Physiologic adaptation to decreasing partial pressure of oxygen in the high altitude environment is known as acclimatization. It is a complex, not yet fully understood, mechanism to preserve cell function despite reduced oxygen supply to the tissues. Chronic adaptation includes improving oxygen transport capacity and restoring oxygen delivery to the tissues. Of the three successful patterns of adaptation to chronic high altitude hypoxia; the Amharas have the legend one. Normal partial pressure of oxygen in arterial blood despite inevitable hypobaric reduction of partial pressure of oxygen in inspired air is a puzzler and big challenge to respiratory physiology. Amharas have elevated nitric oxide which suggests the possibility of adaptation via vasodilatation, which would increase oxygen supply tometabolic tissues. Left shift of ODC under influence of nitric oxide seems to be an integral component of Amharic pattern of adaptation. The mechanism of which is not known. It could be hypothesized that native Amhara highlanders have increased, pulmonary capillary transit times; finite reaction of hemoglobin with oxygen; and oxygen-carrying capacity of hemoglobin than other high altitude populations. Further research is warranted to explore the physiologic mechanism by which Amhara highlanders maintain normal PaO2 despite hypobaric hypoxia. This is a potential breakthrough in management of critically ill hypoxic patients at intensive care settings.

Child Marriage in Bangladesh Due to The Result of Gender Inequality and Poverty: A Detrimental Issue to Society

Mehnaz Karim — Mon, 24 Jun 2024 00:00:00 +0100

Child marriage, considering the girls under eighteen, is a substantial problem faced by many young girls each year. Even though child marriage is habitually accomplished to protect the physical security of young girls, marriage at these ages can posture various intimidations to their lives, wellbeing, and upcoming visions. In this journal I have focused the reasons and impact of child marriage in Bangladesh, while considered our social and economic aspect. Even though Bangladesh is a developing country, it has the eastern cultural impact as it is a part of south-east Asia. This piece of writing will present the demographic picture along with analysis, how the gender inequality, poverty, and social demand became a detrimental issue to the lives of young girls of Bangladesh.

All That Light Up Are Not Sarcoidosis – The Great Masquerader: A Case of LMNA Cardiomyopathy

Sat, 18 May 2024 00:00:00 +0100

Lamin A/C (LMNA) cardiomyopathy is a rare cause of non-ischemic dilated cardiomyopathy (DCM), caused by a gene mutation in Lamin A/C. It manifests with electrical abnormalities before the onset of heart failure, much like cardiac sarcoidosis (CS). Both have similar imaging findings. Detailed family history and genetic testing are crucial in making the correct diagnosis.

Visual Inspection with Acetic Acid (VIA) Screening; Six Months Study to Detect Cervical Cancers And Pre-Cancers In Semi Urban Kog East Population Of Women In North Central Nigeria

Akogu Simon Peterside Onuche, Omotosho O. Dare — Sat, 22 Jun 2024 00:00:00 +0100

Cervical cancer is the commonest gyneacological cancer among Nigerian women, contributing to unaccepted morbidity and mortality. Data on cervical cancer in Kogi State is limited. Majority of the cases present late due to low level of awareness and screening uptake. Aims and Objectives: This study aims to determine the prevalence of cervical precancerous lesions using visual inspection with Acetic acid (VIA) among consenting women aged between 22 and 65 years. Materials and Methods: A prospective study conducted from February 2023 to July 2023 in 6 health facilities in Kogi East of Kogi State. 400 consenting women were recruited by a stratified or Random sampling method. The participants completed a semi-structured questionnaire and underwent VIA performed by trained health personnel. Data collected included demographics, life style characteristics and VIA results. This was input and analyzed using SPSS version 20. Results: The study showed a VIA positive rate of 33.8% using the low threshold diagnostic criteria and a 14.3% using the high threshold criteria. This shows a worrisome burden of cervical precancers. 77.5% of the respondents were married. 71% of the respondents had used contraceptives and 53.5% had an early sexually debut (before age 18 years). 11.8% of the respondents had cervicitis. Conclusion: There is urgent need for increased awareness and screening for precancers to promote early detection and reduce cervical cancer incidence. Authorities should demonstrate the W.H.O 90 – 70 – 90 initiative to improve prevention, screening and therapeutic services.

Progression of Radiation Protection in Radiology & Imaging

Mohd. Arfat, Nisha T K, Taiba, Samita Jha, Jyoti Yadav, Md. Zahiruddin — Fri, 28 Jun 2024 00:00:00 +0100

Radiation protection stands as a critical imperative in our modern technological landscape, where various industries, such as medicine, nuclear energy, and manufacturing, rely on the controlled use of ionizing and non-ionizing radiation. This paper underscores the paramount significance of radiation protection and underscores the imperative for perpetual advancements in this domain. As the utilization of radiation becomes more prevalent in diverse sectors, the potential risks associated with exposure necessitate constant vigilance and refinement of protective measures. The abstract offers a concise introduction to the multifaceted dimensions of radiation protection, emphasizing its pivotal role in safeguarding human health, the environment, and ensuring the sustainable development of technologies reliant on radiation. The ensuing exploration of current practices, recent technological innovations, and future trends collectively contribute to a comprehensive understanding of the evolving landscape of radiation protection.

Contraceptive Prevalence and Pattern Amongst Human Immunodeficiency Virus infected (HIV) Women of Reproductive Age Attending the Special Treatment Clinic (STC) of a Tertiary Health Facility in North Central Nigeria

Mon, 24 Jun 2024 00:00:00 +0100

Background: Nigeria has the second largest burden of HIV in the world and Mother to Child transmission of HIV is the predominant mode of transmission in children. Family planning is the most cost-effective strategy to reduce mother to child transmission of HIV. Aim/Objective: The study was to determine the prevalence and pattern of contraceptive use amongst HIV infected women attending the special treatment clinic of University of Abuja Teaching Hospital. Methods: A cross-sectional descriptive study was carried out on 383 enrolled participants using systematic random sampling technique. Data was collected via a pretested semi structured interviewer administered questionnaire. Results: The contraceptive prevalence among all study participants was 47% while the prevalence of contraceptive use among the sexually active study participants was 64.1%. The most commonly used contraceptive was the male condom (66.1%). The practice of dual contraception among participants who used any form of contraceptive was 25.4% and the commonest combination was condom with oral contraceptive pill. Conclusion: Despite the strides made so far in family planning services among HIV infected women there is still a gap in the reproductive health of these women as 35.9% of study participants did not practice any form of contraception while only 25.4% use dual contraception.

Knowledge, Attitude, Practice of Genotype Screening Among Undergraduate Medical Students In The University Of Abuja

Esther Malachi Cegbeyi, Baba Psalm Inusa, Ramsey M. Yalma, Nicholas Baamlong — Mon, 03 Jun 2024 00:00:00 +0100

Background: Sickle cell disease remains the most common life-threatening genetic disorder worldwide. Globally about 312,000 children are born each year with sickle cell disease (SCD), half of which are from Nigeria[1,2,4,5,7,8]. The prevalence of sickle cell anaemia (SS) in Nigeria is estimated to be 20 per 1000 and 25% of the population have sickle trait (AS)[2,6,9,10,11]. Medical students in Nigeria are key in the future management of sickle cell disease. Therefore, it is important to understand what training in SCD is given to medical students in Nigeria and to identify any important knowledge gaps which may improve training curricula. Method: A student survey was conducted at the College of Health Sciences, University of Abuja in the Federal Capital Territory of Nigeria (FCT) in the 2021/2022 academic year. At this University, all students undergo comprehensive medical tests before admission, which include genotype screening. All medical students were eligible to complete the survey and which was advertised through year group social platforms. Data were collected using a self-administered questionnaire through Google form, after the respondent indicated their consent. The questions focused on knowledge of the disease and attitude towards genotype screening, and whether the student had undergone screening and were aware of their status. Results: In the academic year of 2021/2022 there were a total number of 374 medical students from year one to year six of these 150 (40%) completed the survey. Survey respondents included similar numbers of males and females, with a mean age of 23.7 years and were from all years of study. All the respondents had heard about sickle cell disease and 85% stated that they had attended courses which covered Sickle cell disease topics (from 63% in 1^st year of study rising to over 90% by year 3). A very high proportion knew that Sickle cell disease trait can be transmitted from both parents to offspring (95%), and 90% knew that SCD can affect anyone and can occur when both parents are carriers of the Sickle gene. Fewer students (79%) knew that SCD can be diagnosed at birth. Knowledge of common symptoms for sickle cell patients was variable, while most knew that one of the most common complaints was pain in the limbs (92%), only 23% were aware that yellow eyes is also a common symptom, and 10 students (7%) incorrectly identified skin rashes as a common symptom. A total of 93% of students had been genotype-screened for SCD, and attitudes towards genotype screening, was generally positive. Most agreed that genotype screening can help prevent SCD and that pre-conception genotype screening is important. Of those who had been screened and knew their status, 68.6% were AA (adult haemoglobin without any haemoglobin disorder), 28.6% were AS (had the sickle cell trait) and 2.9% were SS (sickle cell anaemia). Conclusion: Over 90% respondents knew their sickle cell status (Hb genotype) and 2.9% had SCD (HbSS), and 29% had sickle cell trait (HbAS) consistent with consistent with the national burden in Nigeria. Reassuringly, medical students had a good knowledge of and attitude towards SCD irrespective of their year of study. Although identifying symptoms, which may be important in diagnosis, could be improved. Given that almost half of the global burden of SCD is in Nigeria, this study reflects the importance of ensuring adequate health education towards sickle cell disease among Nigerian medical students.

Evaluating the Level of Adherence To The Ministry Of Health Guideline In The Management Of Severe Acute Malnutrition at Adama Hospital Medical College; A Cross-Sectional Study

Sat, 01 Jun 2024 00:00:00 +0100

Background: Severe Acute Malnutrition (SAM) is defined as a weight-for-height (WFH) of < -3 standard deviations or MUAC of < 11.5cm, or bilateral pitting edema among under-five children. WHO developed 10 steps with evidence generated from multiple countries to reduce case fatality rate among SAM cases but their implementation and impact on case fatality locally remain unknown. Objective: To evaluate the level of adherence to MOH guidelines in the management of SAM children. Methods: Descriptive cross-sectional study with systematic sampling techniques was conducted from November 1^st to 30^th, 2023 on medical records of SAM cases. Data analysis done using statistical package for social sciences (SPSS) version 25. Results: Of 200 SAM cases, 103 (51.5%) were female and mean age and SD were 23.56 + 11.93 months. The average length of stay in the hospital was 13.6 days. Overall adherence to MOH guidelines was 15.5%, and the appropriateness of treatment in the management was: Step 1: 20.5%; Step 2: 65.5%; Step 3: 32%; Step 4: 28.5%; Step 5: 41.5%; Step 6: 34%; Step 7: 35%; and Step 8: 39%. Treatment outcome for SAM cases were: stabilized to OTP, cured, transferred out, non-responder, defaulter, and died were 63%, 20%, 2.5%, 2.5%, 2%, and 0%, respectively. Conclusion and Recommendations: Adherence level to MOH guidelines was low at 15.5% and approprieteness for step of management ranges from 20.5 to 65.5%. Thus, improving adherence to MOH guidelines in SAM management and further studies to determine factors affecting adherence and length of hospital stay need to be conducted.

Migraine Aura and Exercise

Otto Appenzeller — Fri, 31 May 2024 00:00:00 +0100

In this self-report I find that the aura of migraine is prolonged by exercise from 3 minutes to 11 minutes. I discuss the possible causes and implications for patient management.

Science as the Last Dogma: An Ironic Reflection

Manfred Doepp — Fri, 28 Jun 2024 00:00:00 +0100

There are several crises in our world, the allegedly dangerous content of which was initiated by scientists. Ever since the Club of Rome proclaimed the climate crisis in 1972 ("The Limits to Growth", 1,2), we have lived in fear that normal life on earth will soon no longer be possible. If it was acid rain back then, today it is CO2 production, always man-made. Until recently, we lived in fear of the Covid-19 virus and around 2/3 of people underwent an insufficiently tested and probably dangerous vaccination, the composition of which was unclear. Today, we are astonished to see excess mortality and "post-vac syndrome". Conclusion : We should be suspicious when "The Science" publishes something. It may not be the truth.

Idiopathic Pulmonary Fibrosis with Comorbidities at Benue State University Teaching Hospital Makurdi, Nigeria: A Report of 2 Cases with Literature Review

Sun, 30 Jun 2024 00:00:00 +0100

Background: Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease due to extensive lung scarring with poor prognosis that is considered rare. Few cases have been reported in Nigeria. Aim: To present 2 cases of Idiopathic Pulmonary Fibrosis occurring with comorbidities in our center. Method: A review of the case folders of 2 patients who presented with chronic dry cough and breathlessness who had radiologically confirmed diagnosis of IPF. Results: The two patients presented with dry cough. Both had clinical and High-resolution computed tomography (HRCT) evidence of Idiopathic pulmonary fibrosis.There was delay in referral and diagnostic challenges. They also had comorbidities. Treatment was given for comorbidities but no definitive treatment was available. Conclusion: We reported 2 cases of radiologically confirmed Idiopathic pulmonary fibrosis who also had comorbidities. There was delay in referral to a pulmonologist and also diagnostic challenges due non availability of the necessary diagnostic facilities. The disease may not be as rare as reported in Africa. We recommend that clinicians should be more alert to the existence of this condition and have a high index of suspicion in to be able to make early diagnosis.

Microcirculation Mini Review: Loven’s Reflex Is Reproduced in The Lungs and Contributes in Pathophysiology of High-Altitude Pulmonary Edema; A Hypothesis

Bahaeldean E. Elawad — Sat, 01 Jun 2024 00:00:00 +0100

High altitude pulmonary edema is a serious potentially fatal state. This article hypothesizes that, Loven’s reflex is reproduced in the lungs and contributes to the pathophysiology of high altitude pulmonary edema. In conclusion, Loven’s reflex induces a positive feedback mechanism which exaggerates hypoxic pulmonary vasoconstriction, elevates pulmonary arterial pressure, and promotes the development of high altitude pulmonary edema.

Psychological Distress and Embitterment in Young Transgender, Homosexual, and Heterosexual Individuals in an Islamic Country

Moujan Tofighi, Michael Linden — Fri, 28 Jun 2024 00:00:00 +0100

Background: Sexual and gender minorities may experience prejudice and discrimination, leading to a reduction in their quality of life (QoL) and harming their mental health. Independent of discrimination, psychological impairment can result from individual-level factors, such as primary mental disorders. By assessing not only general QoL but also specific emotions such as embitterment, which is associated with the experience of injustice, it is possible to differentiate the impairment of QoL resulting from discrimination-caused reactions. The hypothesis was that sexual and gender minorities score higher on embitterment and have a lower QoL than heterosexuals. There should be differences between homosexual and transgender people in a society that punishes homosexual individuals while accepting transgender people such as Iran. Method: 27 female-to-male transgender individuals from a private clinic, 17 homo(bi)sexuals and 18 heterosexual participants in Iran completed the “WHOQOL_BREF”, a measure of the quality of life, and the “Post-Traumatic Embitterment DisorderSelf-ratingg scale DScalee)”. The participants were between 18 and 25 years old. Results: There was a significant negative correlation between QoL and embitterment level. The WHOQOL_BREF and the PTED scores did not differ between the groups. Single items on WHOQOL_BREF revealed that transgender individauls had more problems with physical appearance and self-satisfaction. Conclusion: This study didn't support the hypothesis of poor quality of life or increased embitterment among young sexual and gender minorities in Iran. Transgender participants were dissatisfied with their body appearance. Even in the presence of discrimination discrimination, this does not necessarily lead to mental health impairment in this population.

Agent Orange and Vietnam Veterans: A Review

Alvin Lee Young, Lynda V. Alexander — Wed, 08 May 2024 00:00:00 +0100

Issue: Approximately 3 million Allied personnel from the United States, Australia, New Zealand, and the Republic of Korea served in the Republic of Vietnam from March 1965 through March 1973 in what became known as the Vietnam-American War. In March 1978, a widely distributed documentary “Agent Orange: Vietnams Deadly Fog”, generated fear and anger in Vietnam veterans of that War who became aware that the tactical herbicide Agent Orange, a defoliant, had been deployed in combat operations to improve visibility in enemy controlled jungle and infiltration routes, and around base perimeters. One of the herbicidal components of Agent Orange (2,4,5-T herbicide) contained the contaminant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), a highly toxic chemical associated with industrial accidents and an alleged teratogen in forestry programs where the herbicide was widely sprayed for brush control and conifer release. Following the release of the documentary, thousands of Allied Vietnam Veterans overwhelmed Veterans Administrations claiming Agent Orange and the associated dioxin were responsible for numerous diseases, birth defects, and long-term health issues. Despite the passage of almost 50 years, science has not been able to answer the question of the health impacts of alleged environmental exposures to either the TCDD or the tactical herbicides on Vietnam veterans. Thus, at the heart of the issues the question remains, were Vietnam veterans ever exposed to Agent Orange and TCDD or was it the Vietnam experience that has impacted the long-term health of the Vietnam veteran? Background: From March 1965 through April 1971, the United States Air Force and the US Army Chemical Corps sprayed approximately 74.2 million liters of tactical herbicides on 1.7 million hectares of the inland forests, savannas, and grasslands of South Vietnam. Contained within the 74.2 million L was 43.3 million L of the tactical herbicide known as Agent Orange that was contaminated with 130 kg of TCDD. Numerous research studies have been conducted in Vietnam, all alleging that the TCDD from Agent Orange was responsible for health issues among the Vietnamese. However, a careful assessment of the sources of TCDD in Vietnam indicated that significant quantities of TCDD were in the waterways and atmosphere due to the pollution from industries and open burning of municipal and industrial wastes, and not from Agent Orange. Human Studies: The deployment of in-country medical support in the War by the Allied Forces was instrumental in saving lives. What was unexpected was that more casualties died from insect-transmitted diseases and other health related issues than from enemy bullets and bombs. The more than 50 health studies of Vietnam veterans by the four Allied nations confirmed that with two exceptions (the Air Force Health Study of veterans from Operation RANCH HAND, and health studies of US Army Chemical Corps personnel) Vietnam veterans were never exposed to Agent Orange or TCDD. What the health studies did confirm was that the “Vietnam Experience” impacted the long-term health of the men and women who served in that war. Policy Considerations: The Congress of the United States, the Department of Veterans Affairs, and the Vietnam veteran simply refuse to accept the reality that little or no exposure to the herbicides or TCDD ever occurred in Vietnam. Instead, the Government continues to expand the lists of diseases and locations through the Agent Orange Act of 1991, and the PACT Act of August 2022. We concur that all Vietnam veterans deserve the best possible health care US and Allied nations can provide, and the recognition they are entitled to for having served in Vietnam. Perhaps the governments would have been fairer with a program of “Vietnam Experience” benefits rather than Agent Orange benefits.

Evaluation of Public Health Interventions in Reducing the Burden of Malaria Infection in Emohua Community, Rivers State, Nigeria.

Thu, 16 May 2024 00:00:00 +0100

It is assumed that just a few persons are beneficiaries of one or more public health interventions in local communities. The aim of this study was to evaluate public health interventions in reducing the burden of malaria infection in certain communities in Emohua in Rivers State. A cross-sectional community-based study was conducted on the study population. A pre-tested questionnaire was designed to gather information from the participants in the communities. As part of the study design, blood samples were collected with consents from the participants and were examined for the presence of malaria parasites with the use of rapid diagnostic test (RDT) kits. The result obtained from the information gathered from the participants, showed that 98 % of the participants have pre-knowledge (sensitization) of malaria, 15%, 41 % and 44 % said they were sensitized through TV, radio and medical outreach respectively. 40 % admitted having benefitted from public health interventions. From the 40 % who benefited from public interventions, 20 % said they received mosquito nets, 6 % said they received insecticides, 10 % said they received counseling and 4 % said they received malaria drugs. Furthermore, 46 % of the participants said the interventions were effective in the reduction of malaria while 54 % were not certain about the effectiveness of these interventions. Furthermore, the prevalence of malaria was 8%. In conclusion, the distributions of public health interventions across these communities studied were poor. Less than 50 % of the participants have one way or the other benefited from public health malaria interventions. The malaria prevalence may be due to malaria sensitization preventive measures undertaken by the individuals. There is a need for even distribution of public health intervention in Emohua.

Correlation Between Personality Disorder and Neuroplasticity: Can Deprivation Lead to Advantage and Resourcefulness?

Wendy Thomson — Thu, 16 May 2024 00:00:00 +0100

This paper explores the new hypothesis that neuroplasticity is associated with personality disorder. Specifically, it provides a possible explanation for why some severely deprived individuals develop the ability to positively adapt and adjust. It discusses a case in which [In the Methodology] Often uneducated, they had survived through their own resourcefulness. For example, those of them who were substance-addicted became so because they were self-medicating to combat their health challenges, which, in most cases, were caused by their deprivation. [In the Discussion] At puberty, when there is an explosion of neurons, there is a parallel need for circumstances that both maximise and facilitate neural connections. Privileged children and teens may be deprived of this due to societal and educational constraints, such as lack of freedom to explore, to be innovative and to be open to many different experiences. Thus, they will not benefit in terms of neural connectivity—in fact, they could be in deficit. In this study, the brains of children living so-called ‘deprived lives’, free from normal constraints, such as not complying with social norms for whatever reason, seemed to have developed the ability to make neural connections, which increased their overall potential to cope in the future competitive world. Therefore, deprivation, although negative, appeared to be an asset in these young ‘personality-disordered’ patients.

Giant Intraductal Papilloma of Breast

Thu, 16 May 2024 00:00:00 +0100

Intraductal papillomas are the most common form of papillary lesions. Despite their benign histological aspect, intraductal papillomas may appear with malignant growths, and a biopsy-based diagnosis involves the risk of underestimating breast cancer. This paper includes a literature review of the most relevant studies published to date in relation to a case of giant intraductal papilloma. Treatment is not consistent and depends on the result of clinical and pathological correlations. Therefore, gynecologists need to distinguish women who may be enrolled in the surveillance program from women requiring additional surgical therapy.

The Control of Dengue Hemorrhagic Fever Using Innovations For The Integrated Controlling Aedes Mosquitoes

Apiwat Tawatsin, Usavadee Thavara, Amara Yowang, Udorn Jitphayak, Navy Srivarom — Thu, 16 May 2024 00:00:00 +0100

Dengue hemorrhagic fever (DHF) is an infectious disease transmitted to humans by Aedes aegypti and Ae. albopictus mosquitoes. The prevention and control of these vector mosquitoes are the main strategies to control the disease since no effective vaccine is available for prevention. This project aimed to reduce the Aedes mosquito populations in the study areas using the three innovations of the Department of Medical Sciences (LeO-Trap: lethal ovitrap, AZAI: Aedes larvicide, and RepelMos: mosquito repellent) with community participation. The study was conducted in Chiang Rai Province (Muang District) and Phrae Province (Muang District and Song District) as these provinces were predicted as the potentially epidemic areas of DHF in 2022. The study areas were 2 villages (approximately 100 houses/village) selected from each District; as a result, 815 houses from these 6 villages participated in this study. The owner of each house received 4 sets of LeO-Trap (2 traps for use inside the house and 2 traps for use outside the house), 4 bags (100 g.) of AZAI, and 2 bottles (40 ml.) of RepelMos. Overall, the village health volunteers collected the sponge sheets (substrate for egg laying of Aedes mosquitoes) from the total treated houses ranged from 78% to 100% while the houses positive for Aedes eggs were between 29.6% and 100%. The total number of Aedes eggs collected from inside and outside the houses of the 6 villages in this study was 282,160 eggs; therefore, it could be estimated that 70,540,000 Aedes mosquitoes were rid of by the LeO-Trap in the study areas based on the assumption that a female mosquito could produce 500 offspring in her lifetime. Regarding the data collected by Sub-district, the highest numbers of Aedes eggs were collected from Nang Lae Sub-district in Muang District, Chiang Rai Province (117,557 eggs with an average 87 eggs/house), followed by Hua Muang Sub-district in Song District, Phrae Province (99,326 eggs with an average 97 eggs/house) and Mae Kam Mee Sub-district in Muang District, Phrae Province (65,277 eggs with an average 62 eggs/house). Overall, the number of Aedes eggs collected by the LeO-Trap inside the houses was higher than those obtained outside the houses in the three sub-districts. The results obtained from this study indicated that the innovations used in this project with community participation could substantially reduce Aedes mosquito populations in the study areas and reduce the incidence of DHF. This study could be a model for preventing and controlling Aedes mosquitoes in other areas.

Effectiveness of Nurse Navigated Self-Management Strategies on Knowledge, Skill and Respiratory Parameters Regarding Management of Chronic Obstructive Pulmonary Diseases Among Patients Attending Outpatient Department in Selected Hospital

G. Malathi, Sathiyalatha, Sarathi, V. Hemavathy — Thu, 16 May 2024 00:00:00 +0100

Background: Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible. Aim and Objective: To assess the effectiveness of Nurse Navigated Self-Management Strategies on knowledge, skill and respiratory parameters regarding management of COPD among patients attending OPD. Methodology: Quantitative research approach, Quasi Experimental-Pretest post-test with non-equivalent control group design, was adopted to assess effectiveness of Nurse Navigated Self-Management Strategies (NNSMS) on knowledge, skill and respiratory parameters regarding management of Chronic Obstructive Pulmonary Diseases (CORD) among 300 COPD patients (150 samples in each experimental and control group) attending outpatient department (OPD) at selected hospital. COPD patients who fulfilled the inclusion and exclusion criteria, using Non probability purposive sampling technique was used to select the samples in this study. Nurse Navigated Self-Management Strategies (NNSMS) was administered and the level of knowledge, skill and respiratory parameters and compared with the pre and post-test level between experimental and control group. Results: The study findings revealed that the pretest knowledge score was 10.93 with SD 1.31 and the post-test knowledge score was 19.47 with SD 1.98 and the skill score of pretest was 5.10 with SD 1.86 and post test score was 11.37 with SD 2.70 .The respiratory parameters pretest score was 8.30 with SD 2.18 and posttest Mean score was 5.87 with SD 2.36. The calculated’ Paired t-test’ value (18.89,3.77 and 17.47) for knowledge skill and respiratory parameters, respectively. There was very high statistical significance was found in the experimental group at the level p<0.001. Conclusion: The results revealed that the Nurse Navigated Self-Management Strategies (NNSMS) on knowledge, skill and respiratory parameters was effective in improving the knowledge and skill, and reducing the respiratory parameters regarding management of Chronic Obstructive Pulmonary Diseases. It can be utilized for the home management of patients with COPD and other respiratory diseases. Keywords: Chronic Obstructive Pulmonary Diseases. Nurse Navigated Self-Management Strategies knowledge, skill and respiratory parameters.

Hepatic Sinusoidal Obstruction Syndrome (Veno-Occlusive Disease) Mimicking Hemophagocytic Lymphohistiocytosis in a Post-COVID Patient: A Diagnostic Challenge and Holistic Approach

Thu, 16 May 2024 00:00:00 +0100

we present a unique and challenging case of hepatic SOS in a 48-year-old male following a recent COVID-19 infection such manifestations of COVID induced endothelitis and VOD were only reported during autopsies of COVID patients as per literature and publish this unique case with good long term outcome with appropriate treatment.

Is the Advanced Cardiac Life Support Algorithm Always Correct? A Case of Catecholaminergic Polymorphic Ventricular Tachycardia

Thu, 16 May 2024 00:00:00 +0100

A 19-year-old male with catecholaminergic polymorphic ventricular tachycardia (CPVT) presented with outside-of-hospital cardiac arrest in electrical storm. Ventricular arrhythmias persisted while following the Advanced Cardiac Life Support (ACLS) algorithm using epinephrine boluses. Upon deviation from the ACLS algorithm and use of beta blockers, ventricular arrhythmias ceased and patient was successfully stabilized. Treatment of CPVT electrical storm is challenging due to limited guidelines. Antiarrhythmic agents such as beta blockers and flecainide are among the primary treatment options. This case report highlights a unique example of how deviation from traditional ACLS may be necessary to best treat CPVT storm.

Perceived Benefits of Using Smart Lockers as Virtual Dispensing Units for Chronic Disease Medication: Healthcare Workers’ and Patients’ Perspective

Thu, 16 May 2024 00:00:00 +0100

Chronic diseases present a significant public health challenge globally, particularly in resource-limited settings like Nigeria. Effective management of chronic diseases often requires regular access to medications and adherence to treatment regimens. Smart Lockers, serving as Virtual Dispensing Units (VDU), offer a potential solution to improve medication access and adherence among individuals with chronic illnesses. However, little is known about the perceptions of healthcare workers (HCWs) and patients regarding using Smart Lockers in Nigeria. This study assessed the perceived benefits of Smart Lockers as VDU among HCWs and patients for chronic disease medications. It explored how demographic factors influence these perceptions. A descriptive cross-sectional research design was employed. Data were collected from 405 HCWs and 728 patients via a structured questionnaire. Descriptive statistics were used to analyze demographic characteristics and perceived benefits, including means, standard deviations, and percentages. Additionally, One-way Analysis of Variance (ANOVA) and t-test were conducted to explore relationships between demographics and perceptions, with significance set at p < 0.05. The results revealed that among HCWs, the perceived benefits of Smart Lockers included reduced workload (Mean = 4.40), facility decongestion (Mean = 4.50), and decreased patient waiting time (Mean = 4.57). Patients perceived benefits such as minimization of time spent waiting at healthcare facilities (Mean = 4.26) and reduced transportation costs associated with accessing care (Mean = 3.84) most positively. Significant variations in perceptions among HCWs and patients were observed based on demographic factors such as gender, age, marital status, employment status, and educational qualification. Male HCWs and patients, as well as employed patients, tended to perceive the benefits of Smart Lockers more positively compared to their female counterparts and unemployed patients, respectively (p < 0.05). Additionally, patients with higher educational qualifications expressed more favourable perceptions of Smart Locker’s benefits than those with lower educational levels (p < 0.05). Understanding these perceptions and demographic influences is crucial for effectively implementing and utilizing Smart Lockers technology in healthcare settings. Tailored interventions based on these findings can help address disparities in perceptions and enhance the acceptance and utilization of Smart Lockers for chronic disease management in Nigeria. This study provides significant perspectives into healthcare technology and chronic disease management, ultimately aiming to improve healthcare delivery and patient outcomes in Nigeria.

Building Equitable Healthcare Institutions in Low- and Middle-Income Countries: Lessons from Wealthy Nations

Thu, 13 Jun 2024 00:00:00 +0100

Healthcare disparity continues to serve as serious obstacle in addressing health needs among disadvantaged populations across the globe. The member states of the Organization of Economic Co-operation and Development (OECD) have attained universal health coverage (UHC) for the past decades, and therefore, there are lessons Low- and Middle-Income Countries (LMICs) can learn from them and contextualize to their settings to strengthen their health systems and minimize healthcare disparities. We reviewed the health system strengthening (HSS) journey of the OECD member states, identified, discussed, and provided recommendations on key HSS pillars that can be adapted by the ten poorest countries to accelerate their health system strengthening efforts toward minimizing healthcare disparities and improving the quality of life for their citizens. The HSS pillars are expansion in healthcare access, improved healthcare spending, demand for more responsive healthcare, cross country study and experience sharing, and prevention policies to promote better health. In the report we also discussed the interwoven relationship between suboptimal governance, pervasive poverty, and fragile health systems in LMICs and suggested how addressing them will pave way to bridging health disparity in LMICs. The strategies and recommendations discussed in the review are critical to enacting good governance, strengthening health systems, and bridging healthcare disparities in LMICs. Strong political will and commitments by the governments of the LMICs, effective, transparent, and accountable partnership with OECD serve as the prerequisites for the strategies and recommendations provided in this report to yield desired impact.