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Screening Procedure for Hemihypertrophy: Preliminary Results of International Multicenter Prospective Study
Get PDFIntroduction: Isolated or congenital hemihypertrophy is a rare disorder characterized by asymmetric overgrowth of one side of the body. This article describes the protocol and preliminary results of a lateral body asymmetry (hemihypertrophy) screening procedure performed in healthy adolescents in a multicenter study. The reported incidence of hemihypertrophy varies between different publications and standardized protocols are needed to improve research in this area.Methods: Our screening program is taking place in Australia, Israel, Mexico, Ukraine and USA. Procedure includes two steps: (1) “three measurements – three questions” screening, or assessment of face, palms, and shins; (2) in-depth assessment of selected cases in order to exclude localized, lesional, and syndrome-related cases as well as body asymmetry within normative range and to select suspected cases of isolated hemihypertrophy. This step includes measurements of various anatomical regions and a detailed questionnaire.Results: At this stage, the screening procedure is completed and the selected participants are advised to refer to medical institutions for further clinical and genetic follow up to exclude possible tumors and other accompanying disorders.Conclusion: We present an easy-to-use selection tool to identify children with suspected IH, which results in the selection of the risk group that may benefit from referral to a pediatrician and a clinical geneticist
Interval Hysterectomy for Placenta Percreta – a Case Report
Get PDFIntroduction: Placenta percreta is an abnormality of placentation where it invades the serosa and can go beyond it. Complications include massive hemorrhage, bladder dysfunction, and severe infections during delivery. The aim of this study is to report a complex case of placenta percreta managed by interval hysterectomy.Case presentation: Pre-operative: 34 years old patient with previous three cesarean sections was followed in antenatal clinic. She came with repeated bouts of vaginal bleeding at 30-31 weeks. At 32 weeks and 4 days classical cesarean section was done with placenta left in situ. Prophylactic bilateral internal iliac artery balloon was inserted. Post cesarean section, uterine artery embolization was performed. Post-operative: Clinical features of pulmonary embolism (PE) developed about 4 hours later. Post-Operative Day 13: Total abdominal hysterectomy was done. After few days of discharge, the patient presented to the emergency department with shortness of breath. She was consequently diagnosed with chronic pulmonary embolism and treated with warfarin.Conclusion: This is a case of placenta percreta managed by interval hysterectomy. However, the most widely accepted method of management is cesarean hysterectomy. In this case, interval hysterectomy was done due to the possibility of bladder invasion by placenta, to decrease the amount of blood loss and to reduce the number of days stayed in hospital. Appropriate management for the patient must be personalized, whether it is by cesarean hysterectomy or interval hysterectomy, as each has risks and benefits
Hydatid Disease in the Central Region of Iran: A 5-year Epidemiological and Clinical Overview
Get PDFIntroduction: Hydatid cyst is caused by an infection by the larval stage of Echinococcus granulosus. Patients with cystic echinococcosis often remain asymptomatic until the hydatid cysts grow large enough to cause symptoms and signs. The cysts grow in the course of several years before reaching maturity and the rate of growth depends on the location of the cyst. Methods: This study was conducted in the Central region of Iran and involved all patients diagnosed with hydatid disease from 2012 to 2016 with the records identifed from 10 centers for disease control. Descriptive statistics including range and percentage were used in analyzing the patient characteristics. Results: Hydatid disease was confirmed in 84 cases. The mean age of patients was (23.1±5.1) years (range: 15-53 years) and 55.9% of cases were female. Single organ involvement was found in 86.9% of cases. 98.8% cases were successfully treated. The most common sites of infection were lung (42.9%), followed by liver (38.1%), and joint liver/lung (10.7%). The diagnosis was established by abdominal ultrasound, abdominal CT, and serology in all patients. The diagnosis was confirmed by histology in 80 (95.2%) of cases. All of cases were treated with albendazole, and 80 (95.2%) of cases had surgical intervention. The prevalence of human hydatidosis in our study was 1.16 per 100,000 population. Conclusions: Hydatid disease is common in Iran and should be a focus of public health interventions. The organ sites affected in this study include lung and liver
Non-Communicable Chronic Diseases Among Residents of a Remote Settlement in the Transbaikal Region of the Russian Federation
Get PDFIntroduction: Over a quarter of the population of the Russian Federation resides in rural communities. However, the data on chronic disease rates in these communities are limited, which makes screening for chronic diseases extremely important. The aim of this study was to measure the prevalence of chronic noncommunicable diseases among residents of a remote settlement in the Transbaikal region, Russian Federation.Methods: A sample of residents from the Transbaikal region settlement was screened in August 2017. The screening included a survey to determine the frequency of self-reported chronic diseases as well as sociodemographic and behavioral risk factors. Additionally, vascular stiffness was measured by volumetric sphygmography using the VaSera-1500 device. Descriptive statistics have been used for data analysis.Results: 126 residents were screened for this study. The prevalence of chronic non-communicable diseases and their risk factors were: hypertension (56.3%), gastrointestinal diseases (33.3%), chronic obstructive pulmonary disease (13.5%), smoking (35.7%), obesity (19.1%), and diabetes mellitus (6.3%). Pathological vascular changes typical of atherosclerosis were found by volumetric sphygmography in 17.5% of cases, with 5.5% of those cases corresponding to significant forms of severe peripheral atherosclerosis (ABI<0.9). An analysis of mortality causes for this settlement for 2016-2017 found that cardiovascular diseases accounted for over 50% of the total number of deaths.Conclusion: This study showed a high prevalence of detectable chronic non-communicable diseases and their associated risk factors. Cardiovascular diseases were the main cause of mortality. Active prevention programs and screenings are required to reduce the burden of chronic diseases in this region
Microbiological and Susceptibility Profile of Clinical Gram Positive Isolates at a Tertiary Pediatric and Maternity Hospital in Ulaanbaatar, Mongolia
Get PDFIntroduction: Information on microbiological and susceptibility profiles of Monoglian bacterial isolates is scarce. Resistance profiles, patient demographics and microbiological work-up of gram positive isolates were analyzed in order to develop infection control activities and policies at the National Center for Maternity and Children’s Health (NCMCH) in Ulaanbataar, Mongolia.Methods: All gram positive isolates of specimens submitted to the microbiology laboratory at NCMCH between January 2014 and August 2017 were included. Data collected included demographic data, specimen type, in-/outpatient status, hospital ward of sample origin, and antimicrobial susceptibility testing profile. Susceptibility testing was performed by trained microbiologists at the NCMCH microbiology laboratory. T-test, Mann-Whitney, Chi-square and Fisher exact tests were used as appropriate.Results: Of 11,889 isolates, 4012 (33.7%) were gram positive, with most identified as S. aureus (62.6%, n=2512). Rates of methicillin resistance (MRSA) remained stable at a quarter, but was significantly higher among inpatients (inpatients: 630/2002, 31.5%; outpatients 67/290, 23.1%; p?0.05) and sterile site isolates (sterile: 83/171, 48.5%; non-sterile: 416/1678, 24.8%; p?0.01). The vast majority of S. pneumoniae isolates (12/14; 85%) was found to be penicillin resistant by oxacillin disk diffusion. While identification of Group B streptococci was rare (n=137) due to of lack of diagnostic measures available, the number of enterococcal isolates identified increased signifi-cantly due to implementation of improved microbiological work-up (2015: n=7; 2016: n=26; 2017: n=83).Conclusion: Compared with published studies from neighboring nations, the rates of antimicrobial resistance among gram positive isolates at NCMCH, particularly with respect to S. aureus and S. pneumoniae, were much higher. Further improvement of microbiological diagnostics and collabo-ration of stakeholders is required to address the pressing infection control and stewardship issues and to ensure reliable identification of relevant pathogens in Mongolia
Trends and Determinants of Attitudes Towards People Living with HIV/AIDS Among Women of Reproductive Age in Tajikistan
Get PDFIntroduction: Despite having one of lowest rates of newly diagnosed HIV infections among former Soviet countries, Tajikistan has a substantial level of discriminatory attitudes towards people living with HIV/AIDS (PLWHA). While initial attempts were made to explore discriminatory attitudes of a wide range of professionals, women’s general attitudes towards PLWHA received less scholarly attention. Employing a nationally representative sample from the 2000 and 2005 Multiple Indicator Cluster Surveys (MICS), sociodemographic determinants of HIV-related discriminatory attitudes of women aged 15-49 in Tajikistan were identified and examined over time.Methods: A representative sample included 5,453 women of reproductive age from the capital city and four regions of Tajikistan. Two dichotomized scenarios representing the agreement to let an HIV-infected teacher continue teaching in school and the willingness to buy food from an HIV-infected cashier were constructed. Univariate and multivariable analyses of HIV-related discriminatory attitudes were obtained using Stata 14.Results: Insignificant but positive changes were observed in the women’s attitudes between 2000 and 2005. Logistic regression models showed that negative attitudes were associated with the lack of knowledge of HIV/AIDS prevention methods, endorsement of HIV/AIDS transmission misconceptions, and never having been tested for HIV (p?0.001). Women living in the rural areas, married, with lower education, and from low income households were less tolerant towards PLWHA.Conclusions: The data from Tajikistan underscore the persistence of HIV-related discriminatory attitudes among low socioeconomic status women. The study findings can be potentially used to target the disadvantaged groups and guide the design and implementation of programs that promote voluntary HIV-testing, raise awareness about HIV/AIDS prevention methods, and help dispel transmission misconceptions
Fructose Consumption among Students at The University of Guanajuato
Get PDFIntroduction: Fructose is a monosaccharide commonly found in fruits. However, it can also be found in carbonated beverages, cereals, fruit juices, and in other processed fruit. The consumption of fructose in moderate to high amounts increases levels of triglycerides in plasma and alters hepatic glucose homeostasis. Little information is avialble on fructose consumption in Mexico. The aim of this study was to determine the amount of fructose consumption among college students enrolled at the Unviersity of Guanajuato in Mexico (Celaya-Salvatierra Campus).Methods: This was an explorative, cross-sectional descriptive study. A total of 57 full time students attending Physical Therapy and Rehabilitation program were included in the analysis. Demographic data, food frequency questionnaire, and body mass index (BMI) were collected from all students. Data were analyzed by descriptive statistics; discrete variables were reported as frequencies or percentages and continuous variables were reported as means and standard deviations.Results: The average age of participants was 19.5 ± 2.8 years. 72% of participants were female and 28% were male. The average BMI was 24.0 ± 4.1 Kg / m2, indicating normal BMI range. Fructose consumption was roughly 55g per day.Discussion: Previous research demonstrated that levels below 50 mg per day are safe. Madero et al. reported that that consumption of 50-70 g of fructose per day is considered to be moderate. We found that students consumed 55g of fructose, so their fructose intake is at a moderate level and should not be an obesity-inducing factor, also consistent with BMI ranges of our research participants. Considering obesity epidemic in Mexico, further studies examining the source of calories in Mexican poipualation are warranted, especially among young people
Healthcare Access Experiences Among Indigenous Women in Northern Rural Thailand: A Focused Ethnographic Study
Get PDFIntroduction: Persistent inequities in health and access to healthcare services for indigenous women living in Thailand remain a significant challenge. This study provides narrative accounts of Indigenous women’s experiences accessing healthcare in northern and rural Thailand and explores the complexity of culture and its interaction with multiple intersecting influences on health behaviours.Methods: A focused ethnographic study was conducted to understand and describe the culture of health behaviors and other cultural phenomena. We recruited 21 female participants aged 20-41 years between March and April of 2017. In-depth semi-structured interviews conducted in Thai were used to explore the experiences of the participants living in a northern rural village. Data analysis was informed and guided by Roper and Shapira’s framework for ethnographic analysis.Results: Seven themes presented across three phases of experience (pre-access, making choices, and encountering difficulties) revealed an in-depth understanding of the Indigenous women’s lives, the broader sociocultural context in which they lived, and the challenges they faced when accessing healthcare. Analysis of data showed that the participants did not have equal access to healthcare and often disproportionately experienced discriminatory practices and negative attitudes of mainstream healthcare providers.Conclusions: This is the only study to date that discusses healthcare access challenges experienced by Indigenous women living in a northern rural Thai village. There is an urgent need to focus on citizenship, employment, and general health conditions; gender, familial, and labor roles; specific health conditions, wellness, and cultural practices; the seeking of healthcare services; healthcare provider relationships; the ability to access needed care; and optimization of self-care. Future efforts to improve healthcare access and reduce disease burden might benefit from these findings and allow for the development of more effective strategies, programs, and policies
Trends in the leading causes of childhood mortality from 2004 to 2016 in Qatar
Get PDFIntroduction: Childhood mortality is an important health indicator that reflects the overall health status of a population. Despite the decrease in global childhood mortality rates over the past decades, it still remains an important public health issue in Qatar.Methods: The data from 2004-2016 were extracted from the Qatar Ministry of Public Health Birth and Death Database. International Classification of Diseases (ICD-10) was used for coding the causes of death. The childhood mortality rate was defined as the probability of a child dying between the first and the fifth birthday, expressed as the number of deaths per 1,000 children surviving to 12 months of age. The sex ratio was calculated by dividing the mortality rate of males by that of females. Mann-Kendall trend test was performed to examine time trends. Relative risks were calculated to examine differences by nationality (Qatari and non-Qatari) and sex.Results: A significant decrease in mortality rate of children aged one to five was observed from 1.76 to 1.05 per 1000 children between 2004 and 2016 (Kendall tau=-0.6, p=0.004). Three prominent causes of mortality were motor vehicle accidents, congenital malformations of the circulatory system, and accidental drowning/submersion. A statistically non-significant decrease in childhood mortality from motor vehicle accidents was oberved for all nationalities (total (Kendall tau=-0.03), Qatari (Kendall tau=-0.14), and non-Qatari (Kendall tau=-0.12)). A significant decrease was seen for total accidental drowning and submersion (Kendall tau=-0.54, p=0.012), while no statistically significant decrease was seen for total congenital malformations of the circulatory system (Kendall tau=-0.36, NS). The Qatari population did have a significant decrease in childhood mortality due to congenital malformations of the circulatory system (Kendall tau=-0.67, p=0.003) and accidental drowning and submersion (Kendall tau=-0.55, p=0.016).Conclusion: The study is a first attempt to evaluate childhood mortality statistics from Qatar and could be useful in supporting Qatar’s ongoing national health strategy programs
Nutritional Status and Basic Hygiene Practices of Rural School Age Children of Savar Region, Dhaka, Bangladesh
Get PDFIntroduction: School children in the developing countries are susceptible to nutrition related health problems due to demographic and socio-economic factors, as well as limited access to food. Since BMI is a common proxy measure used to evaluate nutritional status, the aim of this study was to investigate the BMI categories in school-aged children in Dhaka, Bangladesh.Methods: A cross sectional study of 155 children, aged 6-12 years was conducted at Jahangirnagar University School in Dhaka, Bangladesh. The data collection was performed by in-person interviews and semi-structured questionnaires. Descriptive statistics, ?2 test, Fisher’s exact test, and One-Way ANOVA test were performed to compare the variables based on BMI percentiles. Data were analyzed using the Microsoft Excel program (version 2010).Results: Mean BMI of the students was 17.27 (SD=3.16). The prevalence of underweight and overweight/obesity was 11.0% and 25.8%, respectively. Categories of BMI percentiles were associated with birth order (p=0.026), personal hygiene practices (washing hands after coming home from outside (p<0.001) and before meal (p=0.045)), brushing teeth (p<0.001), the number of food items consumed daily (p<0.001), and mothers’ occupation (p=0.006). In context of basic hygiene practice, 61.3 % of respondents washed hands after coming home from outside, and 93.5 % reported washing hands before the meals.Conclusions: This study revealed that more than one third of the students had abnormal BMI. BMI screening in rural schools needs to be recommended in early grades for all children