Search results for “ORS”

Implementing Evidence-Based Occupational Therapy for Multiple Sclerosis Rehabilitation: Exploring Knowledge on Barriers, Facilitators and Strategies

Background A persistent gap remains between evidence-based health care and its application in routine practice. This challenge is particularly prominent in allied health professions like occupational therapy (OT), where interventions are complex, individualized and centred on patients' daily functioning. Objective To identify barriers, facilitators, and implementation strategies for integrating evidence-based OT interventions in multiple sclerosis (MS) rehabilitation. Methods A mapping review was conducted using searches in five databases. Eligible studies included adults with MS, examined OT interventions, and reported on factors influencing implementation. Data were extracted and categorized using Grol’s framework for barriers/facilitators and Mazza’s taxonomy for implementation strategies. Results Fifteen studies met inclusion criteria. Barriers and facilitators were identified at multiple levels of Grol’s framework: 1-Innovation-level: accessibility, feasibility, and perceived attractiveness supported implementation, particularly when interventions incorporated holistic approaches, gamification, or printed manuals. 2-Professional-level: therapists’ competencies and alignment between interventions and patients’ priorities. 3-Patient-related: facilitators included motivation, readiness to change, and peer support, whereas fatigue, pain, and cognitive challenges served as barriers. 4-Social and organizational: effective teamwork, resource availability, and flexible scheduling facilitated successful adoption. 5-Economic or political: no studies. Implementation strategies focused on using manuals, patient empowerment, gamification, and organizational supports. No financial or structural policy-level strategies were identified. Conclusion Successful implementation of evidence-based OT for MS requires multifaceted, context-sensitive strategies addressing innovation, professional, patient, and organizational determinants. Practical approaches enhance uptake, while substantial gaps persist at economic and policy levels. Strengthening these areas may improve longterm integration and sustainability of evidence-based OT in MS rehabilitation.

The Risk Factors, Complications, Management Strategies and Predictors of Morbidity & Mortality Among Pediatric Patients Presenting with Severe Diarrhea at Muhimbili National Hospital’s Emergency Medicine Department

Background Acute diarrhea is the major cause of health public problem among paediatric patients in Tanzania. And in Low income countries (LICs), studies have shown, Acute watery Diarrhea (AWD) is the cause of morbidity and mortality which can be prevented by immediate identification and treatment of complications. Methods A prospective cohort study was done between December 2021 and April 2022 to determine the risks, complications, management strategies and predictors of mortality among paediatric patients ≤12 years of age with severe diarrhea. We excluded those who arrived in cardiac arrest at the Emergency Medicine Department (EMD) of Muhimbili National Hospital (MNH). Proportion was used to summarize the counts and frequency of participants who were at risk of complications and management strategies given and for predictors of outcomes. A Modified Poisson log linear model with a robust estimation test was used to test for significant associations between predictors and outcomes. Multivariate logistic regression was used to adjust for confounders. Results A total 6,570 paediatric patients presented to EMD during study period, and we recruited 144 (2.2%). The median age was 1 (IQR 0.7-2.0) years and most were male 86 (59.7%). Among the study participants with diarrhea, 120 (83.3%) had dehydration, acidosis 60 (42.3%), hypoglycemia 8 (5.6%), hypokalemia 76 (53.1%), and Acute renal failure 11 (7.6%). Those patients with complications received appropriate management, including IV crystalloid solution given to 131 (90.97%), and correction of acidosis 60 (42.3%), hypoglycemia correction with IV dextrose 10% 6 (4.2%), and hypokalemia and infections were corrected with IV potassium chloride 52 (36.1%) and IV antibiotic treatment 84 (58.3%) respectively. Conclusion Pediatric patients under 2 years of age are at high risk of severe diarrhea with dehydration as compared to other ages. Early referral and availability of point care tests are essential in early recognition of accompanied complications.

Anchors of the Self: Cultivating Life Longings (Sehnsucht) and Goals in LGBTQ+ Therapeutic Discourse

We have highlighted the significant harm caused by internalized homophobia in LGBTQ+ individuals and the dimensions of internalized identity that often dim and redirect Motivations and Longings for a meaningful and valuable life for individuals in the LGBTQ+ community. We surveyed the dimensions of Life Goals and Longings as a basis for building motivation and a sense of worth in the individual, which forms the foundation of emotional well-being. From the perspective of the need for Longings and Life Goals, we identified relevant focal points in empowering work to establish these anchors within LGBTQ+ individuals. This process primarily focuses, alongside interpersonal and social dimensions, on the internal feelings associated with an individual's sense of identity. We emphasized the importance of having unique, personally tailored Longings for LGBTQ+ clients that are rooted in the dimensions ('virtues') of what is called 'character.’ As Hammack and Toolis (2014) articulated, we did not focus on others' perceptions of the LGBTQ+ individual as the sole central factor in constructing an individual's sense of self-esteem, although it is an important factor. Instead, we focused on the view that LGBTQ+ individuals mainly construct their self-esteem based on their perception of their values relative to those of society around them. An individual's values and Goals are at the center of constructing their sense of self-esteem when compared to society’s ‘correct' Goals. Individuals see themselves in character traits, less so in terms of function, in relation to their environment, and thus define their self-esteem as being 'good' or 'bad' in their own eyes 666467.

Interactions Between Natural Nuclear Reactors and Microbial Evolutionary Processes

The impact of ionizing radiation on genetic change is well established, yet the extent to which naturally occurring radiation fields have influenced evolutionary trajectories remains incompletely understood. This study examined correlations between microbial evolution and the radiation and geochemical environments associated with natural fission reactors, with emphasis on the Oklo–Bangombé system in present-day Gabon, Africa. The current paper compares plausible doserate regimes adjacent to reactor zones with published observations of radiationinduced phenotypes, geneexpression changes, and repair strategies in model organisms and complex biotas. This study further considers indirect mechanisms (e.g., water radiolysis, redox restructuring, tracemetal mobilization) by which natural reactors could have modulated ecological selection pressures over long timescales. The synthesis supports the plausibility of three interacting pathways: (i) increased mutation supply under low, chronic dose rates; (ii) selection in oxidantrich, redoxstratified niches; and (iii) metabolic subsidies (e.g., H₂) from radiolysis that support chemotrophic guilds. Although temporal–spatial associations exist between reactor activity and biological innovations preserved in Paleoproterozoic strata of Gabon, current evidence remains correlational rather than demonstrably causal. The study further outlines testable predictions and experimental designs capable of discriminating among these mechanisms.

Assessing the Impact of Environmental Factors on Andipalayam Lake's Insect Biodiversity

Andipalayam Lake, a freshwater body located in Tiruppur, Tamil Nadu, plays a significant role in sustaining the local ecosystem, particularly through its diverse insect populations. This study aims to document and analyze the insect biodiversity present in and around Andipalayam Lake, focusing on the ecological roles these species play in maintaining the lake’s health. Insects are key components of aquatic ecosystems, contributing to processes such as pollination and nutrient cycling and serving as prey for higher trophic levels. Despite their ecological importance, studies on the insect biodiversity of Andipalayam Lake have been limited, prompting the need for an extensive survey. This research employed a combination of sweep nets, pitfall traps, and light traps to collect insect species over a year, covering various seasons to capture population dynamics and seasonal variations. Water quality parameters, such as temperature, pH, and dissolved oxygen, were monitored to assess their influence on insect diversity. The study identified over 38 species of insects from diverse orders, including Odonata (dragonflies), Diptera (flies), Coleoptera (beetles), and Hemiptera (true bugs). Seasonal variations were observed, with higher species richness during the monsoon period due to increased vegetation and moisture levels. The most abundant species were found to belong to Diptera and Coleoptera, indicating their adaptability to fluctuating water levels. Environmental factors such as pollution from nearby agricultural runoff and urban development were found to negatively affect insect diversity, with a notable decline in sensitive species during periods of increased contamination.

Prevalence and Risk Factors of Intestinal Parasitic Helminths among Primary School Children in Oru West Lga, Imo State, Nigeria

Intestinal parasitic helminths pose a significant public health burden, particularly among children. This cross-sectional study investigated the prevalence and risk factors of intestinal parasitic helminths among 550 school children aged 4-12 years in Oru-West L.G.A, Imo State, Nigeria. Stool samples were examined using parasitological techniques, and questionnaires were administered to collect data on risk factors. The overall prevalence of intestinal parasitic helminths was 49.1% (270/550), with Ascaris lumbricoides being the most prevalent (30.37%). Multivariate analysis revealed significant associations between intestinal parasitic helminths and lack of hand-washing, insufficient toilet facilities, consumption of unwashed vegetables, and poor environmental sanitation. Males had a significantly higher infection rate than females (P < 0.05). Age-related prevalence was highest among children aged 4-6 (51.85%). Occupational status and educational level of parents were also significant predictors of infection. These findings highlight the need for public health education, provision of basic sanitation facilities, and regular de-worming as preventive measures.

Factors Impacting Nutritional Status in Infants with Single Ventricle Physiology

Infants with single ventricle (SV) physiology are at increased risk of undernutrition, which can contribute to adverse outcomes. This is a retrospective case series examining factors associated with undernutrition in patients with SV physiology at one year of age. It includes 56 infants from a single institution who underwent SV palliation between 2003 and 2023. Undernutrition was defined as a weight-for-length z-score (WLZ) below -1, based on World Health Organization (WHO) normative data. Independent variables included surgical interventions, cardiorespiratory factors, and nutritional interventions. Associations between these variables and nutritional status were assessed using Fisher’s exact test. At one year, a total of nine infants (16%) were undernourished. Undernutrition rates significantly declined after 2013 (p=0.02), demonstrating improvements in nutritional outcomes over our study period. Those who used supplemental oxygen or pulmonary medications were undernourished at lower rates. While this difference was not statistically significant, the number of undernourished patients in the cohort may have limited the study’s power. Our findings suggest that early respiratory interventions may provide nutritional benefits in infants with SV physiology.

Factors Contributing to Domestic Violence Among HIV-Discordant Couples in Kicukiro District, Rwanda

Background Domestic violence among HIV discordant couples poses significant public health challenges, affecting treatment adherence and HIV transmission risks. This study examined factors contributing to domestic violence among HIV discordant couples in Kicukiro District, Rwanda. Methods A cross-sectional study was conducted among 384 HIV discordant couples from eleven health centers using stratified systematic sampling. Data were collected through structured face-to-face interviews and analyzed using descriptive statistics and bivariate analysis. Results Domestic violence prevalence was 41.1% physical violence, 34.2% sexual coercion, and 52.3% emotional abuse. Key socio-demographic risk factors included female gender (56% vs. 29% males, p<0.001), older age (61% in ≥55 years vs. 32% in 18-24 years, p=0.004), unemployment (55% vs. 34% formal employment, p=0.014), and financial hardship (63% vs. 25% comfortable situations, p=0.002). Behavioral factors included alcohol use (58% vs. 38%, p=0.021), substance abuse (62% vs. 35%, p<0.001), and poor conflict resolution (72% vs. 25%, p<0.001). Contextual factors like hostile HIV disclosure reactions (68% vs. 34%, p<0.001) and HIV-related stigma (60% vs. 35%, p<0.001) significantly increased violence risk. Conclusions Domestic violence among HIV discordant couples is multifactorial, driven by socio-economic, behavioral, and HIV-related factors. Integrated interventions addressing economic empowerment, conflict resolution skills, stigma reduction, and couple-centered counseling are urgently needed.

Risk Factors and Control Strategies for Cattle Tick Infestations in Nigeria: Influence of Acaricide Application Methods, Hand-Picking Frequency, and Herd Mobility in Plateau State

Background Tick infestations severely impair cattle health and productivity in Nigeria through blood loss, hide damage, and transmission of tick-borne pathogens. Objective This study assessed key risk factors influencing tick infestation and evaluated control methods among Fulani pastoral herds in Plateau State. Methods A cross-sectional survey involving 250 cattle from ten herds was conducted across five Local Government Areas. Tick burden was analyzed against acaricide application methods (pour-on vs. hand-spray), hand-picking frequency, and herd mobility (sedentary vs. migratory). Data were collected via owner interviews and manual tick counts. Statistical analyses were performed using generalized linear models in R software. Results Cattle treated with pour-on acaricides had significantly lower tick burdens compared to those treated via hand-spray (P<0.05). Herds that practiced hand-picking five times weekly had fewer ticks than those hand-picking thrice weekly (P<0.01). Migratory herds recorded significantly lower infestations than sedentary herds (P<0.05). Conclusion Effective tick control requires the integration of optimized acaricide application, frequent manual removaland consideration of herd mobility patterns. Education, capacity building, and policy support are necessary to enhance adoption of effective tick control measures among pastoralists.

Systematic Review of Spinal Cord Injuries in Equestrian Athletes: Incidence, Risk Factors, and Outcomes

Objective The goal of this systematic review is to identify common themes amongst acute spinal cord injuries (SCI) in equestrian athletes. Design A systematic review was performed using PubMed, CINAHL Plus with Full Text (EBSCO), Cochrane Library, and Scopus with pre-determined MESH terms. The initial search returned 354 studies. Following PRISMA guidelines, 13 articles were included. Exclusion criteria included injuries to the horse only, non-English language, cauda equina, and case reports. Data extraction was completed, and common findings were evaluated narratively due to heterogeneity of data. Results Seven manuscripts listed specific horse-related activities that caused SCI, with fall from horse as the highest percentage of injury. Nine articles identified the injury region, with large variations and no clear dominant area of injury. Five articles identified the length of hospital stay with ranges from 1 to 82 days. Four articles looked at the association of professional vs non-professional riders. Only two articles evaluated helmet use at time of injury, with one article showing 81% of those with SCI used helmets, and the other showing only 35.6% utilized this safety measure. Conclusion SCI in equestrian athletes can have a wide presentation, with large variation on location of injury, length of stay, and other factors. However, non-professional riders are at greater risk of SCI and individuals are more likely to sustain injury from a fall from a horse rather than a kick or another modality of injury. Future study can elicit presenting symptoms, types of surgical intervention used, and long-term outcomes and recovery.

Predictors of COVID-19 Vaccine Uptake Among Healthcare Workers in Kiambu County, Kenya

Coronavirus Disease 2019 (COVID-19) placed significant pressure on global health systems, necessitating rapid and widespread immunization, especially among healthcare workers (HCWs). Despite being prioritized in immunization programs, variations in vaccine uptake among HCWs have been reported across different settings. This study aimed to investigate the predictors of COVID-19 vaccine uptake among HCWs in Kiambu County, Kenya. An analytical cross-sectional study design was employed, involving 112 HCWs sampled using stratified random sampling from Level 2 to Level 5 healthcare facilities. Data were collected through a pre-tested and validated 18-item questionnaire and analyzed using SPSS version 29.0. Statistical methods included descriptive analysis, chi-square tests, logistic regression, and ANOVA. The overall COVID-19 vaccine uptake was 88.9%. Significant predictors of uptake included age (p = 0.048), cadre (p = 0.015), and facility level (p = 0.031). Knowledge of COVID-19 vaccines emerged as the strongest predictor, with HCWs demonstrating good-to-excellent knowledge being 14.97 times more likely to be vaccinated (p < 0.001). Confidence in vaccine safety and effectiveness was also significantly associated with uptake (p < 0.001). Uptake was highest in Level 5 hospitals and lowest in dispensaries. The study reveals high vaccine uptake among HCWs in Kiambu County, but disparities persist due to individual and systemic factors. Strengthening vaccine education, institutional support, and deploying mobile vaccine education units in lower-level facilities could help close these gaps, offering practical strategies for improving HCW vaccine coverage in Kenya and other low- and middle-income countries.

Factors Influencing HIV Status Disclosure Among People Living with HIV/AIDS in Mukono District, Uganda: Beyond Health System Support

Background HIV status disclosure is a complex process influenced by multiple factors beyond health system support. Understanding these factors is essential for developing comprehensive interventions to promote disclosure and improve HIV prevention and care outcomes. Methods A descriptive cross-sectional study was conducted in 10 health facilities offering comprehensive HIV/AIDS care in Mukono district, Uganda. Data was collected from 317 clients through interview-guided questionnaires. Data was entered using EPI data and analyzed using SPSS version 16, including logistic regression to identify factors associated with disclosure. Results Multiple factors influenced HIV status disclosure. Individual factors included knowledge about HIV (OR=2.34, 95% CI: 1.45-3.78), self-efficacy (OR=3.12, 95% CI: 1.87-5.21), and psychological readiness (OR=2.89, 95% CI: 1.76-4.75). Relationship factors included relationship quality (OR=3.56, 95% CI: 2.13-5.94), communication patterns (OR=2.78, 95% CI: 1.65-4.69), and anticipated partner reaction (OR=4.23, 95% CI: 2.54-7.05). Community factors included perceived stigma (OR=0.34, 95% CI: 0.21-0.56), cultural norms (OR=0.45, 95% CI: 0.27-0.75), and religious beliefs (OR=1.87, 95% CI: 1.12-3.14). Structural factors included economic dependence (OR=0.38, 95% CI: 0.23-0.63) and access to support services (OR=2.45, 95% CI: 1.47-4.08). Conclusions HIV status disclosure is influenced by a complex interplay of individual, relationship, community, and structural factors. Effective interventions to promote disclosure must address these multiple levels of influence, going beyond health system support to create enabling environments for disclosure at the individual, relationship, community, and structural levels.

Ecosystem-Based Fishery Management of Antarctic Krill (Euphausia superba) to Support Baleen Whales and other Predators Production Adapted for Potential Climate Change Effects

Antarctic krill is an important component of the zooplankton production in the Southern Ocean and is a major food source for baleen whales. The role of commercial fishing and predation by whales on Krill abundance has been investigated here using the innovative ecosystem-based fishery management, EBFM which maintains the krill to whale food web ecosystem stability. The literature indicates the Krill fishery may have been overfished, so it was reduced to the current annual upper limit of 0.62 million tonnes for support other predators of krill, such as seals, penguins and flying sea birds. However, recent literature suggests a moderate reduction in krill catch in the Antarctic Peninsula area due to its importance for whale migration to temperate areas. The Peninsula area catch was estimated to be reduced by about 10% due to additional concerns about climate change effects on krill abundance in the Southern Ocean, reducing overall catch to 0.556 million tonnes, moderately higher than the maximum taken in 2022. Hence, the krill biomass fishing was reduced to allow for predation by baleen whales and other predators, giving a full ecosystem-based fishing mortality similar to that previously estimated to maintain krill production in the Southern Ocean.

Research Study Reveals Factors That Impacted Ohio Funeral Director Attrition and Retention Rates

A phenomenological qualitative study was conducted to obtain facts and details about the lived experiences of Ohio funeral directors during their first five years of licensure. The goal of the study was to understand these lived experiences as told by funeral directors to understand better the factors that impact the attrition and retention of new licensees. The data was analyzed using the Colaizzi 1978 method. The collected data aided in professional development programs offered to Ohio funeral directors and embalmers which increased the discussion and interest in factors that impact attrition and retention rates of new funeral director licensees at the local and national levels. The information from the study can be applied to allied helping professions such as healthcare, ministerial, and education. The stories and experiences as told by Ohio funeral directors provides new insight into the factors that impact attrition and retention rates of new licensees.

A Study on the Feasibility and Utility of Continuous Glucose Monitors in Elite Football

Physiological performance may be limited by reduced systemic glucose availability to working muscles. Continuous glucose monitors (CGM) measure interstitial glucose every 1-15 minutes, offering a practical way to assess glucose during sporting activity. However, empirical research has predominantly focused on endurance-based sports, whereas glucose responses during professional competitive football matches remain unknown. This study evaluated the feasibility and utility of CGM in professional football. Eight professional, male outfield footballers from the English third tier participated in the study. Participants completed a 14-day food diary control period, followed by a 28-day observation period wearing CGM devices during six matches and sixteen training sessions. CGM devices remained in situ for 98% of training sessions and matches. Mean glucose concentrations were 6.5 ± 1.2 mmol/L during training sessions, 7.5 ± 2.1 mmol/L during match play, and 5.4 ± 0.3 mmol/L overnight. No significant differences were found between glucose concentrations during match play (p = 0.060) or training (p = 0.510), compared to overnight fasted glucose concentrations. There was also no difference between training and match-play glucose concentrations (p = 0.788). Glucose concentrations were highly individualised, with one player displaying minimal change throughout match play (-0.2 mmol/L) whereas another experienced increases of up to 5.8 mmol/L. Non-nutritional factors appeared to influence glucose concentrations; participants (n=3) who used nicotine pouches displayed an transient increase in blood glucose in the 10-55 minutes after administration. This study concludes that CGM use in professional football is feasible for assessing individual glucose responses to  training and match-play.

Factors Influencing Dietary Diversity and Nutritional Status Among Adolescent Pregnant Women in South-Eastern Tanzania: A Hospital-Based Cross-Sectional Study

Introduction Adolescent pregnancy has become a global health concern in recent years, with maintaining dietary diversity being essential to ensure the health of both the mother and fetus. This study aimed to understand the dietary diversity and nutritional status among pregnant adolescents attending antenatal clinic and identify the factors influencing these outcomes. Methodology A hospital based cross-sectional study was done at St Francis Regional Referral Hospital at Ifakara, Tanzania. A total of 131 adolescent pregnant women consented to participate. Data was obtained using questionnaire and 24-hour dietary recall. Results The study revealed that 93.1% (n=122) of adolescent pregnant women met the minimum dietary diversity score based on 24-hour recall period. Similar proportions were observed for age group but vary significantly with the number of children born (p< 0.001), marital status (p = 0.032) and education level (p< 0.001). Additionally, 93.9% (n=123) of adolescent pregnant women had a normal Mid-Upper Arm Circumference (MUAC) and 6.1% (n=8) were undernourished. Similar proportions were observed across age, number of children born, marital status, education status, and occupation. Conclusion Most adolescent pregnant women in this study achieved adequate dietary diversity. However, socio-demographic factors such as age, marital status, and education, as well as challenges like illness and loss of appetite, influenced their dietary diversity and overall nutritional status. Future research should adopt a community-based longitudinal approach to better understand these factors and provide a more comprehensive understanding on the dietary patterns of adolescent pregnant women.

Predictors of COVID-19 Vaccine Hesitancy in North-Central Nigeria

COVID-19 vaccine hesitancy has emerged as a major challenge to global efforts to control the pandemic, particularly in Nigeria, where hesitancy to other effective vaccines such as polio and measles has been widely reported. Several individual, societal, and structural factors contribute to this behaviour and prevent the effectiveness of COVID-19 prevention efforts. Objectives This study sought to identify the predictors of COVID-19 vaccine hesitancy in the seven states of North-Central, Nigeria. Methods A population-based cross-sectional online survey was conducted among residents using a semi-structured questionnaire adapted from the WHO SAGE vaccine hesitancy scale and distributed via social media networks over 8-weeks. Results A total of 1,429 responses met the inclusion criteria and were analysed. Among the respondents, 60.7% were males, 47.5% were between the ages of 26 and 45, and 80.1% had postsecondary education. A total of 421 respondents (29.5%) were hesitant and unwilling to receive the vaccine. The reasons for hesitancy were concerns about side effects (37.1%), doubt about the existence of COVID-19 (11.0%), and the perception of time required to receive the vaccine (9.6%). Post-secondary education (AOR: 0.49, 0.36-0.66) and people of the Islamic faith (AOR: 0.68, 0.52-0.90) were found to be associated with lower levels of hesitancy. Conclusion The study found that vaccine hesitancy is a complex problem that is linked with multiple social determinants of health as lower educational attainment, lower income and Christian faith were found to be predictors of vaccine hesitancy. Confidence, Complacency and Convenience factors were expressed by respondents as concerns about side effects, doubt about the existence of COVID-19 and time required to receive the vaccines were the most prominent reasons for unwillingness to receive the vaccine. In order to protect the public health of communities, targeted interventions are required to increase vaccine acceptance by cultivating trust in vaccines, disseminating accurate information, and engaging with community stakeholders including religious groups.

Understanding Inherited Bleeding Disorders: Genetic Mutations in Blood Coagulation Factors and Regulatory Proteins

Hereditary thrombotic diseases, or inherited bleeding disorders, are a group of genetic conditions that disrupt normal blood coagulation. These diseases result from mutations in genes encoding blood coagulation factors or other regulatory proteins, impairing the body's ability to regulate bleeding and clotting. The most common inherited clotting disorders are hemophilia A and B, which are associated with deficiencies in clotting factors VIII and IX, respectively. Von Willebrand disease (VWD) is another prevalent disorder characterized by a deficiency or dysfunction of the Von Willebrand factor, a protein essential for coagulation. Additionally, the Factor V Leiden mutation is linked to an increased risk of blood clots. The prevalence of inherited coagulation disorders varies significantly by region and subpopulation. It is estimated that 5,000 to 10,000 male newborns are born with hemophilia A or B each year. Von Willebrand disease is much more common, affecting about 1% of the global population. The Factor V Leiden mutation is found in significant percentages of certain populations, with 3–8% of Caucasians being carriers. While antithrombin deficiency is more common in some areas, the incidence of other inherited clotting disorders, such as Factor XI, protein C and S deficiencies, and VWD, varies widely worldwide. This study discusses the incidence of inherited clotting disorders and their impact on affected individuals and their families. It also covers new advancements in disease management, alternative therapy approaches, and contemporary diagnostic techniques, aiming to improve diagnoses, treatments, and outcomes for patients with hereditary clotting disorders.

Unveiling Gender Disparities in ADHD: A Literature Review on Factors and Impacts of Late Diagnosis in Females (2010-2023)

This exploratory study investigates factors and consequences of underdiagnoses or late diagnoses of attention deficit hyperactivity disorder (ADHD) in females favoring males in the referral, diagnosis, and treatment processes resulting in  gender disparities. A literature review in PubMed, PsychINFO, PsychArticles, and PsychiatryOnline from 2010 to 2023 underscores significant implications of delayed ADHD diagnosis in females, hindering timely access, support, and interventions during critical developmental years. Factors associated with underdiagnosis of ADHD among girls include gender differences in symptomology presentation, comorbidity, and gender bias among parents, teachers, and healthcare providers. We highlight the role of ethnicity and cultural factors. This bias prevents girls from receiving necessary ADHD support and treatment, impacting their health, social, and economic outcomes into adulthood. We summarize strategies to urgently address gaps in ADHD research and practice. Raising awareness among communities, healthcare providers, educators, and parents is vital to alleviate these gender disparities. By illuminating factors contributing to delayed diagnoses, the study informs policymakers and stakeholders, facilitating targeted interventions to improve early detection and treatment outcomes for females with ADHD.

Exploring HIV Self-Testing: Barriers and Facilitators among Undergraduate Students

Introduction Globally, 36.7 million individuals live with HIV/AIDS, with 2.5 million new cases annually. Youth (14-25 years) account for 45% of these new infections. Those aged 15-24 years are less likely to be aware of their HIV status and engage in HIV care compared to older adults. This study explores the use of HIV self-testing to improve access to HIV care among Kenyatta University undergraduates. Objective To identify barriers and facilitators to HIV self-testing in this group. Methodology Employing multistage cluster sampling, 398 students were surveyed using a self-administered questionnaire. Results Of the participants (median age 21 years, 1:1.03 male-to-female ratio), 91.7% understood HIV's seriousness, with sexual intercourse as the primary transmission mode. Self-testing usage was 28.8%. Key barriers included fear of partner reaction, stigma, and lack of confidence. Significant facilitators were being female, knowledgeable about HIV, and sexually active. Conclusion Only 24% had prior HIV testing experience. The study highlights the importance of addressing fears and misconceptions while leveraging knowledge and sexual activity awareness to promote HIV self-testing.

Natural Polyphenols as Inhibitors for the Binding of Covid-19 S-RBD with ACE-2

The binding strength of Covid-19 variants, Omicron BQ.1, XBB.1.5, XBB 1.16, FE.1, EG.5, BA.2.86, HV.1, and JN.1, with the ACE-2, was calculated insilicoand evaluated with previous variants; the binding strength of new variants is XBB.1.5 << BA.2.86 < Delta < JN.1 < HV.1 < BA.1 << BA.2. The binding strength of Omicron JN.1 was similar to that of Delta, and that of others was less than that of BA.2.86. The binding inhibition of natural polyphenols was analyzed using a popular Omicron JN.1. The natural polyphenols were (-) Catechin, (+) Catechin, (+) epicatechin, apigenin, apigetrin, daidzein, quercetin, genistein, and oleuropein. The ionization of phenolic hydroxy groups was defined based on the atomic partial charge of oxygen. Polyphenols’ ionized hydroxy groups inhibited the binding of JN.1 S-RPB with ACE-2.

Stratified Analysis of Factors Associated With Mortality in Patients With COVID-19 Based on Cancer and Diabetes

Background Cancer and diabetes are risk factors for COVID-19 mortality rates. Remdesivir, dexamethasone, and vaccines are used to improve clinical outcomes. We aimed to evaluate the factors associated with COVID-19 mortality rates. Methods This retrospective study enrolled moderate to critical COVID-19 patients. The index day was the day of the COVID-19 diagnosis. Patients were followed up until either death or discharge. A two-way analysis of variance examined the interaction between independent mortality risk factors. Results A total of 205 patients were analyzed, and the mortality rate was 29.5% (n=60/205). The cumulative survival rate was significantly lower in patients with a CCI score ≥ 6, cancer, and diabetes. In multivariate analysis, critical illness, cancer, diabetes, chronic liver disease, a CCI score ≥ 6, unvaccinated, and early use of remdesivir/dexamethasone were independent risk factors for mortality. The onset of remdesivir/dexamethasone ≥ 2 days and < 3 doses of vaccinations were higher mortality rate, with its impact being more significant amongst patients with cancer/diabetes, compared to those without cancer/diabetes (p for interaction = 0.046/0.049, 0.060/0.042, and 0.038/0.048 respectively). Conclusions COVID-19 vaccination ≥ 3 doses and early administration of remdesivir and dexamethasone can significantly reduce mortality rates, particularly in patients with cancer or diabetes.

Assessment of Environmentally Responsible Health-Oriented Behaviors in Students

Background & Objective Changing people’s attitude toward the environment is an important approach to the prevention of environmental damages. The present study aimed to evaluate environmentally responsible health-oriented behaviors in students. Materials and Methods This research was performed on 360 medical students (180 males and 180 females) who were selected via stratified random sampling. Data were collected using a responsible environmental behaviors questionnaire. Data analysis was performed in SPSS version 21 using linear regression analysis and Pearson’s correlation-coefficient. Results The scores of the environmental attitude, environmental knowledge, and environmental behaviors of the participants were estimated at 52.63±5.74, 74.43±5.99, and 103.37±11.51, respectively. An insignificant correlation was observed between the environmental knowledge and environmental behaviors of the students (r=0.07; P=0.20). However, the correlation-coefficient between the environmental attitude and environmental behaviors of the students was positive and significant (r=-0.54; P<0.001). A negative, significant correlation was also denoted between the environmental knowledge and environmental attitude of the students (r=-0.39; P<0.001). Conclusion Despite relatively poor environmental awareness and attitude, the majority of the students had proper environmental behaviors. Therefore, it seems that having an environmentally responsible behavior does not rely on environmental attitude and knowledge. In fact, behaviors influenced by social conditions and structure encourage and facilitate environmental behaviors.

Premenstrual Syndrome and Associated Factors among Students in Secondary Schools in Arba Minch Town, Southern Ethiopia: A Cross-Sectional Study, 2021

Background Many women feel physical or mood changes in the days before menstruation. Previous studies in other areas of Ethiopia have not looked at factors that could be related to the premenstrual syndrome. As a result, this study aims to fill these gaps by determining the prevalence and behavioral, reproductive, and menstrual factors that affect premenstrual syndrome in Arba Minch town. Methods An institution-based cross-sectional survey was conducted in Arba Minch town from April 1 to April 25, 2021. Participants were chosen using computerized simple random selection from a list of female students' registration numbers that had been transformed into unique codes. SPSS for Windows version 25.0 was used to analyze and interpret the data. Bivariate analysis was used to fit variables with a P-value of less than 0.2 for multivariable analysis. In multivariable logistic regression, variables with a P-value less than 0.05 are considered statistically significant. Result This study has revealed that 59.8% (95% CI: 55.8%–63.8%) of students have premenstrual syndrome. Dysmenorrhea (AOR = 3.172, 95% CI: 2.032, 4.952), family history of PMS (AOR = 3.155, 95% CI: 2.119, 4.697), normal body mass index (AOR = 0.244, 95% CI: 0.161, 0.37), and overweight (AOR = 3.739, 95% CI: 1.763, 7.931) were significantly associated with premenstrual syndrome. This study has revealed that 59.8% (95% CI: 55.8%–63.8%) of students have premenstrual syndrome. Dysmenorrhea (AOR = 3.172, 95% CI: 2.032, 4.952), family history of PMS (AOR = 3.155, 95% CI: 2.119, 4.697), normal body mass index (AOR = 0.244, 95% CI: 0.161, 0.37), and overweight (AOR = 3.739, 95% CI: 1.763, 7.931) were significantly associated with premenstrual syndrome. Conclusion Six out of ten Arba Minch town secondary school students had premenstrual syndrome. Dysmenorrhea, a family history of premenstrual syndrome, and body mass index were found to be significantly associated.

Disability and prognostic factors of MS severity: An Algerian cohort study

Background The evolution of multiple sclerosis (MS) is highly variable. Predicting this evolution at the beginning of the disease will help in the therapeutic management. The objective of this study was to describe the clinical characteristics and to identify early predictors of long-term disability among MS patients in Algeria. Methods We performed a descriptive and retrospective study of 400 MS patients followed over a 4-years period from July 2012 to July 2016 in the neurology department of Mustapha Bacha hospital in Algiers. The following parameters were systematically assessed for each patient: Age at onset, gender, relapses, initial demyelinating event, interval between first and second attack, residual deficit after first attack, onset of the progressive course, time of assignment of the successive scores of irreversible disability and type of disease modifying therapies. Univariate and multivariate Cox models were used to determine factors influencing time to Expanded Disability Status Scale (EDSS) 4 and 6. Results During the follow-up of this cohort of MS patients, a total of 144 (36%) and 83 (20%) patients reached EDSS scores 4 and 6 respectively. The median times from the onset of MS to assignment of a score 4 and 6 was 10 years and 19 years, respectively. Using the MSSS severity score, and after univariate analysis we identified several risk factors predictive of disease severity. These included male sex (P= 0.002), age of onset ≥ 40 years (P= 0.001), pyramidal (P= 0.0001), cerebellar (P= 0.002), and poly-symptomatic (P=0.0001) onset of the disease, incomplete recovery after the first attack (P= 0.0001), a high number of attacks during the first 2 years (P= 0.04) and the progressive form (P=0.001), and all these factors were correlated with a high MSSS score. However, prognostic factors in the multivariate binomial logistic regression analysis were limited to pyramidal onset, incomplete recovery after the first attack, short interval between the first and second attack, and progressive onset. Conclusion On the whole, the early predictive factors of disability in MS among Algerian patients were age of onset over 40 years, pyramidal onset, incomplete recovery after the first attack, short interval between the first and second attack and progressive form at onset. To increase the generalizability of findings, a national MS registry is strongly recommended, as well as long-term follow-up epidemiological studies.

Outcome of traumatic brain injury and its associated factors among pediatrics patients treated in Amhara national regional state comprehensive specialized hospitals, Ethiopia 2022.

Background Traumatic brain injury in pediatrics is one of the commonest causes of morbidity, disability and mortality worldwide. In low- and middle-income countries Study showed that death of pediatrics from traumatic brain injury was 7.3%. However, there is limited data towards the outcome of traumatic brain injury and its associated factors in Ethiopia. Objective To assess the outcome of traumatic brain injury and associated factors among pediatrics patients in Amhara National Regional State Comprehensive Specialized Hospitals, Ethiopia. Methods An institution based retrospective cross-sectional study was conducted among 423 pediatrics patients from January 1, 2019 to December 30, 2021, and data extraction period was from May 16 to June15, 2022. Systematic random sampling technique was employed to select the study participants. Data were collected from patient charts and registry books by using a data extraction tool. Data were entered into the Epi-info version 7 and analysis was done by SPSS Version 25. Both Bi-variable and multi-variable analyses were employed to identify factors associated with outcome of traumatic brain injury. Result From 423 sampled study participant charts 404 of them had complete information with response rate of 95.5% and included in the final analysis. The overall unfavorable outcome of traumatic brain injury at discharge was found that 12.13% (95% CI: 9.1% - 15.7 %). Sever traumatic brain injury (AOR: 5.11(CI :1.8-14.48), moderate traumatic brain injury (AOR:2.44(CI:1.07-5.58), Hyperglycemia (AOR: 3.01 (CI:1.1-8.04), sign of increased intracranial pressure (AOR:7.4(CI:3.5-15.26), and medical comorbidity (AOR: 2.65(CI:1.19-5.91) were predicted of unfavorable outcome of traumatic brain injury pediatrics patient. Conclusion and recommendations twelve present of traumatic brain injury results unfavorable outcome. Sever and moderate form of traumatic brain injury, hyperglycemia, signs of increased intracranial pressure, and medical comorbidity were factors associated with unfavorable outcome of traumatic brain injury in children. Therefore, it is preferable to improve accesses to acute and post-acute care services to lower the unfavorable outcome of traumatic brain injury in children.

Attitude of Nursing Students towards LGBTIQ Individual and its Associated Factors in Kathmandu Metropolitan City

Background People may have both negative and positive attitudes about other people, their way of living and those attitudes can be influenced by various factors. LGBTIQ individuals are facing various difficulties and barriers to run their daily life due to different attitudes of people. Attitudes may be different from person to person influenced by their knowledge, acceptance behaviour and understanding. By finding out the associated factors that influences the attitude of people we can change people’s view towards LGBTIQ individuals. Each and every person deserves to be treated equally regardless of their gender, sexual orientation, and preferences. Methods This was a cross-sectional study in which the sample size was 423 and the study population was nursing students. A simple random sampling method was used to select sample for the study. Self-administered questionnaire was used to collect data. The collected data was entered in EPI 3.1 and analyzed using SPSS 25. A descriptive statistic was used to find out the frequency and percentage and analysis (chi-square) was used to find out the association between the dependent and independent variables. A p-value of <0.05 was considered statistically significant. Results Results showed that 87.2% have positive attitudes towards LGBTIQ individuals, and the majority (56.6%) have knowledge about homosexuality. Similarly, more than two-thirds (82.7%) of respondents were not homophobic, and 50.4% showed positive stereotypes about LGBTIQ individuals. Religion (p=0.030), caste (p=0.001) and Family type (p=0.016) were statistically significant with regard to the attitudes of students towards LGBTIQ. Conclusion The majority of students had positive attitudes towards LGBTIQ individuals and few had negative attitudes. Almost half of the respondents had adequate knowledge about homosexuality. The majority of students were not homophobic and few were homophobic. Half had positive stereotypes and about other half had negative stereotypes.

Assessment of the Factors that Contribute for the Cause of Asthma Disease in Ambo Town

Asthma is a chronic disease of airways; that is widely characterized by an increased responsiveness to a large variety of stimuli, airway inflammation and obstruction. It is the most common respiratory disorder disease in developed and developing countries. The study was aimed to assess the factors that contribute for the cause of asthma disease in Ambo town and cross-sectional survey was conducted to gather information from March to April 2022. 30 respondents were selected using purposive sampling technique for interview and data collections. According to the study the more affected age group were 22-32(53%) and the major risk factor for the disease was air pollution (53%). The pollution is due to domestic wastes that are discharged to the environment. Therefore, the government and extension health workers should aware the community about the risk factors of asthma and proper waste disposal mechanisms.

Willingness to take COVID-19 Vaccination among People Living with HIV/AIDS on Anti-Retroviral Therapy and Associated Factors in Woldia Comprehensive Specialized Hospital, Woldia, Ethiopia

Background HIV causes immunosuppression, which reduces the body's immunity to diseases like COVID-19 by decreasing CD4 cells. The goal of this study is to determine whether persons living with HIV/AIDS (PLWHA) who are using anti-retroviral therapy (ART) are willing to accept the Coronavirus illness 2019 vaccination and the factors that influence their decision. Method From February 15 to March 15, 2022, 332 PLWHA on ART participated in this facility-based cross-sectional study. The correlation of outcome variables with predictors was investigated using binary and multivariable logistic regression. Result Of the 332 study participants, 110 (33.1 %) and 118 (35.5 %) had poor knowledge and a negative attitude toward the COVID-19 vaccination, respectively. Approximately 31 (9.3%) of study participants believe ART medications can also prevent COVID-19 infection. The willingness to receive the COVID-19 vaccine was 66.3 % with a 95 % confidence interval (60.9, 71.5). Knowledge, attitude, educational status, marital status, residency, duration, and monthly income were all significant predictors of willingness to receive COVID-19 vaccination. Conclusion Increased sensitization regarding the necessity of vaccines and the negative consequences of diseases, particularly among PLWHA, should be emphasized in the preparation of the COVID-19 immunization campaign involving prominent individuals such as health professionals and religious leaders.

Adolescent-Parent Communication on Sexual and Reproductive Health and its Associated Factors among Higher Secondary School Students of Tokha Municipality, Kathmandu, Nepal

Introduction Physical, psychological, and emotional growth are among the changes that define the adolescent stage. As compared to other age groups, adolescents are more vulnerable to sexual and reproductive health issues. Parents can become protective and influencing factors for their children to prevent risky sexual behavior. This study aims to assess adolescent-parent communication on sexual and reproductive health and its associated factors.   Methods A descriptive cross-sectional study was conducted among 212 adolescents aged 15–19 in higher secondary schools of Tokha Municipality. A self-administered structured modified questionnaire to assess the communication used the Weighted Topics Measure of Family Sexual Communication (WTM) tool with a simple random sampling technique of data collection. We performed descriptive statistical analysis and chi-square tests to analyze data and assess the association between variables. Data quality was assured through careful questionnaire design, pretesting, and training.  Results The study found that about 75.9% of adolescents had communicated on SRH topics with their parents. Only 56.1%, 50.1%, 55.2%, and 50.5% of adolescents communicated about choosing a life partner, menstruation, physical and psychological changes during adolescence, and the physical growth and development of reproductive organs, respectively, while topics like using birth controls, when to start having sex, pregnancy, how to handle sexual pressure from a partner, STI and HIV/AIDs, about condoms, and abortion had never communicated by 61.3%, 86.6%, 69.3%, 85.8%, 72.2%, 78.8%, and 82.5% of adolescents, respectively. Adolescent-parent communication on sexual and reproductive health was significantly associated with the level of knowledge regarding sexual and reproductive health (X2 = 5.809, p = 0.01, df = 1). Similarly, there was a significant association with the perceived parenting style (X2 =3.932, p =0.04, df =1), living arrangements (X2 =6.376, p=0.01, df =1), and adolescent-parent communication. Conclusion  It concluded that adolescent-parent communication on SRH issues is not satisfactory. Creating an adolescent-friendly environment at home and conducting awareness programs with the help of the local government of the respective schools would help to increase adolescent-parent communication. 

Improved Latrine Coverage and Associated Factors Among Rural Community in Gicumbi Gistrict, Rwanda

This study aimed at determining improved latrine coverage and associated factors among rural community in Gicumbi district. A cross-sectional study was employed using mixed methods with quantitative and qualitative data collection approaches. The quantitative approach of data collection method was conducted and then qualitative approach followed. A structured questionnaire was used to collect quantitative data and Focus Group Discussions (FGDs) was conducted to collect the qualitative data. The study population consists of household heads or their representatives and key informants from the study area of Gicumbi district. For quantitative the total sample size was 236 households while for qualitative data, a total of three FGDs with eight (8) participants was conducted among twenty four (24) rural community members of Gicumbi district. Raw data from the questionnaire were entered into EPI data and transported into SPSS version 22 for analysis. Descriptive statistics was used to tabulate and describe the data. The strengths of the associations were determined with multiple logistic regressions. The results shows that 69.1% of respondents were male, 30.1% were farmers, 16.9% had formal employment while 57.2% completed secondary education. The prevalence of improved latrine in Gicumbi District was 65.3%. Tertiary education was also 4.3 times more likely to have improved compared to those who did not have formal education (AOR=4.3CI: 95%: 1.027-7.032. P=0.005). Respondents with average monthly income Between 50,000 and 100,000 Rwfs are 2.7 times more likely to have improved latrine (AOR=2.7 CI at 95%:1.009-4.120, P=0.022).

Socio-Demographic Factors Responsible for Uptake of Intermittent Preventive Treatment and Health Seeking Behaviours for Malaria in Pregnancy among Women of Reproductive Ages in Nigeria

Introduction Malaria in pregnancy is a serious public health concern that could result in detrimental health outcomes for pregnant women and their foetuses. In Nigeria, there is still a significant risk of the disease epidemic and adverse effects especially in pregnancy. The aim of this study is to assess the socio-demographic factors associated with Intermittent Preventive Treatment and health seeking behaviours for malaria in pregnancy among women of reproductive ages in Nigeria Methods Using the National Demographic Survey (NDHS) 2018 data, a cross sectional study was conducted to assess socio-demographic factors associated with Intermittent Preventive Treatment (IPT) for Malaria among Nigerian women of reproductive ages. Result Majority were between ages 30-39 years (39.5%), married/cohabiting (91.8%), Muslims (59.5%), from the north (68.9%), uneducated ( 49.9%), poor (47.5%), and grand parous (65.7%). 63.4% of the women had taken fansidar for malaria in pregnancy while only 6.1% had received healthcare for malaria from informal sources. Except for marital status, all socio-demographic variables (regions, highest educational level, wealth index, age group, religion and parity) were significantly associated with intake of IPT. Additionally, region, education, wealth index, age group, marital status and religion were associated with health seeking behaviour for malaria in pregnancy (P<.05). After control for other variables, wealth index, highest educational level, married/cohabiting marital status and religion was significantly associated with intake of IPT while region, primary and secondary education, poorer and richest wealth index, widowed/separation influenced health seeking for malaria in pregnancy (P<.05). Conclusion The National Malaria Elimination programme should evaluate existing policies that develop interventions that are centred on high risk population in order to prevent malaria in pregnancy while improving health seeking behaviours of women of reproductive ages.

Common Clinical Presentations of GBV Survivors Seen Between 2020-2022 at a GBV Clinic in a Tertiary Care Referral Facility in South East Nigeria

Background Gender based violence (GBV) refers to any violence targeted at an individual or group on the basis of their gender. It could occur in different forms with several clinical manifestations. The authors have described several clinical manifestations of GBV in a tertiary health centre, knowledge of which would help in case identification and early clinical management. Methods Retrospective descriptive study of all clients seen at a gbv clinic over a sixteen months period.Data was obtained from case records and clinical presentations were entered into excel. Data analysis was done usingIBM SPSS Statistics for Windows, version 25. The results were presented in frequency tables and graphs Results Of 86 clients studied, 56(65.1%) were of pediatric age (< 18years) while 30(34.9%) were adults with a mean age of 18.33+11.64(range 1-64years).72(82.6%) belonged to the low social class. Physical abuse in the forms of battering, human bite, walking and sitting disturbances, hearing loss possibly from slapping or hitting and red eye possibly from trauma on the eye, constituted 37.6% of the clinical presentations. Other presentations were; sexual abuse in the form of forced sex which constituted 34.9%, while gynaecological / obstetrics presentations in the forms of bleeding per vagina, pregnancy due to forced sex and vaginal pain made up 13.9%. Emotional/psychological abuse was observed in all clients irrespective of their different presenting complaints. Conclusion While various forms of physical abuse were common, emotional abuse was present in all clients but masked probably due to prioritization of physical injuries. Therefore we recommend that all GBV survivors be screened for psycholocal abuse and psychotherapy given.

Factors Associated with Caesarean Section Among Women Delivered at Kirehe District Hospital

The aim of this study is determine the prevalence and factors associated with caesarean section among women delivered at Kirehe District Hospital. A retrospective study was conducted among women delivered at Kirehe District Hospital from January 2018 to December 2019. The medical files of all women delivered at the hospital who meet the inclusion criteria were reviewed. Data were checked for completeness, cleaned, coded and entered into excel sheet, and then exported to SPSS version 22.0 for further analysis. Descriptive statistics was used to estimate the prevalence and description of study participants. Multivariable logistic regression models were used to estimate risk for CS with 95% confidence intervals (CIs). The study was conducted in accordance with the research protocol Mount Kenya University Rwanda research ethical committee. The majority 806 (69.9%) of women who delivered at Kirehe district hospital from January 2018 to December 2019 were aged 22-35 years old. The prevalence of C-section at Kirehe District Hospital was 23.1%. Demographic and economic factors associated with Caesaren section in bivariate and multivariate analysis was respondent’s type of health insurance where women who used private health insurance were 3 times more likely to deliver by C-section. The findings from multivariate analysis revealed that women who experienced eclampisa had 45% risk of C-Setion compared to those without Eclampsia. Women in rural area of Rwanda seem to have increased access to and use of CS. However, the significant increase in the rate of CS is of concern due to the potential of unnecessary CS.

Perceived Barriers and Facilitators to Implementation of Maternal and Child Health Care by Community Health Workers in Rwanda: A Qualitative Study

The motivations and barriers experienced by community health workers (CHWs) during the delivery of maternal and child health (MCH) services are less documented in Rwanda. This study aimed to explore the barriers and facilitators of implementing MCH care as perceived by CHWs. A descriptive qualitative study was conducted, and Semi-structured interviews with flow-up probing questions were used to collect data. A number of 24 interviews were conducted with CHWs from three selected sectors of the Gicumbi district including four supervisors of CHWs from each selected health center and one at the district hospital. Three focus group discussions with CHWs from each site were also conducted. Ethical approval was obtained from Mount Kenya University and permission to collect data from the study sites was granted. NVIVO software was used for analysis, and then the content analysis was adopted to identify themes merging from the interviews and focus group discussions. The study findings revealed emerged factors that facilitate the CHWs to deliver MCH services to their communities: liking their work, trust by the community, respect from the community, the willingness to help, desire to gain knowledge, being human, and sacrifice for the wellness of the community. On another hand, the findings indicated that the work of CHW has various barriers including working many hours, lack of equipment, lack of knowledge, unsatisfactory salary, heavy workload, lack of working space, lack of facilitation for communication, family conflicts, lack of specified working time, and believes.

Quality of Maternal & Newborns Health indicators in Western Province of Rwanda

Data quality is defined as a measure of data status that fulfills the following elements: accuracy, completeness, consistency, reliability, and if the data is current. The World Health Organization (WHO) reported that only 40% of all countries have an adequate system to collect information on birth and deaths. Even though the system is there, vital registration systems are inaccurate and incomplete in developing countries. In Rwanda, maternal health related data was over-reported more than other indicators. These are the main reasons for conducting the study to investigate the data quality of four maternal and newborn health indicators reported by Rwandan Western Province health centers. This concurrent-mixed method study included 61 data managers and 12 key informants. Routine data quality assessment tool and structured interview guide were used to collect data. Descriptive statistics were used to get proportion of respondents’ socio-demographic characteristics. The analysis was done for assessing median of data quality index. The results show that 55.7% of data managers were male while 58.3% of responsible of maternity were female. Majority (58.9%) of participants was in age’s category from 33-42, 61.6% have A1 education level and 53.4% have experience less than five years. Data quality index of one out of four (25%) MNH indicators was found below 95% accepted by WHO. The main reasons for insufiscient quality of data are lack of data validation meetings (57.5%) and incompleteness of reporting tools (36.4%). Monthly data validation meetings chaired by HC leaders are important to contribute to high-quality data in healthcare settings. Supportive supervisions done in data quality and management have to be organized in a supportive, and educative way.

Cross-Reactivity between COX-2 Inhibitors in Patients with Cross-Reactive Hypersensitivity to NSAIDs

The safety of cyclooxygenase (COX)-2 inhibitors has been tested in patients who had cross-reactive hypersensitivity reactions (HSRs) to nonsteroidal anti-inflammatory drugs (NSAIDs). However, these studies have been mainly done before the current classification of NSAID hypersensitivity and cross-reaction between COX-2 inhibitors has been rarely reported.We aimed to assess tolerability of COX-2 inhibitors and to evaluate the cross-reactivity between them in cross-reactive phenotype of NSAID hypersensitivity. The diagnosis was based on clinical features, reliable history of HSRs to at least two chemically different NSAIDs, and/or positive provocation tests with implicated NSAIDs in 151 patients. Single-blind, oral challenges with 1/4 and 3/4 divided doses of placebo, nimesulide, meloxicam, and celecoxib, as COX-2 inhibitors, were performed. The most common cross-reactive phenotype was NSAID-induced urticaria/angioedema (56.3%). Positive reactions to meloxicam, nimesulide, and celecoxib challenges were observed in 23/140 (16.4%), 7/33 (21.2%), and none of six patients, respectively. Overall, 24 patients were tested with two, one was tested with three COX-2 inhibitors. Six (31.6%) of 19 patients with meloxicam intolerance reacted to nimesulide provocation. Nimesulide, meloxicam, and celecoxib appeared safe alternatives in cross-reactive phenotypes of NSAID hypersensitivity. Although celecoxib has the most favorable tolerability, cross-reactivity among COX-2 inhibitors seems to be possible.

Users Perception and Factors Affecting Data Quality in Nyarugenge Public Health Facility, Rwanda

The study evaluated the users' opinions on data quality and related characteristics in ten public-health institutions of Nyarugenge district. A study used a cross-sectional design, data was collected through quantitative (n=150) methodology while qualitative data was obtained using interviews (n=20) and focus group talks (n=3). A checklist was utilized to examine the completeness, accuracy, and timeliness of data quality aspects. Collected quantitative data was analyzed through logistic regression by SPSS to examine the association of variables, while qualitative data was analyzed using the summative content analysis (SCA) to summarize the key themes. A 95 percent confidence level, Odds Ratio (AOR) were used to establish the strength of correlation among study variables, while a p-value of less than (p<0.05) was utilized to identify the variables which were statistically significant associated to HMIS data quality. The study finding showed that the majority (53.0%) was female while, 33 years was an average age, the majority of health practitioner (52.7%) had an A1 diploma. Approximately 90.6% of respondents have a positive perceptions on the system usage. Limited ability and a lack of relevant technology equipment such as computers and the internet have been cited as the challenges while using the system. Factors such as training AOR:2.62(95% CI:1.45, supervision AOR:1.81(95% CI:1.02, AOR:2.50(95% CI:0.85 for education background, works-experience AOR:1.60(95% CI:090 are factors associated with data quality. Maintaining, supportive supervision, regular training and refresher courses should be regularly offered to public health professionals to improve their knowledge in order to maximize the use of health information.

Predictors of Adherence to Pre-Exposure Prophylaxis among Female Sex Workers in South-Western Nigeria

Introduction Pre-exposure prophylaxis (PrEP) is an element of the biomedical interventions of Human Immunodeficiency virus (HIV) prevention. The level of protection is strongly correlated to PrEP drug adherence. In Nigeria, the prevalence of HIV among female sex workers (FSW) is 15.5%. The 2020 integrated biological and behavioral surveillance survey did not report on PrEP adherence among FSW. This study therefore assessed the level of adherence to PrEP and its predictors among FSW in South-Western Nigeria. Methodology This cross-sectional analytical study was conducted in 2021. Study population were brothel-based FSW at Gambari Ogbomoso and Lagos, Nigeria. A total of 156 FSW participated in the study. Data was collected using interviewer-administered semi-structured questionnaire and analyzed using IBM SPSS Version 25. Results One hundred and forty-nine properly completed questionnaires were analyzed. Ninety-nine respondents (66.4%) have been working for more than 5years as a FSW and 65(43.6%) had initiation of sex work before 18 years of age. Respondents’ sexual behavior showed that 55 (36.9%) of total respondents had consistent use of condom. One hundred and thirty-four respondents (89.9%) had good knowledge of PrEP, 97 (65.1%) had good attitude towards PrEP while 111 (74.5%) had good perception of risk of HIV infection. One hundred and thirty-two (88.6%) reported to be taking PrEP and 119 (79.9%) had good adherence to PrEP. Predictors of adherence to PrEP were educational status, age of commencement of sex work and monthly income. It was found that educated sex workers were 2.67 times more likely to adhere to PrEP (OR=2.67, 95% CI=1.280-5.591, p=0.019). Those who commenced sex work after clocking 18 years of age were 75% times less likely to adhere to PrEP (OR=0.251, 95% CI=0.106-0.597, p=0.001) while those with average monthly income more than #10,000 were 1.65 times more likely to adhere to PrEP (OR=1.65, 95% CI=0.674-4.042, p=0.0275. Discussion and Recommendation The level of adherence to PrEP is considerably high and underscores a positive effect of the efforts of the Government of Nigeria in controlling HIV as a threat by 2030. Further studies would be useful to understand the behavioral factors associated with low adherence to PrEP among FSW who have spent more than 5 years in sex work.

Challenges and Factors Associated with Adherence to Non-Pharmaceutical Interventions to Prevent the Spread of COVID-19 in a Slum Setting

Objectives This study aims to evaluate the challenges of implementing non-pharmaceutical interventions, assess adherence, accessibility to prevention materials and identify requirements for the control of the spread of COVID-19 among individuals living in a slum-setting in Lagos, Nigeria. Methods This is a five-month cross-sectional study conducted in Makoko, Lagos an urban-slum community. Data on sociodemographic characteristics, living conditions and adherence to COVID-19 prevention strategies were obtained with a semi-structured questionnaire. Logistics-regression model was used to determine factors associated with adherence to COVID-19 preventive measures. Results There was a total of 357 participants who had a mean age of 45.8 ± 12.9 years. Majority were males (62.2%), married (83.8%), self-employed (66.4%), and had secondary education (31.4%). Most participants (93.8%) had no space for self-isolation as majority lived in a one-room apartment (72.8%), shared toilets/kitchen space (64.4 %), had no constant source of water supply (61.9%) and buy water (62.5%). About 98.8% are aware of the COVID-19 pandemic but only 33.9% adhered. Most of the participants disclosed inability to purchase face masks/ hand sanitizers (68.9%). After adjusting for covariates, the ability to afford facemasks/hand sanitizers (P < 0.0001, aOR 6.646; 95% CI: 3.805-11.609), living alone (P < 0.0001, aOR 3.658; 95% CI: 1.267-10.558), and ability to buy water (aOR: 0.27; 95% CI: 0.14-0.50), had greater odds of association with adherence to the non-pharmaceutical COVID-19 preventive measures. Conclusion The lack of isolation space among majority of the respondents calls for concern. Inability to purchase prevention materials is a major factor influencing poor compliance to COVID-19 prevention strategies.

The Computer Crimes of Vasiliy Gorshkov and Alexey Ivanov

The purpose of this essay was to document the cybercrimes of Vasiliy Gorshkov and Alexey Ivanov, starting from their humble beginnings in Chelyabinsk, Russia to their convictions for conspiracy, violations of the Computer Fraud and Abuse Act, and other federal crimes. The paper outlines the history of these two individuals, describing the circumstances under which they were arrested and prosecuted. The essay concludes by observing that the mainstream media characterized Gorshkov and Ivanov as villainous Russian hackers, whereas in reality, they were would-be Russian entrepreneurs attempting to earn their fortune by illicit means.

Covid-19 Pandemic and Persons with Disabilities: Impacts and Risk Factors, Lessons for Future Interventions

Background The pandemic has disrupted the lives of many globally including persons with disabilities. These disruptions are universal. However, the vulnerable communities are more affected. Purpose The study examines impacts on persons with disabilities to share knowledge and inform interventions that ensure persons with disabilities are supported. Methodology The study is a systematic literature review using different search engines to search for scholarly articles all over the globe. Results Persons with disabilities have been negatively impacted in numerous ways: lack of access to healthcare services, inadequate rehabilitation services, increased human rights violation, stigmatization and discrimination, increased risk of dying, being subjected to violence, losing financial income, lack of access to education and treatment, increased in neglect and traumatization, poverty, lack of access to food, decreased in community support; and worse of all, in comparison with the overall population, the death of persons with disabilities during the Covid-19 is higher. These impacts were precipitated by inaccessible built environment and sense of touching, lack of disability sensitive policies, increased prevalence of risk factors, difficulties in adhering to WHO recommendations, pervasiveness of underlying health conditions, lack of disability-friendly information and inclusive intervention, national budget cuts; and poorly funded institutions. Conclusion Persons with disabilities have been negatively impacted due to many risk factors peculiar to them.

Association of Serum Calcium Level with other Risk Factors of Ischaemic Stroke

Introduction Calcium (Ca2+) plays an important role in the pathogenesis of ischemic cell damage. Intracellular Ca2+ accumulation leads to neuronal damage by triggering the cycle of cytotoxic events, however the relationship of serum Ca levels and the pathways involved in ischemic injury is unclear. Aim of Study To investigate the relationship of serum Ca2+ levels with severity of acute ischaemic stroke, serum calcium (Ca2+) levels were measured within the first 48 hours and were compared with the clinical severity of acute ischaemic stroke. Material and Methods A hospital based cross sectional study was performed among 100 patients of acute ischaemic stroke who fulfilled the inclusion criteria. The Study was done from July 2020 to August 2021 in SPRC & Neurology Hospital Dhaka, Bangladesh And BSMMU Hospital Dhaka, Bangladesh. After hospitalization presenting complaints, physical findings of the patients were recorded. Severity of stroke was measured by NIHSS scale. Serum calcium level of every patient was measured. Calcium level was divided into 3 groups by weighted average. Statistical analysis was carried out by a non-parametric Ruska Wallis test. Results Among the 100 patients 59% were male. Among all patients 57% of patients were found to be smokers (98% male, 2% female). Among all patients 63% patients were found hypertensive and 21% of all patients (24% male, 17% female) were diabetic. Mean cholesterol level was 257.98mg/dl with standard deviation 55.49 which is above the reference range suggesting hypercholesterolemia, Triglyceride was borderline and LDL cholesterol was slightly higher and HDL cholesterol was slightly lower. Calcium level was divided into 3 groups and NIHSS score was calculated for every patient in each group. The median NIHSS score for group1 (calcium level ≤8.8 mg/dl) was 9(2-20), for group 2 (calcium level 8.9-9.6 mg/dl) was 6 (1-17) and for group 3 (calcium level ≥9.7mg/dl) was 4 (1-16). Conclusion Commonest risk factor of ischaemic stroke is hypertension. Other risk factors are smoking, diabetes mellitus and hyperlipidemia, cardiac disease. Higher serum calcium level is associated with less severity of ischaemic stroke.

Stem Cell Differentiation Stage Factors (SCDSFs) Taken from Zebrafish Embryo during Organogenesis and their Role as Epigenetics Regulators able to Reverse Neurosensory Hearing Loss

This translational paper discusses differentiation‑stage factors from zebrafish embryos as epigenetic regulators with potential to reverse neurosensory hearing loss. It outlines experimental evidence, delivery concepts, and research gaps.

Sexual Risk Behaviors of Sex Workers for HIV / AIDS and STIs in the City of Bamako, Mali

Background: HIV / AIDS affects all social strata and including female sex workers who are a particularly vulnerable group at risk of HIV infection. Objective To assess the risky sexual behavior of female sex workers in Bamako, Mali. Methods This is a quantitative cross-sectional analytical study conducted among 288 female sex workers in the city of Bamako, Mali. This study used a questionnaire to collect information from January to April 2021. Results Out of 288 sex workers, 41% came from neighboring countries (Burkina Faso, Cote d'Ivoire, Mauritania). More than half of the participants had started working as sex workers before the age of 20. More than half of sex workers do not always use a condom. About 32% of female sex workers had previously had anal sex, 20% had experienced group sex, and less than a quarter smoked or drank alcohol before sex. A significant relationship was found between the behavior or practice of sex workers with the following variables: ethnicity (P = 0.04); marital status (P = 0.01); monthly income (P = 0.001), age at first sexual intercourse (P = 0.03); the presence of STDs in the past (P = 0.02), knowledge of HIV status (P = 0.04) and nationality (P = 0.03). Conclusions This study highlights negative risk behaviors of sex workers such as not using condoms consistently, anal sex, alcohol, and smoking. It is therefore important to develop education actions to improve the knowledge, attitude, and practice of sex workers related to HIV/ AIDS in Mali.

Stroke Survivors’ Preference of Herbal Center to Hospital

Proceeding to hospital immediately stroke occurs is important for early intervention that would minimize the consequences of stroke. But most stroke patients in developing countries prefer herbal centers than hospital. Reasons for this attitude have not been established. Two well-trained assistants were used to interview 117 stroke survivors who attended Bebe Herbal Center (BHC) in Nigeria for at least two visits. The survivors self-reported their experiences in hospitals visited and at BHC. Data obtained were analyzed using Independent t-test, Pearson’s chi-squared test, on SPSS package version 23. Significant value was set at p<0.05. Results showed the survivors comprised 48.7% males and 51.3% females, with mean age 63.98±10.41 years (range: 40-84 years). Following onset of stroke, 61.5% went firstly to hospital, 21.4% to traditional healing places, and 17.1% to BHC. Eventually all survivors went to BHC and 99.1% said they were satisfied with treatment received at BHC. Seventy-nine (68.1%) said they experienced substantial recovery under one month, 25.9% between 1-6 months. All the survivors who went firstly to hospitals said they received inadequate care in them. None of the hospitals they visited had CT or MRI equipment. Pearson’s chi-squared test showed that the impact of stroke had a significant difference between males and females regarding checking of blood pressure after stroke (χ2=7.62; df=3; P<0.05). The inadequate care received in hospitals and the early satisfactory recovery in BHC influence stroke patients in Nigeria to reject going to hospital.

Factors Influencing Hospital Cleaners’ Knowledge and Practices toward Hepatitis B prevention in Northern Province of Rwanda

This study aimed to assess factors influencing knowledge and practices of hospital cleaners towards hepatitis B prevention. This was a hospital-based cross-sectional study conducted at in Northern Province of Rwanda. A pretested self-administered questionnaire was used to gather data from study participants. A total of 134 cleaners were recruited in the study. Data were entered using Kobo collect toolbox and exported to Microsoft office excel for data cleaning and to entered in SPSS version 21 for analysis. Descriptive and logistic regression analysis was done and the significance level was 5%. More than a half of respondents were female (51.5%), and had primary level of education (54.5%). Results showed that only 9.7% of respondents had a high level of knowledge about HBV and only 2.2% had good practices on HBV practices. The odds of having high level of knowledge towards HBV prevention was 2.3 times (AOR=2.3, 95%CI: (1.1-27.3); p=0.045) among respondents with high school compared to those with no educational level. Respondents with work experience of 5-7 years were 1.5 times to have high level of knowledge towards HBV prevention than those with work experience of less than one year. Being aged between 20-30 years was associated with 2.5 times more likely to have good practices on HBV prevention than respondents aged less than 20 years. The odds of having good practice towards HBV had found to increase with work experience (AOR=2.3; 95%CI: (1.29-4.3); p=0.014). Considerable proportion of participants lacks the requisite knowledge of post-exposure treatment and prevention of HBV. Training programs on HBV infection, including PEP are highly recommended.

Effect of Hours of Use and Age in Years in Estimating Repair and Maintenance Costs for Two Sizes of Agricultural Tractors in Northern Sudan

Repair and maintenance cost is considered as one of important items for machinery management and selection. The present study was carried out in Dongola area for tractor repair and maintenance costs estimation. The data was collected from records of Elshimalya Company for Agricultural Inputs. Forty four tractors rep resenting two sizes of tractors, 75hp and 150hp used in the area were selected for this study. Based on the data collected, regression correlation analysis was carried out and mathematical models were derived to predict the accumulated repair and maintenance (R and M) costs as percent of purchase price in relation to accumulated hours of use and age (years) for each tractor size, and also for the two sizes collectively. Five model forms (linear, logarithmic, polynomial, power and exponential) were derived and the power function was found the best fit to explain the relation. The accumulated Rand M costs as percent of purchase price (Y) was increased as the accumulated hours of use (x) and age (g) of the tractor in years were increased. A high correlation was found between the accumulated R and M cost and both accumulated hours of use and tractor age in years (Average R2 = 0.93). It was concluded that the power function was the best fit for repair and maintenance cost estimations and the following relations may be used as an average for estimation of the accumulated R and M costs as percent of purchase price (Y) with accumulated hours of use (x) and age (g) of the tractor: Y=0.028x0.662 (mean) Y=12.294g1.276 (mean).

From High-Risk Behaviors to Problem-Solving Strategies: Acceptance and Commitment Therapy Effects on Addiction Susceptible Adolescents in Cyberspace

This study aimed to evaluate acceptance and commitment therapy (ACT) effectiveness in reducing high-risk behaviors and elevating problem-solving strategies in adolescents with addiction susceptibility in cyberspace. This study is longitudinal with quantitative methods of data collection and analysis. The target community in this research was 60 female students randomly selected from a Persian high school in Iran. Participants were randomly divided and placed equally into the experimental and control groups. The participants’ entry criteria were gender, aged from 15 to 18 years, addiction susceptibility, and high-risk behaviors cut-off points. Eight training sessions of ACT were presented in cyberspace for the experimental group between the pre-test and post-test intervals. Data collection instruments were the Iranian youth risk-taking scale, problem-solving strategies, and Iranian adolescents’ addiction susceptibility questionnaires. Participants were followed up after two months. The results using multivariate analysis of among subjects ANOVA showed ACT significantly influenced high-risk behaviors and its’ sub-scales except for the violence (p < .001).Furthermore, ACT affected the problem-solving strategies and its’ sub-scales instead of control, creativity, and confidence (p < .001). According to the findings, ACT decreased high-risk behaviors such as drug abuse, smoking, and unprotected sexual behaviors. These changes might be due to decreased helplessness and avoidance as well as increased acceptance and tendency to solve problems. Instead, problem-solving strategies were improved through ACT cyber treatment.

What do we know about Eye and Facial Protectors : Review for COVID-19 Pandemic and Possible Future Epidemics

Personal Protective Equipment (PPE) is mandatory for everybody in a threatening state, they are meant to provide safety and prevent injuries especially in hazardous issues. Facial guards are mostly used for providing eyes and face from splash-kind of hazards. During the COVID-19 pandemic, their use also was recommended to longer the use of masks or respirators, due to their shortage and the excessive demand of their reuse. This review gathered the information on eye and face protectors from various manufacturer, international and local guidelines; also authors’ experiment during the COVID-19 pandemic in Iran.

RETRACTED: Postulation of the Effect of Unpredicted Predisposing Factors for Post-Tonsillectomy Bleeding

This article has been retracted on 20 January 2022. VIEW THE RETRACTION NOTICE (https://doi.org/10.14302/issn.2379-8572.joa-25-5850) Back ground and Objectives Tonsillectomy is the most common surgical procedure in specialty of otorhinolaryngology. Therefore there are frequent premises regarding this procedure to be improved from different aspects, indications, time of surgery, techniques, safety measures, and postoperative care. Hence the tonsils and peritonsillar tissues are highly vascular zone that supplied by direct branches of external carotid artery thus the post-tonsillectomy bleeding remains one of significant issues in relation to this widely performed procedure. The post-tonsillectomy bleeding needs frequently to be postulated for its incidence, prevalence, etiology, predisposing factors, management and prevention. This subject constitutes one of most risky aspects that increase wariness of the surgeons regarding this commonly conducted procedure. Although there are huge numbers of presentative literatures coming from American as well as western institutes that tried to put guidelines for purpose of prevention and management of post-tonsillectomy bleeding but broadly at our middle-east region and locally at our Libyan society we found for some extent difficulties to apply all these guidelines. For this reason this issue has been take the wider spectrum of ENT surgeons’ concentration, discussions, and researches. Therefore this study was conducted prospectively and for long time to confirm the possible predisposing factors that could be responsible for increasing the risk of post-tonsillectomy bleeding at our region and in the same time to illustrate the concluded recommendations to prevent the occurrence of this important complication. Patients and Methods 2880 patients aged from 8 months to 85 years presented at ENT department-AL-hawari ENT and urology teaching center- Benghazi-city – Libya as well as AL-thowra central teaching hospital and AL-tarahom private center – Elbyda city – Libya at period in between September 2003 to March 2015 as cases of chronic adeno-tonsillitis and solitary acute as well as chronic related palatine tonsillar disease with variable patterns of indications for tonsillectomy namely snoring and apnea attacks, recurrent attacks of acute tonsillitis, persistent otitis media with effusion, recurrent attacks of acute suppurative otitis media, failure to thrive, recurrent attacks of chest infection, mal-occlusive dental deformity, unilateral enlarged tonsils, post-traumatic avulsed tonsils, history of quinsy abscess and persistent halitosis. All patients were assessed intra-operatively and post-operatively too for any evidences of primary, reactionary, or secondary hemorrhage in relation to wide spectrum of factors as patient's demographic, medical, and socio-habitual factors, in addition to technical as well as post-operative care factors. Results This presenting study confirmed that the most common type of post-tonsillectomy bleeding was the secondary variety (71%) as compared to primary (22%) and reactionary (7%) among all presented post-tonsillectomy bleeding cases. Although through this presenting serial study there were multifactorial pre-dispositions elucidated for secondary post-tonsillectomy hemorrhage but as general poor post-operative care can be considered as the cornerstone for the pathogenesis of this significantly raised incidence of secondary post-tonsillectomy bleeding this may be in form of inadequate patient's hydration and nutritional supply (47%), poor patient's antibiotic compliance (23%), and child's maternal negligence (19%). The time of surgery was found to be another important pre-disposing factor for post-tonsillectomy bleeding, it was postulated that the incidence of reactionary as well as secondary post-tonsillectomy hemorrhage significantly increased at summer and autumn seasons (69%) as compared to other seasons. The place of surgery was another interesting proposed studied factor among this serial presentation it was observed that the incidence of post-tonsillectomy bleeding among patients who operated at AL-hawari ENT and urology teaching center-Benghazi-city significantly higher (63%) than that among cases who interfered at AL-thowra central teaching hospital and AL-tarahom private center – Elbyda city. Conclusion Generally speaking, post-tonsillectomy bleeding is considered as one of important issues in ENT and one of significant post-tonsillectomy complications which may create a critical morbidity that may rarely extend to post-operative mortality. Hence the most common pattern of post-tonsillectomy bleeding is the secondary type; however this type of post-tonsillectomy hemorrhage is pre-disposed and induced by many factors. Most of these factors are treatable and curable thus the prophylaxis against this significant complication can be achievable.

Retraction Note: Postulation of the Effect of Unpredicted Predisposing Factors for Post-Tonsillectomy Bleeding

What do we know about Torso Protectors and Foot Wears – A Review for COVID-19 Pandemic and Possible Future Epidemics

Personal Protective types of Equipment (PPE) are needed for everybody who would be in danger of threatening state; the COVID-19 pandemic raised the need and global demand for PPE, one of the most used and required equipment are gowns, coveralls, and torso protectors; which their shortage of supply raised the cost globally too. This review article gathered the guidelines and recommendations from manufacturers, international organizations, and self-experiments of authors for these utilities. And, provides recommendations on the level of protection needed for each condition.

Mucormycosis: A Surge in Mucorales Fungal Infection in Post – Covid Patients in Indian States and Insight into Known and Unknown Factors

Factors Affecting Atlantic Salmon Populations Adversely; Using the River Dee, Scotland, as an Example

The stocks of the Atlantic salmon (Salmo salar) in many rivers in North America and Europe have declined in recent years and are experiencing a crisis. Despite their high degree of legal protection, the quality of their aquatic environments within rivers and in the sea, including local coastal waters, appears to be deteriorating. Salmon survival, has declined both within the sea and within rivers. The status of the Atlantic salmon stocks is considered here, together with the adverse effects of different sources, and those steps that may need to be taken to improve the condition of the salmon. This paper is intended to assist management bodies in taking steps to resolve the problems that exist for salmon, both within rivers and in the sea. It makes particular use of information available on the River Dee in Scotland.

The Pathologist's Story and the Colors

This essay reflects on the craft of diagnostic pathology, using color and pattern as a narrative lens. Through case vignettes, it illustrates how morphology, staining, and visual reasoning translate into clinical answers. The perspective emphasizes communication, uncertainty management, and the human dimension of laboratory work.

The Battle for Backdoors and Encryption Keys

This paper argues that the use of backdoors in software is inherently counterproductive and leads to invasion of privacy, either by federal or state governments or by intrusive hackers. The essay outlines encryption’s nature, pointing out that a software backdoor is a secret means of ignoring data authentication. Several examples of known backdoors known to terrorists, criminals, and governments alike are highlighted. Arguments in favor and opposing backdoors are provided, where the Apple Computer, Inc. v. FBI controversy is discussed. Finally, the balancing of harms test as proposed by John Stuart Mill is introduced, where the article concludes that when balancing the opposing positions, the scale tips toward data encryption because an innocent party would suffer the most harm from the existence of a software backdoor.

Prevalence and Factors Associated with Under Nutrition among Children Aged 6 to 59 Months in Ngoma District, Rwanda

In Rwanda, 38% children aged 6-59 months are stunted. In Ngoma District, stunting rate is estimated at 41% among the children aged below 5 years. The study objective was to evaluate the prevalence and factors contributing to under nutrition among children aged 6- 59 months in Ngoma District. Cluster sampling was used to determine the study participants for each sector within 14 sectors by considering the sample size of 442. The WHO Anthro software version 3.2.2 was used to determine the nutritional status of the children. SPSS version 24 was used for analysis. Of 442 children participated in the study 50.9% of them were females, 24.4% were aged 15-23 months and the majority of children (89.8%) born with normal birth weight. Study findings revealed that the prevalence of under nutrition was 33.7% for stunting, 3.6% for wasting and 6.6% underweighted. Poor sanitation facility (AOR: 4.1, 95%CI: 1.83-9.3, p=0.001), poor diet (AOR: 1.9, 95%CI: 1.18-3, p=0.008) were significantly associated with stunting. Factors such as lack of hand-washing facilities (AOR: 2.5, 95% CI: 1.013-6.3, p=0.047), not eat vegetables (AOR: 4.4, 95%CI: 1.7-10.96, p=0.001), and not eat fishes (AOR: 4.1, 95%CI: 1.6-10.6, p=0.003) were associated with wasting. Short breastfeeding duration (AOR: 4.5, 95%CI: 2.9-7.2, p=0.001), not eat vegetables (AOR: 1.9; 95%CI: 1.1-3.05, p=0.008), and not eat eggs (AOR: 2, 95%CI: 1.3-2.9, p=0.001) were associated with underweight. Poor families with under-five children need continuous support that will assist them to improve nutritional status of their children.

Prevalence and Risk Factors of HIV Infection among Children Born from HIV Positive Women Musanze District, Rwanda

In Rwanda the prevalence of mother-to-child HIV transmission is 1.5%, the prevalence was found to be higher in rural area. The purpose of this study was to determine the Prevalence and Risk Factors of HIV Infection among Children born from HIV Positive Women in Musanze District. The study findings help to decrease the rate of HIV infection among children born from mother HIV positive to zero. This study was conducted in Musanze District, Northern Province in Rwanda. The study targeted 420 HIV positive mothers who delivery in different health facilities located in Musanze district form January 2019 to December 2020 and their children. SPSS version 22 was used for analysis. Of 420 children born from HIV positive mothers 91.7% were aged between 18-24 months, 55.2% were female. The majority of HIV positive mothers 80.2% who participated in the study were married. The prevalence of HIV infection among children born from HIV positive women was 2.9%. Children whose mother had poor adherence to ART were 1.5 times more likely to get HIV at birth compared to those whose mother had good adherence (AOR = 1.5; 95% CI: (1.12-2.21)). Children born from mothers in WHO stage II were more likely to get HIV from their mother (AOR = 1.24; 95% CI: (1.32-2.207)). Children born from HIV positive mother with one ANC visit were 2.5 times more likely to get HIV from their mothers (AOR = 1.56; 95% CI: (2.31-5.17)).  

Factors and Conditions that Influence Teenage Pregnancy among In-school Adolescents in Umuahia North Local Government Area (L.G.A) of Abia State, Nigeria

Introduction Adolescence is a critical stage in human development that is characterized by peer pressure, confusion, exuberance and experimentation, particularly with sexual relationships. This is why attention should be paid to adolescents’ reproductive health issues so as to reduce their exposure to aggressive sexual activities which could expose them to sexually transmitted diseases, unwanted pregnancies and others. This study aimed at reducing the factors and conditions that influence teenage pregnancy among in-school adolescents in Umuahia North LGA of Abia State. Materials and Methods The study used a cross sectional descriptive study. A randomly selected sample of 416 adolescents between the ages of 13-19 years were studied. Structured self-administered questionnaire was used for data collection. Descriptive statistics, using frequencies, percentages and means were utilized for data analysis. Results The study found that 198 (47.6%) of the respondents were sexually active and that 89 (45%) of them had been pregnant. More than half 103 (52%) of the study group indicated that peer pressure influenced their sexual activities. About 46(51.7%) of the adolescents said they were pregnant so as to keep the new born baby with motherless babies homes. Conclusion Therefore, there is need for increased sex education for in-school adolescents so as to highlight the effects of teenage pregnancy on adolescents.

The factors for Limited use of Gastric Emptying Scintigraphy in the Management of Diabetic Gastroparesis

A practice review discusses factors limiting the use of gastric emptying scintigraphy in diabetic gastroparesis, including protocols, access, and patient preparation, with suggestions to improve utility.

Knowledge and Factors Associated with Overweight and Obesity Prevention among Women Attending Kibagabaga Hospital, Rwanda

Women in Rwanda are still suffering from overweight and obesity and health-related complications. However, little is known about overweight/obesity prevention knowledge and factors associated with overweight/obesity prevention among women. The aim of this study was to determine knowledge and factors associated with overweight and obesity prevention among women attending Kibagabaga Hospital in Rwanda. A quantitative descriptive cross-sectional design was conducted among women aged 20-45 years that was selected randomly. A structured questionnaire was used to collect data from 384 women seeking health care at the hospital during the study period. SPSS version 21 was used for data analysis; descriptive statistics was used to assess women’s knowledge related to overweight/obesity. Logistic regression was used to determine the factors associated with overweight/obesity prevention, the level of significance was set at 5%. Approval to conduct the study was obtained from the University and Hospital. The majority 35.4% of study participants were aged between 30-34 years. Women who live in urban area dominate the study (76.3%), the majority of study participants were married (60.9%). The study revealed that the 22% and 62% of women had higher level and moderate knowledge respectively. In terms of overweight/obesity prevention practices, we found that 67% mothers had adequate practices towards overweight and obesity prevention. The age of 35-39, and unemployment were found to be significantly associated with overweight/obesity prevention practices. Cost-effective health education focusing on women, physical activity and social support to reduce the socio-cultural constraints that promote overweight/obesity are necessary to combat this epidemic.

Prevalence and Risk Factors of Metabolic Syndrome Among Teaching Staff of Engineering Colleges in Central India

Background Prevalence of Metabolic syndrome is high among Asians including Indians, and is high among those having sedentary occupations. Teaching is one of the important occupations, which demands no strenuous physical activity. However, there is little information available about the prevalence of metabolic syndrome among teaching staff of engineering college. Hence, the present study was conducted to study its prevalence, certain risk factors and co-morbidities among teaching staff of engineering institutes. Methods Teachers from engineering colleges of Nagpur city were the study subjects. Data was collected by interview technique. Clinical examination and laboratory investigations like Fasting blood glucose, High Density Lipoproteins and Serum Triglycerides were done. National Cholesterol Evaluation Programme (NCEP) Adult Treatment Panel Three (ATPIII) criteria were used to study Metabolic syndrome. Blood pressure and anthropometric measurements like height, weight and waist circumference were obtained by standard methods. Results The prevalence of metabolic syndrome was found to be 20.5%. It was 25.32% in females and 19.31% in males. It was more common in subjects of higher age group, muslim religion, and among widows and separated. Alcohol consumption, smoking and sedentary life style was found to be significantly associated with presence of metabolic syndrome. Frozen shoulder, fungal infection and stroke were common co morbidities found among subjects having metabolic syndrome.

Reversible Posterior Encephalopathy Syndrome and Related Factors: Clinical Cases Study

Background Reversible posterior encephalopathy syndrome (RPE) is a clinical and radiological entity characterized by the acute or subacute fitting of symptoms covering headache, vomiting, visual disturbances, seizures and impairment of consciousness. The pathophysiology of RPE syndrome is poorly described. RPE syndrome is characterized by a reversible cerebral edema of often posterior topography in magnetic resonance imagery (MRI). Cases Presentation We consider RPE syndrome four cases under various conditions that are known as airplane flight, hypertension, non-steroidal anti-inflammatory medication, pregnancy and oldness with several pathologies. The RPE was described with several symptoms like headaches, vomiting, focal motor deficit, paresthesia, seizures, disorders of consciousness and photophobia. The imagery findings were varying from cortical hypersignals in Flair sequences to edema of both cortex and sub cortex. The outcome was good with a complete regression of symptoms and imagery lesions. Conclusion The pathophysiological mechanism of RPE syndrome remains unknown. High blood pressure, renal failure and drugs (anti-depressants, NSAIDs, immunosuppressants) are the most etiological factors. The diagnosis is based on clinical arguments and brain MRI. The main location is posterior. The clinical outcome was good with all the patients in our study, no recurrence was noted.

Factors Associated with Persistent malaria transmission in urban Peripheral Areas Dar es Salaam Region, Tanzania

Africa Region has the highest burden of malaria with an estimated of 3.5 million more malaria cases in 2017 compared 212 million cases in reported in 2016. Data collected from 2015 to 2017, shown no global progress in reducing malaria cases. In Mainland Tanzania, malaria control interventions have significantly led to the reduction in malaria prevalence from 18.1% in 2008 to 7.3% in 2017. Despite of these achievements, malaria burden is still highly heterogonous with some regions including urban peripheral areas of Dar es Salaam, presenting persistent malaria transmission ranging from 2 to 57%. Material and Methods A cross- sectional population based survey was carried out in Ilala Municipality in Dar es Salaam; data was collected from 2nd to 31 April, 2019. Multistage cluster sampling was used to select the households where individual member were conveniently selected to participate in the study. Structured questionnaire were administered by the trained researcher assistants to assess individual risk factors for malaria. Rapid Malaria diagnostic test (mRDT) was used to identify individual exposed to malaria infection. Measure of association used was prevalence odds ratio (POR). Multivariate regression model used to determine prevalence odds ratio, variable with p- value < 0.05 were considered as independent risk factor for persistent malaria transmission. Results A total of 830 participants were recruited in the study, mean age was 24yrs ±20.4SD. Majority 489 (58.9%) were female, 459 (55.3%) were >18 yrs old, primary or no education were 687 (82.8%), farmer or unemployed were 639 (77%). Msongola ward contributed 406 (48.9%). Overall malaria prevalence in the study areas was (4.5%). Nets ownership was 141 (16.9%), usage was 121 (85.8%).Low proportion of net ownerships (POR: 7.67, 95% CI: 4.23, 24.6), residing in the households surrounded by mosquito breeding sites POR: 20.07, 95% CI: 7.03, 57.29) and residing in houses with unscreened windows (POR: 1.21, 95% CI: 1.26, 3.40) were independently associated with malaria infection. Conclusion Low nets ownership, residing in the households surrounded by mosquito breeding sites and in households with unscreened windows was independent factors associated with risk of malaria in the areas. Promotion of ITNs coverage, application of biolarvicides through community engagement and house screening was recommended to reduce the risk of malaria infection in the areas.

Risk Factors Associated with Breast Cancer

In Mexico, breast cancer is the second most common site of cancer in women and in most developed and emerging countries. Incidence rates have increased in many countries, although in some, mortality has remained stable with a slight reduction. There are geographical differences with high rates of breast cancer in North America, Northern Europe and Oceania, and lower rates in Central and South America, South and East Europe; in addition to emerging countries in Africa and Asia. Genetic and hereditary factors constitute less than 5% of breast cancer cases and other risk factors for breast cancer are related to the reproductive life of the woman. This work was carried out in order to determine if the risk factors considered classic are really associated with breast cancer in our sample of Mexican women studied.

Investigation of Emerging Risk Factors and Isolation of Potential Pathogenic Bacteria from Domestic Dog Stool in Port Harcourt Metropolis, Niger Delta

This study investigated the potential pathogenic bacteria that are associated with domestic dog stool in Port Harcourt Metropolis. Convenience sampling techniques were used for sample collection outcome. A total of fifty dog stool samples were collected aseptically into a sterile stool container from different locations (Agip Estate, Rumuokoro Community, Government Residential Area, Sand-fill Borokiri, Port Harcourt Township, and Rivers State University lecturers’ quarters) all within Port Harcourt City. Bacteriological analysis was determined using standard microbiological analytical and identification techniques. Statistical analysis was performed using Statistical Package for Social Science version 21 for frequency, percentage, prevalence rate and correlation at 0.01 and 0.05 level of significance. Potential pathogens with associated percentages that were isolated are E coli (20.0%), Klebsiella species (16.0%), Pseudomonas species (4.0%), Proteus species (28.0%), Bacillus species (4.0%), Staphylococcus aureus (14.0%), and unidentified [other Staphylococcus species] (4.0%). However, the research further revealed that Proteus species (28.0%), was the most prevalent pathogen, while Bacillus species (4.0%), Pseudomonas species (4.0%), and Streptococcus species (4.0%), were the least prevalent among pet dogs studied. The correlation analysis showed no significant relationship between isolates with socio-demographic data of pet owner and Pet biodata respectively. From the analysis, correlation coefficient values of .269 and .124 were obtained for Age of Pet Owner and Gender of Owner respectively. It also show a direct correlation but by implication, a very weak, non-significant (p<0.05) relationship existed between the organisms isolated and the variables (Age of Pet Owner and Gender of Pet Owner). However, no relationship exists between isolates and visit to vet Doctor (r-0.038; p>0.05). Furthermore, negative non-significant correlation (p>0.05) was observed for marital status of Pet Owner (r=-.158) and Age of Pet (r=-.023) and isolate. Also, correlation association between isolates and some risk factors using the correlation analysis matrix revealed an indication of an indirect but moderate association between isolates and Caressing (r=-.347, p=0.01). However, other risk factors like vaccination (r=.042), Feeding Pattern(r=.125), Pet Bathing (r=.220) and Eating with pet in same plate (r=.146), did not prove statistical significance at p>0.05. The results from the study strongly suggest that pet dogs carry potential pathogenic organisms in their faecal matter that can serve as a source of infection to the pet owners. It is, therefore, very critical that these pets should be treated and possibly vaccinated frequently, even as their faecal matters should be well disposed to prevent possible zoonotic infectious epidemic outbreak in our global communities.

Factors Affecting Traumatic Brain Injury Outcome Among Patients Treated for Head Injury at Surgical Side, in Nekemte Referral Hospital, Oromia, Ethiopia.

Background Traumatic brain injury is an expanding major public health problem and the leading cause of death of the young and productive part of the world’s population. Research is mainly done in high-income countries where only a small proportion of the worldwide fatalities occur. Only few studies have examined prognostic factors of traumatic brain injury outcome in developing countries including Ethiopia. This study was aimed at defining the peculiar demographic and other associated factors of traumatic brain injury (TBI) outcome among patients treated for head injury at Nekemte Referral Hospital. Objective The main purpose of this study was to describe the magnitude of TBI outcome and assess factors associated with unfavourable outcome of TBI among patients treated for head injury at the surgical side in Nekemte Referral Hospital from July 8, 2016 to July 7, 2018. Methods A retrospective cross-sectional document review was conducted among TBI patients treated for head injury from July 8, 2016 to July 7, 2018 at Nekemte Referral Hospital. Data were collected using a pre-tested data collection format. Data analysis was done using SPSS version 20. Descriptive statistics were computed and association between the dependent and independent variables were assessed by using logistic regression. Odds ratios with 95% confidence interval were computed. Significant association was declared when the p value was <0.05. Results In this study, out of 378 cases 95 (25.1%) were discharged with unfavourable outcome of which 37(9.8%) were neurologic deficits and 58 were deaths giving overall mortality rate of 15.3%. Patient age>60years (AOR: 15.13; 95%CI: 3.575-64.028), time interval from injury to treatment (AOR: 16.054; 95%CI: 5.832-44.194), low GCS (AOR: 18.224; 95%CI: 4.167, 79.695), conservative management (AOR: 20.774; 95%CI: 6.106-70.681), pupils abnormality (AOR: 9.078; 95%CI: AOR: 2.996-27.509) were associated with unfavourable outcome. Conclusions A quarter of patients treated for TBI at Nekemte Referral Hospital are discharged with unfavourable outcomes. Old age, delayed presentation to the hospital, low GCS, conservative management, and pupillary abnormality increase the odds of unfavourable outcome. Timely management of TBI before patients develop secondary brain injury and use of surgical intervention based on CT scan diagnosis will reduce the occurrence of unfavourable outcome.

Experimental Analysis PVP Coated Silver Nanofluid Properties for Application in Photovoltaic/Thermal (PVT) Collectors

Nowadays, supplying energy for the global population has turned into a prominent issue for countries engendering the consumption of huge amounts of fossil fuels which leads to some serious environmental problems. Among the renewable energy technologies, solar collectors can play major role to improve the efficiency, in air conditioning utility systems by minimum pollution. In photovoltaic/thermal (PVT) solar collectors, which are currently considered as the most advanced type to produce electricity and heat simultaneously, working fluid absorbs Energy from photovoltaic (PV) module engendering to decrease temperature of PV module and increase the electricity efficiency and also provide permissible amount of heat for other residential applications. Meanwhile, utilizing nanofluid as the working fluid in collector, regarding that the nanofluid has enhanced thermal properties relative to the base fluid, leads to a higher collector efficiency. In this research, PVP coated silver nanofluid was prepared in three volume concentration being 250, 500 and 1000 ppm by two-step method. To assess the stability of nanofluid the zeta potential is calculated which is obtained -41.6 V. Also, the prominent thermal properties of the nanofluid were analyzed regarding PVT solar collector applications. According to the results, thermal conductivity of the PVP coated silver nanofluid, improves the properties of base fluid, to the extent that thermal conductivity coefficient grows up 50% in some temperatures and increased from 0.594 for base fluid to 1.098 W/mK by escalation of concentration to 1000 ppm. Thus, PVP coated silver nanofluid can be deemed as the vital working fluid to improve the performance of PVT solar collectors.

Factors Influencing Recovery among Children with Moderate Acute Malnutrition Treated at Kirehe District Health Centers

Acute malnutrition affects nearly 52 million of under five years children globally, 75% of them live in low to middle income countries. The treatment of acute malnutrition using supplement foods could help children recovering and could reduce the risk of sickness. The present study investigated the factors associated with recovery among children with moderate acute malnutrition (MAM) under a follow-up program at health facilities. A prospective study was conducted in 16 health centers of Kirehe District of Rwanda and included 200 children from 6 to 59 months. A semi-structured questionnaire was used for data collection. All children enrolled in the study spent three months in nutrition program at health centers. The results show that after 3 months in the program 77.5% recovered from MAM. Children aged above 36 to 59 months were recovered at 90% whereas children aged from 24-35 months were recovered at 73.5%. Micronutrients and deworming provided at health facility were contributed to the recovery as children who received them were recovered at 89.1% and for those who didn’t were recovery at 72.1%. The findings demonstrated that boys were 16 times more likely to recover from MAM in three months of intervention than girls (AOR=16.19, p<0.001, 95% CI: 5.39- 48.63). Children from moderate income families were 3 more likely to recover than those from very low income families (AOR=2.8, p=0.029, 95% CI: 1.11-7.51). Male gender, receiving micronutrients and deworming from health facilities and family income status were factors associated with MAM recovery status

Level of Antenatal Care Services Utilization and Associated Factors Among Mothers who have Given Birth in the Past Twelve Months in Gelemso Town, West Hararghe Zone, Oromia National Regional State, East Ethiopia

Background In Ethiopia, the levels of maternal and infant morbidity and mortality are among the highest in the world. This is attributed to, among other factors, none use of modern health care services by women. According to the 2011 Ethiopian Demographic Health Survey, more than seven in ten mothers did not receive antenatal care at all. Objectives The objective of this study was to determine level and identify factors influencing maternal antenatal care services utilization among mothers who gave birth in the last twelve months in Gelemso town west Hararghe Oromia, Ethiopia. Methods A community-based cross sectional study design was conducted on 347 study participants in Gelemso town west Hararghe Oromia Ethiopia from July 15, 2017 to August 15, 2017 G.C.A probability to proportional to size sampling technique was used to select the study population in two urban Kebeles. Data were collected using a pre tested structured questionairs. Descriptive results were presented using frequencies, and numerical summary measures. Bivariate analysis was carried out to assess the association between outcome variable and each in dependent variables. Odds ratio with 95% confidence level was estimated to identify factors associated with Antenatal Care (ANC) utilization using multivariable logistic regression. The statistical significance was declared at p- value < 0.05. Result The response rate this study was 98%. The prevalence of antenatal care service utilization was 64.6%. About 146 (42.1%) of the pregnant mother started antenatal care visit during the second trimester of pregnancy and a significant proportion 289(83.3%) had less than the recommended four visits. Educational status (AOR;15.19:CI 95%,6.006,38.417), husband attitude (AOR;1.995:CI 95%,1.016,3.916), marital status(AOR:4.587:CI 95%,1.888,11.146), planned pregnancy (AOR:4.938:CI 95%,2.514,9.702) were major factors associated with antenatal care service utilization. Conclusion Though more than half mother used antenatal care service in the study setting, two in ten of the mothers did not have the minimum number of visits recommended by World Health Organization. Promotion of information, education and communication in the community should be strengthened is to sustain antenatal care service utilization in the community.

Assessment of Prescribing and Dispensing Practices Based on WHO Core Prescribing Indicators in Hospital and Community Pharmacies in Khartoum State - Sudan

Background Rational drug management has become an increasingly important topic in order to make optimal use of the drug budget to offer health services of the highest possible standard. It is important that continuous assessment for rational prescribing and use of drug have to be carried. Objective of this study was to gather data on existing drug prescription and dispensing practices and to evaluate the prescribing and dispensing indicators as described by the WHO. Method Observational, cross-sectional, prospective study was designed and conducted to evaluate the performance of hospital and community pharmacies in Khartoum state, related to rational drug use and prescribing and dispensing practices during the period from November 2018 to March 2019. 297 Hospital and community pharmacies from public and private sectors were contacted for carrying out this study survey and the collected data were analysed against WHO standards for core drug use indicators. Results The average number of drugs per encounter was 3.98 drugs. Hospital pharmacies had a higher (4.18±1.516) number of drugs prescribed than community pharmacies (3.87±1.331) with significance difference between mean of two types of pharmacies (P = 0.015). The percentage of antibiotic per prescription was (53.7%). Antibiotic prescribing was much higher (54.0%) in the hospital pharmacies compared to (48.6 %) in community pharmacies. The average percentage of injections per prescription at the facilities was found to be (57.6%). The percentage of prescription with written diagnosis was (26%.0) and the percentage of prescriptions with written dose was (78%.0). The average dispensing time was (1.75) minutes, The Percentage of drugs actually dispensed was (55.99%), the average adequacy of labelling of drugs was (30.4%). Overall prescribing and dispensing indicators were higher than WHO standard. Conclusion The degree of poly pharmacy was greater than of WHO criteria. The completeness and rationality of prescription was found suboptimal and components were missed.

Presentation of Neutralizing Antibodies in Single- or Pooled-Convalescent Immune Plasma from Donors to Prevent the Current SARS-CoV-2 Pandemic

As there is no specific treatment yet, the fight against the COVID-19 pandemic is being carried out with great difficulty today. The use of immune plasma is seen as a promising option since there is expectation that it will reduce mortality, as in influenza pandemics experienced in 1918 and 2009. However, the safety and effectiveness of this treatment option against SARS-CoV-2 viruses are not known for certain. In addition, the optimal obtaining methods and protection time of neutralizing antibodies to be used to provide passive immunization are not fully known. Therefore, it would be very useful to investigate the most effective neutralizing antibody collection methods without disrupting the overall structure and effectiveness of the antibodies subject to the use of the convalescent immune plasma. For this purpose, we found it appropriate to prepare a broad review on the structure and properties of antibodies, as well as the principles and storage conditions of antibodies to be used in passive immunization.

Investigation of Neoplastic Cells in the Bone Marrow of Female Dogs with Mammary Gland Tumors

Background The mammary glands are the second most common tumor development site in female dogs. One of the ways of staging such tumors is to evaluate the presence or absence of distant metastasis, including in bone marrow. Such findings in human medicine are associated with poor survival of women with breast tumors. However, in veterinary medicine, this clinical staging is used more for patients with lymphomas and mastocytomas. Studies using bone marrow biopsies as a staging method for mammary tumors are scarce. Objectives The present study was to evaluate mammary lesions and bone marrow in 23 female dogs, searching for disseminated tumor cells or metastatic foci. Results: Grade I carcinoma in mixed tumors was the type most observed (22.4%), and there was no statistical difference in relation to tumor size or presence of metastasis in lymph nodes. In the bone marrow of one female dog with carcinosarcoma (4.35%), there was cytoplasmic marking of a probable disseminated tumor cell of epithelial origin, and immunohistochemical evaluation showed presence of cytokeratin-19 antibodies. None of the female dogs presenting reduced cellularity or medullary fibrosis, confirmed through Masson’s trichrome technique, had cell marking in immunohistochemical analyses. Conclusions Bone marrow evaluation can be used as a staging method for mammary gland tumors in female dogs, since disseminated tumor cells present the potential to become secondary lesions and to disseminate to distant foci, thereby causing tertiary metastases over an indeterminate period of time.

Factors Influencing Tuberculosis Knowledge among TB Patients in Gakenke District, Rwanda

Knowledge of tuberculosis has been shown to influence health seeking behaviour. The study aim was to assess knowledge of tuberculosis and identify the associated factors. This study was a cross sectional descriptive research design with quantitative approach. The target population was the TB patients visited health facilities in Gakenke District. A sample of 376 TB patients was randomly selected from three health centers. Interview-administrated structured questionnaire was used to collect data from 376 TB patients. Data was analyzed with SPSS-version 22. The study protocol was approved by Mount Kenya University Rwanda. The majority of respondents 71.0% were male, 51.6% were aged 45 years and above, 81.9% were married, and 65.2% had completed primary education. Few respondents identified a germ as the cause of TB (24.7%). This study revealed that 54.3% of TB patients had good knowledge about TB. The findings from multivariate analysis show that male were three times more likely to have good knowledge about TB compared to female (AOR=3.31, 95%CI: 1.98-5.53, p<0.001). Compared to TB patients aged 45 years and above, respondents aged 25-34 years old were more likely to have good knowledge about TB (AOR=38.71, 95%CI: 9.22-162.48, p<0.001). TB patients who live between 2-5 km from nearest health facility were more likely to have good knowledge about TB compared to those who live at more than 5 km (AOR=33.58, 95%CI: 14.95-74.40, p<0.001). The ministry of health and other stakeholders in health sector need to continue the interventions that aim to reduce TB infection.

Identity Crisis - Common Tumors in Exceptional Locations, A Case Series

Mucoepidermoid carcinoma (MEC) accounts for only 5% of all salivary gland tumors and is most often seen in the parotid glands. MEC occurrence in the larynx is, however, rare. The incidence of primary squamous cell carcinoma (SCC) of salivary glands is also scarce and comprises only about 1.6% of all salivary gland malignancies. Hereby, we share our experience in managing two patients with rare and opposite variants of malignancy which were diagnosed at the same time; MEC of the larynx and SCC of the parotid. In MEC tumors, the presence of the intermediate and mucous cells with positivity in mucicarmine stain are the significant features. For SCC tumors, identification of the usual tumor markers (p40, CK 5/6 and p63) are pathognomonic. Although MEC and SCC are common in the head and neck regions, the existence of these malignancies in exceptional locations must be considered. The key features mentioned in our comparison table can help distinguish both these tumors and to deliver the correct treatment modalities. The prevalence of genomic and carcinogenic factors in the occurrence of these tumors in uncommon locations needs to be explored in future studies.

Using Human Development Indices to Identify Indicators to Monitor the Corona Virus Pandemic

Introduction The Corona virus (CoVID-19) pandemic has hit the most developed countries and has thence spread to inflict other countries around the world. It is the first pandemic that appears in countries not linked to poverty and poor hygiene. Aim To study the relationship between human development and the pattern of the pandemic caused by the CoVID-19 and to identify development indicators that can be useful in monitoring the pandemic. Methods Data collected included confirmed cases of CoVID-19 by country, number of cases that recovered and cases that died and population density per million in this particular country. The data for this information was obtained from the online data on the daily reports on CoVID-19 from the different countries. Data for the Human Development index (HDI) and the ranking for each country were obtained from the most recent United Nations Development of Populations (UNDP) report for 2019. We analyzed data for 166 countries for which the HDI was available for the date of cases reported online on 27th March, 2020 at midnight. Findings There were significant differences by ANOVA for the confirmed cases of CoVID19 cases and total cases per one million population between the countries in the 4 tier group of Human Development. HDI was significantly correlated with confirmed cases, case density and cases that died from CoVID-19 (P<0.01) for all countries but the significance decreased by tier group. Country ranking was inversely correlated with confirmed cases of CoVID-19 (r-0.25 at P=0.001), CoVID-19 cases per million (r-0.4 at P=0.000) and cases that died from CoVID-19 (r-0.2 at P=0.03). Recovery was not inked to HDI or country ranking. The upper HDI tier groups (very high, high and medium) showed significant correlations with total cases per one million population P<0.05, but no correlation was found with confirmed cases or cases that died or recovered from CoVID-19 P>0.05. Conclusions Total cases of CoVID-19 per one million population seems to be a better indicator of the pandemic. The pattern of spread is closely linked to industry.

Educational Needs of Mothers about using Oral Rehydration Salt (ORS) at Home During Acute Diarrhea in Children under 5 at Urmia Population Research Center

Preventable factors such as infectious diseases (pneumonia, diarrhea, and malaria), malnutrition and neonatal complications are still the leading cause of child mortality worldwide 1 In 2013, it is estimated that 6.3 million babies born worldwide died before the age of 5, and approximately 9.2% of these deaths were due to diarrheal diseases 23 in simple, accessible ways, and effective treatment can reduce diarrhea-related mortality and make hospital admissions unnecessary, and the role of mothers is the most important 4. Since the presentation of Oral Rehydration Therapy (ORT) in 1979, mortality has reduced. Diarrhea has had a steady downward trend 5. If mothers who have children under 5 years of age, used correctly ORS, they could easily resolve the problem of dehydration in acute diarrhea 6. Mothers didn’t use correctly ORS because of their Low literacy and lack of knowledge and wrong attitude about ORT7. Some health care workers provide mothers’ required equipments, regardless of their educational needs, and mothers may not use ORS. In this study, health workers identified mothers' educational needs and subsequently they trained them about using ORS at home in acute diarrhea in children under 5 years of age.

Nutritional Status of Reproductive Ethnic Woman Living in Chittagong Hill Tracts of Bangladesh: Influence of Socio-economic and Nutritional Factors

Aim This cross-sectional study assessed the nutritional status of ethnic reproductive women aged between 15-40 years, comprising 85 lactating women (LW) and 86 non-pregnant-non-lactating women (NPNLW) who lived in various parts of three hilly districts (Bandarban, Khagrachari and Rangamati) of the Chittagong Hill Tracts (CHTs) of Bangladesh. Materials and Method Research tool was pretested semi-structured questionnaire for this observational study. Anthropometric indices like weight, height and mid-upper-arm-circumference (MUAC) were used in assessing the nutritional status. Results Most (44.4%) of the ethnic women were Marma, followed by Chakma (39.8%), Bam (8.2%) and Tripura (5.8%). No significant (P>0.05) differences were observed in socio-economic variables between LW and NPNLW. Overall, mean age of the women was 28 (±7.2) years; mean family income was 18,822.2 (±3091) BDT and majority (86%-87%) were reported to be food secured throughout the year. Mean Dietary calorie (2631±798 kcal) intake of both groups were up to the mark according to the recommended dietary allowances (RDAs) and most (80.3%-86%) of them also possessed good nutritional knowledge. However, no significant (P>0.05) differences were observed in dietary calorie intake and nutritional knowledge score between two groups of women. Overall, most (68.4%) of the women had normal body max index (BMI kg/m2), 11.7% were found to be undernourished or thin and 19.9% were overweight. It was noticed that better nutritional status of LW and NPNLW were significantly associated with literacy (P<0.05), occupancy in household chores (P<0.05), better income (P<0.05), food security (P<0.05), recommended calorie intake level (P<0.05) and better nutritional knowledge score (P<0.05). Conclusion This study showed that vast majority of the ethnic reproductive women of CHTs are in better nutritional status with normal BMI (kg/m2) and daily calorie intake according to RDA. Most of them were food secured and their nutritional knowledge score was also up to the mark. Better socio-economic condition, nutritional knowledge and accurate calorie intake play a vital role in achieving healthy nutritional status of the two women groups of CHTs.

Structural Equation Modeling to Detect Predictors of CD4 Cell Count Change due to Long Term Antiretroviral Therapy Administered to HIV-Positive Adults at Felege Hiwot Teaching and Specialized Hospital, Bahir Dar, Ethiopia

Background The relationship between predictors and the variable of interest was estimated using a structural equation model which is used to predict latent variables. The main advantage of the SEM is the ability to estimate the direct and indirect pathways of the effect of the primary independent variable on the outcome, given sufficient sample sizes. Despite not directly modeling the mediated pathways, GLMMs excluding mediating variables performed well with respect to power, bias and coverage probability in modeling the total effect of the primary independent variables on the outcome. In longitudinal studies, data are collected from subjects at several time points. The main purpose of longitudinal analysis is to detecting the trends or trajectories of the variables of interest. Methods A longitudinal study was conducted on 792 adults living with HIV/AIDS who commenced HAART. Structural equation modeling was used to construct a model to detecting predictors of CD4 cell count change. The procedure was illustrated by applying it to longitudinal health-related quality-of-life data on HIV/AIDS patients, collected from September 2008 to August 2012 monthly for the first six months and quarterly for remaining study period. Results The result of current investigation indicates that CD4 cell count change was highly influenced by certain socio-demographic and clinical variables. Out of all the participants, 141 (82%) have been considered 100% adherent to antiretroviral therapy. Structural equation modeling has confirmed the direct effect that personality (decision-making and tolerance of frustration) has on motives to behave, or act accordingly, which was in turn directly related to medication adherence behaviors. In addition, these behaviors have had a direct and significant effect on viral load, as well as an indirect effect on CD4 cell count. The final model demonstrates the congruence between theory and data (x2/df. = 1.480, goodness of fit index = 0.97, adjusted goodness of fit index = 0.94, comparative fit index = 0.98, root mean square error of approximation = 0.05), accounting for 55.7% of the variance. Conclusions The results of this study support our theoretical model as a conceptual framework for the prediction of medication adherence behaviors in persons living with HIV/AIDS. Implications for designing, implementing, and evaluating intervention programs based on the model are to be discussed.

Comparative Analysis of Atherosclerosis Risk Factors in the Staff of the Tbilisi (Georgia) Cleaning Service

Objective Search of pathogenetic mechanisms and risk factors of atherosclerosis in the employees of the cleaning service in Tbilisi. Materials and Methods As a result of a preliminary survey and examination of 200 employes of Tbilisi cleaning service aged 25-45 years (2014-2016), 22 patients with angina, hypercholesterolemia, intimae-media thickness > 0.65 mm, were selected into I group, and 23 individuals without these disorders into II group. In the blood plasma of the selected patients the intensity of oxidative metabolism parameters, TAA and MDA were determined. The variance and correlation analysis (АNOVA) was used for conducting the comparative analysis of the levels of studied parameters. Results In the combined group (I+II) there are several reliable correlations between the Age -TCol, Age-MDA, BMI-Tg, BMI-MDA, LDLChol-HDLChol, LDLChol–TChol, HDLChol-TChol, LDLChol-MDA, LDLChol-TAA. no correlation between these parameters in individual groups (I and II) was found. That indicates that we have an imaginary correlation related to the large intergroup difference between the average values of the group indicators, that is the values of various indicators change during the development of the pathological process, but there is no causal relationship between these alterations. The reliable TAA-MDA correlation in the combined group (I+II) is related to the high anticorrelation between these parameters and the significantly higher average value of TAA in the low-risk group (II) in comparison to the high-risk group (I). Conclusion The results analysis indicates both the diagnostic value of redox status indicators and their leading role in the atherogenesis processes. In populations with a high risk of atherosclerosis, monitoring of serum TAA is recommended.

Observations and analysis of risk factors for GDV in a single institution: a case-control study

Objective To evaluate/ determine the risk factors for dogs presented with Gastric Dilation- Volvulus (GDV) to a referral veterinary centre and to compare the results with those currently reported in veterinary literature. Materials and Methods The observational case-control study comprised a population of 215 dogs that attended the referral centre between 2000 and 2018. Medical records were searched for GDV and those matching the criteria were manually reviewed. A questionnaire was completed by the owners of the dogs involved in the study (both case and control populations) in order to gain further information that could be considered relevant to GDVs. In particular, information included the dogs’ behaviour and the dogs daily activities. Results The study included 115 cases of GDV and 115 controls. Out of the GDV dogs 13% (15/115) were small breed dogs and the remaining 87% (100/115) either large or giant breeds. The following risk factors for developing a GDV have been identified: Purebred dogs over 3 years old and either large of giant breeds, weighing > 30 kg. Foreign body ingestion, diarrhoea, and grass consumption were also associated to increase the likelihood in developing GDV. Behavioural temperament was not associated with developing GDV. Clinical Significance The findings support previously identified risk factors in the development of GDV, but characteristics related to the dogs temperament warrant further investigation. Knowledge of these results will further allow clinicians to make evidence‐based recommendations to owners in attempting to prevent GDV in dogs. Furthermore this paper confirms that the risk of GDV in certain breeds and in certain conditions is always high and that GDV is still an extremely current disease.

Interest of Confirmation Tests in the Diagnosis of Viral Hepatitis C to Blood Donors in Abidjan-Côte d'Ivoire

Introduction The anti-HCV RIBA test verifies the presence of anti-HCV serum antibodies detected by the Elisa test. In Côte d'Ivoire, screening for hepatitis C is done exclusively by enzyme immunoassays. In order to reduce the number of HCV positive blood donor exclusions on ELISA, we conducted this study which aimed to demonstrate the value of the RIBA test in confirming diagnosis of viral hepatitis C to blood donors. Methods Our study, which took place from 02 to 23 February 2008 in the laboratory of Abidjan NBTC, focused on 200 sera of blood donors anti-HCV positive (Elisa test) selected according to the ratio. The DECISCAN HCV PLUS confirmation test of BIORAD was used. Results Among the 200 HCV samples positive by EIA, 49% (98/200) were confirmed positive. RIBA gave an indeterminate result in 40% of cases (80/200); and negative in 11% of cases (22/200) corresponding to false ELISA devices. In RIBA 96 samples had a low ELISA ratio of which 21% (20/96) were RIBA negative, and 79% (76/96) were indeterminate. RIBA positive samples (98/200) had a high ratio in 82% of cases (80/98). The presence of NS3 (C33) and NS4 (C100) was noted in 100% of cases (98/98, C2 in 37% (36/98) of cases and C1 in 18% of cases (18/98). RIBA indeterminate noted the presence of NS3 in 98% of cases (78/80) and NS4 in 30% of cases (24/80). Proteins C1, C2 and NS4 are essential for the diagnosis of confirmation of viral hepatitis C by RIBA. Conclusion These results attest to the lower specificity of enzyme immunoassays (ELISAs); hence the benefit of using RIBA confirmatory tests. A significant number of donors are excluded from blood donation in Côte d'Ivoire on the basis of false positive results obtained by the ELISA technique.

Peroxidase from Coleus Forskohlii: Purification and Biochemical Characterization

In this study, a peroxidase from new source was purified using ion exchange and gel filtration techniques. The recovery for peroxidase activity was 19% with 11-fold purification and specific activity of 749 unit/mg protein. Purified peroxidase demonstrated a molecular mass of 39 kDa using gel filtration and was confirmed as a single band on SDS-PAGE. The purified peroxidase revealed a broad optimum pH activity at 6.0-6.5 and 50°C temperature. The kinetic parameters for purified peroxidase toward H2O2 and guaiacol as substrates were found to be Km = 3.355, 5.395 mM, Kcat = 99.52, 79.56 s-1 and Vmax =1.531, 1.242 µmole ml-1 min-1, respectively. The catalytic efficiency (kcat/Km) of the purified peroxidase was 14.75 and 29.66 s−1 mM−1 for guaiacol and H2O2, respectively. Peroxidase activity was observed to be enhanced by Cu2+, Co2+, Ni2+ and inhibited in the presence of Sn2+, Al3+, Hg2+, NaN3, EDTA and urea. Characterization showed that peroxidase purified from C. forskohlii has the ability to be used for food industrial applications.

Relationship Between the Immunodetection of Alpha-Smooth Muscle Actin and the Aggressiveness of Mammary Papillar Tumors in Female Dog

Papillary carcinoma is a mammary neoplasia of women and female dogs characterized by papillary fibrovascular projections lined by epithelial cells. Evaluation on the biology of these tumors can be done by immunohistochemistry through detection of alpha-smooth muscle actin protein in the papillary myoepithelium, which lacks such a molecule during malignant proliferations. Thus, this study aimed at determining the malignancy degree of papillary mammary tumors of female dogs by immunohistochemistry. Twenty samples of mammary neoplastic tissues collected from female dogs treated in the Veterinary Hospital at FCAV were evaluated by Hematoxylin and Eosin staining (H&E) and tumor cells were immunolabelled with monoclonal antibody to alpha-smooth muscle actin (α-SMA). Five out of 20 cases showed positive immunolabeling greater than 10% of the total immunolabeling. The remaining fourteen cases presented immunostaining lesser than 10% showing decrease or absence of α-SMA labeling in the myoepithelium of the papilla tumors. All those cases in which immunostained cell was over 10% of the neoplasm (5 immunostains of 20 total cases) were classified as benign whereas those below 10% of immunostained in the slid were considered as malignant. Therefore, immunohistochemistry played an essential role in differentiating benign and malignant papillary tumors of bitches as already described for female. Tumor classification by conventional methods, such as H&E staining, can lead to erroneous interpretations on the real biological behavior of the papillary mammary tumor.

Dispositional Mindfulness, Perceived Stress, and Mental Well-Being in the Cancer Survivorship

The present study aims to investigate how dispositional mindfulness affects the mental well-being of cancer patients through the way they perceive stress. A total of 182 moderate and advanced gastrointestinal cancer patients volunteered to complete the Mindful Attention Awareness Scale (MAAS), the Chinese Perceived Stress Scale (CPSS), and the General Health Questionnaire (GHQ). Results showed that perceived stress significantly mediated the relationship between dispositional mindfulness and all dimensions of the mental well-being as captured by the GHQ (i.e. anxiety/depression, social dysfunction, and loss of confidence), and perceived stress was positively correlated with all the dimensions of mental well-being. Results of the Structural Equation Model showed that the model fit the data very well (χ2/df = 1.72，RMSEA = 0.063 (95% CI = 0.014 ~ 0.103), CFI = 0.984, TLI = 0.970, SRMR=0.041). Further analyses showed that dispositional mindfulness predicted all the dimensions of psychological well-being. Specifically, higher levels of dispositional mindfulness predicted reduced subjective perceptions of stress, which in turn predicted lower levels of anxiety/depression, social impairment, and loss of confidence. This study indicated a possible mechanism of intervention focused on improving mindfulness capability. Future work is encouraged to investigate the long-term influence of dispositional mindfulness on perceived stress and psychological well-being in cancer patients with other types of cancer.

Nucleoside and Nucleotide Reverse Transcriptase Inhibitors Induce Aging by Inhibiting Telomerase Function

The telomeres existing at the end of the eukaryotic chromosome, play an important role in localization, pairing of homologous chromosomes during cell division and synapsis formation, while telomerase is involved in maintenance of the telomere length. The application of antiHIV-1 molecules particularly NRTIs have been shown to interfere with telomerase function thereby inducing aging processes. Since the application of these molecules has already indicated production of oxidative stress and toxicity in AIDS patients, their adverse impact on telomerase function may further worsen the situation. In addition, the negative influence of antiHIV-1 regimens on certain host factors involved in telomerase function may enhance aging. HAART changes the landscape of the disease by progressively decreasing the progression of HIV-1, but exerts prolonged adverse effects on the telomerase function. Though there is no exact information available on this issue, intensive efforts are needed to explore regulation of telomerase expression in HIV infected individuals and particularly those receiving antiretrovirals. 

Perspectives on Sub–Nanometer Level of Electronic Structure of the Synchrotron with Mendelevium Nanoparticles for Elimination of Human Cancer Cells, Tissues and Tumors Treatment Using Mathematica 12.0

Mendelevium nanoparticles absorb energy of descendent light and generate some heat in the particle. The generated heat transferred to the surrounding environment and leads to increase in temperature of adjacent points to nanoparticles. Heat variations can be obtained by heat transfer equation. In the current study, thermoplasmonic characteristics of Mendelevium nanoparticles with spherical, core–shell and rod shapes are investigated. In order to investigate these characteristics, interaction of synchrotron radiation emission as a function of the beam energy and Mendelevium nanoparticles were simulated using 3D finite element method. Firstly, absorption and extinction cross sections were calculated. Then, increases in temperature due to synchrotron radiation emission as a function of the beam energy absorption were calculated in Mendelevium nanoparticles by solving heat equation. The obtained results show that Mendelevium nanorods are more appropriate option for using in optothermal human cancer cells, tissues and tumors treatment method. When Mendelevium nanoparticles are subjected to descendent light, a part of light scattered (emission process) and the other part absorbed (non–emission process). The amount of energy dissipation in non–emission process mainly depends on material and volume of nanoparticles and it can be identified by absorption cross section. At the other hand, emission process which its characteristics are depend on volume, shape and surface characteristics of nanoparticles explains by scattering cross section. Sum of absorption and scattering processes which lead to light dissipation is called extinction cross section. 

Risk Factors of Persistent Diarrhoea in Children below Five Years of Age

Background Persistent diarrhoea is a commonly observed phenomenon both in Bangladesh and all over the developing countries. It is the single most important cause of diarrhoea related deaths in the community, accounting for over half of them. If associated factors are properly identified & treated, it is possible to prevent most cases of persistent diarrhoea. Objective This study was undertaken to find out the possible risk factors associated with persistent diarrhoea in children below 5 years of age. Methods This was a prospective analytical case control study carried out in a tertiary care hospital, Dhaka. A total of 30 consecutive cases of persistent diarrhoea and 60 consecutive acute diarrhoea controls (matched for age and sex) under 5 comprised the study subjects in this study. Children beyond the age and whose parents didn’t give written consent were excluded from the study. Data were collected using a structured questionnaire and a standered case definition of acute & persistent diarrhoeawere adopted. Data were later processed and analyzed using SPSS (Statistical Package for Social Science version 12) in the year 2012. Results were considered statistically significant when p value was <0.05. Results According to the study, 56.6% of cases and 63.3% of controls were in the ‘6 to 12 months’ age group and about two-third of the participants in both cases 20 (66.7%) and controls 39 (65.0%) were males.Strong association was found with ‘bottle feeding’ RR=2.2556; 95% CI: 1.259, ‘presence of blood/mucus’ RR=2.5038; 95% CI: 1.4129, ‘WAZ≤ 2)’ RR=2.8867; 95% CI: 1.7202 and ‘early complementary feeding [RR=4.67; 95% CI: 2.5017-8.7175 and OR=7.8858; 95% CI: 3.6791-16.9 Conclusion In the present studyfour factors showed some association with persistent diarrhoea, namely: ‘use of animal milk’; ‘antibiotic use during acute diarrhoea’; ‘history of diarrhoea in previous 3 months’ and ‘pre-lacteal feed’. Strong association was found with ‘bottle feeding practices’ ‘presence of blood &/or mucus in stool’, WAZ <-2 and ‘early complementary feeding

Parent-adolescent Communication on Sexual and Reproductive Health Matters and Associated Factors among Secondary and Preparatory School Students in Robe Town, Bale zone, Southeast Ethiopia, 2017

Background Adolescents is the transition from childhood to adulthood .Which is a time of opportunity, but also one of risk. In Ethiopia, sexual and reproductive health problems of adolescents are increasing from time to time related to many parents not feeling happy to discuss sexual matters in addition to early sexual commencement among adolescents. Objective This study was intended to assess parent-adolescent communication on sexual and reproductive health matters and associated factors among secondary and preparatory school students in Robe Town, Bale Zone, South East Ethiopia, 2017. Methods Institution based cross sectional study was conducted among 394 secondary and preparatory school students in Robe town from April 10-25, 2017. Simple random sampling technique was used. Data was obtained through the use of a self administered questionnaire and supplemented by focus group discussion with parents. Data was entered using Epi Data 3.1 and analyzed by SPSS 20. Descriptive statistics and logistic regression analyses were done. Data quality was assured through careful questionnaire design, pretest and training. Results One hundred eighty six (47%) of the study participants had discussed at least two SRH issues with their parents. Grade eleven students were about nearly five times more likely discussed on sexual and reproductive matters with their parent compared with grade nine students (AOR: 4.88, 95% CI: 1.76, 13.54). Those living with relatives were 3.13 times less likely discussed as compared to those students are living with both parents (AOR: 0.32, 95%CI: (0.12, 0.80) and the odds of discussion on SRH matters is 2 times higher among females compared with their counterpart (AOR=2.02, 95% CI: 1.25, 3.26). Conclusions Communication on sexual and reproductive health matters between adolescent and parent was low. Majority of student preferred to discuss with their peers than parent. Being ashamed, parents lack of communication skill and parent knowledge on SRH issues were the major reasons mentioned by the students for not discussing about SRH matters with their parents. Therefore; comprehensive family life education needs to be initiated for the students and parents. Sexual information exchange between peers needs to be strengthened.

Forest Fragmentation Shapes Resource Partitioning for Endemic Pollinators (Hymenoptera: Meliponini)

A field study was undertaken along six diverse habitat gradients of Kenya to evaluate the occurrence and underlining drivers that shape meliponine bee species diversity. These gradients ranged from continuous forest habitats (Indigenous forests, mixed forests and exotic forest patch) representing unfragmented habitats to dispersed habitats (Mixed deciduous woodlands, Grasslands dominated by perennial grasses such as Cenchrus ciliaris, Chloris roxburghiana and Acacia dominated bush lands) representing fragmented habitats respectively. A total of four different species of meliponine bees were encountered with Hypotrigona gribodoi being the most abundant species, followed by Meliponula ferruginea (black), Plebeina hildebrandti and Hypotrigona ruspolii in descending order. Occurrence and diversity of Hypotrigona gribodoi, Melipona ferruginea (black), Plebeina hildebrandti and Hypotrigonaruspolii was significantly influenced by the degree of fragmentation (vegetation type) and floral diversity (P = 0.0056); the mean number of colonies recorded per study site ranged from 2.3 in dispersed habitats in the lowlands to 1.0 in continuous forest landscapes in the highlands, whereas the mean population density ranged from 2.0 to 172 colonies/25 ha-transects. The results provide substantial support to better understand interactions between habitat structure and the degree of fragmentation in linking species diversity to habitat loss.

Cardiac Inflammatory Pseudotumors in Behçet’s Disease

Introduction Cardiac non-specific inflammatory pseudotumors (NSIPT) are exceptionally associated to Behçet's disease (BD) and represent a real diagnostic and therapeutic challenge. The meaning and the mechanisms of this association are not yet well understood. The purpose of this paper is to study the epidemiologic, therapeutic, and evolutionary characteristics of cardiac NSIPT during BD Methods Systemic review of all reported cases of cardiac NSIPT associated with BD. Results We found only 6 cases of NSIPT associated with BD. Of these six patients, 4 were men (66.66%) and 2 were women (33.33%): Sex ratio =2. The average age was 26.66 years (9-35 years). The pseudotumor was unique in all cases. The chronology of occurrence of these NSIPT compared to the underlying angiitis was variable: inaugural of the disease in 4 cases, and complicating a previously known BD in 2 cases. The surgery was performed in all cases. It was carried out for diagnostic purpose in 4 cases, and therapeutic in the other 2. Additional medical treatment based on systemic corticosteroids with or without immunosuppressants was indicated in 4 patients. The evolution was favorable in 5 cases and a single case was quickly fatal. Recurrence of NSIPT was reported in one patient (20%). Conclusion The results of this review suggest a very likely association between BD and cardiac NSIPT; especially because of the scarcity of these two conditions in the general population, and the epidemiological characteristics clearly different from those of cardiac NSIPTs in the general population. The pathogenic mechanisms common to these two conditions (immune, inflammatory, reactive, and vascular) reinforce this causal link. The main differential diagnoses of these pseudotumors during BD remain cancer and intracardiac thrombosis.

Risk Factors of HIV among Voluntary Counseling and Testing Centers Clients, Elgenina Town, West Darfur, Sudan.

This study was conducted in two (VCTs) at Elgenina town, the capital of West Darfur State in Sudan in period from November 2010 to February 2011, the study included all people attending VCTs in Elgeniena town for voluntary checking one hundred and fifty clients who visited the (VCT) centers and volunteered were included in this study, nonprobability sample, 150 volunteers was taken and covered all ages, One ml of blood was taken from each of the study sample and tested by rapid Immune Chromatographic (ICT) for HIV, a structured questionnaire was designed and the interviewed after a written consent to participate in the study was signed, data was analyzed using the SPSS statistical programmer and for possible association between study variables, the Chi square test was used, the study showed that 35 volunteers (23.33%) were positives, of whom 54.3% 19 were males. People having more than one sex partner were high 63.6% with statistically significant factor of getting infection (P.value = 0.00). Also, practicing unsafe sex were 5.2% another major risky (P.value = 0.00). Among the HIV positive cases 34.3% were drug users, compared to 20.9% from the HIV negatives (p. value = 0.10). There is no relation between education level and infection with HIV (p .value = 0.154). Forty two percent of the participants were single, 30% married, 10% divorced, 7.3% widows and 10.7% were separate

The Temporal World in Caregivers of Cancer Survivors: Intertextual Analysis of their Experiences about the Perception of Time Compared with Excerpts from the Book "Einstein's Dreams

Purpose: The perception of time and its measurements depend on subjective constructs that vary according to changes in health. The evidence has shown that cancer diagnosis induces new relationships with time in patients and caregivers. The purpose of this study was to propose a multifaceted view about time perception referred by caregivers of cancer survivors. Methods: This study used a qualitative phenomenological methodology including semi-structured interviews with caregivers of cancer survivors. Transcripts of the interviews were analyzed using an approach for intertextual analysis, taking as reference the book "Einstein's dreams". Results: The analysis of transcripts shows changes caregivers’ time perception. Participants were grouped into three essential moments related to each stage of the disease. The variations found in the perception of time in caregivers can be explained by common physiological and behavioral responses associated with the diagnosis of a chronic disease (i.e. stress, anxiety, fear, unhappiness, and sadness), which can be modified in the course of the disease. Conclusions: We propose that a holistic approach to patient and caregiver care should include management of time perception, thus establishing interventions that facilitate a change in the experience of time perception into a more pleasant experience after a cancer diagnosis. The above may result in increased quality of patient care and possibly increased quality of life of caregivers.

Factors Associated to the Decision to Terminate or not an Unwanted Pregnancy among a Sample of Civil Servant in São Paulo State, Brazil.

This is a cross sectional study of a sample of civil servants from the interior of São Paulo state, carried out with the purpose of evaluating the occurrence of unwanted pregnancies, the proportion which were terminated, the reason given for having or not having an abortion and which factors were associated to the decision whether or not to terminate an unwanted pregnancy. Just over one fifth declared to have experienced an unwanted pregnancy and over half of them were aborted. The reasons to abort concentrate on interferance with their life expectancy: “to continue studying or working” “being single”, “too young to get married” and “to become a father or mother”. Also important were fear of parents and rejection by the respondents'partner. Among those who did not terminate the unwanted pregnancy religion acted as a barrier among almost one third and the legal barrier for almost one fourth. Not having a permanent partner, being in use of behavioral or barrier method of contraception and higher education were associated with higher incidence of abortion of the unwanted pregnancy, but in multiple regression, only higher education remain significantly associated. Our results showed that once the unwanted pregnancy occur, more than half of them will be aborted, confirming the need to concentrate the efforts in reducing unwanted pregnancies if we want to prevent abortion.

Should All Living Kidney Donors Receive Donor Health Insurance? - Ethical Guidance for Evaluating Policies and Actions that Provide Financial Benefits to Living Organ Donors

This review article provides ethical guidance for determining which kinds of financial benefits provided to living organ donors are ethically appropriate. It does so by way of ethical analysis of a policy case study: the National Kidney Registry (NKR) has implemented a donor insurance program to all its living donors. Is such a policy ethically supportable, or is it an unethical practice? The article proceeds as follows. First, a framework for grounding the ethical commitments of transplant programs is defended. It is argued that this framework can be accepted by all who work in transplant medicine, regardless of differences in ethical theory preference or background. Second, from this framework two ethical principles are formulated. (1) Living donors should, as far as possible, not be worse off for donating. (2) Disincentives towards donation should be removed as much as possible. Third, issues with unethical incentives are explored: undue inducement, commodification of the body, potential decreased organ donation rates, and potential exploitation of vulnerable populations. Lastly, these ethical considerations are applied to the policy change at the NKR, showing that the NKR policy change appears to be ethically supportable. Financial benefits provided to donors are ethically sound if they are in keeping with principles (1) and (2), and do not cause undue inducement, commodification, decreased organ donation, or exploitation. It is ethically appropriate for transplant programs to institute as well as study such programs with the goal of serving the welfare and interests of patients, donors, and the general public.

Enhanced Alkaloid Production from Cell Culture System of Catharanthus roseus in Combined Effect of Nutrient Salts, Sucrose and Plant Growth Regulators

Callus and biomass culture of Catharanthus roseus L. were established to check for the presence of total alkaloid and its subsequent yield. Various treatments like strength of nutrient salts, sucrose concentrations and combinations of plant growth regulators (PGR’s) were applied to both MS and B5 in agar as well as suspension medium to test their effects on enhanced alkaloid content and its yield. There was no significant difference in any of the observable parameters of fresh wt, dry wt, alkaloid content, production, productivity and yield if the culture were treated similarly in both types of media formulations (MS or B5 salts). Physical state (agar solidified or the liquid suspension) of the medium had significant effect on all the parameters particular on fresh wt, alkaloid content and yields. Although, the fresh wt. and dry wt. of biomass in suspension culture was 2-3 times less than that of callus obtained from agar medium. However, the alkaloid content and yield was 2-3 times higher in suspension culture compared to agar medium in similar treatments. The highest alkaloid content observed was 5.67mg/g dwt in B5 suspension medium containing 3% sucrose and modified with 0.5mg/l 2,4-Dichlorophenoxy acetic acid (2,4-D) + 1 mg/l Kinetin (KIN) + 2mg/l α- naphthalene acetic acid (NAA). The combined effects of these factors on the enhanced production of total alkaloids were expected to contain higher yield of anticancer vinblastine and vincristine in the cell suspension culture system.

Prevalence of Diarrhea and Associated Factors among Under Five Years Children in Harena Buluk Woreda Oromia Region, South East Ethiopia, 2018

Background: Acute diarrheal diseases are the leading cause of preventable childhood death, especially in developing countries. It is the second leading cause of death in under-five year children nest to pneumonia. Objectives: The aim of this study was to determine the magnitude and associated factors of diarrhea in under-five in Harena Buluk district. Methods: A community based Cross sectional study was conducted in February, 2018. A two stage stratified sampling method was done to select the eligible households. Data was collected by trained data collectors using pretested questionnaire list which was prepared based on EDHS and WHO core questionnaires related to diarrhea. Data was entered in to a computer using Epi data 3.1 and exported to SPSS V.20 for further analysis. Logistic regression was used to determine level of association with 95% CI. A p-value <0.05 in the final model were considered as significant. Result: The two weeks period magnitude of diarrhea among under-five children was 28.4% with 95% CI (14.5-20.8) which was associated with households with one under five children (AOR: 0.268, 95% CI(.08,0.90)), living in the home with single room ((AOR = 6.01, 95% CI(1.01,36.01)), clean latrine/faces not seen around the pit or on the floor of latrine(AOR: 0.298, 95% CI(0.097,0.92)), long time take to fetch water from source (AOR: 0.046,95%CI(0.01,0.22)), home based water treatment ((AOR = 0.15, 95% CI: (0.04, 0.62)), living with animal in the same house(AOR: 8.31, 95% CI(2.46,28.06)), children who took gruel type of food(AOR: 0.24, 95% CI(0.07,0.81)), hand washing practice before cooking food (AOR: 0.195(0.066, 0.574)). Conclusion: The two weeks period magnitude of acute under-five diarrhea was relatively high and number of under five children in the household, cleanness latrine, time taking from the source of water, home based water treatment, number of rooms in the home, live with animal in the same house, type of food child take, hand washing before food preparation had significant association with the occurrence of under-five diarrhea. Improve community about home and environmental sanitation and hand practices were recommended.

Causative Factors behind an Efficacious Teacher: Evaluating Teacher Efficacy

In the third world school dropout rates are the highest, which is largely attributable to a dearth of efficacious teachers. The present research is an analysis of the teacher efficacy based on the teaching milieu. The Ohio State Teacher Efficacy Scale was used for data collection. Probability sampling design was used to select 171 secondary school teachers. As per the results, subject specialization affects teacher efficacy the most whereas, institution type influences teacher efficacy the least. The less experienced teachers have a greater self-efficacy than the experienced teachers, teachers teaching uncrowded classes are more efficacious than those teaching crowded classes.

The Use of Mirnas as Activators of Dental Implant Surfaces, A Review

MicroRNAs are short sequences of non-coding RNAs crucial in regulation of cell development, proliferation and differentiation. Some of them showed to be related with the expression of osteogenic genes. Aim of the present review was to evaluate the biological effects of titanium implant surfaces activated with miRNAs or antimiRNAs. A bibliographical electronic research was carried out on PubMed/Medline. Articles investigating the influences of miRNA functionalized surfaces on human or animal cells were included. Reports were excluded if investigating surfaces modified with molecules different from miRNAs, if miRNAs were not loaded to titanium surfaces. Five articles met the inclusion criteria. Surfaces functionalized with miRNAs showed to up-regulate the expression of osteogenic genes like RUNX2, OPN, OCN, BMP, OSX, ALP, COL1 and COL3. Investigated surfaces additionally showed more bone-like mineralized tissues, bone lacunae, osteocytes and new blood vessels. MiRNAs loaded to titanium implant surfaces stimulate the expression of genes related to osteoblasts differentiation, osteogenesis, osseointegration and reparation of mineralized tissues. Vectors used to link titanium surfaces and miRNAs did not show cytotoxicity or interference with cells’ viability.