bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing medical impoverishment and associated factors in health care in Ethiopia
Authors: Obse Amarech Guda , Ataguba John E.
Published: August 2019

Background

About 5% of the global population, predominantly in low-and-middle income countries, is forced into poverty because of out-of-pocket (OOP) health spending. In most countries in sub-Saharan Africa, the share of OOP health spending in current health expenditure exceeds 35%, increasing the likelihood of impoverishment. In Ethiopia, OOP payments remained high at 37% of current health expenditure in 2016. This study aims to assess impoverishment resulting from OOP health spending in Ethiopia, and examine the factors associated with this impoverishment.

Methods

This paper uses data from the Ethiopian Household Consumption Expenditure Survey (HCES) 2010/11. The HCES covered 10,368 rural and 17,664 urban households. OOP health spending includes spending on various out-patient and inpatient services. Impoverishing impact of OOP health spending was estimated by comparing poverty estimates before and after OOP health spending. A probit model was used to assess factors that are associated with impoverishment.

Results

Using the Ethiopian national poverty line of Birr 3,781 per person per year (equivalent to US$2.10 per day), OOP health spending pushed about 1.19% of the population (i.e. over 877,000 individuals) into poverty. Living in rural areas (highland, moderate, or lowland) increased the likelihood of impoverishment compared to an urban residence. On the other hand, the households headed by males, and adults with a formal education decreased the likelihood of impoverishment, compared to their counterparts.

Conclusion

In Ethiopia, OOP health spending impoverishes a significant number of the population. Although the country had piloted and initiated many reforms, e.g. the fee waiver system and community-based health insurance, a significant proportion of the population still lack financial protection. More is required to provide financial protection to achieve universal health coverage in Ethiopia, where the informal sector is relatively large.
Communication Skills Training for Physicians Improves Health Literacy and Medical Outcomes among Patients with Hypertension: A Randomized Controlled Trial
Authors: Sany Seyedeh Belin Tavakoly , Behzhad Fatemeh , Ferns Gordon , Peyman Nooshin
Published: August 2019

Background: Improving the training of physician about communication skills and patient health literacy (HL) is a major priority that remains an open question. We aimed to examine the effect of communication skills training for physicians on the HL skills and hypertension outcomes among patients with uncontrolled blood pressure (BP).
Methods: A randomized controlled trial method was conducted to enroll 242 hypertensive patients and 35 physicians from healthcare clinics in the Mashhad, Iran. Regression model and bivariate analysis were used to assess whether the physician training improved physicians-patient communication skills, hypertension outcomes, self-efficacy, and patient medication adherence after intervention.
Results: after the physician communication training, there was significant improvement in physicians-patient communication skills, hypertension outcomes, medication adherence, and self-efficacy among the patients being managed by the physicians receiving training, compared to the control group.

Conclusion: The educational intervention leads to better BP control; it may have been sufficient training of physicians change to impact counseling, HL and self-efficacy and adherence. The quality of physician-patient relationship is an important modifiable element of the medical communication that may influences health outcomes in hypertensive Iranian patients.

Trial registration: Iranian Registry of Clinical Trials (IRCT), IRCT20160710028863N24. Registered April 4, 2018 [retrospectively registered].
Influencing factors of serum lactate in patients undergoing partial hepatectomy with fluid restriction: a prospective cohort study
Authors: Yu Ling , Sun Hongwei , Jin Huangmo , Tan Hongyu
Published: August 2019

Background: This prospective cohort study was designed to investigate the factors related to serum lactate in hepatectomy patients with fluid restriction before resection of liver lesions. Methods: Patients for an open procedure for elective partial hepatectomy were chosen for this study. Limited fluid was infused at a rate of 6 ml·kg -1 ·h -1 before liver resection. The infusion speed was increased after resection of liver lesion. Stable hemodynamics was maintained by additional fluid infusion or vasoconstrictor drug. An additional infusion of 200 ml crystalloid liquid over ten min was given when urine output was less than 20ml/h, and/or when systolic blood pressure was less than 90mmHg for 1 minute and for more than 3 times. An injection of 6mg Ephedrine was given when the systolic blood pressure was less than 90 mm Hg for 1 minute. The duration of portal triad clamping, the central venous pressure (CVP), the frequency of additional fluid infusion , the frequency of ephedrine , and the intraoperative blood loss were recorded. The serum lactate was measured from arterial blood-gas analysis at 4 time points: T1: before anesthesia; T2: after liver dissection, and immediately before liver resection; T3: 10 min after the liver lesion was removed; and T4: before the patient was discharged from the post-anesthesia care unit . The lactate clearance rate was calculated and linear regression analysis was employed to identify the relationship between serum lactate level and the influence factors. Results: The highest serum lactate was observed at T3 in all 110 patients. Lactate clearance rate averaged 14.4±17.2% in all patients. The i nfluence factors contributed to the highest serum lactate listed by level of importance: duration of portal triad clamping, frequency of ephedrine, operation time. Conclusions: Hepatic portal clamping can result in the increase of serum lactate. The inadequate perfusion of organ during the fluid restriction may be due to increased serum lactate. Accelerated fluid infusion after resection of liver lesions can improve the tissue perfusion.
Trial registration: The registration number is ChiCTR1900023167. Retrospectively registered on 14th, May, 2019
The effects of analgesics and local anesthetics on gene transcription mediated by NFATc2 and Sp1 in pancreatic carcinoma
Authors: Malsy Manuela , Graf Bernhard , Bundscherer Anika
Published: August 2019

Background

Pancreatic adenocarcinoma is one of the most lethal cancers worldwide with very poor long-term survival. The treatment of choice next to chemotherapy or radiation treatment is surgical removal of the tumor. However, medication, surgery, and perioperative immunosuppression induce the constitutive activation of important signaling pathways and change the regulation of transcription factors, which may facilitate tumor progression and metastasis. Recent research has identified the transcription factors NFATc2 and Sp1 as key regulators in the carcinogenesis of pancreatic carcinoma. It is still unclear to what extent the transcription factors NFATc2 and Sp1 are influenced by analgesics given via peridural anesthetics or lidocaine infusions administered in perioperative settings or as postoperative pain therapy.Aims

To conduct an in vitro analysis of the impact of clinically achievable dosages of ketamine, s-ketamine, metamizole, and paracetamol as well as of sufentanil, ropicavaine, and lidocaine on pancreatic carcinoma cells in dependency of NFATc2 and Sp1.Methods

Analgesic stimulation and its effects on the expression of NFATc2 and Sp1 were investigated with immunoblot. Cell proliferation was measured with the ELISA BrdU assay.Results

In PaTu8988t pancreatic carcinoma cells, 48h stimulation with ketamine and s-ketamine significantly inhibited proliferation and contemporaneously decreased endogen expression of NFATc2 in the nucleus. The addition of metamizole and lidocaine to PaTu8988t cells reduced proliferation after 48h.Conclusions

New treatment concepts target the efficient modulation of specific signaling and transcription pathways. The extent to which drugs influence these mechanisms in vulnerable phases of pancreatic carcinoma cells needs to be investigated in future studies. The basis of novel therapeutic approaches to any disease is detailed knowledge of the carcinogenesis and profound molecular and biological understanding of the mechanisms.
Level of medication self-management capacity among patients on ambulatory care exiting hospital pharmacy at Muhimbili National hospital, Tanzania: a descriptive cross-sectional study
Authors: Mlyuka Hamu Joseph , Salehe Hija , Mikomangwa Wigilya P , Kilonzi Manase E , Marealle Alphonce I , Mutagonda Ritah F , Bwire George M.
Published: August 2019

Objectives

Medication management capacity of a patient on ambulatory care is direct related to adherence. To our knowledge data on medication management capacity for ambulatory care patients exiting outpatient pharmacy outlets in Tanzania are scarce. This study aimed to determine the level of medication management capacity among patients on ambulatory care exiting Muhimbili National Hospital outpatient pharmacy outlet.Results

Majority (62.3%) of the patients on ambulatory care had poor medication management capacity; 65.3% out of 387 patients were unable to correctly read the prescription and match the drugs they are carrying. More than half (57.4%) were unable to correctly take the dose, 57.4% were unable to correctly tell the dosing frequency and duration. Only 10.6% out 155 patients with prescription containing drugs with warning or precaution or contraindication or potential side effects were aware.
Polydrug use is associated with new HIV infections among men who have sex with men in China: a multicenter cross-sectional survey
Authors: Mao Xiang , Leuba Sequoia I. , Hu Qinghai , Yan Hongjing , Wang Zhe , Lu Lin , Zhuang Minghua , Chen Xi , Fu Jihua , Geng Wenqing , Jiang Yongjun , Shang Hong , Xu Junjie
Published: August 2019

Background: Recreational drug use is popular among men who have sex with men (MSM), while there is limited information about polydrug use and its consequent impact on sexual health and human immunodeficiency virus (HIV) acquisition.
Methods: MSM were recruited from a multicenter cross-sectional survey conducted in seven Chinese cities. Participants were divided into four subgroups based on the number of recreational drugs (RDs) used in the past 6 months. “Polydrug use” was defined as simultaneous use of ≥2 types of RDs. Information on demographics and HIV high-risk behaviors (HIV-HRBs) was collected, and blood samples were tested for recent HIV infection by the BED capture enzyme immunoassay.
Results: A total of 4,496 Chinese MSM participated, of which 28.4% used RDs, and 5% were polydrug users. Polydrug users commonly took poppers with one or more types of other RDs (e.g. methamphetamine). Polydrug users were likely to be aged 26–30 years, have low educational attainment, be internal migrants, have a high monthly income, use versatile positions during anal intercourse, and have inadequate knowledge about prevention of HIV infection ( P <0.05 for all). As the number of RDs used in the past 6 months increased, the prevalence of HIV-HRBs increased ( P <0.05 for all). The odds of recent HIV infection were higher among those who used one type (aOR = 2.2, 95%CI: 1.5–3.0) or two types of RDs (2.3, 1.0–5.2) in the past 6 months compared with those who did not use RDs. The population-attributable fractions of most HIV-HRBs for recent HIV infection were higher among polydrug users compared with those who used only one type of RD or used no RD in the past 6 months.
Conclusion: The level and pattern of polydrug use among Chinese MSM were different from developed countries. Polydrug use had a dose-effect relationship with HIV-HRBs. Polydrug users who have greater levels of RDs use are more likely to engage in various sexual risks, thus may associated with new HIV infections.
Understanding Barriers to Adoption of Facility Assisted Delivery in a Maasai Community in Ngorongoro District, Tanzania: A qualitative study to document psychosocial preferences, agency for decision-making, access barriers, and other factors that influence where a woman in Nainokanoka Ward will deliver
Authors: Mosley Paul D , Saruni Kisiaya , Lenga Bernadetha
Published: August 2019

BACKGROUND

Tanzania’s One Plan II health sector program aims to increase facility deliveries from 50% to 80% from 2015-2020. Success is uneven among certain Maasai pastoralist women in Northern Tanzania who resist going to a facility for birth even after completing 4+ ANC visits. EbOO is a program in Nainokanoka ward to promote facility-births through a care-group model using traditional birth attendants (TBAs) as facilitators. Results to date are promising but show a consistent gap between women completing ANC and those going to a facility for birth.

METHODS

A qualitative study was conducted in Nainokanoka ward to understand psychosocial preferences, agency for decision-making, and access barriers that influence where a woman in the ward will deliver. Interviews were conducted with twenty-three pregnant and/or parous women, along with 3 men’s and 2 TBA’s focus groups, and finally 3 key-informants from ward health facilities. Interviews were coded and analyzed thematically using a grounded theory approach.

RESULTS

Most women interviewed expressed preference for a home delivery with a TBA and even those who expressed agency and preference for a facility delivery usually had their last delivery at home attributed to unexpected labor. TBAs are engaged by husbands and play a significant influential role in deciding place of delivery as husbands defer to their judgment. TBAs claim to support facility deliveries but in practice use them as a last resort and reported a significant trust gap based on a bad experience at a facility where women in labor were turned away.

CONCLUSIONS

EbOO project data and study results show a slow but steady change in norms in Nainokanoka ward. Gaps between expressed intention and practice, especially around ‘unexpected labor’ present opportunities to accelerate this process by more intentionally promoting birth plans, and perhaps constructing a maternity waiting house near the ward health center. Rebuilding trust between facility midwives, TBAs, and the community on the availability of health facility services and assurance that women in labor will not be denied service, could also close the gap between the number of women who are currently using facilities for ANC and those returning for a facility delivery.
Protective and Therapeutic Effects of Nanoliposomal Quercetin on Acute Liver Injury in Rats
Authors: Liu Xiangyan , Zhang Yang , Liu Ling , Pan Yifeng , Hu Yu , Yang Pu , liao mingmei
Published: August 2019

Background

Quercetin, a pigment (flavonoid) found in many plants and foods, has good effects on protecting liver function but poor solubility and bioavailability in vivo. A drug delivery system can improve the accumulation and bioavailability of quercetin in liver.

Objective

In this study, we used liposomal nanoparticles to entrap quercetin and evaluated its protective and therapeutic effects on drug-induced liver injury in rats.

Design

The nanoliposomal quercetin was prepared by a thin film evaporation-high pressure homogenization method and characterized by morphology, particle size and drug content. Acute liver injury was induced in rats by composite factors, including carbon tetrachloride injection, high-fat corn powder intake and ethanol drinking. After pure quercetin or nanoliposomal quercetin treatment, liver function was evaluated by detecting serum levels of glutamic-pyruvic transaminase (GPT), glutamic-oxal acetic transaminase (GOT) and direct bilirubin (DBIL). Histology of injured liver tissues was evaluated by hematoxylin and eosin staining.

Results and discussion

On histology, liposomal nanoparticles loading quercetin were evenly distributed spherical particles. The nanoliposomal quercetin showed high bioactivity and bioavailability in rat liver and markedly attenuated the liver index and pathologic changes in injured liver tissue. With nanoliposomal quercetin treatment, the serum levels of GPT, GOT and DBIL were significantly better than treated with pure quercetin. Using liposomal nanoparticles to entrap quercetin might be an effective strategy to reduce hepatic injury and protect hepatocytes against damage.

Conclusions

Liposomal nanoparticles may improve the solubility and bioavailability of quercetin in liver. Furthermore, nanoliposomal quercetin could effectively protect rats against acute liver injury and may be a new hepatoprotective and therapeutic agent for patients with liver diseases.
The utility of a shortened palliative care screening tool to predict death within 12 months – a prospective observational study in two South African hospitals with a high HIV burden
Authors: Raubenheimer Peter , Day Cascia , Abdullah Faried , Manning Katherine , Cupido Clint , Peter Jonny
Published: August 2019

Background

Timely identification of people who are at risk of dying is an important first component of end-of-life care. Clinicians often fail to identify such patients, thus trigger tools have been developed to assist in this process.

Aim

To evaluate the performance of a screening tool (based on the Gold Standards Framework Prognostic Indicator Guidance) to predict death at 12 months in a population of hospitalised patients in South Africa

Design

Prospective cohort observational study using linkage analysis of hospitalised patients to death certification records.

Setting/participants

Patients admitted to the acute medical services in two public hospitals in Cape Town, South Africa

Results

822 patients (median age of 52 years), admitted with a variety of medical conditions were assessed during their admission. 22% of the cohort were HIV-infected. 218 patients were identified as meeting one of the specific indicators. Mortality in this group was 56% at 12 months, compared with 7% for those not meeting any criteria. The specific indicator component of the tool performed best in predicting death in both HIV-infected and HIV-uninfected patients, with a sensitivity of 74% (68-81%), specificity of 85% (83-88%), a positive predictive value of 56% (49-63%) and a negative predictive value of 93% (91-95%). The hazard ratio of 12-month mortality for those identified vs not was 11.52 (7.87 – 16.9; p < 0.001).

Conclusions

The identification tool is suitable for use in hospitals in low-middle income country setting that have both a high communicable and non-communicable disease burden amongst relatively young patients.
Genetic diversity of aflatoxin-producing Aspergillus flavus isolated from groundnuts in selected agro-ecological zones of Uganda
Authors: Acur Amos , Arias Renée S. , Odongo Steven , Tuhaise Samuel , Ssekandi Joseph , Muhanguzi Dennis , Adriko John , Buah Stephen , Kiggundu Andrew
Published: August 2019

Background

Aspergillus is the main fungal genus causing pre- and post-harvest contamination of groundnuts. Aspergillus flavus belongs to section Flavi, a group consisting of both the aflatoxigenic species (A. flavus, A. parasiticus and A. nomius) and non-aflatoxigenic species (A. oryzae, A. sojae and A. tamarii). Aflatoxins are food-borne toxic secondary metabolites produced by Aspergillus species, causing hepatic carcinoma and stunting in children and are the most toxic carcinogenic mycotoxins ever identified. Despite the well-known public health problems associated with aflatoxicosis in Uganda, information about the genetic diversity of the main aflatoxin causing fungus, Aspergillus flavus in this country is still limited.

Results

A cross-sectional survey was therefore carried out in three main groundnut-growing agro-ecological zones (AEZs) of Uganda; West Nile farming system, Lake Kyoga basin mixed farming system and Lake Victoria basin farming system. This was to assess the genetic diversity of A. flavus and to establish the contamination rates of groundnuts with Aspergillus species at pre- and post-harvest stages. Out of the 213 A. flavus isolates identified in this study, 96 representative isolates were fingerprinted using 16 insertion/deletion microsatellite markers. Data from fingerprinting were analyzed through Neighbor Joining while polymorphism was determined using Arlequin v 3.5. The pre- and post-harvest contamination rates were; 2.5% and 50.0% (West Nile farming system), 55.0% and 35.0% (Lake Kyoga basin mixed farming system) and 32.5% and 32.5% (Lake Victoria basin farming system) respectively. The Chi-square test showed no significant differences between pre- and post-harvest contamination rates among AEZs (p = 0.199). Only 67 out of 96 isolates produced suitable allele scores for genotypic analysis. Analysis of genetic diversity showed higher variation within populations than among populations. Two major clusters (aflatoxigenic and non-aflatoxigenic isolates) were identified as colonizing groundnuts at pre- and post-harvest stages.

Conclusions

These findings provide a first insight on the existence of non-aflatoxigenic strains of A. flavus in Uganda. These strains are potential candidates for developing local Aspergillus bio-control agent.
Evaluation of Bacterial Load and Antibiotic Resistance Pattern of Staphylococcus aureus from Ready-to-Eat Raw Beef in Bahir Dar City
Authors: Tsehayneh Bizuneh , Yayeh Taddesse , Agmas Birhan , Yilkal Semahegn
Published: August 2019

Background

Staphylococcus aureus is one of the most important causes of foodborne intoxication and most frequent antibiotic resistant pathogen in the world. Regular evaluation of the current safety status of food is a pro-active measure to minimize the possible danger of foodborne pathogens. Therefore, this study was conducted on to assess the bacterial load and antibiotic resistance profile of S. aureus from ready-to-eat raw beef in Bahir Dar city.

Methodology

This cross-sectional study was conducted from October 2018 to April 2019 by collecting a total 101 raw beef samples from butcher shops using simple random sampling method. Isolation and microbial load determination of S. aureus using was performed conventional culture method as well as antibiotic susceptibility test was conducted by using Kirby Bauer disk diffusion method on Mueller-Hinton agar. The data were analyzed by using STATA software version 12.0.

Result

Out of 101 raw beef samples, 55 (54.45%) were positive for S. aureus with mean bacterial count of 3.40±0.63(log10cfu/g). About 13% of butcher shops had unacceptable and potentially dangerous (above 104cfu/g) bacterial load. High S. aureus drug resistance were observed on penicillin (92.73%) followed by cefoxitin (74.5%), tetracycline (63.63%), clindamycin (50.9%). On the other hand there were highest susceptibility for ciprofloxacin (100%) followed by gentamycin (90.91%) and erythromycin (87.27%). Multi-drug resistance was also found in 54 (98%) of the isolates.

Conclusion

In this study highly drug resistant S. aureus was a major meat contaminant in butcheries of Bahir Dar city. Therefore, appropriate antimicrobial use and staphylococcal control methods should be employed to prevent S. aureus intoxications in foods.
Risk factors for Clostridium difficile infection and colonization among patients admitted to intensive care units in Shanghai, China
Authors: Cui Yingchao , Zhang Lihua , Dong Danfeng , Wang Daosheng , Jiang Cen , Ni Qi , Wang Chen , Mao Enqiang , Peng Yibing
Published: August 2019

Background : Clostridium difficile is considered to be the main pathogen responsible for hospital-acquired infections in western countries, but few studies on C. difficile have been carried out in China. This study performed a prospective study to describe the prevalence, molecular epidemiological characteristics and risk factors of Clostridium difficile infection (CDI) and Clostridium difficile colonization (CDC) among patients in intensive care units (ICUs), with the aim of providing strategies for efficient CD prevention and control.Methods: Stool samples were collected from adult patients on admission to an 18-bed ICU department, and were anaerobically cultured for C. difficile . The identified isolates were tested for toxin genes, followed by multilocus sequence typing to analyze the genotypes. Patients were divided into CDI, CDC and control groups according to clinical features. The medical records of these groups were collected and further analyzed using logistic regression to investigate the risk factors.Results: Of the 800 patients included in the study, 33 (4.12%) and 25 (3.12%) patients were identified with CDI and CDC, respectively. An association was found between CDI patients and having a fever (OR=13.993) or metabolic disorder (OR=7.972), and treatment with fluoroquinolone (OR=42.696) or a combination of antibiotics (OR=2.856). CDC patients were characterized by longer hospital stays (OR=1.137), an increased number of comorbidities (OR=36.509), respiratory diseases (OR=0.043) and treatment with vancomycin (OR=18.168). However, treatment with metronidazole was simultaneously found to be a protective factor in the two groups (OR=0.042; OR=0.013). Eighteen sequence types (STs) were identified. Among the CDI group, the isolates were predominantly toxin A- and toxin B-positive (A+B+) strains and genotype ST-2 was the epidemic clone. In the CDC group, the dominant strains were A+B+ and ST-81 was the epidemic clone.Conclusions: The prevalence of C. difficile colonization and infection in our ICU patients was relatively high, suggesting the importance of routine screening to detect the acquisition of this pathogen. Future prevention and treatment strategies for C. difficile -related disease should take into consideration the duration of hospital stays, enteral nutrition, underlying comorbidities, as well as the use of combined antibiotics. Moreover, metronidazole could be a protective factor for both CDI and CDC.
TIA and minor stroke: A qualitative study of long-term impact and experiences of follow-up care
Authors: Turner Grace M , McMullan Christel , Atkins Lou , Foy Robbie , Mant Jonathan , Calvert Melanie
Published: August 2019

Background

Transient ischaemic attack (TIA) and minor stroke are often considered transient events; however, many patients experience residual problems and reduced quality of life. Current follow-up healthcare focuses on stroke prevention and care for other long-term problems is not routinely provided.

We aimed to explore patient and healthcare provider (HCP) experiences of residual problems post-TIA/minor stroke, the impact of TIA/minor stroke on patients’ lives, and current follow-up care and sources of support.

Methods

This qualitative study recruited participants from three TIA clinics, seven general practices and one community care trust in the West Midlands, England. Semi-structured interviews were conducted with 12 TIA/minor stroke patients and 24 HCPs from primary, secondary and community care with framework analysis.

Results

A diverse range of residual problems were reported post-TIA/minor stroke, including psychological, cognitive and physical impairments. Consultants and general practitioners generally lacked awareness of these long-term problems; however, there was better recognition among nurses and allied HCPs. Residual problems significantly affected patients’ lives, including return to work, social activities, and relationships with family and friends. Follow-up care was variable and medically focused. While HCPs prioritised medical investigations and stroke prevention medication, patients emphasised the importance of understanding their diagnosis, individualised support regarding stroke risk, and addressing residual problems.

Conclusion

HCPs could better communicate lay information about TIA/minor stroke diagnosis and secondary stroke prevention, and improve their identification of and response to important residual impairments affecting patients.
Magnetic Resonance Enterography, Colonoscopy, and Fecal Calprotectin correlate in colonic Crohn’s Disease
Authors: Somwaru Alexander Stephen , Khanijow Vikesh , Katabathina Venkat
Published: August 2019

Background

Fecal calprotectin (FCP), magnetic resonance enterography (MRE), and colonoscopy are complementary biometric tests that are used to assess patients with Crohn’s Disease (CD). While prior studies have evaluated the association between combinations of two of these tests or surgical specimens, no study has established a correlation between all three: FCP, MRE, and colonoscopy. We investigated if the correlation between these three tests may result in improved clinical outcomes that can then be used to streamline patient monitoring and treatment modification.

Methods

156 patients with colonic CD were examined between March 2017 and December 2018. FCP levels, MRE, and colonoscopy were assessed in parallel on all 156 patients. Clinical CD activity was measured with the Crohn’s Disease Activity Index (CDAI). CD activity with FCP was measured with a quantitative immunoassay. CD activity on MRE was measured with the Magnetic Resonance Index of Activity (MaRIA). CD activity on colonoscopy was measured with the Crohn’s Disease Endoscopic Index of Severity (CDEIS).

Results

112 patients (72%) had active disease (Crohn’s Disease Activity Index > 150) and 44 patients (28%) were in clinical remission disease (Crohn’s Disease Activity Index < 150). FCP levels, MaRIA, and CDEIS are highly correlated with positive and significant Pearson and Spearman coefficients, respectively (P < 0.0001), in univariate analyses. Regression analysis (multivariate analyses) demonstrates significant, positive correlation between FCP and MaRIA (r = 1.07, P < 0.0001) and between FCP and CDEIS (r = 0.71, P = 0.03), and between

MaRIA and CDEIS (r = 0.63, P = 0.01).

Conclusions

FCP levels significantly correlate with the degree of active inflammation in patients with colonic Crohn’s Disease. Improved clinical results may be achieved by using a biometric strategy that incorporates FCP, colonoscopy, and MRE together. This strategy may in-turn be used in the future to streamline monitoring disease activity and adjustment of therapy to improve long term patient outcomes.
Health Pregnancy, Healthy Baby: Testing the added benefits of pregnancy ultrasound for child development in a randomised control trial
Authors: Richter Linda Marlene , Slemming Wiedaad , Norris Shane A , Stein Alan , Poston Lucilla , Pasupathy Dharmintra
Published: August 2019

Background
The 2016 World Health Organization Antenatal Guidelines and the 2015 South African Maternal and Child Health Guidelines recommend one early antenatal ultrasound scan to establish gestational age and to detect multiple pregnancies and fetal abnormalities. Prior research indicates that ultrasound can also increase parental-fetal attachment. We aim to establish whether, compared to routine care, messages to promote parental attachment and healthy child development, conducted during one or two pregnancy ultrasounds improve early child development and growth, exclusive breastfeeding, parental-child interactions and pre- and post-natal clinic attendance.
Methods
The effect of messages to sensitise mothers and fathers to fetal development will be tested in a 3-armed randomised trial with 100 mothers and their partners from Soweto-Johannesburg in each arm. The primary outcome is child development at 6 months post-natal. Secondary outcomes include infant feeding, parental attachment and interaction, parental mental health and infant growth, assessed at 6 weeks and 6 months. Parents in Arm 1 receive a fetal ultrasound <25 weeks during routine antenatal care at tertiary hospitals, and a second standard ultrasound at the research site within 2 weeks. Arm 2 participants receive the routine antenatal ultrasound and an additional ultrasound <25 weeks at the research site, together with messages to promote parental attachment and healthy child development. Arm 3 participants receive the routine ultrasound and two additional ultrasounds at the research site, <25 weeks and <36 weeks, together with messages to promote parental attachment and healthy child development.
Discussion
Evidence from high-income countries suggests that first-time prospective mothers and fathers enjoy seeing their fetus during ultrasound and that it is an emotional experience. A number of studies have found that ultrasound increases maternal attachment during pregnancy, a predictor of positive parent-infant interactions which, in turn, promotes healthy infant development. It is generally agreed that studies are needed which follow up parental-child behaviour and healthy child development postnatally, include fathers, and examine the construct in a wider diversity of settings, especially in low- and middle-income countries. Testing the added benefits of pregnancy ultrasound for child development is a gap that the proposed trial in South Africa seeks to address.
Trial Registration
The trial is registered with the Pan African Clinical Trials Registry (https://pactr.samrc.ac.za) on 15 August 2018 (identifier: PACTR201808107241133).
Potential contributions of an on-site nurse mentoring program on neonatal mortality reductions in rural Karnataka state, South India: evidence from repeat community cross-sectional surveys
Authors: Ramesh B.M. , Kar Arin , Jayanna Krishnamurthy , Hallad Jyoti S. , Troy Cunningham , Potty Rajaram , Mohan H L , Crockett Maryanne , Bradley Janet , Fischer Elizabeth , Sudarshan H , Blanchard James , Moses Stephen , Avery Lisa
Published: August 2019

Background: We assessed the effects of a nurse mentoring program on neonatal mortality in eight districts in India. Methods: From 2012 to 2015, nurse mentors supported improvements in critical MNCH-related practices among health providers at primary health centres (PHCs) in northern Karnataka, South India. Baseline (n=5,240) and endline (n=5,154) surveys of randomly selected ever-married women were conducted. Neonatal mortality rates (NMR) among the last live-born children in the three years prior to each survey delivered in NM and non-NM-supported facilities were calculated and compared using survival analysis and cumulative hazard function. Mortality rates on days 1, 2-7 and 8-28 post-partum were compared. Cox survival regression analysis measured the adjusted effect on neonatal mortality of delivering in a nurse mentor supported facility. Results: Overall, neonatal mortality rate in the three years preceding the baseline and endline surveys was 30.5 (95% CI 24.3-38.4) and 21.6 (95% CI 16.3-28.7) respectively. There was a substantial decline in neonatal mortality between the survey rounds among children delivered in PHCs supported by NM: 29.4 (95% CI 18.1-47.5) vs. 9.3 (95% CI 3.9-22.3) (p=0.09). No significant declines in neonatal mortality rate were observed among children delivered in other facilities or at home. In regression analysis, among children born in nurse mentor supported facilities, the estimated hazard ratio at endline was significantly lower compared with baseline (HR: 0.23, 95% CI: 0.06-0.82, p=0.02). Conclusion: The nurse mentoring program was associated with a substantial reduction in neonatal mortality. Further research is warranted to delineate whether this may be an effective strategy for reducing NMR in resource-poor settings. [b]Key words:[/b] Nurse mentoring, Quality of care, Neonatal mortality This work was supported by the Bill & Melinda Gates Foundation, Grant Number OPPGH5310
Effects of GPX3 and GSTA1 Polymorphisms on the Risk of Schizophrenia in Chinese Han Population
Authors: Liu Chao , Song Sijia , Zhang Junkai , Li Xiao , gao huijie
Published: August 2019

Background: Several lines of evidence support the fact that the presence of oxidative stress plays an important role in the pathophysiological mechanisms of schizophrenia (SCZ). The glutathione peroxidases (GPXs) and glutathione S-transferases (GSTs) are the major antioxidant enzymes. Polymorphic variants of GPX and GST can affect the antioxidant activities of their encoded enzymes. This study explored the possible associations of the GPX3 and GSTA1 gene polymorphisms and schizophrenia in the Chinese Han population.
Methods: DNA from 316 healthy controls and 303 schizophrenic patients was genotyped for single nucleotide polymorphisms(SNPs) rs736775 in GPX3 and rs3957357 in GSTA1 using a PCR-LDR genotyping assay. The χ2 test compared differences in genetic distributions between the two groups in a case–control study.
Results: No significant differences in allelic or genotypic frequencies of GPX3 rs736775 or GSTA1 rs3957357 were detected between cases and controls(GPX3 rs736775: χ2 =0.036, P=0.982 by genotype, χ2=0.020, P=0.888, odds ratio=1.017, 95% confidence interval=0.801-1.292 by allele; GSTA1 rs3957357: χ2 =1.100, P=0.577 by genotype, χ2=0.924, P=0.336, odds ratio=1.176, 95% confidence interval=0.845-1.637 by allele).
Conclusions: Our results suggest that GPX3 rs736775 and GSTA1 rs3957357 SNPs are unlikely to be a candidate gene for susceptibility to SCZ in at least Chinese Han population. However, these results should be validated by replication in different populations.
Analysis of exosomal circRNAs upon irradiation in pancreatic cancer cell repopulation
Authors: Chen Yi-yun , Jiang Ming-jie , Chen Zhi-long , Tian Ling
Published: August 2019

Background

Pancreatic cancer is one of most malignant tumors. However, radiotherapy can lead to tumor recurrence, which is the cause of the residual surviving cells repopulation by some molecular released from dying cells. Exosomes may mediate cell-cell communication and transfer kinds of signals from the dying cells to the surviving cells for stimulating tumor repopulation. Circular RNAs (circRNAs) may be one vital kind of exosomal cargos involving in modulating cancer cell repopulation.

Methods

Next generation sequencing (NGS) and bioinformatics were performed to analysis and annotate the expression profiles and functions of exosome-derived circRNAs in pancreatic cells during radiation. 4 circRNAs were chosen for qRT-PCR analysis to validate the sequencing.

Results

A total of 12572 circRNAs were identified, and 3580 circRNAs were annotated in literatures and circBase. There were 196 filtered differentially expressed circRNAs (182 for up-regulated and 14 for down-regulated, fold change >2, p-value <0.05). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses indicated that regulation of metabolic process and lysine degradation were the main biological processes and pathway enrichment.

Conclusions

The hsa_circ_002130-hsa_miR_4482-3p-NBN interaction network suggested potential miRNA sponge and target mRNA. Our results provided potential functions of circRNAs to explore molecular mechanisms and therapeutic targets in pancreatic cancer cell repopulation upon irradiation.
Fecal DNA Isolation and Degradation in Clam Cyclina sinensis: Noninvasive DNA Isolation for Conservation and Genetic Assessment
Authors: Zhang Min , Wei Min , Dong Zhiguo , Mao Shuang , Duan Haibao , Feng Senlei , Li Wenqian , Sun Zepeng , Li Jiawei , Yan Kanglu , Liu Hao , Meng Xueping , Ge Hongxing
Published: August 2019

Background

To avoid destructive sampling for conservation and genetic assessment, we isolated the DNA of clam Cyclina sinensis from their feces. DNA electrophoresis and PCR amplification were used to determine the quality of fecal DNA. And we analyzed the effects of different conditions on the degradation of feces and fecal DNA.Results

The clear fecal DNA bands were detected by electrophoresis, and PCR amplification using clam fecal DNA as template was effective and reliable, suggesting that clam feces can be used as an ideal material for noninvasive DNA isolation. In addition, by analyzing the effects of different environmental temperatures and soaking times on the degradation of feces and fecal DNA, we found that the optimum temperature was 4 °C. In 15 days, the feces maintained good texture, and the quality of fecal DNA was good. At 28 °C, the feces degraded in 5 days, and the quality of fecal DNA was poor.Conclusions

The clam feces can be used as an ideal material for noninvasive DNA isolation. Moreover, the quality of fecal DNA is negatively correlated with environmental temperature and soaking time.
Intention to Use Long Acting and Permanent Contraceptive Methods and Associated Factors in Health Institutions of Aksum Town, north Ethiopia
Authors: Syum Hailay , Kahsay Gizienesh , Huluf Teklehaymanot , Beyene Berhe , Gerensea Hadgu , Gidey Gebreamlak , Desta Haftom , Abay Mebrahtu , Nuguse Haben , Haile Kebede
Published: August 2019

Abstract Objective: In Ethiopia majority of married women practice predominantly short acting contraceptive methods. Therefore the aim of this study is to assess intention to use LAPMs and its determinants among short acting users in Health Institutions of Aksum Town, North Ethiopia. Results: Prevalence of intention to use LAPMs was 52.1% (95% CI: 47.4-57.0). Good knowledge on LAPMs [AOR=2.15; 95% CI (1.29,3.56)], positive attitude towards LAPMs [AOR=3.41; 95% CI (1.99,5.85)], 18-24 years of age [AOR=3.18; 95% CI (1.30,7.79)], being primary school in educational level [AOR=0.34; 95% CI (0.14,0.78)], decision on the number of children jointly with partner [AOR=2.05; 95% CI (1.01,4.18)], having more than two children [AOR=10.67; 95% CI (1.29,88.31)], and no [AOR=10.21; 95% CI (3.10,33.58)] and one [AOR=4.70; 95% CI (1.68,13.13)] extra number of children desired were factors significantly associated with having intention to use LAPMs compared to their counterparts. Intention to use LAPMs was low. Therefore, appropriate information, education and communication strategies must be designed to raise awareness and change negative attitude of the community on LAPMs. Key words: LAPMs, intention to use, factors, Axum, Ethiopia
The Dental complications of canine tooth bud removal in 2-12 years old children in North West Ethiopia
Authors: Teshome Amare , Assefa Berihun
Published: August 2019

Objective: Canine tooth bud removal is a process of gouging out an infant’s canine tooth buds, using unsterile tools such as Sharpe blade, garlic, or knitting needle, without anesthesia. The aim of the study was to reveal dental complications of canine tooth bud removal among children visited the dental clinic of the University of Gondar hospital. This study was an institution-based cross-sectional conducted from January 2015-September 2016 at university of Gondar hospital on 2-12 years children. The tooth was assessed for whether it had previously oral mutilated or not. In addition to this, the oral cavity was evaluated for the presence of missed, malformed or normal canine Results: A group of 355 children aged 2-12 years was examined clinically. The mean age of the children was 7.32±3.12 (SD). The prevalence of canine tooth bud removal was 86.8% which was high in 6-9 years old (54.87%) and first position children (40.26%). The most common dental complications were; malformed enamel (hypoplastic) canine (48.5%) and missed/Unerupted canine (38.6%).
Intestinal parasitic infections and determinant factors among school age children in Ethiopia: a cross-sectional study
Authors: Dessie Awrajaw , Gebregzabher Tesfay , Kiros Berihu , Wami Sintayehu Daba , Chercos Daniel Haile
Published: August 2019

[EXSCINDED] Objective The aim of this study was to determine the prevalence of intestinal parasitic infections and associated factors among school children in Sobeya primary school, Northern Ethiopia, 2017.Results The prevalence of intestinal parasites in school age children was (29.9%). E.histolytica/dispar 62 (49.21%), G.lamblia 28 (22.22%), and A. lumbricoides 23 (18.25%) were the most prevalent parasitic organisms identified. Unclean finger nail (AOR= 1.72), defecating in the open field (AOR=2.82), and being barefooted (AOR=1.72) were the determinant factors for intestinal parasitic infections. Frequently washing hands reduced the chance of infections by 68%. Furthermore, children in grade 1-4 and 5-6 had higher odds developing the infections than those in grade 7-8 (AOR=8.21 and AOR=2.50, respectively).
Preterm Births and Associated Factors among Mothers Who Gave Birth in Axum and Adwa Town Public Hospitals, Tigrai, Northern Ethiopia, 2018.
Authors: Gebremeskel Gebrekiros Aregawi , kassa Nega Assefa , Mengistu Frehiwot mesfin , Welay Fisseha Tekulu , Hailu Tesfay Adhena , Gebremedhin Mussie Mulugeta , Assefa Guesh gebreayezgi
Published: August 2019

Objective: The objective of this study was to determine the prevalence and associated factors of preterm births among mothers who gave birth in Axum and Adwa public hospitals, Tigray, North Ethiopia, 2018. Result: This study showed that 13.3% from the total 472 mothers gave a preterm birth. Being a rural resident (AOR=2.13,95% CI:(1.07,4.22), short inter pregnancy interval (AOR= 5.4, 95% CI: (1.32, 22.05), previous preterm birth(AOR= 3.74, 95% CI: (1.03, 16.34), Premature rupture of membrane(AOR=4.14, 95% CI: (1.92, 8.89), induced onset of labor(AOR=2.49, 95% CI: (1.06, 5.85) multiple pregnancy(AOR= 5.69, 95% CI: (2.27, 14.28), malaria during pregnancy (AOR= 4.71, 95% CI: (1.98, 11.23), Presence of chronic illness (AOR= 4.55, 95% CI: (1.83, 11.26) were significantly associated with preterm birth.
Efficacy and safety of two Ayurvedic dosage forms for Allergic rhinitis: Study protocol for an open-label randomized controlled trial
Authors: Dahanayake JM , Perera Pathirage Kamal , Galappaththy P , Samaranayake D
Published: August 2019

Background Allergic rhinitis (AR) is an immune response of the nasal mucosa to airborne allergens and involves nasal congestion, watery nasal discharge, itching of the nose and sneezing. The symptoms of allergic rhinitis may significantly affect a patient’s quality of life and can be associated with conditions such as fatigue, headache, cognitive impairment and sleep disturbances. Various complementary and alternative medicine treatments have been used for this condition in clinical practice. The Ayurveda system of medicine is the most common complementary medicine system in Sri Lanka. The aim of this study is to find out whether the use of two preparations (decoction and its freeze dried powder) over a period of 4 weeks is able to cure the symptoms of allergic rhinitis. Study design This is a three arm open label non-inferiority randomized controlled clinical trial in patients with AR. The study duration is 28 days oral administration of the two Ayurvedic dosage forms (Decoction and freeze dried) and the antihistamine loratidine into the 3 arms allocated randomly. After a 1 week run-in period, eligible subjects are randomly assigned to the TMD12 decoction group, TMD12 freeze dried group and the antihistamine group. Total Nasal symptom Score (TNSS) of the patients are used as the primary efficacy outcome. TNSS is recorded and compared in all 3 arms prior to visit 1, at the end of 28 days, end of the first month of follow up and second month of follow up. Symptom scores of daytime nasal symptoms, night time nasal symptoms, non-nasal symptoms and Health Related Quality of Life questionnaire are used as secondary end points. Discussion This clinical trial will be able to provide supportive evidence based scientific data on classical Ayurvedic dosage forms and the new dosage forms developed as freeze dried powder in the treatment of allergic rhinitis. Also by this trial, it is expected to develop capacity to scientifically evaluate Ayurvedic treatments that may help patients having conditions such as allergic rhinitis.