bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of abdominal expiratory muscle thickness pattern, diaphragmatic excursion, diaphragmatic thickness fraction and lung ultrasound score in critically ill patients and their association with weaning patterns: A prospective study
Authors: Bansal Priyanka , Jakhar Bhawna , Arya Rajesh C. , Sultania Nidhi S. S. , Puhal Sudha , Bansal Kunal , Verma Devyani , Aggarwal Aditya , Singhal Suresh
Published: November 2024

Introduction:

Weaning of patient from ventilator and finally extubation is a challenge, especially in critical care setup. Though many parameters are available, based on which, the decision of extubation is taken but still many times, there is failure of weaning.

Aim:

We conducted a prospective observational study to look for diaphragm and abdominal muscle thickness, contraction, and lung ultrasound as indicator for weaning and extubation.

Material and Methods:

Patients of either gender aged between 20-50 years, who were on invasive mechanical ventilation for more than 48 hrs. and put on spontaneous breathing trial. A bedside ultrasound examination was performed. Abdominal expiratory muscle thickness, diaphragmatic excursion (DE), diaphragmatic thickness fraction (DTF) and lung ultrasound score (LUS) were measured.

Results:

12 patients had simple weaning pattern whereas 5 patients had difficult weaning and 8 patients had prolonged weaning. The mean value of DE was 1.97 cm, DTF- 2.3 mm. The mean value of SOFA score is significant between simple, difficult, prolonged weaning (2.24, 4.56, 7.33 respectively). The DE, which is 2.52, 1.26, 1.81 in simple difficult and prolonged weaning respectively is highly significant. The mean value of LUS was 8.34 and is significant in all weaning patterns. The highest sensitivity is found for SOFA score (84.62) with AUC of 0.88.

Conclusion:

Evaluation of patient with diaphragm thickness fraction (mean DTF of 26%) and diaphragm excursion (2.52 cm) with mean LUS score of 4.67 opens a new dimension to predict weaning in critically ill patients who are put on spontaneous breathing trial. The sequence of thickness of abdominal expiratory muscles adds to accuracy in successful weaning. Larger muti-center trials are required to make these parameters as a standard practice for weaning patients in critical care setup.
Comparative Efficacy of Antipsychotic Medication for Stereotypic Behavior in Autism Spectrum Disorder: A Systematic Review and Meta-analysis
Authors: Kattimani Shivanand , Selvarajan Sandhiya , Varadharajan Natarajan , Gopalakrishnan Prabhavaty
Published: November 2024

Background:

Stereotypic movements in autism form core symptoms under the rubric of repetitive and restricted patterns of behavior.

Aim:

The systematic review was aimed to find which antipsychotic has better efficacy in treating stereotypic behavior in autism spectrum disorder.

Methods:

We searched for journal publications in the English from PubMed and Cochrane databases (CENTRAL), January 1992–June 2024, for randomized controlled trials that compared antipsychotics with a placebo of at least 6 weeks’ trial, with the outcome measure being a change in stereotypy score. Quality assessment of the included studies in the meta-analysis was done using Cochrane risk of bias tool version 2. We followed PRISMA guidelines for systematic review. The mean difference in change of stereotypy symptoms score was calculated between antipsychotic and placebo participants along with 95% confidence interval (CI) using the random-effects model.

Results:

146 studies were screened, and 25 studies were deemed eligible to retrieve full-length articles for review. A total of nine studies were included in the systematic review that had used aripiprazole, risperidone, or lurasidone as an antipsychotic. Six studies (n = 726) that had all data on mean difference in stereotypy scores on the Aberrant Behavior Checklist (ABC)-Stereotypy subscale and four studies (n = 554) that reported stereotypy scores using Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)-Compulsions subscale were included in the meta-analysis. Antipsychotics showed a significant reduction in ABC-Stereotypy scores (−1.84 [−2.84, −0.85; 95% CI], Z = 3.83, P < 0.001) with moderate heterogeneity between the studies (I
2 = 53%). Whereas, antipsychotics did not show significant improvement in compulsions as measured on CY-BOCS (−0.87 [−1.89, 0.16; 95% CI], Z = 1.65, P = 0.10).

Conclusion:

Stereotypy in autism is difficult to measure, and no uniform measure exists. Trials are limited to short duration and limited to few antipsychotics. Among antipsychotics, risperidone has robust efficacy in reducing stereotypic behaviors.
Efficacy of Acceptance and Commitment Therapy in Social Anxiety Disorder: A Systematic Review and Meta-analysis
Authors: Mattikoppa Neha V. , Harshitha G. S , Yahiya Gazzali Kassim M. , Paluru Manasa Sudhir
Published: November 2024

Background:

Acceptance and commitment therapy (ACT) is a novel third-wave therapy becoming popular in the management of various anxiety disorders. In this systematic review, we wish to gather the data that have been studied to determine the effectiveness of ACT in treating social anxiety disorder (SAD).

Methods:

This study followed standard systematic review guidelines and was registered with PROSPERO prior to undertaking the review. Databases, namely PubMed, PsycINFO, Ovid MEDLINE, and gray literature (ClinicalTrials.gov, BASE) with relevant keywords, were searched from inception to February 2024. Randomized controlled trials encompassing both clinical and nonclinical populations aged more than 10 years diagnosed with SAD were included. These trials compared ACT with wait list controls (n = 6) and cognitive behavioral therapy (n = 3). The primary outcome focused on the reduction of symptoms associated with social anxiety, while quality of life served as a secondary outcome. Measures of effect were determined through pre-test and post-test mean values, alongside their respective standard deviations. The random effect model was used to calculate pooled effect size. The quality of the included papers was assessed using Cochrane RoB-1. Covidence software was used for the initial selection of studies, and meta-analyses were performed using RevMan software.

Results:

From the initial 442 study records that were searched, finally 9 studies were included for the systematic review, of which 6 studies were found suitable for meta-analysis. The pooled estimate for studies comparing ACT with wait list found that the overall effect size for social anxiety symptoms was g = −1.28 (95% confidence interval of -1.88, -0.69) favoring ACT intervention significantly.

Conclusion:

This review found that ACT is efficacious in treating SAD. Most of the studies included were conducted in adolescent females. Varying ACT intervention modalities were incorporated, with the primary outcome assessed using a range of scales. The results of our meta-analysis should be interpreted with caution because of heterogeneity and smaller number of studies being included. ACT can be considered a psychotherapeutic option for the management of SAD.
Effectiveness of Repetitive Transcranial Magnetic Stimulation in Mild Cognitive Impairment and Early Alzheimer’s Disease: A Systematic Review and Meta-analysis
Authors: Malo Palash Kumar , Ghosh Aishwarya , Menon Anjana J. , Sandhya G. , Roy Dwaiti , Issac Thomas Gregor
Published: November 2024

Background:

Dementia encompasses cognitive decline that significantly affects daily living. In recent years, there has been a notable shift toward nonpharmacological treatments, with transcranial magnetic stimulation (TMS) gaining attraction for its potential to enhance cognitive function in predementia and early Alzheimer’s Disease (AD). In this meta-analysis, we have integrated the results from different studies with varied protocols to explore the efficacy of repetitive TMS (rTMS) in improving cognitive functioning in people with mild cognitive impairment (MCI) and early AD.

Methods:

We used three databases, namely PubMed, MEDLINE, and PsycINFO. Studies until March 2024 were included. Mini–Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) were used to assess global cognition. A random-effects meta-analytical model was adopted, and Hedge’s g standardized mean differences (SMDs) and its 95% confidence intervals (CIs) were reported. The study protocol has been registered with PROSPERO (CRD42024507575).

Results:

Twenty-three studies were included in the meta-analysis. The mean (standard deviation) age of participants in studies using ADAS-Cog (71.8 [6.19] years) was found to be more than studies using MMSE (70.0 [6.72] years). Post-intervention MMSE scores were significantly better in active rTMS as compared to that of sham TMS (SMD [95% CI] =0.60 [0.15–1.04]; P = 0.009). However, the difference between the two study groups was not statistically significant for ADAS-Cog (−0.09 [−0.49 to 0.32]; [P = 0.67]). Sensitivity analyses for studies using MMSE also indicated that rTMS contributed to cognitive enhancement.

Conclusions:

The study found that active rTMS led to significant improvement in MMSE scores in people with MCI and early AD.
Efficacy of Antidepressants in Management of Depressive Symptoms in Dementia: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Pai R. Shantheri , Shashikala I. M. , Sudhakar P. Hasitha
Published: November 2024

Background:

Dementia is associated with a complex array of neuropsychiatric manifestations which require consideration as they worsen the course of illness, especially in neurodegenerative etiologies. Depression and subsyndromal depressive symptoms are common in dementia, usually managed with antidepressants, but evidence is weak.

Objective:

The objective is to study the efficacy of antidepressants compared to placebo in management of depressive symptoms in dementia.

Methodology:

Electronic databases such as PubMed, MEDLINE, PsychINFO, ClinicalTrials.gov, BASE, and MedNar were searched from their date of inception to March 18, 2024, with appropriate search-terms. Randomized controlled trials (RCTs) that are double-blind in nature with placebo as comparator of dementia patients (Alzheimer’s disease [AD], Frontotemporal, Lewy body, and Parkinson disease dementia) treated with antidepressants for at least ≥ 4 weeks with severity of depressive symptoms measured on standardized rating scales were included. Studies with nonrandomized/nondouble-blind design, active drug or brain stimulation methods as comparator and nonneurodegenerative etiologies of dementia were excluded. Cochrane tool for risk of bias assessment, Covidence and Microsoft Excel for data extraction and review manager version 5.4.1 for data analysis were used.

Results:

Our search yielded 13(N) RCTs for systematic review, majority of which reported on AD (n = 12), selective serotonin reuptake inhibitors as intervention (n = 7), and high risk of bias (n = 9). Efficacy analysis using forest-plot with seven RCTs showed no statistically significant treatment effect (standardized mean differences [SMD] = −0.04, 95%confidence interval [−0.36, 0.27], Z = 0.26, P = 0.79) between intervention and placebo group. Substantial significant heterogeneity (I
2 = 74%, P < 0.001) was noted across studies.

Discussion:

Antidepressants administered for 6–13 weeks and different rating scales used to measure outcome in RCTs were possible reasons for heterogeneity. We conclude that antidepressants have not been found to be efficacious compared to placebo in management of depressive symptoms in dementia. Findings cannot be generalized to other etiologies as our analysis found limited data majorly on AD and RCTs with high risk or some concerns in the bias, thus throws a light on need for robust RCTs in this area.
Efficacy of Antidepressants in Depression in Breast Cancer: A Systematic Review and Meta-analysis
Authors: Chikkamath Vinuta C. , Kariyannavar Lingaraj , Rattehalli Ranganath , Pai B. Srinivas
Published: November 2024

Background:

Breast cancer is the most common malignancy in women worldwide. Depression is a common psychological issue among these patients as they experience significant stress, and it impacts their quality of life. In this regard, the efficacy of antidepressants in depression for breast cancer is not studied.

Objective:

The objective of the study was to study the efficacy of antidepressants in the management of depression in breast cancer.

Methods:

Our databases included PubMed, MEDLINE, PsycINFO, Cochrane, Scopus, and Gray literature published in English. Studies included were randomized, placebo-controlled, double-blind trials of antidepressants for women diagnosed with breast cancer and depression. Studies were excluded if they were nonrandomized trials, had an active comparator, or if the antidepressant drug was not primarily used for depression. The severity of depressive symptoms was measured using standardized rating scales for depression. The risk of bias was assessed using the Cochrane risk of bias 2 tool. Covidence and Microsoft Excel were used for data extraction and RevMan 5.4.1 for efficacy outcome estimates, heterogeneity, and sensitivity analysis.

Results:

Of a total of 155 studies, 13 studies (9 parallel design and 4 crossover) met the inclusion criteria for systematic review and seven for meta-analysis involving 595 participants. The risk of bias assessment showed that five studies had low risk, four studies had some concerns, and four studies had high risk of bias. The antidepressants noted to have a favorable outcome were fluoxetine, paroxetine, mianserin, and mirtazapine. The pooled analysis (standardized mean difference [SMD] −0.28 [confidence interval = −0.56, 0.01] z = 1.87 [P = 0.06]) and subgroup analysis (selective serotonin reuptake inhibitor) did not favor antidepressants (SMD = −0.23 [−0.52, 0.07], z = 1.51, [P = 0.13]). Sensitivity analysis did not show a significant difference in outcome measures between antidepressants and placebo. Considerable heterogeneity, with a value of 69%, was found to be statistically significant (P = 0.003).

Conclusion:

We conclude that based on the available research, there was no evidence that antidepressants were superior to placebo in the management of depression in breast cancer. The possible reasons for heterogeneity are variations in the duration of study periods and antidepressant administration, different stages of breast cancer, and different scales used for assessing depression in RCTs.
Efficacy of Transcranial Direct Current Stimulation on Cognitive Function in Dementia and Mild Cognitive Impairment Secondary to Neurodegenerative Etiology: A Systematic Review and Meta-Analysis
Authors: Rangarajan Subhashini K. , Anupama V. V. , Sehrawat Megha , Mittal Apurva , Yashwanth G. , Sreeraj Vanteemar S. , Sivakumar Palanimuthu Thangaraju , Venkatasubramanian Ganesan
Published: November 2024

Background:

Dementia is a chronic progressive illness with significant impairment in a person’s functioning ability. The currently available treatment options for dementia are limited in modifying disease progression. Non-invasive brain stimulation techniques such as transcranial direct current stimulation (tDCS) are emerging as potential treatment options for cognitive as well as behavioral symptoms in dementia. The objective of this systematic review and meta-analysis is to assess the efficacy of tDCS on cognitive function in mild cognitive impairment (MCI) and dementia due to neurodegenerative disorders to provide an update on the existing evidence considering an increasing number of trials using tDCS.

Methods:

The study was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines with a prespecified protocol registered in PROSPERO (CRD42024503852). The study selection was made through a search on databases such as PubMed, Ovid MEDLINE, APA PsycInfo, and Cochrane trials registry and a gray literature search on ClinicalTrials.gov. All randomized controlled trials that have used tDCS as a standalone intervention for cognitive impairment were included in the present study. Risk of bias (RoB) was assessed by the Cochrane RoB2 tool. Meta-analysis of outcomes was performed using RevMan software version 5.4. Pooled estimates of standardized mean difference (SMD) and 95% confidence interval (CI) were obtained for global cognition (primary outcome) and other domain-specific cognitive outcomes.

Results:

A total of 24 studies were finally included in the review. Most of the studies had “some concerns” with regard to the overall RoB. A total of 164 subjects in the true tDCS group and 151 subjects in the sham tDCS groups out of eight studies were analyzed for global cognitive outcome, giving a pooled SMD (95% CI) of 0.80 (0.35, 1.26), giving an overall effect of Z = 3.45 (P < 0.001), with I2 value of 72%, favoring true tDCS. On a sub-group analysis, a significant improvement was noted in the Alzheimer’s dementia group but not MCI.

Discussion:

The study findings suggest that tDCS is effective in improving global cognition in participants with Alzheimer’s dementia but not MCI. Owing to a smaller number of studies, the domain-specific cognitive outcomes could not be assessed effectively. There was a wide heterogeneity in the included studies in terms of tDCS stimulation protocols.
Measure-valued solutions to a generalized Landau–Lifshitz–Bloch equation
Authors: Ayouch Chahid , Meskine Driss , Tilioua Mouhcine
Published: November 2024

This paper considers a generalized version of the Landau–Lifshitz–Bloch equation. We prove existence of measure-valued solutions for the model in a bounded domain of

\mathbb{R}^{d}

(d\geq1)

. The main difficulties in this study are due to the loss of compactness in the equation and the presence of a nonlinear term of type

\boldsymbol{u}\wedge\mathrm{div}(a(\nabla\boldsymbol{u}))

which does not satisfy the monotonicity assumption in the sense of Leray–Lions. We use a compactness result proved in Landes et al. [Ark. Mat. 25 (1987), 29–40] and the concept of measure-valued solutions which are appropriate to solve this problem.
Long-term mortality of adult patients with carbon monoxide poisoning presenting to the emergency department in Korea: a population-based cohort study
Authors: Lee Sang Hwan , Ryu Soo Rack , Yoo Kyung Hun , Lee Juncheol , Cho Yongil , Lim Tae Ho , Kang Hyunggoo , Oh Jaehoon , Ko Byuk Sung
Published: November 2024

Background: Carbon monoxide (CO) poisoning can lead to significant morbidity and mortality. However, relatively few studies have investigated its long-term mortality impact. This nationwide population-based cohort study examined the association between CO poisoning and long-term mortality.Methods: This retrospective study utilized data from the National Health Insurance Service database in South Korea. We compared the patients with CO poisoning to those without CO poisoning. Inverse probability treatment weights were applied to both groups to control for potential confounding factors. Subsequently, mortality was assessed using the incidence rate and Cox proportional hazard ratios.Results: This study included 23,387 patients with CO poisoning and 359,851 without it. Over a median follow-up period of 7.6 years after CO poisoning diagnosis, the mortality risk was 2.6 times higher in patients with CO poisoning compared to that in the control group. In a long-term follow-up of patients surviving beyond 30 days, mortality remained 2.18 times higher. Additionally, a higher mortality risk was observed in the relatively younger age group (18–39 years) and the group with fewer underlying diseases, as indicated by a Charlson Comorbidity Index score of 0.Conclusions: CO poisoning is associated with an elevated long-term mortality rate particularly in a relatively young and healthy population.
Epidemiological Changes in Acute Febrile Diseases after the COVID-19 Pandemic in Thailand
Authors: Prasertbun Rapeepun , Mori Hirotake , Hadano Yoshiro , Mahittikorn Aongart , Maude Rapeephan R. , Naito Toshio
Published: November 2024

Acute undifferentiated febrile illnesses (AUFIs) are short-duration infectious diseases with nonspecific symptoms. In Thailand, common AUFIs include dengue, malaria, leptospirosis, scrub typhus, and typhoid fever. This study aimed to determine the case numbers of AUFI etiologies in Thailand before coronavirus disease 2019 (COVID-19) (phase 1 from January 2018 to February 2020) and during the COVID-19 pandemic with preventive measures (phase 2 from March 2020 to April 2022), and the loosening of the preventive measures (phase 3 from May 2022 to December 2022). We used Thailand’s national database from 2018 to 2022 to determine the case numbers of AUFIs and geographic heat maps to identify endemic areas in Thailand. The case numbers of malaria, dengue, leptospirosis, typhoid, and scrub typhus significantly decreased during phase 2 (preventive measures) (P = 0.02), and cases of malaria and leptospirosis increased during phase 3 (loosened preventive measures) (P = 0.01). In 2022, malaria and leptospirosis increased by 39% and 48%, respectively, compared with the previous year. Malaria increased in western Thailand along the border between Thailand and Myanmar, where malaria preventive measures were insufficient, whereas leptospirosis increased in northern Thailand. The epidemiology of acute febrile diseases changes significantly depending on the global epidemic of infectious diseases such as COVID-19 and the implementation of preventive measures, such as face masks, hand hygiene, social distancing, and stay-at-home and lockdown measures.
Transcription and Copy Number Variation of Plasmodium falciparum var2csa among Nonpregnant Malaria Patients in Thailand
Authors: Chaikitgosiyakul Sethawud , Kuamsab Napaporn , Tia Taweesak , Putaporntip Chaturong , Jongwutiwes Somchai
Published: November 2024

Placental malaria is an important cause of fetomaternal morbidity and mortality among pregnant women infected with Plasmodium falciparum. The pathogenesis involves the binding of VAR2CSA on the surface of infected erythrocytes to chondroitin sulfate proteoglycans on syncytiotrophoblasts in the intervillous space of the placenta. Anti-VAR2CSA antibodies confer protection from adverse pregnancy outcomes in falciparum malaria; therefore, VAR2CSA is a strong vaccine candidate against placental malaria. To date, little is known about transcription of var2csa among isolates from male and nonpregnant patients in low transmission areas. In this study, transcription and copy number variation of var2csa were analyzed in 55 P. falciparum isolates from nonpregnant women, men and children with symptomatic malaria in five endemic provinces of Thailand. Reverse transcription polymerase chain reaction (PCR) detected var2csa transcripts in 43 (78.2%) blood samples. Multiple copies of var2csa were identified in 16 of 55 (29.1%) isolates by quantitative real-time PCR. Copy number variation of var2csa was not associated with the patients’ sex, age group, ethnicity, parasite genotypes, parasite density, and geographic origins. These data suggest that P. falciparum carrying multicopy var2csa had a wide geographic distribution in Thailand with a prevalence rate comparable to those observed in high transmission areas of Africa. The high prevalence of isolates from male and nonpregnant patients with var2csa transcription suggests that the transcription of this gene occurs naturally during blood stage infection. Whether VAR2CSA is expressed and immunogenic among nonpregnant falciparum malaria patients requires further study.
Biofilm Formation and Plasmid-Mediated Quinolone Resistance Genes at Varying Quinolone Inhibitory Concentrations in Quinolone-Resistant Bacteria Superinfecting COVID-19 Inpatients
Authors: Basnet Ajaya , Chand Arun Bahadur , Bajracharya Sohani , Shrestha Mahendra Raj , Shrestha Shila , Tamang Basanta , Dulal Maina , Pokhrel Nayanum , Shrestha Lok Bahadur
Published: November 2024

The likelihood of antimicrobial failure in COVID-19 patients with bacterial superinfection arises from both phenotypic (biofilms) and genotypic mechanisms. This cross-sectional study aimed to determine the inhibitory concentrations of quinolones—nalidixic acid, norfloxacin, ciprofloxacin, ofloxacin, and levofloxacin—in biofilm formers (minimum biofilm inhibitory concentration [MBIC]) and nonformers (minimum inhibitory concentration [MIC]) and correlate inhibitory concentrations with plasmid-mediated quinolone resistance (PMQR) genes in quinolone-resistant bacteria isolated from COVID-19 inpatients. Quinolone-resistant bacteria (n = 193), verified through disc diffusion, were tested for quinolone inhibitory concentrations using broth microdilution and biofilm formation using microtiter plate methods. The polymerase chain reaction was used to detect PMQR genes. Study variables were analyzed using SPSS v.17.0, with a significance level set at P <0.05. MIC-to-MBIC median fold increases for ciprofloxacin, ofloxacin, and levofloxacin were 128 (2–8,192), 64 (4–1,024), and 32 (4–512) in gram-positive cocci (GPC, n = 43), respectively, whereas they were 32 (4–8,192), 32 (4–2,048), and 16 (2–1,024) in fermentative gram-negative bacilli (F-GNB, n = 126) and 16 (4–4,096), 64 (2–64), and 16 (8–512) in nonfermentative gram-negative bacilli (NF-GNB, n = 24). In biofilm-forming F-GNB and NF-GNB, qnrB (10/32 versus 3/10), aac(6′)-Ib-cr (10/32 versus 4/10), and qnrS (9/32 versus 0/10) genes were detected. A 32-fold median increase in the MIC-to-MBIC of ciprofloxacin was significantly (P <0.05) associated with qnrA in F-GNB and qnrS in NF-GNB. Biofilms formed by F-GNB and NF-GNB were significantly associated with the aac(6′)-Ib-cr and qnrS genes, respectively. Nearly one-third of the superinfecting bacteria in COVID-19 patients formed biofilms and had at least one PMQR gene, thus increasing the need for quinolones at higher inhibitory concentrations.
Understanding the Challenges of Advocacy Communication, Social Mobilization, and Operationalization for COVID-19 and Routine Immunization in Nigeria
Authors: Isiaka Saheed , Asaolu Stephen , Gab-Deedam Shiva , Jimoh Akolade , Samuel Olugbemisola , Sampson Sidney , Odey Grace , Atobatele Sunday , Okoye Irene
Published: November 2024

The primary goal of program communication in public health is to influence behaviors. It also aims to raise awareness and ultimately improve health outcomes. Under the umbrella of program communication exist three interconnected, interrelated, and mutually supportive communication aspects: advocacy, communication, and social mobilization (ACSM). While advocacy involves promoting political dedication and holding authorities accountable for fulfilling commitments and achieving success, social mobilization brings together various sectors and individuals to raise awareness and demand for a specific program. This study aimed to understand the operationalization and challenges of ACSM activities among health workers addressing COVID-19 and routine immunization in Nigeria. The study used a qualitative study design. In-depth interviews were conducted among health workers in the ACSM unit of the state’s primary health care system, using a two-tier approach. The recorded interviews were transcribed in Microsoft Word format by professional transcribers and coded using Dedoose. A total of 38 health care workers across six states were selected to participate in this study. Our study found that ACSM coordination structures existed across the six states. Routine ACSM activities were either funded by the government or local development partners implementing programs. Lack of technological devices, unavailability of funds, unavailability of data tools, and lack of technological skills are major barriers to ACSM operationalization. This study highlighted the critical role of government and agency funding in sustaining ACSM activities. However, barriers that hinder the effective operationalization of ACSM efforts remain. Therefore, the results support the need for strategic investment in technology, staff capacity building, and appropriate resource allocation to overcome these barriers.
Pregnancy Outcomes of Elderly Primigravidae in a Tertiary Hospital in West Africa: A Retrospective Cohort Study
Authors: Asah-Opoku Kwaku , Mumuni Kareem , Ntumy Michael , Boafor Theodore , Ameme Donne Kofi , Okere Maxfield , Godi Anthony , Oppong Samuel A. , Samba Ali
Published: November 2024

Elderly primigravidae refers to women who become pregnant for the first time from age 35 years and above. Advanced maternal age is a known risk factor for numerous maternal and perinatal complications. This study sought to determine pregnancy outcomes of elderly primigravidae at the Korle-Bu Teaching Hospital (KBTH). A retrospective cohort study was conducted. Women who had their first delivery at KBTH from January 1, 2015 to December 31, 2017 had their demographic and obstetrics and gynecology history and maternal and fetal outcomes retrieved from the department’s electronic database. Women aged 35 years or more who had their first delivery within the study period constituted the exposed, whereas those between 20 and 34 were considered unexposed. Modified Poisson regression with robust error variance estimation and the log link function between the sociodemographic and obstetric factors and maternal and fetal outcomes to estimate adjusted risk ratios (aRRs) and 95% CI were used. Of 29,243 total deliveries, elderly primigravidae constituted 1.81% (530/29,243). Maternal outcomes associated with elderly primigravidae were increased incidence of Caesarean section or instrument delivery (aRR [95% CI] = 1.73 [1.56–1.92]) and prolonged length of stay in hospital (aRR [95% CI] = 1.14 [1.06–1.23]). Fetal outcome associated with the elderly primigravidae was stillbirth (aRR [95% CI] = 1.91 [1.25–2.91]). Elderly primigravidae therefore require more intensive monitoring, even in the absence of any obvious maternal complications. These findings will help in counseling and in the shared decision-making for delivery of elderly primigravidae.
Cost of Snakebite and Its Impact on Household Economy in Southern Nepal
Authors: Pandey Deb Prasad , Adhikari Bhojraj , Pandey Parash , Sapkota Kalyan , Bhusal Mina Kumari , Kandel Priti , Shrestha Durga Laxmi , Shrestha Bhola Ram
Published: November 2024

We aimed to estimate the cost of snakebite and its impact on the economy of snakebite-affected households in southern Nepal. We conducted cross-sectional and prospective studies of confirmed snakebite cases at two hospitals in south central and southwestern Nepal during May to October 2020. We estimated the economic impact of snakebite on affected households by evaluating direct and indirect costs for treatments and opportunity costs of patients and attendants (household members or relatives). We included 553 snakebites that caused 185 envenomings (34%), resulting in 15 deaths (case fatality rate, 8%). These occurred across 87 subdistricts, 21 districts, and six provinces (25% rural, 75% urban overall). Median direct, indirect, and opportunity costs of snakebite were US$95.30, US$65.80, and US$4,995.20 for envenomings and US$14.50, US$13.50, and US$10.10 for nonenvenomed snakebites, respectively. The impact of snakebite envenomings on household economy included not only the remarkable out-of-pocket expenditure but also the loss of patients’ and visitors’ productivity (i.e., daily income/wages while seeking snakebite care in hospitals). Lack of insurance for snakebite treatment increased the psychosocial and economic burden. Deterioration in family economy and psychology was particularly severe when death from snakebite affected breadwinners. Therefore, taking action to minimize the impact of snakebite envenoming becomes a priority for all.
A Cost of Illness Analysis of Children with Encephalitis Presenting to a Major Hospital in Vietnam
Authors: Huong Nguyen Hoang Thien , Toan Nguyen Duc , Khanh Truong Huu , Thinh Le Quoc , Nhan Le Nguyen Thanh , Minh Ngo Ngoc Quang , Thoa Nguyen Thi Kim , Hung Nguyen Thanh , Quy Du Tuan , Thwaites C. Louise , Irani Sarosh R. , Tan Le Van , Turner Hugo C.
Published: November 2024

Encephalitis is a significant global health problem, especially in children. Knowledge of its economic burden is essential for policymakers in prioritizing the development and implementation of interventions but remains limited. An observational study was prospectively conducted at a major children’s hospital in Ho Chi Minh City, Vietnam from 2020 to 2022. Data on direct medical costs, direct nonmedical costs, and productivity costs were collected alongside demographic information, clinical features, diagnosis, severity, and outcomes of study participants. This was used to undertake a cost of illness analysis from a societal perspective. Data were collected from a total of 164 pediatric patients. The median cost of illness was estimated at US $1,859 (interquartile range [IQR]: US $1,273–$3,128). The direct costs were the main cost driver, accounting for 83.9% of the total cost of illness (US $1,560; IQR: US $975–$2,460). The productivity costs accounted for a median of US $275 (IQR: US $154–$474). The cost of illness was higher in more severe patients, patients with sequelae, patients with morbidities, and ventilated patients. Most direct medical costs were attributed to hospitalization and resulted in out-of-pocket payments from the patient’s family (30.2%; US $316). The results showed that the cost of illness of encephalitis in children is considerable and will be useful for policymakers in prioritizing resources for the development and implementation of intervention strategies to reduce the burden of pediatric encephalitis.
Predictors of Cholera and Acute Watery Diarrhea among Climate-Vulnerable People Living in Cabo Delgado, Mozambique: A Cross-Sectional Study
Authors: Segala Francesco Vladimiro , Occa Edoardo , Chambisse Elsa , Cavallin Francesco , Cobre Rumela , Gelfi Giorgia , Laguessa Vitor , Moniz Jose , Chorai Abdul , Chitnis Ketan , Marotta Claudia , Chuau Inusso , Ghelardi Angelo , Mahomed Aida , Putoto Giovanni , Mussa Manuel Aly , Saracino Annalisa , Di Gennaro Francesco
Published: November 2024

Climate change, driven primarily by greenhouse gas emissions from the Global North, is increasing the frequency and intensity of tropical cyclones in Mozambique. After Cyclones Idai and Kenneth in 2019, Cabo Delgado experienced its most severe cholera outbreak in decades. This study explores the factors associated with the prevalence of acute watery diarrhea (AWD) and cholera among people exposed to both climate disasters and armed conflicts in Mozambique. This cross-sectional, community-based study assessed the prevalence and predictors of cholera and AWD in Cabo Delgado Province. Trained community health workers conducted a structured face-to-face survey in December 2023. Associations between variables were investigated using the χ2 test or Fisher’s exact test, and a logistic regression model identified independent risk factors for cholera-like events. The study included 1,615 households and 8,366 people from six districts of Cabo Delgado Province. Children under 14 years old comprised 88% of the population, and 37.9% of households included internally displaced people. Overall, 4.3% of households experienced AWD or cholera within 3 months. Multivariable analysis identified factors associated with AWD, including study district (P <0.0001), overcrowding (P = 0.02), access to safe water (P <0.0001), and handwashing (P = 0.004). Among people exposed to climate disasters, factors associated with cholera or AWD were overcrowding and lack of access to safe water and handwashing facilities. These findings can guide policymakers in designing targeted climate adaptation interventions.
Exploring the current provision of pancreatic transplantations in low- and middle-income countries: Current landscape, challenges, future prospects
Authors: Bharadwaj Hareesha Rishab , Tan Joecelyn Kirani , Ali Syed Hasham , Shah Muhammad Hamza , Nicholas Aderinto , Ahmed Khabab Abbasher Hussien Mohamed , Irfan Khansa , Dalal Priyal , Mehta Aashna , Awuah Wireko Andrew , Dhali Arkadeep
Published: November 2024

This comprehensive review addresses the global health challenge of disparities in pancreas transplant access, particularly in low- and middle-income countries (LMICs) compared to high-income countries. Despite advancements in surgical techniques and immunosuppression for procedures like simultaneous pancreas-kidney, pancreas-after-kidney, and pancreas-transplant alone, LMICs face significant challenges, including limited infrastructure, financial constraints, and a shortage of skilled medical professionals. Donation after brain death remains constrained by sociocultural barriers. Region-specific analyses highlight progress in Latin America, Asia, Russia, and South Africa, showcasing the regional disparities in access and outcomes. Future prospects involve minimally invasive surgeries, telemedicine for enhanced post-operative care, international collaborations with organizations like the European Union of Medical Specialists, and robust funding networks to improve organ availability. In conclusion, the review underscores the importance of multifaceted strategies to address economic, sociocultural, and infrastructural barriers, aiming to improve accessibility, quality, and effectiveness of pancreas transplantation services in LMICs.
Sex balance in anatomical research and education
Authors: Nurani Khulud , Kipkorir Vincent , Njoroge Jimmy , Estreed Merna Akram , Ongeti Kevin , Ogeng'o Julius
Published: November 2024

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The Relationship Between Skit Programmes And Moral Behaviour Of Pupils In Public Primary Schools In Calabar Metropolis Of Cross River State, Nigeria
Authors: Samuel Eburu Odey , Julius Eneji Ogah , Augustine Adaje Odey
Published: November 2024

The study examined the relationship between skit programmes and moral behaviour of pupils in public primary schools in Calabar Metropolis, Cross River State- Nigeria. Three research questions were posed which were converted to three statements of hypotheses. Literature review was carried out based on the variables under study. Survey research design was used for the study. A purposive sampling technique was used in selecting the 198 primary school pupils from 5 public primary schools. A validated 20 items four-point modified Likert scale questionnaire was the instrument used for data collection. Pearson’s Product Moment Correlation was used to test the hypotheses at 0.5 level of significance. The result revealed that there is a significant relationship between dramatic skits, comedy skits and religious skits and moral behaviour of pupils in public primary schools in Calabar Metropolis. It is recommended that, Parents and guardians should endeavour to control and increase access to positive dramatic comedies by their children. This will enable them to be mindful of the level of attention their children give to unnecessary comedies. National film and Video Censor Board should ensure strict rules and regulations on skit programmes that contain violence, nudity,dishonesty, illicit acts and drug abuse. Hence, bans and penalties should be strictly levied on any television stations and skit channels that deviate from the broadcasting down rules and regulations.
Magnetic Resonance Imaging Brain Findings Among Patients With Seizure Disorder In Port Harcourt Metropolis
Authors: Omini Paulinus Samson , Eyo Archibong Bassey , Usani Usani Ephraim , Ukam Ofem Owai , Wueseter Ijever Andrew , Onen Egbe Nneoyi
Published: November 2024

OBJECTIVE: Seizure disorder is one of the most common chronic neurological disorders, affecting approximately 50 million worldwide. About 100,000 new cases are reported in Nigeria each year. To comprehend the prevalence of Magnetic Resonance Imaging (MRI) abnormalities and their correlation with seizures, local data is essential.
METHOD: A retrospective study design was adopted to review clinical data and MRI reports of 122 patients at a tertiary medical imaging facility in Port Harcourt, Rivers State between January 2015 and January 2023. Demography, image findings, and the relationship between the MRI findings, age, and sex were data obtained and analysed using descriptive and inferential statistics with the degree of significance set at p < 0.05.
RESULTS: This study involved 64 females and 58 males, aged 0 to 89 years.  About 69 (57%) patients had normal brain MRI findings, while 53 (43%) were abnormal. The most common pathologies noted were cerebrovascular disorder 14 (11.48%), followed by white matter disease 13 (10.66%), and brain tumour 10 (8.20%). Age group 0-17 years had the highest number of pathological findings (20/53; 37%), followed by age group 36-53 years (11/53; 21%), and the age group 54-57 years (9/53; 17%). Age group spanning from 73 to 86 years, had the least of abnormal findings (4/53; 0.1%). No significant association existed between sex and MRI findings.
CONCLUSION:  Brain MRI findings were normal in majority of seizure patients; the most common findings were cerebrovascular abnormalities, white matter disease, and brain tumours respectively, which were more common in younger patients. The study emphasizes the significance of early MRI scans in identifying seizure-related brain pathologies, particularly in children and adolescents in their diagnostic workup of seizure disorder.
Enhancing Student Learning Through Computational Techniques: A Review Of Educational Technologies In Computer Science
Authors: Kaijage Kashaija Japhet
Published: November 2024

This paper presents a systematic literature review on the integration of computational techniques and educational technologies in computer science education. The study explores three main research questions: (1) Which computational techniques and educational technologies are most effective in enhancing student learning outcomes in computer science? (2) How do these technologies influence key aspects of learning, such as cognitive development, problem-solving abilities, and student engagement? (3) What are the main challenges and limitations associated with the implementation of these technologies, and how can they be addressed? Through an analysis of recent studies, we identify the most effective technologies, including virtual reality (VR), artificial intelligence (AI), learning analytics, and gamification. These tools significantly improve cognitive development, foster problem-solving skills, and boost student engagement. However, the findings also highlight several challenges, such as infrastructure limitations, lack of teacher training, and issues related to student accessibility and equity. To address these challenges, we propose recommendations focusing on infrastructure development, professional development for educators, and strategies to promote equitable access and integration. The paper concludes that while educational technologies offer significant potential to transform computer science education, addressing implementation barriers is critical to realizing their full impact.
Influence Of Land Use/Land Cover On Land Surface Temperature In Lagos State, Nigeria
Authors: O B Fadipe , O A Ogidan , B l Olajiire Ajayi , F O Agboola , O A Ogundana , D A Adenuga , M B Oyedeji , R T Afolabi , A S Adetunji
Published: November 2024

The research was carried out to assess the land use and land cover (LULC) changes in Lagos State for 23 years as well as its impact on the land surface temperature. Landsat 8 images of the years 2000 and 2023 were downloaded and analyzed to determine these changes using supervised classification method after which the land surface temperature was estimated using appropriate formula where necessary. The result showed that barren land and built-up areas increased in 2000 from 0.16% and 47.03% to 5.84% and 50.80% respectively while vegetation and water body decreased from 36.43% and 16.39% to 28.81% and 14.55% respectively. Also, land surface temperature ranged from 17.04°C to 35.38°C in 2000 while in 2023, 17.54°C to 39.85°C. Within the 23yrs of the research, it showed that land use and land cover changes in the state impacted the temperature increase which was majorly caused by the reduction in vegetation and water body. The research conclude that Lagos is becoming warmer and therefore the research recommend that urban forestry should be encouraged by the government.
An Appraisal Of The Impact Of Leachates From A Waste Dumpsite On Coastal Soils And Groundwater System Of The Metropolitan Area Of Lagos, Southwestern Nigeria
Authors: E Nyong Victor , V Nyong Mercy
Published: November 2024

Open dump being the common waste disposal practice in most of the urban centres has posed serious challenges to groundwater quality especially within its vicinity. This study assessed the impact of solid waste disposal on the quality of groundwater and soils in Oke-Odo area of Metropolitan Lagos, Nigeria. Field physicochemical parameters such as pH, electrical conductivity (EC), total dissolved solids (TDS) and temperature were measured using PC Testre Model 35. A total of 36 water samples, two leachate samples and 15 soil samples were analyzed for their major ions and trace metal components using titration and Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) methods. Results revealed a decrease in concentrations of trace and major elements with respect to their distance from the waste dumpsite. A decrease in concentrations of Fe was observed with distances from the dumpsite with values ranging from 12.6 to 0.03mg/l and 4.3 to 0.03mg/l for samples within 500 m and 500-1,500 m, respectively. With exception of a few locations having higher concentrations of Fe, Al, Br, Cu, Mn and Pb, the groundwater sources in the study area are chemically potable with respect to their chemical compositions and generally conform to the World Health Organization and the Nigerian Standard for drinking Water Quality standards for drinking water; and thus, fit for domestic purposes. Sodium adsorption ratio ranges between 0.82 and 5.80 %, indicating low sodium and medium to high salinity hazards. This implies suitability of the water for irrigation purpose. The leachate from the active part of the waste dumpsite showed high concentrations of heavy metals such as Pb (4 mg/l), Cd (0.7 mg/l), Zn (6.54 mg/l) and Cu (3.57 mg/l), which indicates a potential environmental risk. The absence of these metals in the groundwater can be attributed to the attenuating role of the soil above the water table as confirmed by higher concentration of the measured trace metals in comparison to the control sites, with values ranging from 280 to 636 mg/l for Pb, 2 to 9.9 mg/l for Cd, 1041 to 10,000 mg/l for Zn and 102 to 1,307 mg/l for Cu. A total of 66.6 % of soil samples havevery high degree of contamination while 33.3% is considerably contaminated. Hydrochemical characterization of the water revealed predominant Na-K-Cl end-member water type and Ca-Mg-Cl water type which could be attributed to the influence of leachate from the waste dumpsite and possible contribution of seawater from the adjoining lagoons and cation exchange process. This study has revealed that soils and groundwater quality within the vicinity of Oke-Odo dumpsite has been impacted minimally.