Search results for: pregnancy hypertension

Authors: Eman M. El-Sayed, Sahar A. Abdelaziz, Maha M. Saber Abd El Latif

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Neural tube defects (NTD) are important causes of infant mortality. Poor nutrition was essential factor for central nervous system deformation. Mothers gave NTD offspring had abnormal serum levels of micronutrients. The present research was designed to study the effect of maternal micronutrient levels and oxidative stress on the incidence of NTD in offspring. The study included forty mothers; twenty of them of 30.9+7.28 years had conceived fetuses with NTD were considered as cases; and twenty mothers of 28.2 + 7.82 years with healthy neonates. We determined serum vitamin B12 and folic acid by using radioimmunoassays. Also, serum zinc was assessed using atomic absorption spectrophotometry. While serum copper and iron were measured colorimetrically and serum ceruloplasmin was analyzed by radialimmunodiffusion. Cases showed significantly lower levels of folic acid, vitamin B12 and zinc (P< 0.0005, 0.01, 0.01 respectively) than that of the control. Concentrations of copper, ceruloplasmin, and iron were markedly increased in cases as compared to controls (P < 0.01, 0.01, and 0.05 respectively). In conclusion, the current study clearly indicated the etiology of NTD cannot be explained with one strict etiologic mechanism, on the contrary, an interaction among maternal nutritional factors and oxidative stress would explain these anomalies. Vitamin B12, folic acid, and zinc supplementations should be considered for further decrease in the occurrence of NTD. Preventing excess iron during pregnancy favors better pregnancy outcomes.

Keywords: ceruloplasmin, copper, folic acid, iron, neural tube defects, oxidative stress, vitamin b12, zinc

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Authors: Ngwa Lodence Njwe

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This study investigated the response of hemodialysis patients to an established nutrition therapy guide accompanied by a 7-day menu plan administered for a month. End Stage Renal Disease (ESRD), also known as End Stage Kidney Disease (ESKD), is a non-communicable disease primarily caused by hypertension and diabetes, posing significant challenges in both developed and developing nations. Hemodialysis is a key treatment for these patients. In this experimental study, 100 hemodialysis patients from Douala General Hospital in Cameroon participated. A questionnaire was used to collect data on sociodemographic and anthropometric characteristics, health status, and dietary intake, while medical records provided biomedical data. The levels of the biochemical parameters (Phosphorus, calcium and hemoglobin) were determined before and one month after the distribution of the nutrition education guide and the use of a 7-day menu plan. The Phosphorus and Calcium levels were measured using an LTCC03 semi-automatic chemistry analyzer. Blood was collected from each patient into a test tube, allowed to clot and centrifuged. 50µl of the serum was aspirated by the analyzer for Ca and P level analysis, and results were read from the display. The hemoglobin level was measured using the URIT–12 hemoglobin Meter. The blood sample was collected by hand prick and placed in a strip, and the results were read from the screen. The means of the biochemical parameters were then computed. The most prevalent age group was 40-49 years, with males constituting 70% and females 30% of respondents. Among these patients, 80% were hypertensive, 3% had both hypertension and diabetes, 9% were hypertensive, diabetic, and obese, and 1% suffered from hypertension and heart failure. Analysis of anthropometric parameters revealed a high prevalence of underweight, overweight, and obesity, highlighting the urgent need for targeted nutrition interventions to modify cooking methods, enhance food choices, and increase dietary variety for improved quality of life. Before the nutrition therapy guide was implemented, average calcium levels were 73.05 mg/L for males and 89.44 mg/L for females; post-implementation, these values increased to 77.55 mg/L and 91.44 mg/L, respectively. Conversely, average phosphorus levels decreased from 42.05 mg/L for males and 43.55 mg/L for females to 41.05 mg/L and 39.3 mg/L, respectively, after the intervention. Additionally, average hemoglobin levels increased from 8.35 g/dL for males and 8.5 g/dL for females to 9.2 g/dL and 8.95 g/dL, respectively. The findings confirm that the nutrition therapy guide and the 7-day menu significantly impacted the biomedical parameters of hemodialysis patients, underscoring the need for ongoing nutrition education and counseling for this population.

Keywords: end stage kidney disease, nutrition therapy guide, nutritional status, anthropometric parameters, food frequency, biomedical data

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Authors: Elizabeth McLean, Katrina Skewes-McFerran, Grace Thompson

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Scholarship highlights the need to further examine and better understand and foster the process of becoming a parent to a premature baby in the neonatal context to support the critical development of the parent-infant relationship. Music therapy research documents significant benefits of music therapy on neonatal physiological and neurodevelopmental function, reduced maternal anxiety and validating parents’ relationship with their premature baby, yet limited studies examine the role of music in supporting parental identity. This was a multi-site study, exploring parents’ musical engagement with their hospitalised baby and parental identity in a NU. In-depth interviews with nine parents of a premature baby across varying time points in their NU journey took place. Data collection and analysis was influenced by Constructive Grounded Theory methodology. Findings in the form of a substantive grounded theory illuminated the contribution of parents’ musical engagement on their sense of parental identity in the NU. Specifically, the significance of their baby’s level and type of response during musical interactions in influencing parents’ capacity to engage in musical dialogue with their baby emerged. Specific conditions that acted as both barriers and fosters in parents’ musical engagement across a high- risk pregnancy and NU admission also emerged. Recommendations for future research into the role of music and music therapy in supporting parental coping and transition to parenthood during a high-risk pregnancy and birth and beyond the NU will be discussed.

Keywords: grounded theory, musical engagement, music therapy, parental identity

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Authors: Sanjeev Singh

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Background: Obstructed total anomalous pulmonary venous connection (OTAPVC) typically presents with severe cardiovascular decompensation and requires urgent surgical management. Pulmonary arterial hypertension (PAH) is a major risk factor affecting mortality. Perioperative management focuses on providing inotropic support and managing potential pulmonary hypertensive episodes. The aim of this study was to determine the outcome of patients with high pulmonary arterial pressure (PAP) with milrinone alone and a combination of milrinone and inhaled nitric oxide (INO). Material and Methods: After the approval of the ethical committee, this single-center prospective randomized and observational study was conducted over a period of two years among eighty-six patients with obstructed TAPVC repair with severe PAH. Group-I patients received milrinone, and Group-II patients received both milrinone (after aortic cross-clamp removal) and INO during the post-operative period at the cardiac care unit (CCU). Clinical outcomes such as ventilation time, length of stay (LOS) in the CCU, LOS in the hospital, complications, and hospital mortality were compared between the two groups. Result: The average ventilation time, LOS in CCU, and LOS in hospital for group I were 96.82 ± 19.46 hours, 10.91 ± 7.53 days, and 14.46 ± 7.58 days, respectively, and for group II, it was 85.14 ± 15.79 hours, 7.28 ± 3.68 days, and 10.21 ± 3.14 days, respectively, which was statistically significantly lower for group II. Reintubation, RV dysfunction, and hospital mortality were 16.3%, 37.2%, and 6.9% in group I, and 4.8%, 14.6%, and 2.4% in group II, respectively. The P value for each variable was significant < 0.05 (except mortality). Conclusion: Preoperative obstruction is a risk factor for postoperative obstruction, as 235 patients with obstructed TAPVC had severe PAH (39.98%) in this study. Management of severe PAH with a combination of milrinone and INO had a better outcome than milrinone alone.

Keywords: inhaled nitric oxide, milrinone, pulmonary artery hypertension, total anomalous pulmonary venous connection

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Authors: Ebenezer Kwesi Armah-Ansah, Kenneth Fosu Oteng, Esther Selasi Avinu, Eugene Budu, Edward Kwabena Ameyaw

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Background: Maternal mortality, particularly in Benin, is a major public health concern in Sub-Saharan Africa. To provide a positive pregnancy experience and reduce maternal morbidities, all pregnant women must get appropriate and timely prenatal support. However, many pregnant women in developing countries, including Benin, begin antenatal care late. There is a paucity of empirical literature on the prevalence and predictors of early antenatal care visits in Benin. As a result, the purpose of this study is to investigate the prevalence and predictors of early antenatal care visits among women of productive age in Benin. Methods: This is a secondary analysis of the 2017/2018 Benin Demographic and Health Survey (BDHS) data. The study involved 6,919 eligible women. Data analysis was conducted using Stata version 14.2 for Mac OS. We adopted a multilevel logistic regression to examine the predictors of early ANC visits in Benin. The results were presented as odds ratios (ORs) associated with 95% confidence intervals (CIs) and p-value <0.05 to determine the significant associations. Results: The prevalence of early ANC visits among pregnant women in Benin was 57.03% [95% CI: 55.41-58.64]. In the final multilevel logistic regression, early ANC visit was higher among women aged 30-34 [aOR=1.60, 95% CI=1.17-2.18] compared to those aged 15-19, women with primary education [aOR=1.22, 95% CI=1.06-142] compared to the non-educated women, women who were covered by health insurance [aOR=3.03, 95% CI=1.35-6.76], women without a big problem in getting the money needed for treatment [aOR=1.31, 95% CI=1.16-1.49], distance to the health facility, not a big problem [aOR=1.23, 95% CI=1.08-1.41], and women whose partners had secondary/higher education [aOR=1.35, 95% CI=1.15-1.57] compared with those who were not covered by health insurance, had big problem in getting money needed for treatment, distance to health facility is a big problem and whose partners had no education respectively. However, women who had four or more births [aOR=0.60, 95% CI=0.48-0.74] and those in Atacora Region [aOR=0.50, 95% CI=0.37-0.68] had lower odds of early ANC visit. Conclusion: This study revealed a relatively high prevalence of early ANC visits among women of reproductive age in Benin. Women's age, educational status of women and their partners, parity, health insurance coverage, distance to health facilities, and region were all associated with early ANC visits among women of reproductive in Benin. These factors ought to be taken into account when developing ANC policies and strategies in order to boost early ANC visits among women in Benin. This will significantly reduce maternal and newborn mortality and help achieve the World Health Organization’s recommendation that all pregnant women should initiate early ANC visits within the first three months of pregnancy.

Keywords: antenatal care, Benin, maternal health, pregnancy, DHS, public health

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Authors: Ghirmay Teklemicheal, Samsom Mehari, Sara Tesfay

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Objectives: A total of 1074 suspected chikungunya cases were reported in Tesseney Province, Gash Barka region, Eritrea, during an outbreak. This study was aimed to assess the possible association of chikungunya severity among ABO blood groups and other potential determinants. Methods: A sex-matched and age-matched case-control study was conducted during the outbreak. For each case, one control subject had been selected from the mild Chikungunya cases. Along the same line of argument, a second control subject had also been designated through which neighborhood of cases were analyzed, scrutinized, and appeared to the scheme of comparison. Time is always the most sacrosanct element in pursuance of any study. According to the temporal calculation, this study was pursued from October 15, 2018, to November 15, 2018. Coming to the methodological dependability, calculating odds ratios (ORs) and conditional (fixed-effect) logistic regression methods were being applied. As a consequence of this, the data was analyzed and construed on the basis of the aforementioned methodological systems. Results: In this outbreak, 137 severe suspected chikungunya cases and 137 mild chikungunya suspected patients, and 137 controls free of chikungunya from the neighborhood of cases were analyzed. Non-O individuals compared to those with O blood group indicated as significant with a p-value of 0.002. Separate blood group comparison among A and O blood groups reflected as significant with a p-value of 0.002. However, there was no significant difference in the severity of chikungunya among B, AB, and O blood groups with a p-value of 0.113 and 0.708, respectively, and a strong association of chikungunya severity was found with hypertension and diabetes (p-value of < 0.0001); whereas, there was no association between chikungunya severity and asthma with a p-value of 0.695 and also no association with pregnancy (p-value =0.881), ventilator (p-value =0.181), air conditioner (p-value = 0.247), and didn’t use latrine and pit latrine (p-value = 0.318), among individuals using septic and pit latrine (p-value = 0.567) and also among individuals using flush and pit latrine (p-value = 0.194). Conclusions: Non- O blood groups were found to be at risk more than their counterpart O blood group individuals with severe form of chikungunya disease. By the same token, individuals with chronic disease were more prone to severe forms of the disease in comparison with individuals without chronic disease. Prioritization is recommended for patients with chronic diseases and non-O blood group since they are found to be susceptible to severe chikungunya disease. Identification of human cell surface receptor(s) for CHIKV is quite necessary for further understanding of its pathophysiology in humans. Therefore, molecular and functional studies will necessarily be helpful in disclosing the association of blood group antigens and CHIKV infections.

Keywords: Chikungunya, Chikungunya virus, disease outbreaks, case-control studies, Eritrea

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Authors: Ali Kassem, Mohamed Alsenbasy, Ahmed Nagaah

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Background: Diabetic foot is one of the often neglected complications of diabetes mellitus It was reported that patients of diabetic foot ulcer (DFU) have considerable morbidity and mortality. Due to arterial abnormalities, diabetic neuropathy, as well as the tendency to delayed wound healing, foot infection and or gangrene is relatively common in diabetic patients. Foot related problems are responsible for up to 50% of diabetic related hospital admissions. Aim of work: The aim of the present study is to assess the risk factors for DFU in diabetic patients attending Sohag University Hospitals (Upper Egypt) Material and methods: The present study includes 100 diabetic foot patients attending the diabetic outpatient clinic of Sohag University Hospitals. For all of the studied patients the following were done: Full medical history and clinical examination; thorough foot examination; Laboratory tests including: Blood glucose level, HBA1c, serum lipids and renal function tests, ECG and Echocardiography, Doppler study on the lower limbs. Results: Sixty eight percent of the affected patients were males versus 32 % female patients. All male patients and none of the female were smoker. Seventy nine percent of patients were living in rural areas versus 14 % in urban areas. Duration of diabetes was more than 12 years in 74%, less than 12 years in 26% of patients. Fifty percent of patients have associated hypertension, 46% have dyslipidemia, 18% have ischemic heart disease or old myocardial infarction and 8% have impaired renal function. History of previous foot ulcers was reported in 11 % and foot amputation in 2% of patients. Conclusion: Male gender, low socioeconomic status, smoking, long duration of diabetes, other cardiovascular risk factors particularly hypertension and previous history of foot ulceration are the major risk factors for diabetic foot in our locality.

Keywords: diabetic foot, diabetic neuropathy, foot gangrene, risk factors for diabetic complications

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Authors: Majeda Hammoud

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Background: Anemia during pregnancy increases the risk of delivery by cesarean section, low birth weight, preterm birth, perinatal mortality, stillbirth, and maternal mortality. In this study, we aimed to assess the prevalence of anemia in pregnant women and its associated factors in the Kuwait birth cohort study. Methods: The Kuwait birth cohort (N=1108) was a prospective cohort study in which pregnant women were recruited in the third trimester. Data were collected through personal interviews with mothers who attend antenatal care visits, including data on socio-economic status and lifestyle factors. Blood samples were taken after the recruitment to measure multiple laboratory indicators. Clinical data were extracted from the medical records by a clinician including data on comorbidities. Anemia was defined as having Hemoglobin (Hb) <110 g/L with further classification as mild (100-109 g/L), moderate (70-99 g/L), or severe (<70 g/L). Predictors of anemia were classified as underlying or direct factors, and logistic regression was used to investigate their association with anemia. Results: The mean Hb level in the study group was 115.21 g/L (95%CI: 114.56- 115.87 g/L), with significant differences between age groups (p=0.034). The prevalence of anemia was 28.16% (95%CI: 25.53-30.91%), with no significant difference by age group (p=0.164). Of all 1108 pregnant women, 8.75% had moderate anemia, and 19.40% had mild anemia, but no pregnant women had severe anemia. In multivariable analysis, getting pregnant while using contraception, adjusted odds ratio (AOR) 1.73(95%CI:1.01-2.96); p=0.046 and current use of supplements, AOR 0.50 (95%CI: 0.26-0.95); p=0.035 were significantly associated with anemia (underlying factors). From the direct factors group, only iron and ferritin levels were significantly associated with anemia (P<0.001). Conclusion: Although the severe form of anemia is low among pregnant women in Kuwait, mild and moderate anemia remains a significant health problem despite free access to antenatal care.

Keywords: anemia, pregnancy, hemoglobin, ferritin

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Authors: Odunayo Christy Atewolara-Odule, Olapeju O. Aiyelaagbe

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The search for new natural anti-oxidants has grown tremendously over the years because reactive oxygen species (ROS) production and oxidative stress have been linked to a large number of human degenerative diseases, such as cancer, cardiovascular diseases, inflammation, and diabetes. Tapinanthus bangwensis, a parasitic plant commonly known as mistletoe belonging to the Loranthaceae family, is mostly employed traditionally to treat inflammation, cancer, diabetes, and hypertension to mention a few. In this study, air-dried pulverized leaves and stem of Tapinanthus bangwensis were successively extracted with n-hexane, ethyl acetate, and methanol to give the corresponding crude extracts. The extracts were purified by column chromatography and high-performance liquid chromatography to give the isolated compounds. Structural elucidation was done using mass spectrometry, Fourier transform infra-red, 1D and 2D NMR spectroscopy. The antioxidant activity of the compounds was evaluated using 2,2-diphenyl-1-picrylhydrazyl (DPPH) and ascorbic acid as standard. Three compounds; Friedelin, Eudesmic acid (3,4,5-trimethoxybenzoic) and Methyl-3,4,5-trimethoxybenzoate were isolated from the extracts of Tapinanthus bangwensis. Friedelin was isolated from the ethyl acetate extract of the stem while the two other compounds were isolated from the methanol extract of the leaves. The percentages of free radical scavenging activities of the compounds are as follows: Friedelin, 73.69%, methyl-3,4,5-trimethoxybenzoate, 79.33% and eudesmic, 87.68% anti-oxidant activity which were quite comparable to 93.96% given by ascorbic acid. We are reporting, to our best knowledge, for the first time the occurrence of friedelin and eudesmic acid in Tapinanthus bangwensis. The high anti-oxidant activity of these compounds supports the use of this plant in the management of diabetes and hypertension as they will be useful in combating complications arising from the disease.

Keywords: column chromatography, eudesmic acid, friedelin, Tapinanthus bangwensis

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Authors: Roohallah Fallah-Moshkani, Mohammad Ali Mohsenpour, Reza Ghiasvand, Hossein Khosravi-Boroujeni, Seyed Mehdi Ahmadi, Paula Brauer, Amin Salehi-Abargouei

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Purpose: Several investigations have proposed the protective association between dietary approaches to stop hypertension (DASH) style diet and risk of cancers; however, they have led to inconsistent results. The present study aimed to systematically review the prospective cohort studies conducted in this regard and, if possible, to quantify the overall effect of using meta-analysis. Methods: PubMed, EMBASE, Scopus, and Google Scholar were searched for cohort studies published up to December 2017. Relative risks (RRs) which were reported for fully adjusted models and their confidence intervals were extracted for meta-analysis. Random effects model was incorporated to combine the RRs. Results: Sixteen studies were eligible to be included in the systematic review from which 8 reports were conducted on the effect of DASH on the risk of mortality from all cancer types, four on the risk of colorectal cancer, and three on the risk of colon and rectal cancer. Four studies examined the association with other cancers (breast, hepatic, endometrial, and lung cancer). Meta-analysis showed that high concordance with DASH significantly decreases the risk of all cancer types (RR=0.83, 95% confidence interval (95%CI):0.80-0.85); furthermore participants who highly adhered to the DASH had lower risk of developing colorectal (RR=0.79, 95%CI: 0.75-0.83), colon (RR=0.81, 95%CI: 0.74-0.87) and rectal (RR=0.79, 95%CI: 0.63-0.98) cancer compared to those with the lowest adherence. Conclusions: DASH-style diet should be suggested as a healthy approach to protect from cancer in the community. Prospective studies exploring the effect on other cancer types and from regions other than the United States are highly recommended.

Keywords: cancer, DASH-style diet, dietary patterns, meta-analysis, systematic review

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Authors: Loyce Nahwera, Joy Wachira, Edwin Kiptolo, Constance Nsibambi, Mshilla Maghanga, Timothy Makubuya

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Introduction: Hypertension is one of the most prominent risk factors for cardiovascular diseases globally, and it can be modified through lifestyle interventions such as exercise. The objective of this study was to investigate the effects of a 12-week aerobic dance programme on systolic blood pressure (SBP) in stage 1 hypertensive individuals. Methods: This study employed an experimental research design. A total of 36 stage 1 hypertensive individuals who were randomly assigned into experimental and control groups completed the study. Systolic BP was measured using a mercury sphygmomanometer at baseline, mid-point and after the program. The experimental group participants trained 3 days a week, 45 minutes per session, at a moderate intensity of 40-60% of maximum oxygen consumption (VO2max) monitored by Garmin heart rate monitors. Data were analyzed using SPSS version 20. The significance level was set at p<0.05. A paired sample t-test was used to compare mean differences within the groups. Results: Data from the 36 participants (22 males and 14 females) (experimental; n=18, control; n=18) show that the experimental group had a mean SBP of 143.83±6.382 mmHg at baseline while the control had a mean of 137.61±6.400 mmHg. Following the end of a 6-week aerobic dance, the mean SBP of the experimental group reduced to 138.06±9.539 mmHg while that of the control marginally decreased to 137.00±8.073 mmHg. At the completion of a 12-week program, the mean SBP of the experimental group reduced to 136.33±9.191 mmHg, while that of the control marginally increased to 139.56±9.954 mmHg. This implies that both the 6-week and 12-week aerobic dance program reduced the SBP of the experimental group by 5.77±7.133 mmHg and 7.50±8.487 mmHg, respectively, while the control group fast reduced marginally by 0.61 before ultimately increasing by 1.95±7.974 mmHg at 12-weeks. The changes were statistically significant (p<0.05) at both 6 and 12 weeks of an aerobic dance program. Conclusion: The study concluded that aerobic dance is an effective non-pharmacological method for managing SBP of stage 1 hypertensive individuals both in the short-term (6 weeks) and long-term (12 weeks).

Keywords: aerobic dance, blood pressure, stage 1 hypertension, systolic blood pressure.

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Authors: Ibrahim Mohammed

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Background: Diabetes mellitus is a chronic disease that can cause devastating secondary complications, reducing the quality and length of life as well as increasing medical costs for the patient and society. The guidelines recommend both clinical and preventive strategies for diabetes management and are regularly updated. The aim of the study is to assess the level of adherence of physicians to American Diabetes Association Guidelines. Method: Observational multicenter retrospective study will be conducted among different hospitals in the central region. Patient data will be collected from the records of the last three years (2017- 2020). Records will be selected randomly after a complete randomized design. The study focuses on the management of type 2 according to ADA not changed in the last three updating; those standards; all patients should be taking Metformin 1500 to 2000 mg/day as recommended dose and should be received a high dose of statin if the high risk to ASCVD or moderate statin if not at risk, patients with hypertension and diabetes should taking ACE or ARBS. Result: The study aimed to evaluate the commitment of physicians in the central region to the ADA. Out of the 153 selected patients, only 17 % were able to control their diabetes with an average A1c below 7. ADA stated that to reach the minimum benefit of using Metformin, the daily dose should be between 1500 and 2000 mg. Results showed that 110 patients were on Metformin, where 68% of them were on the recommended dose. ADA recommended the intake of high statin for diabetic patients with ASCVD risk, while diabetic patients without ASCVD risk should be on a moderate statin. Results showed that 61.5% of patients with ASCVD risk were at high statin while only 36% of patients without ASCVD risk were at moderate statin. Results showed that 89 patients have hypertension, and 80% of them are getting ACE/ARBs as recommended by the ADA. Recommendation: It is necessary to implement periodic training courses for some physicians to enhance and update their knowledge.

Keywords: American Diabetic Association, diabetes mellitus, atherosclerotic cardiovascular disease, ACE inhibitors

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Authors: Manpreet Kaur, Badaruddoza, Sandeep Kaur Brar

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The increasing prevalence of adolescent obesity is one of the major causes to be hypertensive in adulthood. Various statistical methods have been applied to examine the performance of anthropometric indices for the identification of adverse cardiovascular risk profile. The present work was undertaken to determine the significant traditional risk factors through principal component factor analysis (PCFA) among population based Punjabi adolescents aged 10-18 years. Data was collected among adolescent children from different schools situated in urban areas of Punjab, India. Principal component factor analysis (PCFA) was applied to extract orthogonal components from anthropometric and physiometric variables. Association between components were explained by factor loadings. The PCFA extracted four factors, which explained 84.21%, 84.06% and 83.15% of the total variance of the 14 original quantitative traits among boys, girls and combined subjects respectively. Factor 1 has high loading of the traits that reflect adiposity such as waist circumference, BMI and skinfolds among both sexes. However, waist circumference and body mass index are the indicator of abdominal obesity which increases the risk of cardiovascular diseases. The loadings of these two traits have found maximum in girls adolescents (WC=0.924; BMI=0.905). Therefore, factor 1 is the strong indicator of atherosclerosis in adolescents. Factor 2 is predominantly loaded with blood pressures and related traits (SBP, DBP, MBP and pulse rate) which reflect the risk of essential hypertension in adolescent girls and combined subjects, whereas, factor 2 loaded with obesity related traits in boys (weight and hip circumferences). Comparably, factor 3 is loaded with blood pressures in boys and with height and WHR in girls, while factor 4 contains high loading of pulse pressure among boys, girls and combined group of adolescents.

Keywords: adolescent obesity, cvd, hypertension, punjabi population

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Authors: M. Keršič, M. Lužnik, J. Lužnik

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Cervical dilatation and membrane herniation before 26th week of gestation poses very high risk for extremely and very premature childbirth. Cerclage with mesh cap (mesh cerclage, MC) can greatly diminish this risk and provide additional positive effects. Between 2005 and 2014, MC has been performed in 9 patients with singleton pregnancies who had prolapsed membranes beyond external cervical/uterine os before 25th week of pregnancy (one in 29th). With patients in general anaesthesia, lithotomy and Trendelenburg position (about 25°) prolapsed membranes were repositioned in the uterine cavity, using tampon soaked in antiseptic solution (Skinsept mucosa). A circular, a type of purse-string suture (main band) with double string Ethilon 1 was applied at about 1 to 1.5 cm from the border of the external uterine os - 6 to 8 stitches were placed, so the whole external uterine os was encircled (modified McDonald). In the next step additional Ethilon 0 sutures were placed around all exposed parts of the main double circular suture and loosely tightened. On those sutures, round tailored (diameter around 6 cm) mesh (Prolene® or Gynemesh* PS) was attached. In all 9 cases, gestation was prolonged on average for 9 weeks and 4 days (67 days). In four cases maturity was achieved. Mesh was removed in 37th–38th week of pregnancy or if spontaneous labour began. In two cases, a caesarean section was performed because of breech presentation. In the first week after birth in 22nd week one new born died because of immaturity (premature birth was threatening in 18th week and then MC was placed). Ten years after first MC, 8 of 9 women with singleton pregnancy and MC performed have 8 healthy children from these pregnancies. Mesh cerclage successfully closed the opened cervical canal or uterine orifice and prevented further membrane herniation and membrane rupture. MC also provides a similar effect as with occluding the external os with suturing but without interrupting the way for excretion of abundant cervical mucus. The mesh also pulls the main circular band outwards and thus lowers the chance of suture cutting through the remaining cervix. MC prolonged gestation very successfully (mean for 9 weeks and 4 days) and thus increased possibility for survival and diminished the risk for complications in very early preterm delivered survivors in cases with cervical dilatation and membrane herniation before 26th week of gestation. Without action possibility to achieve at least 28th or 32nd week of gestation would be poor.

Keywords: cervical insufficiency, mesh cerclage, membrane protrusion, premature birth prevention, physical exam-indicated cerclage, rescue cerclage

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Authors: Oluwafunmibi Omotayo Fasanya, Augustine Kena Adjei

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Effective management of hypertension remains a critical public health challenge, particularly among racially and ethnically diverse populations. This study employs sophisticated statistical models to rigorously investigate the predictors of poor blood pressure (BP) control, with a specific focus on demographic, socioeconomic, and clinical risk factors. Leveraging a large sample of 19,253 adults drawn from the National Health and Nutrition Examination Survey (NHANES) across three distinct time periods (2013-2014, 2015-2016, and 2017-2020), we applied multivariable logistic regression and generalized estimating equations (GEE) to account for the clustered structure of the data and potential within-subject correlations. Our multivariable models identified significant associations between poor BP control and several key predictors, including race/ethnicity, age, gender, body mass index (BMI), prevalent diabetes, and chronic kidney disease (CKD). Non-Hispanic Black individuals consistently exhibited higher odds of poor BP control across all periods (OR = 1.99; 95% CI: 1.69, 2.36 for the overall sample; OR = 2.33; 95% CI: 1.79, 3.02 for 2017-2020). Younger age groups demonstrated substantially lower odds of poor BP control compared to individuals aged 75 and older (OR = 0.15; 95% CI: 0.11, 0.20 for ages 18-44). Men also had a higher likelihood of poor BP control relative to women (OR = 1.55; 95% CI: 1.31, 1.82), while BMI ≥35 kg/m² (OR = 1.76; 95% CI: 1.40, 2.20) and the presence of diabetes (OR = 2.20; 95% CI: 1.80, 2.68) were associated with increased odds of poor BP management. Further analysis using GEE models, accounting for temporal correlations and repeated measures, confirmed the robustness of these findings. Notably, individuals with chronic kidney disease displayed markedly elevated odds of poor BP control (OR = 3.72; 95% CI: 3.09, 4.48), with significant differences across the survey periods. Additionally, higher education levels and better self-reported diet quality were associated with improved BP control. College graduates exhibited a reduced likelihood of poor BP control (OR = 0.64; 95% CI: 0.46, 0.89), particularly in the 2015-2016 period (OR = 0.48; 95% CI: 0.28, 0.84). Similarly, excellent dietary habits were associated with significantly lower odds of poor BP control (OR = 0.64; 95% CI: 0.44, 0.94), underscoring the importance of lifestyle factors in hypertension management. In conclusion, our findings provide compelling evidence of the complex interplay between demographic, clinical, and socioeconomic factors in predicting poor BP control. The application of advanced statistical techniques such as GEE enhances the reliability of these results by addressing the correlated nature of repeated observations. This study highlights the need for targeted interventions that consider racial/ethnic disparities, clinical comorbidities, and lifestyle modifications in improving BP control outcomes.

Keywords: hypertension, blood pressure, NHANES, generalized estimating equations

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Authors: Samarpreet Singh, Gerald Giesbrecht

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Both c-section and antibiotic exposure are linked to gut microbiota imbalance in infants. Such disturbance is associated with the Hypothalamic-Pituitary-Adrenal (HPA) axis function. However, the literature only has contradicting evidence for the association between c-sections and the HPA axis. Therefore, this study aims to test if the mode of delivery and antibiotics exposure is associated with the HPA axis. Also, whether exposure to both interacts with the HPA-axis. It was hypothesized that associations and interactions would be observed. Secondary data analysis was used for this co-relational study. Data for the mode of delivery and antibiotics exposure variables were documented from hospital records or self-questionnaires. In addition, cortisol levels (Area under the curve with respect to increasing (AUCi) and Area under the curve with respect to ground (AUCg)) were based on saliva collected from three months old during the infant’s visit to the lab and after drawing blood. One-way and between-subject ANOVA analyses were run on data. No significant association between delivery mode and infant cortisol level was found, AUCi and AUCg, p > .05. Only the infant’s AUCg was found to be significantly higher if there were antibiotics exposure at delivery (p = .001) or their mothers were exposed during pregnancy (p < .05). Infants born by c-section and exposed to antibiotics at three months had higher AUCi than those born vaginally, p < .02. These results imply that antibiotic exposure before three months is associated with an infant’s stress response. The association might increase if antibiotic exposure occurs three months after a c-section birth. However, more robust and causal evidence in future studies is needed, given a variable group’s statistically weak sample size. Nevertheless, the results of this study still highlight the unintended consequences of antibiotic exposure during delivery and pregnancy.

Keywords: HPA-axis, antibiotics, c-section, gut-microbiota, development, stress

Procedia PDF Downloads 72

Authors: Nur Atiqah Adam, Mor Jack Ng, Bernard Chern, Kok Hian Tan

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Introduction: Gestational diabetes (GDM) is a common pregnancy complication with short and long-term health consequences for both mother and fetus. Factors such as family history of diabetes mellitus, maternal obesity, maternal age, ethnicity and parity have been reported to influence the risk of GDM. In a multi-racial country like Singapore, it is worthwhile to study the GDM prevalences of different ethnicities. We aim to investigate the influence of ethnicity on the racial prevalences of GDM in Singapore. This is important as it may help us to improve guidelines on GDM healthcare services according to significant risk factors unique to Singapore. Materials and Methods: Obstetric cohort data of 926 singleton deliveries in KK Women’s and Children’s Hospital (KKH) from 2011 to 2013 was obtained. Only patients aged 18 and above and without complicated pregnancies or chronic illnesses were targeted. Factors such as ethnicity, maternal age, parity and maternal body mass index (BMI) at booking visit were studied. A multivariable logistic regression model, adjusted for confounders, was used to determine which of these factors are significantly associated with an increased risk of GDM. Results: The overall GDM prevalence rate based on WHO 1999 criteria & at risk screening (race alone not a risk factor) was 8.86%. GDM rates were higher among women above 35 years old (15.96%), obese (15.15%) and multiparous women (10.12%). Indians had a higher GDM rate (13.0 %) compared to the Chinese (9.57%) and Malays (5.20%). However, using multiple logistic regression model, variables that are significantly related to GDM rates were maternal age (p < 0.001) and maternal BMI at booking visit (p = 0.006). Conclusion: Maternal age (p < 0.001) and maternal booking BMI (p = 0.006) are the strongest risk factors for GDM. Ethnicity per se does not seem to have a significant influence on the prevalence of GDM in Singapore (p = 0.064). Hence we should tailor guidelines on GDM healthcare services according to maternal age and booking BMI rather than ethnicity.

Keywords: ethnicity, gestational diabetes, healthcare, pregnancy

Procedia PDF Downloads 226

Authors: Ariunaa.S., Javzandulam E., Chimegsaikhan S., Altantsetseg B., Oyungerel S., Bat-Erdene T., Naranbaatar S., Otgonbayar B., Suvdaa N., Tumenbayar B.

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Introduction: Prenatal stress has been linked to heightened allergy sensitivity in offspring. However, there is a notable absence of research on the mesovarium structure of offspring born from mothers subjected to cold stress during pregnancy. Understanding the impact of maternal cold stress on the mesovarium structure could provide valuable insights into reproductive health outcomes in offspring. Objective: This study aims to investigate structural changes in the mesovarium of offspring born from cold-stress affected rats. Material and Methods: 20 female Westar rats weighing around 200g were chosen and evenly divided into four containers; then, 2-3 male rats were introduced to each container. The Papanicolaou method was used to estimate the spermatozoa and estrus period from vaginal swabs taken from female rats at 8:00 a.m. Female rats examined with the presence of spermatozoa during the estrous phase of the estrous cycle are defined as pregnant. Pregnant rats are divided into experimental and control groups. The experimental group was stressed using the model of severe and chronic cold stress for 30 days. They were exposed to cold stress for 3 hours each morning between 8:00 and 11:00 o’clock at a temperature of minus 15 degrees Celsius. The control group was kept under normal laboratory conditions. Newborn female rats from both experimental and control groups were selected. At 2 months of age, rats were euthanized by decapitation, and their mesovaria were collected. Tissues were fixed in 4% formalin, embedded in paraffin, and sectioned into 5μm thick slices. The sections were stained with H&E and digitized by digital microscope. The area of brown fat and inflammatory infiltrations were quantified using Image J software. The blood cortisol levels were measured using ELISA. Data are expressed as the mean ± standard error of the mean (SEM). The Mann-Whitney test was used to compare the two groups. All analyses were performed using Prism (GraphPad Software). A p-value of < 0.05 was considered statistically significant. Result: Offspring born from stressed mothers exhibited significant physiological differences compared to the control group. Specifically, the body weight of offspring from stressed mothers was significantly lower than the control group (p=0.0002). Conversely, the cortisol level in offspring from stressed mothers was significantly higher (p=0.0446). Offspring born from stressed mothers showed a statistically significant increase in brown fat area compared to the control group (p=0.01). Additionally, offspring from stressed mothers had a significantly higher number of inflammatory infiltrates in their mesovarium compared to the control group (p<0.047). These results indicate the profound impact of maternal stress on offspring physiology, affecting body weight, stress hormone levels, metabolic characteristics, and inflammatory responses. Conclusion: Exposure to cold stress during pregnancy has significant repercussions on offspring physiology. Our findings demonstrate that cold stress exposure leads to increased blood cortisol levels, brown fat accumulation, and inflammatory cell infiltration in offspring. These results underscore the profound impact of maternal stress on offspring health and highlight the importance of mitigating environmental stressors during pregnancy to promote optimal offspring outcomes.

Keywords: brown fat, cold stress during pregnancy, inflammation, mesovarium

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Authors: Rachel Dolan

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Background: Over two thirds of women in prison in England are mothers, and estimates suggest between 100 and 200 women per year give birth during imprisonment. There are currently six mother and baby units (MBUs) in prisons in England which admit women and babies up to the age of 18 months. Although there are only 65 places available, and despite positive impacts, they are rarely full. Mental illness may influence the number of admissions, as may interpretation of admission criteria. They are the only current alternative to separation for imprisoned mothers and their babies. Aims: To identify the factors that affect the decision to apply for/be offered a place in a prison MBU; to measure the impact of a placement upon maternal mental health and wellbeing; To measure the Initial outcomes for mother and child. Methods: A mixed methods approach - 100 pregnant women in English prisons are currently being recruited from prisons in England. Quantitative measures will establish the prevalence of mental disorder, personality disorder, substance misuse and quality of life. Qualitative interviews will document the experiences of pregnancy and motherhood in prison. Results: Preliminary quantitative findings suggest the most prevalent mental disorders are anxiety and depression and approximately half the participants meet the criteria for one or more personality disorders. The majority of participants to date have been offered a place in a prison MBU, and those in a prison with an MBU prior to applying are more likely to be admitted. Those with a previous history of childcare issues, who are known to social services are less likely to be offered a place. Qualitative findings suggest that many women are often hungry and uncomfortable during pregnancy, many have feelings of guilt about having a child in prison and that feelings of anxiety and worry are exacerbated by lack of information.

Keywords: mothers, prison, mother and baby units, mental health

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Authors: Rahaf Mandura, Fatmah Abusharkh, Layan Kurdi, Rahaf Shigdar, Khadijah Alattas

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Introduction: Age-related macular degeneration (AMD) in older individuals are serious health issues that severely impact the quality of life of millions globally. In 2020, the fourth leading cause of blindness worldwide was AMD. The global prevalence of AMD is estimated to be around 8.7%. AMD is a progressive disease involving the macular region of the retina, and it has a complex pathophysiology. RPE cell dysfunction plays a crucial step in the pathway leading to irreversible degeneration of photoreceptors with yellowish lipid-rich, protein-containing drusen deposits accumulating between Bruch's membrane and the RPE. Furthermore, lipofuscinogenesis, drusogenesis, inflammation, and neovascularization are four main processes responsible for the formation of the two types of AMD: the wet (exudative, neovascular) and dry (non-exudative, geographic atrophy) types. We retrospectively evaluated the prevalence of AMD among patients visiting the retina clinic at King Abdulaziz University Hospital (Jeddah, Makkah Province, Saudi Arabia) to identify the commonly associated risk factors of AMD. Methods: The records of 3,067 individuals from 2017 to 2021 were reviewed. Of these, 1,935 satisfied the inclusion criteria and were included in this study. We excluded all patient below 18 years, and those who did not undergo fundus imaging or attend their booked appointments, follow-ups, treatments, and referrals were excluded. Results: The prevalence of AMD among the patients was 4%. The age of patients with AMD was significantly greater than those without AMD (72.4 ± 9.8 years vs. 57.2 ± 15.5 years; p < 0.001). Participants with a family history of AMD tended to have the disease more than those without such a history (85.7% vs. 45%; p = 0.043). Ex- and current smokers were more likely to have AMD than non-smokers (34% and 18.6% vs. 7.2%; p < 0.001). Patients with hypertension and those without type 1 diabetes were at a higher risk of developing AMD than those without hypertension (5.5% vs. 2.8%; p = 0.002) and those with type 1 diabetes (4.2% vs. 0.8%; p = 0.040). In contrast, sex, nationality, type 2 diabetes, and abnormal lipid profile were not significantly associated with AMD. Regarding the clinical characteristics of AMD cases, most cases (70.4%) were of the dry type and affected both eyes (77.2%). The disease duration was ≥5 years in 43.1% of the patients. The most frequent chronic diseases associated with AMD were type 2 diabetes (69.1%), hypertension (61.7%), and dyslipidemia (18.5%). Conclusion: In summary, our single tertiary center study showed that AMD is widely prevalent in Jeddah, Saudi Arabia (4%) and linked to a wide range of risk factors. Some of these are modifiable risk factors that can be adjusted to help reduce AMD occurrence. Furthermore, this study has shown the importance of screening and follow-up of family members of patients with AMD to promote early detection and intervention of AMD. We recommend conducting further research on AMD in Saudi Arabia. Concerning the study design, a community-based cross-sectional study would be more helpful for assessing the disease's prevalence. Finally, recruiting a larger sample size is required for more accurate estimation.

Keywords: age related macular degeneration, prevelence, risk factor, dry AMD

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Authors: Savita, Anurag Sharma, Harsukhpreet Singh

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Fetal Electrocardiogram (fECG) is a widely used technique to assess the fetal well-being and identify any changes that might be with problems during pregnancy and to evaluate the health and conditions of the fetus. Various techniques or methods have been employed to diagnose the fECG from abdominal signal. This paper describes the facile approach for the estimation of the fECG known as Adaptive Comb. Filter (ACF). The ACF can adjust according to the temporal variations in fundamental frequency by itself that used for the estimation of the quasi periodic signal of ECG signal.

Keywords: aECG, ACF, fECG, mECG

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Authors: Bidisha Chatterjee, Sonal Grover, Rekha Gurung

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Postpartum dissection of the internal carotid artery is a relatively rare condition and is considered as an underlying aetiology in 5% to 25% of strokes under the age of 30 to 45 years. However, 86% of these cases recover completely and 14% have mild focal neurological symptoms. Prognosis is generally good with early intervention. The risk quoted for a repeat carotid artery dissection in subsequent pregnancies is less than 2%. 36-year Caucasian primipara presented on postnatal day one of forceps delivery with tachycardia. In the intrapartum period she had a history of prolonged rupture of membranes and developed intrapartum sepsis and was treated with antibiotics. Postpartum ECG showed septal inferior T wave inversion and a troponin level of 19. Subsequently Echocardiogram ruled out post-partum cardiomyopathy. Repeat ECG showed improvement of the previous changes and in the absence of symptoms no intervention was warranted. On day 4 post-delivery, she had developed symptoms of droopy right eyelid, pain around the right eye and itching in the right ear. On examination, she had developed right sided ptosis, unequal pupils (Rt miotic pupil). Cranial nerve examination, reflexes, sensory examination and muscle power was normal. Apart from migraine, there was no medical or family history of note. In view of Horner’s on the right, she had a CT Angiogram and subsequently MR/MRA and was diagnosed with dissection of the cervical portion of the right internal carotid artery. She was discharged on a course of Aspirin 75mg. By 6 week post-natal follow up patient had recovered significantly with occasional episodes of unequal pupils and tingling of right toes which resolved spontaneously. Cervical artery dissection, including VAD and carotid artery dissection, are rare complications of pregnancy with an estimated annual incidence of 2.6–3 per 100,000 pregnancy hospitalizations. Aetiology remains unclear though trauma during straining at labour, underlying arterial disease and preeclampsia have been implicated. Hypercoagulable state during pregnancy and puerperium could also be an important factor. 60-90% cases present with severe headache and neck pain and generally precede neurological symptoms like ipsilateral Horner’s syndrome, retroorbital pain, tinnitus and cranial nerve palsy. Although rare, the consequences of delayed diagnosis and management can lead to severe and permanent neurological deficits. Patients with a strong index of suspicion should undergo an MRI or MRA of head and neck. Antithrombotic and antiplatelet therapy forms the mainstay of therapy with selected cases needing endovascular stenting. Long term prognosis is favourable with either complete resolution or minimal deficit if treatment is prompt. Patients should be counselled about the recurrence risk and possibility of stroke in future pregnancy. Coronary artery dissection is rare and treatable but needs early diagnosis and treatment. Post-partum headache and neck pain with neurological symptoms should prompt urgent imaging followed by antithrombotic and /or antiplatelet therapy. Most cases resolve completely or with minimal sequelae.

Keywords: postpartum, dissection of internal carotid artery, magnetic resonance angiogram, magnetic resonance imaging, antiplatelet, antithrombotic

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Authors: Ellen Bautista, Rebecca M. Flueckiger, Easter Dasmarinas, Rajeev Colaco, Fulbert Alec R. Gillego, Alma M. Lozada, Cristina Bisson

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Lactational Amenorrhea Method (LAM) for family planning is at least 98% effective at preventing pregnancy when all criteria are met; (1) the mother is exclusively or nearly exclusively breastfeeding, (2) the mother is amenorrheic (not menstruating), and (3) the baby is six months old or younger. LAM is particularly suited for women interested in family planning accepted by religious authorities. As a majority catholic nation, LAM is a common and accepted form of family planning in the Philippines. The USAID funded, LuzonHealth project conducted a prospective evaluation in Legazpi City to inform the enhancement of guidelines aimed at increasing LAM compliance and encouraging a second form of contraceptive once LAM protection expires. LAM compliance, reasons for non-compliance, family planning referral and uptake of secondary modern family planning methods were tracked over a nine-month period among 521 postpartum women. The evaluation found that at three months postpartum, 97% of women either met LAM criteria or had shifted to a non-LAM modern family planning method. In month six 87% of women no longer met LAM criteria and of these only 35% had shifted to an alternative modern family planning method. This means that at six-months postpartum 65% of the women in this evaluation were not protected against pregnancy through modern family planning methods. By postpartum month nine, 70% of the women had been referred to family planning counseling, yet of those referred only 34% reported using modern family planning methods. This evaluation clearly indicates scale-up of non-LAM modern family planning does not sufficiently complement the scale-down of LAM compliance. There is a need to increase client knowledge and understanding of LAM as a temporary family planning method with a strong focus on preparing to shift to another form of modern family planning once LAM protection expires. Additionally, there is great need to restructure the referral mechanism to ensure efficacy and quality of care.

Keywords: Philippines, family planning, lactational amenorrhea method, contraceptives

Procedia PDF Downloads 242

Authors: Rebecca Johnson, Elizabeth Hoban

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Condom use among young men in Cambodia has declined between 2005 and 2014 which has public health implications such as increased risks of sexually transmitted infections, including HIV, and unplanned pregnancies. Conversations about sexual and reproductive health issues, including condom use, are not socially sanctioned in Cambodian society leaving young adults with limited knowledge of, and poor access to sexual and reproductive health services. Additionally, men play a dominant role in decision making regarding condom use within sexual partnerships. This study sought to fill a gap in knowledge by exploring young adult males’ attitudes, perceptions and behaviours regarding condom use. In February and March 2018, twenty young adult males, aged 18 to 24 years, were recruited from urban, peri urban and rural areas in Cambodia. The young adult males participated in a face-to-face semi structured interview that used an interview guide and photo elicitation method. The interview explored participants’ knowledge of sexual and reproductive health issues and efficacy, sexual behaviours, and use of condoms. Inductive thematic analysis was conducted and the following major themes emerged: understanding of reproduction, understanding of sexually transmitted infections, knowledge about condoms, condom use, access to condoms, and sexual behaviour. Participants’ knowledge of condoms and specific reasons for their use varied; most participants understood that condoms provide protection from sexually transmitted infections and prevent pregnancy. Stigma associated with condom access was consistently referred to as a problem and the main reason cited by young men for not using condoms during sexual intercourse. The perceived importance of condom use altered with partner type and relationship status, dependent upon the need for protection from sexually transmitted infections or pregnancy. Condoms were used for infection control in the context of multiple relationships, or as a contraceptive method for unmarried and some married couples. The majority of young men engaged in premarital sexual intercourse, of those men the many used condoms. The inconsistent use of condoms by young men in Cambodia is of public health concern because of the increased risk of sexually transmitted infections (including HIV), and unplanned pregnancy. Public health action is required in order to minimize long term health issues for individuals and the community. Health education is required to increase knowledge of condom use, sexually transmitted infections and HIV, and reduce the stigma associated with this topic. Sustainable health promotion programs are needed to increase ease of access to condoms for young people. Public health policy in Cambodia needs to be reviewed to improve sexual and reproductive health outcomes for young adults.

Keywords: Cambodia, condom use, sexual and reproductive health, young adult males

Procedia PDF Downloads 128

Authors: Rajesh Kumar Suman, Ipseeta Ray Mohanty, Manjusha K. Borde, Ujjawala maheswari, Y. A. Deshmukh

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Background: Metabolic syndrome encompasses cluster of risk factors for cardiovascular disease which includes abdominal obesity, dyslipidemia, hypertension, and hyperglycemia. The incidence of metabolic syndrome is on the rise globally. Objective: The present study was designed to develop a unique animal model that will mimic the pathological features seen in a large pool of individuals with diabetes and metabolic syndrome; suitable for pharmacological screening of drugs beneficial in this condition. Material and Methods: A combination of high fat diet (HFD) and low dose of streptozotocin (STZ) at 30, 35 and 40 mg/kg was used to induce metabolic syndrome co-existing with diabetes mellitus in Wistar rats. Results: The 40 mg/kg STZ produced sustained hyperglycemia and the dose was thus selected for our study to induce diabetes mellitus. Rat fed HFD (HF-DC) group showed significant (p < 0.001) increase in body weight on 4th and 7th week as compared with NC (Normal Control) group rats. However, the increase in body weight of HF-DC group rats was not sustained at the end of 10th weeks. Various components of metabolic syndrome such as dyslipidemia {(Increased Triglyceride, total Cholesterol, LDL Cholesterol and decreased HDL Cholesterol)}, diabetes mellitus (Blood Glucose, HbA1c, Serum Insulin, C-peptide), hypertension {Systolic Blood pressure (p < 0.001)} were mimicked in the developed model of metabolic syndrome co existing with diabetes mellitus. In addition significant cardiac injury as indicated by CPK-MB levels, artherogenic index, hs-CRP. The decline in hepatic function {(p < 0.01) increase in the level of SGPT (U/L)} and renal function {(increase in creatinine levels (p < 0.01)} when compared to NC group rats. The histopathological assessment confirmed presence of edema, necrosis and inflammation in Heart, Pancreas, Liver and Kidney of HFD-DC group as compared to NC. Conclusion: The present study has developed a unique rodent model of metabolic syndrome; with diabetes as an essential component.

Keywords: diabetes, metabolic syndrome, high fat diet, streptozotocin, rats

Procedia PDF Downloads 348

Authors: Radmila Maksimovic, Sonja Ketin, Rade Biocanin, Jelena Maksimovic

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The abnormal conditions of life and work genetic factors often play a major role in incidence of diabetes-diabetes, heart disease and vascular disease, jaundice, and post traumatic stress. Trauma and post traumatic stress are most common in the displaced persons,and the focus of this paper is to shed light on this issue in former Yugoslavia, Yugoslavia and now in our country. This is caused by increased beta-cell sensitivity to viruses, the development of autoimmune antibodies against its own pancreascells, degenerative changes in cells that r esult in change of structure and insulin. In this paper, we dealt with traumatic events and long-term psycho social consequences for internally displaced persons, several years after displacement, and found a high level of PTSD symptoms. This stress is present in almost 1/3 of internally displaced persons, and every sixth person is suffering from PTSD in the past. Respondents generally suffer from symptoms of intrusion, but there was a large number of symptoms, avoidance and increased arousal. We also found that gender, age andeducation related to the symptoms. Females, and older respondents and internally displaced persons with lower levels of education how a higher level of PTSD symptoms, especially symptoms of intrusion and increase darousal. It is a highly traumatized sample in which more than 1/2 of respondents experienced more than three traumatic events in life,although the number of traumas experienced before, during and after the conflict varies.We found that during the war, internally displaced persons haveexperienced more traumatic events compared with the periodbefore and after the conflict. Trauma are different in type. No significant correlation between the number of experienced trauma and PTSD, suggesting that it is necessary to further study the structure of past traumas and the intermediary effects of certain risk factors and protective factors.

Keywords: living environment, displaced persons, jaundice, diabetes, trauma, diabetic hypertension, post-traumatic stress (PTSD), treatment

Procedia PDF Downloads 393

Authors: Shannon Rappe, Elizabeth Morse, David Phillippi

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Postpartum women with an opioid use disorder (OUD) are at high risk for treatment disengagement, leaving them vulnerable to overdose and death between seven and twelve months postpartum. Intensive case management programs have been proposed as an effective strategy to reduce barriers and increase treatment engagement among postpartum women. The purpose of this project is to determine the effects of early engagement in an intensive case management program on postpartum engagement and infant health outcomes among postpartum women with opioid use. This retrospective review of secondary data was collected on 225 infants, and 221 postpartum women enrolled in an intensive case management program in Tennessee between May 1, 2019, and May 5, 2020. Chi-squares were computed to examine the timing of engagement during pregnancy, maternal treatment outcomes, and infant health outcomes, including neonatal abstinence syndrome (NAS), birth weight, gestational age, and length of stay. The mean prenatal program engagement was 109 days (SD = 67.6); 16.7% (n = 37) enrolled during the first trimester, 37.6% (n = 83) in the second trimester, and 45.7% (n = 101) in the third trimester. Of the 221 women engaged, 45.2% (n = 100) remained engaged in the case of management at the time of data collection, and 40% (n = 89) remained engaged in MAT at the time of data collection. Twenty- five percent (n = 25) of mothers who graduated sustained engagement in MAT. Of 225 infants 28.9% (n = 65) had a positive NAS status, mean birth weight was 6.5 lbs. (SD = 19.3); mean gestational age was 38.3 weeks (SD = 19.3) and mean length of stay was 8.19 days (SD = 9.8). This study's findings identified that engaging mothers during pregnancy in a program designed to meet their unique challenges positively impacts both the mother and infant outcomes, regardless of their timing.

Keywords: intensive case management, neonatal abstinence syndrome, opioid addiction, opioid crisis, opioid use in pregnant women, postpartum addiction

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Authors: Sobhy A. El-Sohaimy, Mohamed G. Shehata, Ashwani Mathur, Amira G. Darwish, Nourhan M. Abd El-Aziz, Pammi Gauba, Pooja Upadhyay

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Sea buckthorn is a temperate bush plant native to Asian and European countries, explored across the world in traditional medicine to treat various diseases due to the presence of an exceptionally high content of phenolics, flavonoids and antioxidants. In addition to the evaluation of nutrients and active compounds, the focus of the present work was to assess the optimal levels for L. plantarum RM1 growth by applying response surface methodology (RSM), and to determine the impact of juice fermentation on antioxidant, anti-hypertension and anticancer activity, as well as on organoleptic properties. Sea buckthorn berries were shown to contain good fiber content (6.55%, 25 DV%), high quality of protein (3.12%, 6.24 DV%) containing: histidine, valine, threonine, leucine and lysine (with AAS 24.32, 23.66, 23.09, 23.05 and 21.71%, respectively), and 4.45% sugar that pro- vides only 79 calories. Potassium was shown to be the abundant mineral content (793.43%, 22.66 DV), followed by copper and phosphorus (21.81 and 11.07 DV%, respectively). Sea buckthorn juice exhibited a rich phenolic, flavonoid and carotenoid content (283.58, 118.42 and 6.5 mg/g, respec- tively), in addition to a high content of vitamin C (322.33 mg/g). The HPLC profile indicated that benzoic acid is the dominant phenolic compound in sea buckthorn berries (3825.90 mg/kg). Antiox- idant potentials (DPPH and ABTS) of sea buckthorn showed higher inhibition than ascorbic acid. Antimicrobial potentials were most pronounced against Escherichia coli BA12296 (17.46 mm). The probiotic growth was 8.5 log cfu/mL, with juice concentration, inoculum size and temperature as the main contributors to probiotic growth with a 95% confidence level. Fermentation of sea buck- thorn juice with L. plantarum RM1 enhanced the functional phenolic and flavonoid content, as well as antioxidant and antimicrobial activities. The fermentation with L. plantarum RM1 enhanced the anti-hypertension and anticancer properties of the sea buckthorn juice and gained consumers’ sensorial overall acceptance.

Keywords: sea buckthorn juice, L. plantarum RM1, fermentation, antioxidant, antimicrobial, angiotensin converting enzyme inhibition

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Authors: Nneka U. Igboeli, Maxwell O. Adibe

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Iron and folate supplementation in pregnancy are important interventions that prevent maternal anaemia and fetal anomaly. Thus, daily oral doses of iron and folic acid are recommended throughout pregnancy as part of antenatal care. However, low adherence has been a major drawback leading to low effectiveness of these programs. The effect of mobile text message reminders to pregnant women to take their routine medications on adherence was evaluated in this study. The first 100 women who consented to the study were recruited and randomized to either receive a text message reminder on adherence to routine medications or not. Adherence was assessed using the 8-item Modified Morisky Adherence Scale (8-MMAS). The folders of successfully recruited women were tagged with the a study number assigned to each of them. The womens’ phone numbers were collected and these were used to send text messages reminders on adhering to routine drugs only to women in the intervention group. The text messages were sent three times per week for a period of four weeks with an adherence reassessment at the one month follow-up antenatal visit for recruited women. At one month follow-up, the lost to follow-up were 6 (16%) women for the intervention group and 17 (34%) for the control group. The across group mean difference in adherence score was 0.07 (-0.96 – 1.10) at baseline and 0.3 (-0.31 – 0.92) after intervention, both insignificant at p > 0.05. The within group change were increases of 0.58 (0.00 – 1.16) (p = 0.05) from baseline for the intervention group and a 0.35 (-0.51 – 1.20) (p = 0.395) for the control group. Non-significant increase in adherence scores were recorded for both groups. However, the increase in adherence scores of women in the intervention group was greater and may be potentially transformed into more positive results if the study period is increased with possibly reduced study drop-outs shows great promise for more positive results.

Keywords: adherence, mobile phone, pregnant women, reminders

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Authors: Dhananjay W. Bansod, Santosh Phad

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Non-Communicable Diseases (NCD) are major contributing factors to the disease burden in the world as well as in India. With a growing proportion of older persons in India gives rise to several challenges. With the advancement of age, elderly is exposed to various kinds of health problems more specifically NCDs. Therefore, an effort has been made to examine the prevalence of NCDs among older persons and its treatment-seeking behaviour, also it is tried to explore the association between the NCDs and its effect on the overall wellbeing of older persons. Data used from “Building Knowledge Base of Population Ageing Survey” conducted in 2011 in seven states of India. Six chronic diseases used (non-communicable diseases) namely Arthritis, Hypertension, Cataract, Diabetes, Asthma and Heart diseases to understand the issues related to NCDs. Also seen the effect of NCDs on the wellbeing of the elderly, the subjective well-being consists of nine questions from which SUBI score generated for mental health status, which ranges from 9 to 27. This Index indicates that lower the score better is the mental health status. Further, this index modified and generated three categories of Better (9-15), Average (16-20) and Worse (21-27). The reliability analysis is carried out with the coefficient (Cronbach’s alpha) of the scale was 0.8884. The result shows that Orthopedic / musculoskeletal ailments involving arthritis, rheumatism and osteoarthritis are the most common type of ailment followed by hypertension. Two-thirds of the elderly reported suffering from at least one chronic ailment. Most chronic illness conditions received some form of treatment and mainly depend on public health facilities. Financial insecurity is the primary obstruction in seeking treatment for most of the chronic ailments which typically require a longer duration of medication and repeated medical consultations, both having significant economic implications. According to SUBI index, only 15 per cent of the elderly are in Better mental health status, and one-third of the elderly are with the worse score. Elderly with the ailments like Cataract, Asthma and Arthritis have worse mental health. It depicts that the burden of disease is more among the elderly and it is directly affecting the overall wellbeing of older persons.

Keywords: NCD, well-being, older person, India

Procedia PDF Downloads 147