Search results for: attending antiretroviral clinic

Authors: Mohd Radzi Hilmi, Mohd Zulfaezal Che Azemin, Khairidzan Mohd Kamal, Azrin Esmady Ariffin, Mohd Izzuddin Mohd Tamrin, Norfazrina Abdul Gaffur, Tengku Mohd Tengku Sembok

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Purpose: The purpose of this study is to predict optical quality changes after pterygium surgery using tissue redness grading. Methods: Sixty-eight primary pterygium participants were selected from patients who visited an ophthalmology clinic. We developed a semi-automated computer program to measure the pterygium fibrovascular redness from digital pterygium images. The outcome of this software is a continuous scale grading of 1 (minimum redness) to 3 (maximum redness). The region of interest (ROI) was selected manually using the software. Reliability was determined by repeat grading of all 68 images and its association with contrast sensitivity function (CSF) and visual acuity (VA) was examined. Results: The mean and standard deviation of redness of the pterygium fibrovascular images was 1.88 ± 0.55. Intra- and inter-grader reliability estimates were high with intraclass correlation ranging from 0.97 to 0.98. The new grading was positively associated with CSF (p<0.01) and VA (p<0.01). The redness grading was able to predict 25% and 23% of the variance in the CSF and the VA respectively. Conclusions: The new grading of pterygium fibrovascular redness can be reliably measured from digital images and show a good correlation with CSF and VA. The redness grading can be used in addition to the existing pterygium grading.

Keywords: contrast sensitivity, pterygium, redness, visual acuity

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Authors: Marjan Kamyabi

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Attending tourism in the current century is one of the key factors in the success of the tourism industry and, consequently, the prosperity of the economies of the countries. In this regard, accessible tourism can play a major role in the development of tourism, taking into account the attractions, facilities and capabilities of the development of tourism in Northern Cyprus, and given that the satisfaction of tourists from the product and destination of tourism has an undeniable role in attracting tourists. The purpose of this study is to investigate the environmental barriers and accessibility of the tourism industry in Northern Cyprus. Another goal of this study is to introduce this consumer group to the tourism community. In order to achieve the objectives of this paper, a questionnaire was designed and provided to three tourism professionals to assess the reliability, and then, among the 200 people with physical and mental disabilities who travelled to Cyprus, The data analysis was used as a confirmatory factor analysis method. The environmental barrier for tourists with disabilities is classified in three sections of transport, attractions and accommodation, each section being separately identified separately. In general, observance of the principles and standards of proper fitting in the main sectors of the tourism industry of Northern Cyprus in the situation The facilities and transportation were identified as the first problem and obstacle for the development of tourism for people with physical and mental disabilities and, finally, suggestions and solutions for the development of tourism for people with physical and physical disabilities were presented.

Keywords: accessible tourism, environmental barriers, tourism, people with disability, accessibility

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Authors: Yingjin Cui, Xue Bai, Serena Reese

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Student engagement and student interest during class instruction are important conditions for active learning. Engagement, which has an important relationship with learning motivation, influences students' levels of persistence in overcoming challenges. Lack of student engagement and absence from face-to-face lectures and tutorials, in turn, can lead to poor academic performance. However, keeping students motivated and engaged in the learning process in different instructional modes poses a significant challenge; students can easily become discouraged from attending lectures and tutorials across both online and face-to-face settings. Many factors impact students’ engagement in the learning process. If you want to keep students focused on learning, you have to invite them into the process of helping themselves by providing an active learning environment. Active learning is an excellent technique for enhancing student engagement and participation in the learning process because it provides means to motivate the student to engage themselves in the learning process through reflection, analyzing, applying, and synthesizing the material they learn during class. In this study, we discussed how to create an active learning class (both face-to-face and synchronous online) through engagement activities, including reflection, collaboration, screen messages, open poll, tournament, and transferring editing roles. These activities will provide an uncommon interactive learning environment that can result in improved learning outcomes. To evaluate the effectiveness of those engagement activities in the learning process, an experimental group and a control group will be explored in the study.

Keywords: active learning, academic performance, engagement activities, learning motivation

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Authors: Rami S. Alasmari, Abdullah Al Zahrani, Hattan A. Hassani, Hattan A. Hassani, Nawwaf A. Almalky, Abdullah F. Bokhari, Alwalied A. Hafez

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Diabetes mellitus type 2 (DMT2) is a major chronic condition that is considered common among elderly people, with multiple potential complications that could contribute to falls. However, this concept is not well understood, thus, the aim of this study is to determine whether diabetes is an independent risk factor for falls in elderly. In this observational cross-sectional study, 309 diabetic patients aged 60 or more who visited the primary healthcare centers of the Ministry of National Guard Health Affairs in Jeddah were chosen via convenience sampling method. To collect the data, Semi-structured Fall Risk Assessment questionnaire and Fall Efficacy Score scale were used. The mean age of the participants was estimated to be 68.5 (SD:7.4) years. Among the participants, 48.2% experienced falling before, and 63.1% of them suffered falls in the past 12-months. The results showed that gait problems were independently associated with a higher likelihood of fall among the elderly patients (OR = 1.98, 95%CI, 1.08 to 3.62, p = 0.026. This paper suggests that diabetes mellitus is an independent fall risk factor among elderly. Therefore, identifying such patients as being at higher risk and prompt referral to a specialist falls clinic is recommended.

Keywords: diabetes, fall, elderly, risk factors

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Authors: Chia-Hui Chen, Chien-Kuo Wang

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Background: Full field digital mammography (FFDM) is widely used in diagnosis of breast cancer. Digital breast tomosynthesis (DBT) has recently been introduced into the clinic and is being used for screening for breast cancer in the general population. Hence, the radiation dose delivered to the patients involved in an imaging protocol is of utmost concern. Aim: To compare the surface radiation dose (ESD) of digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) by using breast phantoms. Method: We analyzed the average entrance surface dose (ESD) of FFDM and DBT by using breast phantoms. Optically Stimulated luminescent Dosimeters (OSLD) were placed in a tissue-equivalent Breast phantom at difference sites of interest. Absorbed dose measurements were obtained after digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM) exposures. Results: An automatic exposure control (AEC) is proposed for surface dose measurement during DBT and FFDM. The mean ESD values for DBT and FFDM were 6.37 mGy and 3.51mGy, respectively. Using of OSLD measured for surface dose during DBT and FFDM. There were 19.87 mGy and 11.36 mGy, respectively. The surface exposure dose of DBT could possibly be increased by two times with FFDM. Conclusion: The radiation dose from DBT was higher than that of FFDM and the difference in dose between AEC and OSLD measurements at phantom surface.

Keywords: full-field digital mammography, digital breast tomosynthesis, optically stimulated luminescent dosimeters, surface dose

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Authors: Salam Hadid, Mohammad Khatib

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The International Council of Nurses-ICN defined nursing as a sphere integrating autonomous and collaborative care intended for the individual, family and community within and outside of the care setting. Nursing as a care profession has developed broadly over recent decades in terms of its essentials, expertise and primarily academically. Despite the impressive growth of the profession, there is still extreme diversity in the public’s perceptions and opinions of the profession and its professionals and in the knowledge on the fundamentals of its true function and spheres of engagement. The current study examines the existing knowledge among the general population regarding the nursing profession. The population consisted of 498 respondents, 236 women and 262 men, age 18-81. The respondents noted that nursing focuses on the technical, and the emotional aspects and promotion of health for the patient are not the nurse’s responsibility. Most of the respondents saw nurses working mainly in hospital and community-based clinic settings. They considered nursing to be a high prestige profession in general, but less prestigious among respondents exposed to healthcare provision. Most of the respondents considered nursing to be a humane profession but without independence and with no need for academic studies. The findings are incompatible with the definition of nursing and its spheres of action as defined in the ICN Code of Ethics. Two suggestions are to work through nursing schools addressing the student nurses, as ambassadors for the profession. The second is using the healthcare encounter between the nursing staff and the public to improve the image of nurses.

Keywords: ethics, nurse image, public, nursing

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Authors: Abrar Noorain, Zeinab Amara, Sulaf Abdelaziz

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Background: Diabetic foot disease imposes a financial burden on diabetic patients and healthcare services. In Sudan, diabetic foot ulcer prevalence reached 18.1%. This study aims to assess the knowledge, attitudes, and practices and the correlation between the level of foot care knowledge and self-care practices among diabetic patients in Sudan. Methodology: In a cross-sectional study involving 262 patients with type 1 and type 2 diabetes attending diabetic clinics in three primary care centers in Khartoum, Sudan, during September to November 2022, information regarding participants sociodemographic status, foot care knowledge, attitudes, and practices was gathered using a validated, structured questionnaire in a face-to-face interview method. These data were analyzed using the statistical package for the social sciences (SPSS) 22. Results: The patients’ mean age was 54.9 years, with a female predominance (56%). Of the participants, 37% had diabetes mellitus for over ten years. On the topic of foot care, 35.5% of patients showed good knowledge, and 76% were aware of the risk of reduced foot sensation. In relation to nail care, only 19% knew how to cut nails correctly. Conclusion: Knowledge, attitudes, and practices about diabetic foot care are substandard. There is a positive correlation between foot care knowledge and self-care practices. Hence, educating diabetic patients with foot care knowledge through an awareness program and the characteristics of diabetic shoes may improve self-care practices.

Keywords: DM, DFD, DFU, PHC, SPSS

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Authors: Şemsettin Şahin, Ahmet Oğuz Aktürk, İsmail Çelik

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This study investigated the views of teachers, students and students' parents on the FATIH (Movement of Enhancing Opportunities and Improving Technology) Project, which was put into service by the Ministry of National Education in cooperation with the Ministry of Transportation in Turkey in November 2010 for the purpose of increasing students' success and planned to be completed within 5 years. The study group consisted of teachers employed in a pilot school in the province of Karaman in central Turkey included within the scope of the FATIH Project, students attending this school and parents whose children are students in that school. The research data were collected through forms developed by the researchers to determine the views of teachers, students and students' parents on the FATIH Project. The descriptive analysis method, one of the qualitative research methods, was used in the study. An analysis of the data revealed that a large majority of the teachers and the students believed that if computers were used to serve their set purpose, then they could make considerable contributions to education. A large majority of the students' parents, on the other hand, regard the use of computers in education as a great opportunity for the students. The views of the teachers, students and students' parents on the FATIH Project usually overlap. Most of the participants in the study pointed out that the FATIH Project was intended to use technology effectively in education. Moreover, each individual participant described their role in the FATIH Project in accordance with their relative position and stated that they could perform whatever was expected of them for the effective and efficient use and progress of the project. The views of the participants regarding the FATİH Project vary according to the kind of the participants.

Keywords: education, FATIH project, technology, students

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Authors: A. Zurraini, Syed Alwi Sar, H. Helmy, H. Nazeefah

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Early Dementia Questionnaire (EDQ) was developed as a screening tool to detect patients with early dementia in primary care. It was developed based on 20 symptoms of dementia. From a preliminary study, EDQ had been shown to be a promising alternative for screening of early dementia. This study was done to further test on EDQ’s reliability and validity. Using a systematic random sampling, 200 elderly patients attending primary health care centers in Kuching, Sarawak had consented to participate in the study and were administered the EDQ. Geriatric Depression Scale (GDS) was used to exclude patients with depression. Those who scored >21 MMSE, were retested using the EDQ. Reliability was determined by Cronbach’s alpha for internal consistency and construct validity was assessed using confirmatory factor analysis (principle component with varimax rotation). The result showed that the overall Cronbach’s alpha coefficient was good which was 0.874. Confirmatory factor analysis on 4 factors indicated that the Cronbach’s alpha for each domain were acceptable with memory (0.741), concentration (0.764), emotional and physical symptoms (0.754) and lastly sleep and environment (0.720). Pearson correlation coefficient between the first EDQ score and the retest EDQ score among those with MMSE of >21 showed a very strong, positive correlation between the two variables, r = 0.992, N=160, P <0.001. The results of the validation study showed that Early Dementia Questionnaire (EDQ) is a valid and reliable tool to be used as a screening tool to detect early dementia in primary care.

Keywords: Early Dementia Questionnaire (EDQ), screening, primary care, construct validity

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Authors: André C. Silva, Débora N. Sousa, Elenice M. S. Silva, Thales P. Fontes, Raphael S. Tomaz

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Starches are widely used as depressant in froth flotation operations in Brazil due to their efficiency, increasing the selectivity in the inverse flotation of quartz depressing iron ore. Starches market have been growing and improving in recent years, leading to better products attending the requirements of the mineral industry. The major source of starch used for iron ore is corn starch, which needs to be gelatinized with sodium hydroxide (NaOH) prior to use. This stage has a direct impact on industrials costs, once the lowest consumption of NaOH in gelatinization provides better control of the pH in the froth flotation and reduces the amount of electrolytes present in the pulp. In order to evaluate the gelatinization degree of different starches and flour were subjected to the addiction of NaOH and temperature variation experiments. Samples of starch (corn, cassava, HIPIX 100, HIPIX 101 and HIPIX 102 commercialized by Ingredion) and flour (cassava and potato) were tested. The starch samples were characterized through Scanning Electronic Microscopy and the amylose content were determined through spectrometry, swelling and solubility tests. The gelatinization was carried out through titration with NaOH, keeping the solution temperature constant at 40 ^oC. At the end of the tests, the optimal amount of NaOH consumed to gelatinize the starch or flour from different botanical sources was established and a correlation between the content of amylopectin in the starch and the starch/NaOH ratio needed for its gelatinization.

Keywords: froth flotation, gelatinization, sodium hydroxide, starches and flours

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Authors: Nawal A. Abu-Shady, Ibrahim M. I. Hamoda, Ahmed R. Z. Baghdadi, Mohammed K. Mohamed

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Background: The aim of this work was to investigate the efficacy of Transcranial Magnetic Therapy (TMT) on balance in hemiparetic stroke patients. It was conducted in outpatient clinic and in BIODEX balance system lab in Faculty of Physical Therapy, Cairo University. Subjects and Methods: Thirty hemiparetic stroke patients from both sexes represent the sample of this study. The patients' ages ranged from 45 to 55 years. They were assigned randomly into two equal groups; the study group (GA) and the control group (GB). control group treated by selected therapeutic physical therapy program. GA treated by the same program of treatment as the GB in addition to TMT. The duration of treatment was six weeks, three times weekly.day after day. The different aspects of dynamic balance (overall stability, anteroposterior stability and mediolateral stability indices) were assessed pre and post treatment objectively by Biodex balance system and clinically by Short Form of Berg Balance Scale (SFBBS) in both groups. Results: Comparison of each variable pre and post treatment in each group revealed a significant improvement in all different parameters in both groups ( p < 0.01), however comparison between post results revealed that the GA showed a high significant improvement higher than the GB in all different variables.

Keywords: stroke, TMT, SFBBS, biodex balance system

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Authors: Sanaa Mekdad, Leenah Alsayed

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Pharmacists play an important role in the CDTM in the care of patients with heart failure (HF). CDTM allows specialized, dedicated clinical pharmacists in a formal agreement in collaborative practice with physicians. Thus, the aim of this study is to investigate the role of cardiology clinical pharmacists in CDTM in decreasing hospitalization and cost. We studied patients with left ventricular systolic dysfunction in a cluster-randomized selection in a tertiary care center. We allocated 296 patients to pharmacist intervention from 1480 patients. Results: With an acceptance rate of 86%, we documented 696 interventions carried out by clinical pharmacists in cardiology. The average intervention was 2.4 patients, and the admission after interventions decreased from 0.79 to. 0.24 (p value = 0.001). Conclusions: In HF CDTM, clinical pharmacists play a crucial role in enhancing medication management, patient education, and lifestyle modification of patients with chronic heart failure. These efforts improve patients' outcomes and lower costs by reducing hospitalization and other associated expenses.

Keywords: cardiology, medication management, heart failure, outpatient therapy, pharmacist-based services, chronic heart failure, heart failure recommendations, CDTM, Middle East, pharmacist-based services, quality of life, pharmacist

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Authors: Naser Shagerdi Esmaeli, Mohsen Hamidpour, Parisa Hasankhani Tehrani

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Background: The TP53 mutation is frequently detected in acute myeloid leukemia (AML) patients with complex karyotype (CK), but the stability of this mutation during the clinical course remains unclear. Material and Methods: In this study, TP53 mutations were identified in 7% of 500 patients with de novo AML and 58.8% of patients with CK in Tabriz, Iran. TP53 mutations were closely associated with older age, lower white blood cell (WBC) and platelet counts, FAB M6 subtype, unfavorable-risk cytogenetics, and CK, but negatively associated with NPM1 mutation, FLT3/ITD and DNMT3A mutation. Result: Multivariate analysis demonstrated that TP53 mutation was an independent poor prognostic factor for overall survival and disease-free survival among the total cohort and the subgroup of patients with CK. A scoring system incorporating TP53 mutation and nine other prognostic factors, including age, WBC counts, cytogenetics, and gene mutations, into survival analysis proved to be very useful to stratify AML patients. Sequential study of 420 samples showed that TP53 mutations were stable during AML evolution, whereas the mutation was acquired only in 1 of the 126 TP53 wild-type patients when therapy-related AML originated from different clone emerged. Conclusion: In conclusion, TP53 mutations are associated with distinct clinic-biological features and poor prognosis in de novo AML patients and are rather stable during disease progression.

Keywords: acute myloblastic leukemia, TP53, FLT3/ITD, Iran

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Authors: Jun Hong Lee

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Background: Many dementia patients complain insomnia and depressive mood, and hypnotics and antidepressants are being prescribed. As prevalence of dementia is increasing, insomnia and depressive mood are becoming more important. Objective: We evaluated insomnia and depression in outpatients of dementia center. Patients and Methods/Material and Methods: We reviewed medical records of the patients who visited outpatients clinic of NHIS Ilsan Hospital Dementia Center during 2016. Results: Total 716 patients are included; Subjective Memory Impairment (SMI) : 143 patients (20%), non-amnestic Mild Cognitive Impairment (MCI): single domain 70 (10%), multiple domain 34 (5%), amnestic MCI: single domain 74 (10%), multiple domain 159 (22%), Early onset Alzheimer´s disease (AD): 9 (1%), AD 121 (17%), Vascular dementia: 62 (9%), Mixed dementia 44 (6%). Hypnotics and antidepressants are prescribed as follows; SMI : hypnotics 14 patients (10%), antidepressants 27 (19%), non-amnestic MCI: single domain hypnotics 9 (13%), antidepressants 12 (17%), multiple domain hypnotics 4 (12%), antidepressants 6 (18%), amnestic MCI: single domain hypnotics 10 (14%), antidepressants 16 (22%), multiple domain hypnotics 22 (14%), antidepressants 24 (15%), Early onset Alzheimer´s disease (AD): hypnotics 1 (11%), antidepressants 2 (22%), AD: hypnotics 10 (8%), antidepressants 36 (30%), Vascular dementia: hypnotics 8 (13%), antidepressants 20 (32%), Mixed dementia: hypnotics 4 (9%), antidepressants 17 (39%). Conclusion: Among the outpatients of Dementia Center, MCI and SMI are majorities, and the number of MCI patients are almost half. Depression is more prevalent in AD, and Vascular dementia than MCI and SMI, and about 22% of patients are being prescribed by antidepressants and 11% by hypnotics.

Keywords: insomnia, depression, dementia, antidepressants, hypnotics

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Authors: Helen Nelly Naiga, Christopher Garimoi Orach

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Introduction: Long-acting reversible contraceptive (LARC) methods are highly effective. However, LARC use in Uganda is low (13%). We assessed the factors associated with the use of long-acting reversible contraceptives among women of reproductive age (15-49 yrs) in Jinja District. Methods: We conducted a facility-based cross-sectional study. A total of 314 women aged 15–49 years attending public health facilities (1 hospital and 3 health center IV) in Jinja district, were randomly selected. A total of 6 key informants and 6 in-depth interviews were conducted. Logistic regression analysis was conducted using Stata version 14. Qualitative data were analysed using thematic analysis. Results: The study found that 40.45% of the respondents had ever used LARC. The commonest LARC method used was implanting (38.22%). The factors significantly associated with use of LARC were employment (AOR =2.91; 95% CI (1.05-8.08), access to LARC methods (AOR =4.48; 95% CI (1.24-16.21), husband support (AOR =4.90; 95% CI (1.56-15.41), and experience of no side effects (AOR =3.48; 95% CI (1.00-12.19). Conclusion and recommendations: The study showed that 4 in 10 women of reproductive age in Jinja District were using LARC. The factors associated with LARC use were employment, husband support, access to LARC methods, and the lack of side effects. There is a need to strengthen client education, improve accessibility to LARC methods at all levels of health centers, improve male partner’s decision-making in LARC use and manage the side effects effectively.

Keywords: family planning, implants, intrauterine device, long-acting reversible contraceptives (LARC)

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Authors: Wan Azuati Wan Omar, Selva Rani John Jasudass, Siti Rohaiza Md. Saad

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Introduction & objective: The objectives of this study were to assess patient’s knowledge of appropriate sublingual glyceryl trinitrate (GTN) use as well as to investigate how patients commonly store and carry their sublingual GTN tablets. Methodology: This was a cross-sectional survey, using a validated researcher-administered questionnaire. The study involved cardiac patients receiving sublingual GTN attending the outpatient and inpatient departments of Taiping Hospital, a non-academic public care hospital. The minimum calculated sample size was 92, but 100 patients were conveniently sampled. Respondents were interviewed on 3 areas, including demographic data, knowledge and use of sublingual GTN. Eight items were used to calculate each subject’s knowledge score and six items were used to calculate use score. Results: Of the 96 patients who consented to participate, majority (96.9%) were well aware of the indication of sublingual GTN. With regards to the mechanism of action of sublingual GTN, 73 (76%) patients did not know how the medication works. Majority of the patients (66.7%) knew about the proper storage of the tablet. In relation to the maximum number of sublingual GTN tablets that can be taken during each angina episode, 36.5% did not know that up to 3 tablets of sublingual GTN can be taken during each episode of angina. Fifty four (56.2%) patients were not aware that they need to replace sublingual GTN every 8 weeks after receiving the tablets. Majority (69.8%) of the patients demonstrated lack of knowledge with regards to the use of sublingual GTN as prevention of chest pain. Conclusion: Overall, patients’ knowledge regarding the self administration of sublingual GTN is still inadequate. The findings support the need for more frequent reinforcement of patient education, especially in the areas of preventive use, storage and drug stability.

Keywords: glyceryl trinitrate, knowledge, adherence, patient education

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Authors: Enkelejda Shkurti, Diamant Shtiza

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Background: Health-related quality of life (HRQoL) is a significant consequence in health care. The objective of our study was to recognize features related to lower HRQoL scores in children with anorectal malformation (ARM) and Hirschsprung disease (HD). Methods: Children younger than 18 years, with HD or ARM, that were assessed at our private clinic in Tirana, Albania, from December 2018 to October 2019, were acknowledged. The outcomes of broad questionnaires concerning diagnosis, symptoms, and preceding health/surgical history and authenticated tools to measure urinary status, stooling grade, and HRQoL were appraised. Results: In patients aged 0-6 years, vomiting and abdominal enlargement were allied with a substantial decrease in total HRQoL scores. In children > 6 years of age, vomiting, abdominal swelling, and abdominal discomfort were also linked to a considerably lower HRQoL. The main indicator of lower HRQoL scores on regression tree analysis in all age clusters was the occurrence of psychosomatic, behavioral, or progressive comorbidity. Conclusion: Children with both HD or ARM that have a psychosomatic, behavioral, or growing problem experience considerably lower HRQoL than patients deprived of such problems, proposing that establishment of behavioral/growing sustenance as part of the care of these patients may have a considerable influence on their HRQoL.

Keywords: anorectal malformation, Hirsch Sprung disease, quality of life, Albania

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Authors: R. H. Bustos, L. Martinez, J. García, F. Suárez

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MRP1 (Multi-drug resistance associated protein 1) and MRP2 (Multi-drug resistance associated protein 2) are two proteins belonging to the transporters of ABC (ATP-Binding Cassette). These transporter proteins are involved in the efflux of several biological drugs and xenobiotic and also in multiple physiological, pathological and pharmacological processes. Evidence has been found that there is a correlation among different polymorphisms found and their clinical implication in the resistance to antiepileptic, chemotherapy and anti-infectious drugs. In our study, exonic regions of MRP1/ABCC1 y MRP2/ABCC2 were studied in the Colombian population, specifically in the region of the central Savannah (Cundinamarca) to determinate SNP (Single Nucleotide Polymorphisms) and determinate its allele frequency and its genomics frequency. Results showed that for our population, SNP are found that have been previously reported for MRP1/ABCC1 (rs200647436, rs200624910, rs150214567) as well as for MRP2/ABCC2 (rs2273697, rs3740066, rs142573385, rs17216212). In addition, 13 new SNP were identified. Evidences show an important clinic correlation for polymorphisms rs3740066 and rs2273697. The study object population displays genetic variability as compared to the one reported in other populations.

Keywords: ATP-binding cassette (ABCC), Colombian population, multidrug-resistance protein (MRP), pharmacogenetic, single nucleotide polymorphism (SNP)

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Authors: V. A. Adzika, D. Ayim-Aboagye, T. Gordh

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Background and aims: Prevalence of Sickle Cell Disease (SCD) is high in Ghana but not much is known in terms of research into non-medical strategies for managing and coping with the pain associated with SCD. This study was carried out to examine effective non-medical related strategies patients use to cope and manage their SCD condition. Methods: SCD patients (387) consisting of 180 males and 204 females between 18-65 years old years participated in the study. A cross-sectional research design was used in which participants completed questionnaires on pain, non-medical coping and management strategies, anxiety, and depression. Results of multiple regression analysis showed that socio-demographic characteristics contributed to the variance in the pain associated with SCD. Results: Over 90% of participants reported that pains associated with SCD were the main reason for seeking treatment in SCD crisis. In terms of non-medical related coping strategies, attending a place of worship and praying were the main coping strategies used in SCD crises, suggesting that patients’ beliefs, particularly in a supernatural being, served as a mitigating factor in the process of coping with the pain associated with SCD crisis. Also, avoidance and withdrawal from people and social activities were reported to be strategies used to cope effectively with the pain associated with SCD crisis. Conclusion: This indicates that it is imperative to incorporate non-medical related coping and management strategies, especially religious beliefs and psychosocial factors, to coping and management of the pain associated with SCD.

Keywords: anxiety, depression, sickle cell disease, quality of life, socio-demographic characteristics, Ghana

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Authors: Danielle Morin, Jennifer D. E. Thomas, Raafat G. Saade, Daniela Petrachi

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Over the past few decades, more and more students choose to enroll in online classes instead of attending in-class lectures. While past studies consider students’ attitudes towards online education and how their grades differed from in-class lectures, the profile of the online student remains a blur. To shed light on this, an online survey was administered to about 1,500 students enrolled in an undergraduate Fundamental Business Technology course at a Canadian University. The survey was comprised of questions on students’ demographics, their reasons for choosing online courses, their expectations towards the course, the communication channels they use for the course with fellow students and with the instructor. This paper focused on the research question: Do the perspectives of online students concerning the online experience, in general, and in the course in particular, differ according to age profile? After several statistical analyses, it was found that age does have an impact on the reasons why students select online classes instead of in-class. For example, it was found that the perception that an online course might be easier than in-class delivery was a more important reason for younger students than for older ones. Similarly, the influence of friends is much more important for younger students, than for older students. Similar results were found when analyzing students’ expectation about the online course and their use of communication tools. Overall, the age profile of online users had an impact on reasons, expectations and means of communication in an undergraduate Fundamental Business Technology course. It is left to be seen if this holds true across other courses, graduate and undergraduate.

Keywords: communication channels, fundamentals of business technology, online classes, pedagogy, user age profile, user perspectives

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Authors: B. Nageshwar Rao

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Urinary tract infection (UTI) represents the most commonly acquired bacterial infection worldwide, with substantial morbidity, mortality, and economic burden. The objective of the study is to characterize the microbial profiles of uropathogenic in the obstetric population by RTPCR. Study design: An observational cross-sectional study was performed at a single tertiary health care hospital among 50 pregnant women with UTIs, including asymptomatic and symptomatic patients attending the outpatient department and inpatient department of Obstetrics and Gynaecology.Methods: Serotyping and genes detection of various uropathogens were studied using RTPCR. Pulse filed gel electrophoresis methods were used to determine the various genetic profiles. Results: The present study shows that CsgD protein, involved in biofilm formation in Escherichia coli, VIM1, IMP1 genes for Klebsiella were identified by using the RTPCR method. Our results showed that the prevalence of VIM1 and IMP1 genes and CsgD protein in E.coli showed a significant relationship between strong biofilm formation, and this may be due to the prevalence of specific genes. Finally, the genetic identification of RTPCR results for both bacteria was correlated with each other and concluded that the above uropathogens were common isolates in producing Biofilm in the pregnant woman suffering from urinary tract infection in our hospital observational study.

Keywords: biofilms, Klebsiella, E.coli, urinary tract infection

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Authors: Chengbin Wang, Li Lu, Luodan Suo, Qinghai Wang, Fan Yang, Xu Wang, Mona Marin

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Background: Two-dose varicella vaccination has been recommended in Beijing since November 2012. We investigated a varicella outbreak in a highly vaccinated elementary school population to examine transmission patterns and risk factors for vaccine failure. Methods: A varicella case was defined as an acute generalized maculopapulovesicular rash without other apparent cause in a student attending the school from March 28 to May 17, 2015. Breakthrough varicella was defined as varicella >42 days after last vaccine dose. Vaccination information was collected from immunization records. Information on prior disease and clinical presentation was collected via survey of students’ parents. Results: Of the 1056 school students, 1028 (97.3%) reported no varicella history, of whom 364 (35.4%) had received 1-dose and 650 (63.2%) had received 2-dose varicella vaccine, for 98.6% school-wide vaccination coverage with ≥ 1 dose before the outbreak. A total of 20 cases were identified for an overall attack rate of 1.9%. The index case was in a 2-dose vaccinated student who was not isolated. The majority of cases were breakthrough (19/20, 95%) with attack rates of 7.1% (1/14), 1.6% (6/364) and 2.0% (13/650) among unvaccinated, 1-dose, and 2-dose students, respectively. Most cases had < 50 lesions (18/20, 90%). No difference was found between 1-dose and 2-dose breakthrough cases in disease severity or sociodemographic factors. Conclusion: Moderate 2-dose varicella vaccine coverage was insufficient to prevent a varicella outbreak. Two-dose breakthrough varicella is still contagious. High 2-dose varicella vaccine coverage and timely isolation of ill persons might be needed for varicella outbreak control in the 2-dose era.

Keywords: varicella, outbreak, breakthrough varicella, vaccination

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Authors: James Alberto Ortega Morales, Nelson Andrés Martínez Marín

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The bulding industry is one of the most important sectors all around the world in terms of contribution to index like GDP and labor. On the other hand, it is a major contributor to Greenhouse Gases (GHG) and waste generation contributing to global warming. In this sense, it is necessary to establish sustainable practices both from the strategic point of view to the operations point of view as well in all business and industries. Business models don’t scape to this reality attending it´s mediator role between strategy and operations. Business models can turn from the traditional practices searching economic benefits to sustainable bussines models that generate both economic value and value for society and the environment. Recent advances in the analysis of sustainable business models find different classifications that allow finding potential triple bottom line (economic, social and environmental) solutions applicable in every business sector. Into the metioned Advances have been identified, 11 groups and 45 patterns of sustainable business models have been identified; such patterns can be found either in the business models as a whole or found concurrently in their components. This article presents the analysis of a case study, seeking to identify the components and elements that are part of it, using the ECO CANVAS conceptual model. The case study allows showing the concurrent existence of different patterns of business models for sustainability empirically, serving as an example and inspiration for other Latin American companies interested in integrating sustainability into their new and existing business models.

Keywords: sustainable business models, business sustainability, business model patterns, case study, construction industry

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Authors: Abhishek Sharma, Amit Gupta, Manish Singhal

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Background: The management of patients with penetrating neck injuries in the prehospital setting and in the emergency department has evolved with regard to the use of multidetector computed tomographic (MDCT) imaging. Hence, there is a shift in the management of neck injuries from mandatory exploration in certain anatomic areas to more conservative approach using imaging and so-called “no zone approach”. Objective: To study the no zone approach in the management of penetrating neck injury using routine imaging in all stable patients. Methods: 137 patients with penetrating neck injury attending emergency department of level 1 trauma centre at AIIMS between 2008–2014 were retrospectively analysed. All hemodynamically stable patients were evaluated using CT scanning. Results: Stab injury is most common (55.91%) mode of pni in civilian population followed by gunshot(18.33%). The majority of patients could be managed with imaging and close observation. 39 patients (28.46%) required operative intervention. The most common indication for operative intervention was vascular followed by airway injury manifesting as hemodynamic destabilisation.There was no statistical difference between the zonal distribution of injuries in patients managed conservatively and those taken to OR. Conclusions: Study shows that patients with penetrating neck trauma who are haemodynamically stable and exhibit no “hard signs” of vascular injury or airway injury may be evaluated initially by MDCT imaging even when platysma violation is present. “No Zone” policy may be superior to traditional zone wise management.

Keywords: penetrating neck injury, zone approach, CT scanning, multidetector computed tomographic (MDCT)

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Authors: Haile Nega Mulata, Seifu Daniel, Umeta Melaku, Wendwesson Ergete, Natesan Gnanasekaran

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Background: In Ethiopia, medicinal plants have been used for various human and animal diseases. In this study, we have examined the potential effect of hydroethanolic extract of Calpurnia aurea seed against hepatotoxicity and haematotoxicity induced by Highly Active Antiretroviral Therapy (HAART) drugs in Albino Wistar rats. Methods: We collected Matured dried seeds of Calpurnia aurea from northern Ethiopia (south Tigray and south Gondar) in June 2013. The powder of the dried seed sample was macerated with 70% ethanol and dried using rotavapor. We have investigated the Preliminary phytochemical tests and in-vitro antioxidant properties. Then, we induced toxicity with HAART drugs and gave the experimental animals different doses of the crude extract orally for thirty-five days. On the 35th day, the animals were fasted overnight and sacrificed by cervical dislocation. We collected the blood samples by cardiac puncture. We excised the liver and brain tissues for further histopathological studies. Subsequently, we analysed serum levels of the liver enzymes- Alanine Aminotransferase, Aspartate Aminotransferase, Alkaline Phosphatase, Total Bilirubin, and Serum Albumin, using commercial kits in Cobas Integra 400 Plus Roche Analyzer Germany. We have also assessed the haematological profile using an automated haematology Analyser (Sysmex KX-2IN). Results: A significant (P<0.05) decrease in serum enzymes (ALT and AST) and total bilirubin were observed in groups that received the highest dose (300mg/kg) of the seed extract. And significant (P<0.05) elevation of total red blood cell count, haemoglobin, and hematocrit percentage was observed in the groups that received the seed extract compared to the HAART-treated groups. The WBC count mean values showed a statistically significant increase (p<0.05) in groups that received HAART and 200 and 300mg/kg extract, respectively. The histopathological observations also showed that the oral administration of varying doses of the crude extract of the seed reversed to a normal state. Conclusion: The hydroethanolic extract of the Calpurnia aurea seed lowered the hepatotoxicity and haematotoxicity in a dose-dependent manner. The antioxidant properties of the Calpurnia aurea seed extract may have possible protective effects against the drug's toxicity.

Keywords: calpurnia aurea, hepatotoxicity, haematotoxicity, antioxidant, histopathology, HAART

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Authors: Roger WUMBA

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The objective of this study was to determine the prevalence of intestinal parasites, with special emphasis on microsporidia and Cryptosporidium, as well as their association with human immunodeficiency virus (HIV) symptoms, risk factors, and other digestive parasites. We also wish to determine the molecular biology definitions of the species and genotypes of microsporidia and Cryptosporidium in HIV patients. In this cross-sectional study, carried out in Kinshasa, Democratic Republic of the Congo, stool samples were collected from 242 HIV patients (87 men and 155 women) with referred symptoms and risk factors for opportunistic intestinal parasites. The analysis of feces specimen were performed using Ziehl–Neelsen stainings, real-time polymerase chain reaction (PCR), immunofluorescence indirect monoclonal antibody, nested PCR-restriction fragment length polymorphism, and PCR amplification and sequencing. Odds ratio (OR) and 95% confidence intervals were used to quantify the risk. Of the 242 HIV patients, 7.8%, 0.4%, 5.4%, 0.4%, 2%, 10.6%, and 2.8% had Enterocytozoon bieneusi, Encephalitozoon intestinalis, Cryptosporidium spp., Isospora belli, pathogenic intestinal protozoa, nonpathogenic intestinal protozoa, and helminths, respectively. We found five genotypes of E. bieneusi: two older, NIA1 and D, and three new, KIN1, KIN2, and KIN3. Only 0.4% and 1.6% had Cryptosporidium parvum and Cryptosporidium hominis, respectively. Of the patients, 36.4%, 34.3%, 31%, and 39% had asthenia, diarrhea, a CD4 count of ,100 cells/mm³, and no antiretroviral therapy (ART), respectively. The majority of those with opportunistic intestinal parasites and C. hominis, and all with C. parvum and new E. bieneusi genotypes, had diarrhea, low CD4+ counts of ,100 cells/mm³, and no ART. There was a significant association between Entamoeba coli, Kaposi sarcoma, herpes zoster, chronic diarrhea, and asthenia, and the presence of 28 cases with opportunistic intestinal parasites. Rural areas, public toilets, and exposure to farm pigs were the univariate risk factors present in the 28 cases with opportunistic intestinal parasites. In logistic regression analysis, a CD4 count of ,100 cells/mm³ (OR = 4.60; 95% CI 1.70–12.20; P = 0.002), no ART (OR = 5.00; 95% CI 1.90–13.20; P , 0.001), and exposure to surface water (OR = 2.90; 95% CI 1.01–8.40; P = 0.048) were identified as the significant and independent determinants for the presence of opportunistic intestinal parasites. E. bieneusi and Cryptosporidium are becoming more prevalent in Kinshasa, Congo. Based on the findings, we recommend epidemiology surveillance and prevention by means of hygiene, the emphasis of sensitive PCR methods, and treating opportunistic intestinal parasites that may be acquired through fecal–oral transmission, surface water, normal immunity, rural area-based person–person and animal–human nfection, and transmission of HIV. Therapy, including ART and treatment with fumagillin, is needed.

Keywords: diarrhea, enterocytozoon bieneusi, cryptosporidium hominis, cryptosporidium parvum, risk factors, africans

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Authors: JoVontae Butts

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A central and enduring theme in the study of American politics is political participation, which indicates the health of a democracy, citizen buy-in, and fair political representation. Though voting push factors have been thoroughly researched and are becoming better understood, the effect of those same push factors often varies for marginalized people. Black voters begun to cast votes at a steadily increasing rate following the 1996 election, gradually growing to its highest level in the 2012 presidential election, even surpassing white voter participation rates. The thirty-year growth period of Black voter engagement concluded in the 2016 election, with the number of participating Black voters stumbling by approximately 7% while other demographics remained roughly the same. Theories for the shift in Black voter behavior range from vote suppression to discouragement due to Barack Obama’s concluding tenure in office. Furthermore, Black voter engagement rebounded in the 2020 election, leaving turnout and race scholars to speculate even further, predicting that disapproval of Trump energized the Black voter bloc. Though there is much conjecture regarding the changes in Black voter behavior, there is truly little empirical evidence to vet those suppositions. This study engages and quantifies speculations for the changes in Black voter engagement in recent elections using 2016 and 2020 American National Election Studies Pilot Study data. Additionally, this study expands upon McGregor’s theory of political hypervigilance by exploring differences in political engagement for church-attending Black voters and those that do not.

Keywords: race, religion, evangelicalism, political engagement

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Authors: Osama Shakeel

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The objective of the paper is to study the clinic-pathological factors, survival analyses, recurrence rate, metastatic rate, risk factors and the management of cutaneous malignant melanoma at Shaukat Khanum Memorial Cancer Hospital and Research Center. Methodology: From 2014 to 2017, all patients with a diagnosis of cutaneous malignant melanoma (CMM) were included in the study. Demographic variables were collected. Short and long term oncological outcomes were recorded. All data were entered and analyzed in SPSS version 21. Results: A total of 28 patients were included in the study. Median age was 46.5 +/-15.9 years. There were 16 male and 12 female patients. The family history of melanoma was present in 7.1% (n=2) of the patients. All patients had a mean survival of 13.43+/- 9.09 months. Lower limb was the commonest site among all which constitutes 46.4%(n=13). On histopathological analyses, ulceration was seen in 53.6% (n=15) patients. Unclassified tumor type was present in 75%(n=21) of the patients followed by nodular 21.4% (n=6) and superficial spreading 3.5%(n=1). Clark level IV was the commonest presentation constituting 46.4%(n=13). Metastases were seen in 50%(n=14) of the patients. Local recurrence was observed in 60.7%(n=17). 64.3%(n=18) lived after one year of treatment. Conclusion: CMM is a fatal disease. Although its disease of fair skin individuals, however, the incidence of CMM is also rising in this part of the world. Management includes early diagnoses and prompt management. However, mortality associated with this disease is still not favorable.

Keywords: malignant cancer of skin, cutaneous malignant melanoma, skin cancer, survival analyses

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Authors: Mustafa Ali Abugila, Basma Nuri Kajruba, Hanan Elhadi, Rehab Ramadan Wali

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Iron deficiency anemia is characterized by a decrease of Hb (hemoglobin), serum iron, ferritin, and RBC (red blood cells) (shape and size). Also, it is characterized by an increase in total iron binding capacity (TIBC). Red blood cells become microctytic and hypochromic due to a decrease in iron content. This study was conducted in the north west of Libya and included 210 women in childbearing age (18-45 years) who were visiting women clinic. After filling the questionnaire, blood samples were taken and analyzed for hematological and biochemical profiles. Biochemical tests included measurement of serum iron, ferritin, and total iron binding capacity (TIBC). Among the total sample (210 women), there were 87 (41.42%) pregnant and 123 (58.57%) non-pregnant women (includes married and single). Pregnant women (87) were classified according to the gestational age into first, second, and third trimesters. The means of biochemical and hematological parameters in the studied samples were: Hb = 10.37± 2.02 g/dl, RBC = 3.78± 1.037 m/m3, serum iron 61.86± 40.28 µg/dl, and TIBC = 386.01 ± 94.91 µg/dl. In this study, we considered that any women have hemoglobin below 11.5 g/dl is anemic. 89.1%, 69.5%, and 47.8% of pregnant women who belong to third trimester had low (below normal value) Hb, serum iron, and ferritin, i.e. iron deficiency anemia was more common in third trimester among the first and the second trimesters. Third trimester pregnant women also had high TIBC more than first and second trimesters.

Keywords: red blood cells, hemoglobin, total iron binding capacity, ferritin

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Authors: Siwanit Autthawuttikul, Prakob Koraneekid, Sayamon Insa-ard

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The purposes of this research were to development creatively integrated teaching skills using Information and Communication Technology (ICT) for professional teacher in schools under the education area of the basic education commission, ministry of education both schools under the office of primary education and those under The office of secondary education in eight western region provinces of Thailand. This is useful in defining a vision for the school strategy and restructuring schools in addition, teachers will have developed skills in teaching creative integrated ICT. The research methodology comprises quantitative and qualitative data collection. The Baseline Survey, focus group for discussions and then the model was developed creatively integrated teaching skills using ICT. The findings showed that 7 elements were important: (1) Academy Transformation (2) Information Technology Infrastructure (3) Personal Development (4) Supervision, Monitoring and Evaluation (5) Motivating and Rewarding (6) Important factor affecting the success of teaching integrated with ICT were knowledge, skills, attitudes and (7) The role of the individual concerned. The comparison creatively integrated teaching skills before and after participating in the overall shows that the average creatively integrated teaching skills using ICT after attending the event is 3.27, and standard deviation was 0.56, higher than before which is 2.60 and the standard deviation was 0.56. There are significant differences significant statistically level of .05. The final average score of the evaluation plan design creatively integrated teaching skills using ICT teachers' average score was 26.94 at the high levels.

Keywords: integrated curriculum, information and communications technology, teachers in the western region, schools

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