Search results for: rare disease policy

Authors: Kasun U. G. Palihakkara

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Although vaccine coverage in Sri Lanka is close to 100%, with the widely spreading vaccine rejection trend reaching South Asian regions, it is essential to catch on whether Sri Lankans are being misinformed from the common misconceptions regarding vaccines. As the rates of target diseases decrease, parents become less accepting of even minor common adverse events. It is essential to preserve the integrity of immunization programs and protect public health by finding out the prevalence of anti-immunization trends. The primary objective of this study was to assess the immunization practices and prevalence of trends related to anti-immunization among urban community in Sri Lanka. A descriptive cross-sectional quantitative study on 323 participants using convenient sampling with 213 self-administered questionnaires. Additionally, 110 online questionnaires were distributed. 31% of the study population does not maintain immunization records for their children. While majority seek information regarding immunization from reliable sources such as the family physician or specialist pediatricians, 30% also refer to unreliable sources such as online communities for their opinion. 31% of study population had not vaccinated for Japanese encephalitis. 73% of the study population had encountered with side effects of vaccination such as fever & 47% believed that such side effects are rare. 52% of the population had hostile attitude regarding the administration of several doses multiple vaccines within a child’s first year. Diseases like polio had been successfully eradicated from Sri Lanka with the help of vigorous vaccination programs. However, majority of the study population believe that there’s no need to keep vaccinating the children for those eradicated diseases and exposing the child for adverse effects of such vaccines. Majority of the population were aware of the existing misconceptions regarding immunization. The most popular misconceptions about vaccines popular among the study population were the MMR (Measles, Mumps, and Rubella) vaccine being a possible cause leading to autism and bowel disease and children getting infected with the disease even after they get vaccinated, may be due to the inactivated vaccine. Disturbingly 22% of the study population believed that vaccines are useless in preventing diseases nowadays. These data obtained from the urban study population reveals that even though statistically Sri Lankan immunization coverage is 100%, there is a possibility of anti-vaccination trend arising in Sri Lanka due to the prevalence of various misconceptions and rumors related to it. Therefore these data recommend the need for thorough awareness among the mothers.

Keywords: anti-vaccination, immunization, infectious diseases, pediatric health

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Authors: Popoola I. Olayinka, Alamu E. Oladeji, B. Maziya-Dixon

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Cassava, an indigenous crop grown locally by subsistence farmers in Nigeria has potential to bring economic benefits to the country. Consumption of bread and other confectionaries has been on the rise due to lifestyle changes of Nigerian consumers. However, wheat, being the major ingredient for bread and confectionery production does not thrive well under Nigerian climate hence the huge spending on wheat importation. To reduce spending on wheat importation, the Federal Government of Nigeria intends passing into law mandatory inclusion of 20% high-quality cassava flour (HQCF) in wheat flour. While the proposed policy may reduce post harvest loss of cassava, and also increase food security and domestic agricultural productivity, there are downsides to the policy which include reduction in nutritional quality and low sensory appeal of cassava-wheat bread, reluctance of flour millers to use HQCF, technology and processing challenges among others. The policy thus presents an ethical dilemma which must be resolved for its successful implementation. While inclusion of HQCF to wheat flour in bread and confectionery is a topic that may have been well addressed, resolving the ethical dilemma resulting from the act has not received much attention. This paper attempts to resolve this dilemma using various approaches in food ethics (cost benefits, utilitarianism, deontological and deliberative). The Cost-benefit approach did not provide adequate resolution of the dilemma as all the costs and benefits of the policy could not be stated in the quantitative term. The utilitarianism approach suggests that the policy delivers greatest good to the greatest number while the deontological approach suggests that the act (inclusion of HQCF to wheat flour) is right hence the policy is not utterly wrong. The deliberative approach suggests a win-win situation through deliberation with the parties involved.

Keywords: HQCF, ethical dilemma, food security, composite flour, cassava bread

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Authors: Zhou Shangcheng, Yi Sicen

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Objective: To understand the mortality patterns of Zhangwan District in 2010 and provide the basis for the development of scientific and rational health policy. Methods: Data are collected from the Sixth Census of Zhangwan District and disease surveillance system. The statistical analysis include death difference between age, gender, region and time and the related factors. Methods developed for the Global Burden of Disease (GBD) Study by the World Bank and World Health Organization (WHO) were adapted and applied to Zhangwan District population health data. DALY rate per 1,000 was calculated for varied causes of death. SPSS 16 is used by statistic analysis. Results: From the data of death population of Zhangwan District we know the crude mortality rate was 6.03 ‰. There are significant differences of mortality rate in male and female population which was respectively 7.37 ‰ and 4.68 ‰. 0 age group population life expectancy in Zhangwan District in 2010 was 78.40 years old(Male 75.93, Female 81.03). The five leading causes of YLL in descending order were: cardiovascular diseases(42.63DALY/1000), malignant neoplasm (23.73DALY/1000), unintentional injuries (5.84DALY/1000), Respiratory diseases(5.43 DALY/1000), Respiratory infections (2.44DALY/1000). In addition, there are strong relation between the marital status , educational level and mortality in some to a certain extend. Conclusion Zhangwan District, as city level, is at lower mortality levels. The mortality of the total population of Zhangwan District has a downward trend and life expectancy is rising.

Keywords: sixth census, Zhangwan district, death level differences, influencing factors, cause of death

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Authors: Gulnaz Erkomaishvili

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The paper discusses mineral water consumer market and development policy in Georgia, the tools and measures, which will contribute to the production of mineral waters and increase its export. The paper studies and analyses current situation in mineral water production sector as well as the factors affecting increase and reduction of its export. It’s noted that in order to gain and maintain competitive advantage, it’s necessary to provide continuous supply of high-quality goods with modern design, open new distribution channels to enter new markets, carry out broad promotional activities, organize e-commerce. Economic policy plays an important role in protecting markets from counterfeit goods. The state also plays an important role in attracting foreign direct investments. Stable business environment and export-oriented strategy is the basis for the country’s economic growth. Based on the research, the paper suggests the strategy for improving the competitiveness of Georgian mineral waters, relevant conclusions and recommendations are provided.

Keywords: mineral waters, consumer market for mineral waters, export of mineral waters, mineral water development policy in Georgia

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Authors: Ozlem Temiz-Arpaci, Meryem Tasci, Fatma Sezer Senol, İlkay Erdogan Orhan

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Alzheimer’s disease (AD), a neurodegenerative disorder characterized by a progressive deterioration of memory and cognition, occurs more frequently in elderly people. Current treatment approaches in this disease with the major therapeutic strategy are based on the AChE and BChE inhibition. On the other hand, tyrosinase inhibition has become a target for the treatment of Parkinson’s disease (PD) since this enzyme may play a role in neuromelanin formation in the human brain and could be critical in the formation of dopamine neurotoxicity associated with neurodegeneration linked to PD. Also benzoxazoles are structural isosteres of natural nucleotides that can interact with biopolymers so that benzoxazoles showed a lot of different biological activities. In this study, a series of 2,5-disubstituted-benzoxazole derivatives were synthesized and were evaluated as possible inhibitors of acetylcholinesterase (AChE) / butyrylcholinesterase (BChE) and tyrosinase. The results demonstrated that the compounds exhibited a weak spectrum of AChE / BChE inhibitory activity ranging between 3.92% - 54.32% except compound 8 which showed no activity against AChE and compound 4 which showed no activity against BChE at the specified molar concentrations. Also, the compounds indicated lower than tyrosinase inhibitory activity of ranging between 8.14% - 22.90% to that of reference (kojic acid).

Keywords: AChE and BChE inhibition, Alzheimer’s disease, benzoxazoles, tyrosinase inhibition

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Authors: Naim Izet Kajtazi

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Context: Increased intracranial pressure and associated symptoms such as headache, papilledema, motor or sensory deficits, seizures, and conscious disturbance are well-known in acute CVT. However, visual loss is not commonly associated with this disease, except in the case of secondary IIH associated with it. Process: We report a case of a 40-year-old male with Behçet’s disease and cerebral venous thrombosis, and other multiple comorbidities admitted with a four-day history of increasing headache and rapidly progressive visual loss bilaterally. The neurological examination was positive for bilateral papilledema of grade 3 with light perception on the left eye and counting fingers on the right eye. Brain imaging showed old findings of cerebral venous thrombosis without any intraparenchymal lesions to suggest a flare-up of Behçet’s disease. The lumbar puncture, followed by the lumbar drain insertion, gave no benefit in headache or vision. However, he completely lost sight. The right optic nerve sheath fenestration did not result in vision improvement. The acute spinal shock complicated the lumbar drain removal due to epidural hematoma. An urgent lumbar laminectomy with hematoma evacuation undertook. Intra-operatively, the neurosurgeon noted suspicious abnormal vessels at conus medullaris with the possibility of an arteriovenous malformation. Outcome: In a few days following the spinal surgery, the patient vision started to improve. Further improvement was achieved after plasma exchange sessions followed by cyclophosphamide. In the recent follow-up in the clinic, he reported better vision, drove, and completed his Ph.D. studies. Relevance: Visual loss in patients with Behçet’s disease should always be anticipated and taken reasonable care of, ensuring that they receive well-combined immunosuppression with anticoagulation and agents to reduce intracranial pressure. This patient’s story is significant for a high disease burden and complicated hospital course by acute spinal shock due to spinal lumbar drain removal with a possible underlying spinal arteriovenous malformation.

Keywords: Behcet disease, optic neuritis, IIH, CVT

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Authors: Choi Younshick, Lee Wonseok, Lee Jaemeun, Park Sun-Hyun, Kim Sunwoung, Park Sua, Kim Eun Ho, Kim Jong-Ki

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Iron accumulation in the brain accelerates Alzheimer’s disease progression. To cure iron toxicity, we assessed the therapeutic effects of noncontact transcranial electric field stimulation to the brain on toxic iron deposits in either the Aβ-fibril structure or the Aβ plaque in a mouse model of Alzheimer’s disease (AD). A capacitive electrode-based alternating electric field (AEF) was applied to a suspension of magnetite (Fe₃O₄) to measure the field-sensitized electro-Fenton effect and resultant reactive oxygen species (ROS) generation. The increase in ROS generation compared to the untreated control was both exposure-time and AEF-frequency dependent. The frequency-specific exposure of AEF to 0.7–1.4 V/cm on a magnetite-bound Aβ-fibril or a transgenic Alzheimer’s disease (AD) mouse model revealed the removal of intraplaque ferrous magnetite iron deposit and Aβ-plaque burden together at the same time compared to the untreated control. The results of the behavioral tests show an improvement in impaired cognitive function following AEF treatment on the AD mouse model. Western blot assay found some disease-modifying biological responses, including down-regulating ferroptosis, neuroinflammation and reactive astrocytes that eventually made cognitive improvement feasible. Tissue clearing and 3D-imaging analysis revealed no induced damage to the neuronal structures of normal brain tissue following AEF treatment. In conclusion, our results suggest that the effective degradation of magnetite-bound amyloid fibrils or plaques in the AD brain by the electro-Fenton effect from electric field-sensitized magnetite offers a potential electroceutical treatment option for AD.

Keywords: electroceutical, intraplaque magnetite, alzheimer’s disease, transcranial electric field, electro-fenton effect

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Authors: Aneri Mehta, Krunal Mehta

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A doctrine, any doctrine, incorporates a set of beliefs or principles held by a body of persons. A national nuclear doctrine represents, therefore, the collective set of beliefs or principles held by the nation in regard to the utility of its nuclear weapons. India’s foreign policy has been profoundly affected by the nuclear explosions conducted in May 1998. The departure from the professed peaceful nuclear policies has had several implications for India’s defense and foreign policies. The explosions in Pokhran have aggravated tensions in south Asia by disrupting diplomatic initiatives with Pak and China. Diplomacy has been reduced to damage control. The object of India’s nuclear deterrence is to persuade an adversary that the costs to him of seeking a military solution to his political problems with India will far outweigh the benefits. The paper focuses on India’s guidelines governing nuclear policy, development of nuclear materials for effective deterrence as well as civil development purpose. The paper finds that security concerns and technological capabilities are important determinants of whether India develops a nuclear weapons programs, while security concerns, economic capabilities, and domestic politics help to explain the possession of nuclear weapons.

Keywords: foreign policy, nuclear deterrence, nuclear policy, development

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Authors: Bahareh Khakifirooz, Arian Shojaei, Amirhossein Hajialigol, Bahare Abdolahi

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Laceration of the inner layer of the myometrium can cause massive bleeding during and after childbirth, which can lead to the death of the mother if it is not diagnosed in time. We studied a rare case of massive intrapartum bleeding following myometrial laceration that was diagnosed correctly, and the patient survived with in-time treatments. The patient was a 26 years-old woman who was under observation for term pregnancy and complaint of rupture of membranes (ROM) and vaginal bleeding. Following the spontaneous course of labor and without receiving oxytocin, during the normal course of labor, she had an estimated total blood loss of 750 mL bleeding, which, despite the normal fetal heart rate and with the mother's indication for cesarean section, was transferred to the operating room and underwent cesarean section. During the cesarean section, the amniotic fluid was clear; after the removal of the placenta, severe and clear bleeding was flowing from the posterior wall of the uterus, which was caused by the laceration of the inner layer of the myometrium in the posterior wall of the lower segment of the uterus. The myometrial laceration was repaired with absorbable continuous locked sutures, and hemostasis was established, then, the patient used uterotonic drugs, and after monitoring, the patient was discharged from the hospital in good condition.

Keywords: intrapartum hemorrhage, inner myometrial laceration, labor, Increased intrauterine pressure

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Authors: Haider Karar, Saghir Ahmad, Amjad Ali, Ibrar Ul Haq

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The experiment was conducted at Cotton Research Station, Multan to study the impact of weather factors and red cotton bug (RCB) on cotton boll disease yielded yellowish lint during 2012. The population on RCB along with abiotic factors was recorded during three consecutive years i.e. 2012, 2013, and 2014. Along with population of RCB and abiotic factors, the number of unopened/opened cotton bolls (UOB), percent yellowish lint (YL) and whitish lint (WL) were also recorded. The data revealed that the population per plant of RCB remain 0.50 and 0.34 during years 2012, 2013 but increased during 2014 i.e. 3.21 per plant. The number of UOB were more i.e. 13.43% in 2012 with YL 76.30 and WL 23.70% when average maximum temperature 34.73◦C, minimum temperature 22.83◦C, RH 77.43% and 11.08 mm rainfall. Similarly in 2013 the number of UOB were less i.e. 0.34 per plant with YL 1.48 and WL 99.53 per plant when average maximum temperature 34.60◦C, minimum temperature 23.37◦C, RH 73.01% and 9.95 mm rainfall. During 2014 RCB population per plant was 3.22 with no UOB and YL was 0.00% and WL was 100% when average maximum temperature 23.70◦C, minimum temperature 23.18◦C, RH 71.67% and 4.55 mm rainfall. So it is concluded that the cotton bolls disease was more during 2012 due to more rainfall and more percent RH. The RCB may be the carrier of boll rot disease pathogen during more rainfall.

Keywords: red cotton bug, cotton, weather factors, years

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Authors: Kyngäs Helvi, Patala-Pudas, Kaakinen Pirjo

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It has been reported that COPD -patients may experience much emotional distress, which can compromise positive health outcomes. The aim of this study was to explore disease-related uncertainty as reported by Chronic Obstructive Pulmonary Disease (COPD) patients. Uncertainty was defined as a lack of confidence; negative feelings; a sense of confidence; and awareness of the sources of uncertainty. Research design was a non-experimental cross-sectional survey. The data (n=141) was collected by validated questionnaire during COPD -patients’ visits or admissions to a tertiary hospital. The response rate was 62%. The data was analyzed by statistical methods. Around 70% of the participants were male with COPD diagnosed many years ago. Fifty-four percent were under 65 years and used an electronic respiratory aid apparatus (52%) (oxygen concentrator, ventilator or electronic inhalation device). Forty-one percent of the participants smoked. Disease-related uncertainty was widely reported. Seventy-three percent of the participants had uncertainty about their knowledge of the disease, the pulmonary medication and nutrition. One-quarter (25%) did not feel sure about managing COPD exacerbation. About forty percent (43%) reported that they did not have a written exacerbation decision aid indicating how to act in relation to COPD symptoms. Over half of the respondents were uncertain about self-management behavior related to health habits such as exercise and nutrition. Over a third of the participants (37%) felt uncertain about self-management skills related to giving up smoking. Support from the care providers was correlated significantly with the patients’ sense of confidence. COPD -patients who felt no confidence stated that they received significantly less support in care. Disease-related uncertainty should be considered more closely and broadly in the patient care context, and those strategies within patient education that enhance adherence should be strengthened and incorporated into standard practice.

Keywords: adherence, COPD, disease-management, uncertainty

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Authors: Mark Angelo Maranon, David Endriga

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Objective: The aim of the study is to determine the differences in functional outcome and quality of life of adult patients with Potts disease who have undergone surgical versus non-surgical management. Methods: In this prospective cohort study, 45 patients were followed up for 1 year after undergoing pharmacologic treatment alone versus a combination of anti-Kochs and surgery for Potts disease. Oswestry Disability Index (ODI) and Short Form-36 (SF-36) were obtained on initiation of treatment, after three months, six months and one year. Results: ASIA scores from the onset of treatment and after 1 year significantly improved (p<0.001) for both non-surgical and surgical patients. ODI scores significantly improved after 6 months of treatment for both surgical and non-surgical patients. Both surgical and non-surgical patients showed significant improvement in their SF-36 scores, but scores were noted to be higher in patients who underwent surgery. Conclusions: Significant improvement with regards to functional outcome and quality of life was noted from both surgical and non-surgical patients after 1 year of treatment, with earlier improvements and better final scores in SF 36 and ODI in patients who underwent surgery.

Keywords: tuberculosis, spinal, potts disease, functional outcome

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Authors: Dharmendra Pratap

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Large Cardamom (Amomum subulatum), family Zingiberaceae is an aromatic spice crop and has rich medicinal value. Large Cardamom is as synonymous to Sikkim as Tea is to Darjeeling. Since Sikkim alone contributes up to 88% of India's large cardamom production which is the world leader by producing over 50% of the global yield. However, the production of large cardamom has declined almost to half since last two decade. The economic losses have been attributed to two viral diseases namely, chirke and Foorkey. Chirke disease is characterized by light and dark green streaks on leaves. The affected leaves exhibit streak mosaic, which gradually coalesce, turn brown and eventually dry up. Excessive sprouting and formation of bushy dwarf clumps at the base of mother plants that gradually die characterize the foorkey disease. In our surveys in Sikkim–Darjeeling hill area during 2012-14, 40-45% of plants were found to be affected with foorkey disease and 10-15% with chirke. Mechanical and aphid transmission study showed banana as an alternate host for both the disease. For molecular identification, total genomic DNA and RNA was isolated from the infected leaf tissues and subjected to Rolling circle amplification (RCA) and RT-PCR respectively. The DNA concatamers produced in the RCA reaction were monomerized by different restriction enzymes and the bands corresponding to ~1 kb genomes were purified and cloned in the respective sites. The nucleotide sequencing results revealed the association of Nanovirus with the foorkey disease of large cardamom. DNA1 showed 74% identity with Replicase gene of FBNYV, DNA2 showed 77% identity with the NSP gene of BBTV and DNA3 showed 74% identity with CP gene of BBTV. The finding suggests the presence of a new species of nanovirus associated with foorkey disease of large cardamom in Sikkim and Darjeeling hills. The details of their epidemiology and other factors would be discussed.

Keywords: RCA, nanovirus, large cardamom, molecular virology and microbiology

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Authors: Fatma Al-Maadheed

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Following an ethnographic approach this study explored bilingual programmes offered by two types of primary schools in Qatar: international and Independent schools. Qatar with its unique linguistic and socio-economic situation launched a new initiative for educatiobnal development in 2001 but with hardly any research linked to theses changes. The study reveals that the Qatari bilingual schools context was one of heteroglossia, with three codes in operation: Modern Standard Arabic, Colloquial Arabic dialects and English. The two schools adopted different models of bilingualism. The international school adopted a strict separation policy between the two languages following a monoglossic belief. The independent school was found to apply a flexible language policy. The study also highlighted the daily challnges produced from the diglossia situation in Qatar, the difference between students and teacher dialect as well as acquiring literacy in the formal language. In addition to an abscence of a clear language policy in Schools, the study brought attention to the instructional methods utilised in language teaching which are mostly associated with successful bilingual education.

Keywords: diglossia, instructional methods, language policy, qatari primary schools

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Authors: R. Cooper, M. Kurien

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Background: Coeliac Disease affects around 1 in 100 people. Untreated, it can result in serious morbidity such as malabsorption and cancers. The only treatment is to adhere to a gluten free diet (GFD). International guidelines recommend that people with the coeliac disease receive follow-up healthcare annually to detect complications early and support their adherence to a GFD. However, there is a finite amount of healthcare in the UK, and as such, not all patients receive follow-up care as recommended by the guidelines. Furthermore, there is an increasing number of patients being diagnosed with coeliac disease. Given the potential severe morbidity that non-adherence to a GFD could result in, alongside reports that the rate of non- GFD adherence could be as high as 91%, it is imperative that action is taken. One potential solution to this would be to provide follow-up care digitally through utilising technology. This abstract reports on a rapid review undertaken to explore the existing evidence in this area. Methods: In June 2020, 11 bibliographic databases were searched to find any pertinent studies. The inclusion criteria required the study to be written in the English language and report on the use of digital healthcare interventions for people with Coeliac Disease. Results: A small amount of evidence (n=8) was found which met our inclusion criteria and pertained to the provision of CD follow-up digitally. These studies focussed either on educating and supporting patients to adhere to a GFD or providing consultation remotely with a focus on detecting complications early. These studies showed that there is potential for digital healthcare interventions to positively impact people with coeliac disease. However, it is suggested that the effectiveness of these interventions may depend on local circumstances, individual knowledge of CD and general attitudes. Conclusion: The above studies suggest that providing follow-up care digitally may offer a potential solution; however, the evidence about how this should be done and in what circumstances this will work for individuals is scarce. In the light of the COVID-19 pandemic, the introduction of digital healthcare interventions appears to be highly topical, and as such, this review may benefit from being refreshed in the future.

Keywords: coeliac disease, follow-up, gluten free diet, digital healthcare interventions

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Authors: Thaer Khaleel Swaid, Maryam Al Ahmad, Ishtiaq Ahmad

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47-year-old female, known to have a liver cyst and hemangiomas, presented to the gastroenterology clinic for chronic moderate postprandial epigastric pain, which is aggravated by food, leaning forward and relieved on lying flat. The pain was associated with nausea, vomiting, heartburn and excessive burping. She opened her bowel daily, having well-formed stools without blood or mucus. The patient denied NSAID intake, smoking or alcohol. On physical examination during the episode of pain abdomen revealed a soft, lax abdomen and mild tenderness in the epigastric region without organomegaly. Bowel sounds were audible. Her routine hematological and biochemical parameters were within normal, including CBC, Celiac serology, Lipase, Metabolic profile and H pylori stool antigen. The patient underwent an Ultrasound of the abdomen which showed multiple liver cysts, hemangioma, normal GB and biliary tree. Based on the clinical picture and to narrow our differential diagnosis, an ultrasound Doppler for the abdomen was ordered, and it showed celiac artery peak systolic velocity in expiration is 270cm/s, suggestive of median arcuate ligament syndrome. She Had computerized tomography abdomen done and showed a Narrowing of the celiac artery at the origin, likely secondary to low insertion of the median arcuate ligament. Furthermore, Gastroscopy and, later on colonoscopy were done, which was unremarkable. A laparoscopic decompression of the celiac trunk was indicated, for which the patient was referred to vascular surgery. This case confirms that Median Arcuate Ligament syndrome is an unusual diagnosis and is always challenging. Usually, patients undergo extensive workups before a final diagnosis is achieved. Our case highlights the challenge of diagnosing MALS since this entity is rare. It is a good choice to perform abdominal ultrasound with Doppler imaging on a patient with symptoms such as postprandial angina.

Keywords: Unveiling the Mystery, MALS, rare entity, Rare vascular phenomenon

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Authors: Melkamu A., Woldu B., Sitotaw C., Seyoum M., Aynalem M.

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Background: Liver disease is any condition that affects the liver cells and their function. It is directly linked to coagulation disorders since most coagulation factors are produced by the liver. Therefore, this study aimed to assess the magnitude and associated factors of coagulation abnormalities among liver disease patients. Methods: A cross-sectional study was conducted from August to October 2022 among 307 consecutively selected study participants at the University of Gondar Comprehensive Specialized Hospital. Sociodemographic and clinical data were collected using a structured questionnaire and data extraction sheet, respectively. About 2.7 mL of venous blood was collected and analyzed by the Genrui CA51 coagulation analyzer. Data was entered into Epi-data and exported to STATA version 14 software for analysis. The finding was described in terms of frequencies and proportions. Factors associated with coagulation abnormalities were analyzed by bivariable and multivariable logistic regression. Result: In this study, a total of 307 study participants were included. Of them, the magnitude of prolonged Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) were 68.08% and 63.51%, respectively. The presence of anemia (AOR = 2.97, 95% CI: 1.26, 7.03), a lack of a vegetable feeding habit (AOR = 2.98, 95% CI: 1.42, 6.24), no history of blood transfusion (AOR = 3.72, 95% CI: 1.78, 7.78), and lack of physical exercise (AOR = 3.23, 95% CI: 1.60, 6.52) were significantly associated with prolonged PT. While the presence of anaemia (AOR = 3.02; 95% CI: 1.34, 6.76), lack of vegetable feeding habit (AOR = 2.64; 95% CI: 1.34, 5.20), no history of blood transfusion (AOR = 2.28; 95% CI: 1.09, 4.79), and a lack of physical exercise (AOR = 2.35; 95% CI: 1.16, 4.78) were significantly associated with abnormal APTT. Conclusion: Patients with liver disease had substantial coagulation problems. Being anemic, having a transfusion history, lack of physical activity, and lack of vegetables showed significant association with coagulopathy. Therefore, early detection and management of coagulation abnormalities in liver disease patients are critical.

Keywords: coagulation, liver disease, PT, Aptt

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Authors: Sunidhi Syal, Rasangi Tennakoon, Patrick O'Donoghue

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Polyglutamine (polyQ) diseases are a group of diseases related to neurodegeneration caused by repeats of the amino acid glutamine (Q) in the DNA, which translates into an elongated polyQ tract in the protein. The pathological explanation is that the polyQ tract forms cytotoxic aggregates in the neurons, leading to their degeneration. There are no cures or preventative efforts established for these diseases as of today, although the symptoms of these diseases can be relieved. This study specifically focuses on Huntington's disease, which is a type of polyQ disease in which aggregation is caused by the extended cytosine, adenine, guanine (CUG) codon repeats in the huntingtin (HTT) gene, which encodes for the huntingtin protein. Using this principle, we attempted to create six models, which included mutating wildtype tRNA alanine variant tRNA-AGC-8-1 to have glutamine anticodons CUG and UUG so serine is incorporated at glutamine sites in poly Q tracts. In the process, we were successful in obtaining tAla-8-1 CUG mutant clones in the HTTexon1 plasmids with a polyQ tract of 23Q (non-pathogenic model) and 74Q (disease model). These plasmids were transfected into mouse neuroblastoma cells to characterize protein synthesis and aggregation in normal and mistranslating cells and to investigate the effects of glutamines replaced with alanines on the disease phenotype. Notably, we observed no noteworthy differences in mean fluorescence between the CUG mutants for 23Q or 74Q; however, the Triton X-100 assay revealed a significant reduction in insoluble 74Q aggregates. We were unable to create a tAla-8-1 UUG mutant clone, and determining the difference in the effects of the two glutamine anticodons may enrich our understanding of the disease phenotype. In conclusion, by generating structural disruption with the amino acid alanine, it may be possible to find ways to minimize the toxicity of Huntington's disease caused by these polyQ aggregates. Further research is needed to advance knowledge in this field by identifying the cellular and biochemical impact of specific tRNA variants found naturally in human genomes.

Keywords: Huntington's disease, polyQ, tRNA, anticodon, clone, overlap PCR

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Authors: Manoj Kumar Reddy Pulim, Lakshmi Muthukrishnan, Geetha Jayapathy, Radhika Raman

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Introduction: In the past two decades, noninvasive positive pressure ventilation (NIPPV) emerged as one of the most important advances in the management of both acute and chronic respiratory failure in children. In the acute setting, it is an alternative to intubation with a goal to preserve normal physiologic functions, decrease airway injury, and prevent respiratory tract infections. There is a need to determine the clinical profile and parameters which point towards the need for NIV in the pediatric emergency setting. Objectives: i) To study the clinical profile of children who required non invasive ventilation and invasive ventilation, ii) To study the clinical parameters common to children who required non invasive ventilation. Methods: All children between one month to 18 years, who were intubated in the pediatric emergency department and those for whom decision to commence Non Invasive Ventilation was made in Emergency Room were included in the study. Children were transferred to the Paediatric Intensive Care Unit and started on Non Invasive Ventilation as per our hospital policy and followed up in the Paediatric Intensive Care Unit. Clinical profile of all children which included age, gender, diagnosis and indication for intubation were documented. Clinical parameters such as respiratory rate, heart rate, saturation, grunting were documented. Parameters obtained were subject to statistical analysis. Observations: Airway disease (Bronchiolitis 25%, Viral induced wheeze 22%) was a common diagnosis in 32 children who required Non Invasive Ventilation. Neuromuscular disorder was the common diagnosis in 27 children (78%) who were Intubated. 17 children commenced on Non Invasive Ventilation who later needed invasive ventilation had Neuromuscular disease. High frequency nasal cannula was used in 32, and mask ventilation in 17 children. Clinical parameters common to the Non Invasive Ventilation group were age < 1 year (17), tachycardia n = 7 (22%), tachypnea n = 23 (72%) and severe respiratory distress n = 9 (28%), grunt n = 7 (22%), SPO2 (80% to 90%) n = 16. Children in the Non Invasive Ventilation + INTUBATION group were > 3 years (9), had tachycardia 7 (41%), tachypnea 9(53%) with a male predominance n = 9. In statistical comparison among 3 groups,'p' value was significant for pH, saturation, and use of Ionotrope. Conclusion: Invasive ventilation can be avoided in the paediatric Emergency Department in children with airway disease, by commencing Non Invasive Ventilation early. Intubation in the pediatric emergency department has a higher association with neuromuscular disorders.

Keywords: clinical parameters, indications, non invasive ventilation, paediatric emergency room

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Authors: A. A. M. A. S. S. Perera, L. A. Ranasinghe, T. K. H. Nimeshika, D. M. Dhanushka Dissanayake, Namalie Walgampaya

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Nowadays, skin fungal diseases are mostly found in people of tropical countries like Sri Lanka. A skin fungal disease is a particular kind of illness caused by fungus. These diseases have various dangerous effects on the skin and keep on spreading over time. It becomes important to identify these diseases at their initial stage to control it from spreading. This paper presents an automated skin fungal disease identification system implemented to speed up the diagnosis process by identifying skin fungal infections in digital images. An image of the diseased skin lesion is acquired and a comprehensive computer vision and image processing scheme is used to process the image for the disease identification. This includes colour analysis using RGB and HSV colour models, texture classification using Grey Level Run Length Matrix, Grey Level Co-Occurrence Matrix and Local Binary Pattern, Object detection, Shape Identification and many more. This paper presents the approach and its outcome for identification of four most common skin fungal infections, namely, Tinea Corporis, Sporotrichosis, Malassezia and Onychomycosis. The main intention of this research is to provide an automated skin fungal disease identification system that increase the diagnostic quality, shorten the time-to-diagnosis and improve the efficiency of detection and successful treatment for skin fungal diseases.

Keywords: Circularity Index, Grey Level Run Length Matrix, Grey Level Co-Occurrence Matrix, Local Binary Pattern, Object detection, Ring Detection, Shape Identification

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Authors: Hee-Young Song

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Background and objectives: In 2011, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations proposed a multidimensional assessment of patients’ conditions that included both functional parameters and patient-reported outcomes, with the aim to provide a comprehensive assessment of the disease, thus meeting both the needs of the patient and the role of the physician. However, few studies have evaluated patient-reported outcomes as well as objective functional assessments among individuals with chronic obstructive pulmonary disease (COPD) in clinical practice in Korea. This study was undertaken to explore the relationship between functional status assessed by the 6-minute walking distance (MWD) test and subjective health status reported by stable patients with COPD residing in community. Methods: A cross-sectional descriptive study was conducted with 118 stable COPD patients aged 69.4 years old and selected by a convenient sampling from an outpatient department of pulmonology in a tertiaryhospitals. The 6-MWD test was conducted according to standardized instructions. Participants also completed a constructed questionnaire including general characteristics, smoking history, dyspnea by modified medical research council (mMRC) scale, and health status by COPD assessment test (CAT). Anthropometric measurements were performed for body mass index (BMI). Medical records were reviewed to obtain disease-related characteristics including duration of the disease and forced expiratory volume in 1 second (FEV1). Data were analyzed using PASW statistics 20.0. Results: Mean FEV1% of participants was 63.51% and mean 6-MWD and CAT scores were 297.54m and 17.7, respectively. The 6-MWD and CAT showed significant negative correlations (r= -.280, p=.002); FEV1 and CAT did as well correlations (r= -.347, p < .001). Conclusions: Findings suggest that the better functional status an individual with COPD has, the better subjective health status is, and provide the support for using patient-reported outcomes along with functional parameters to facilitate comprehensive assessment of COPD patients in real clinical practices.

Keywords: chronic obstructive pulmonary disease, COPD assessment test, functional status, patient-reported outcomes

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Authors: Joseph Falzon, Margaret Nelson

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Background: Policy makers at European Union (EU) and national levels address the re-use of historic buildings calling for sustainable practices and approaches. Implementation stages of policy are crucial so that EU and national strategic objectives for historic building sustainability are achieved. Governance remains one of the key objectives to ensure resource sustainability. Objective: The aim of the research was to critically examine policies for the regeneration and adaptive re-use of historic buildings in the EU and national level, and to analyse gaps between EU and national legislation and policies, taking Malta as a case study. The impact of policies on regeneration and re-use of historic buildings was also studied. Research Design: Six semi-structured interviews with stakeholders including architects, investors and community representatives informed the research. All interviews were audio recorded and transcribed in the English language. Thematic analysis utilising Atlas.ti was conducted for the semi-structured interviews. All phases of the study were governed by research ethics. Findings: Findings were grouped in main themes: resources, experiences and governance. Other key issues included identification of gaps in policies, key lessons and quality of regeneration. Abandonment of heritage buildings was discussed, for which main reasons had been attributed to governance related issues both from the policy making perspective as well as the attitudes of certain officials representing the authorities. The role of authorities, co-ordination between government entities, fairness in decision making, enforcement and management brought high criticism from stakeholders along with time factors due to the lengthy procedures taken by authorities. Policies presented an array from different perspectives of same stakeholder groups. Rather than policy, it is the interpretation of policy that presented certain gaps. Interpretations depend highly on the stakeholders putting forward certain arguments. All stakeholders acknowledged the value of heritage in regeneration. Conclusion: Active stakeholder involvement is essential in policy framework development. Research informed policies and streamlining of policies are necessary. National authorities need to shift from a segmented approach to a holistic approach.

Keywords: adaptive re-use, historic buildings, policy, sustainable

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Authors: Jai Hyung Park, Eugene Kim, Jin Hun Park, Min Joon Oh

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Introduction: Subchondral insufficiency fracture of the femoral head (SIF) is a rare complication; however, it has been recognized to cause femoral head collapse. Subchondral insufficiency fracture (SIF) is caused by normal or physiological stress without any trauma. It has been reported in osteoporotic patients after the fixation of the proximal femur with an Intramedullary nail. Case presentation: We reported 5 cases with SIF of the femoral head after proximal femur fracture fixation with Intra-medullary nail. All patients had osteoporosis as an underlying disease. Good reduction was achieved in all 5 patients. SIF was found from about 3 months to 4 years after the initial operation, and all the fractures were solidly united at the final diagnosis. We investigated retrospectively the feature of those cases and several factors that affected the occurrence of SIF. Discussion: There are a few discussions regarding the SIF of the femoral head. These discussions may include the predisposing risk factors, how to diagnose the SIF in osteoporotic patients, and the peri-operative factors to prevent SIF. Conclusion: Subchondral insufficiency fracture of the femoral head is a considerable complication after the internal fixation of the proximal femur. There are several factors that can be modified. If they could be controlled in the peri-operative period, SIF could be prevented or handled in advance. Other options related to arthroplasty can be considered in old osteoporotic patients.

Keywords: insufficiency fracture of femoral head, intra-medullary nail, osteoporosis, proximal femur fracture

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Authors: Mohammad Javad Esmaeili

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Background: Coagulopathy is one of the complications with end stage renal disease with high prevalence in the world. Thromboelastogram is adynamic test for evaluation of coagulopathy and we have compared our patient's coagulation profiles with the results of TEG. Material and methods: In this study 50 patients with ESRD who were on regular hemodialysis for at least 6 months was selected with simple sampling and their coagulation profile was done with blood sampling and also TEG was done for every patient. Data were analyzed with SPSS and P<0.05 consider significant. Results: Protein s, Protein c and Antithrombin III deficiency was detected in 32%, 16% and 20% of patients and activated protein c resistance was abnormal in 2% of patients. In TEG, R time in 49% and K in 22/5% of patients was lower than normal and a-angle in 26% and maximum amplitude in 36% of patients was upper than normal (Hypercoagulable state). PS with R and ATIII with K have correlation. Conclusion: R time and K in TEG can be a suitable screening test in patients with suspicious to PS and ATIII deficiency.

Keywords: thromboelastography, chronic kidney disease, Coagulating disorder, hemodialysis

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Authors: Vanita Singh

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In developing countries, there are conflicting political agendas; policy makers have to prioritize issues from a list of issues competing for the limited resources. Thus, it is imperative to understand how some issues gain attention, and others lose in the policy circles. Multiple-Streams Theory of Kingdon (1984) is among the influential theories that help to understand the public policy process and is utilitarian for health policy makers to understand how certain health issues emerge on the policy agendas. The issue of maternal mortality was long standing in India and was linked with high birth rate thus the focus of maternal health policy was on family planning since India’s independence. However, a paradigm shift was noted in the maternal health policy in the year 1992 with the launch of Safe Motherhood Programme and then in the year 2005, when the agenda of maternal health policy became universalizing institutional deliveries and phasing-out of Traditional Birth Attendants (TBAs) from the health system. There were many solutions proposed by policy communities other than universalizing of institutional deliveries, including training of TBAs and improving socio-economic conditions of pregnant women. However, Government of India favored medical community, which was advocating for the policy of universalizing institutional delivery, and neglected the solutions proposed by other policy communities. It took almost 15 years for the advocates of institutional delivery to transform their proposed solution into a program - the Janani Suraksha Yojana (JSY), a safe-motherhood program promoting institutional delivery through cash incentives to pregnant women. Thus, the case of safe motherhood policy in India is worth studying to understand how certain issues/problems gain political attention and how advocacy work in policy circles. This paper attempts to understand the factors that favored the agenda of safe-motherhood in the policy circle in India, using John Kingdon’s Multiple-Stream model of agenda-setting. Through document analysis and literature review, the paper traces the evolution of safe motherhood program and maternal health policy. The study has used open source documents available on the website of Ministry of Health and Family Welfare, media reports (Times of India Archive) and related research papers. The documents analyzed include National health policy-1983, National Health Policy-2002, written reports of Ministry of Health and Family Welfare Department, National Rural Health Mission (NRHM) document, documents related to Janani Suraksha Yojana and research articles related to maternal health programme in India. The study finds that focusing events and credible indicators coupled with media attention has the potential to recognize a problem. The political elites favor clearly defined and well-accepted solutions. The trans-national organizations affect the agenda-setting process in a country through conditional resource provision. The closely-knit policy communities and political entrepreneurship are required for advocating solutions high on agendas. The study has implications for health policy makers in identifying factors that have the potential to affect the agenda-setting process for a desired policy agenda and identify the challenges in generating political priorities.

Keywords: agenda-setting, focusing events, Kingdon’s model, safe motherhood program India

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Authors: Rameesha Javaid

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Agriculture is the backbone of the economy of the province of Balochistan which is known as the ‘fruit basket’ of Pakistan. Its climate zones comprising highlands and plateaus, dependent on rain water, are more suited for the production of deciduous fruit. The vagaries of weather and more so the persistent droughts prompted the government to announce flat rates of electricity bills per month irrespective of the size of the farm, quantum or water used and the category of crop group. That has, no doubt, resulted in increased cropping intensity, more production and employment but has enormously burdened the official exchequer which picks up the residual bills in certain percentages amongst the federal and provincial governments and the local electricity company. This study tests the desirability of continuing the subsidy in the present mode. Optimization of social welfare of farmers has been the focus of the study with emphasis on the contribution of positive externalities and distortions caused in terms of negative externalities. By using the optimization technique with due allowance for distortions, it has been established that the subsidy calls for limiting policy distortions as they cause sub-optimal utilization of the tube well subsidy and improved policy programming. The sensitivity analysis with changed rankings of contributing variables towards social welfare does not significantly change the result. Therefore it leads to the net findings and policy recommendations of significantly reducing the subsidy size, correcting and curtailing policy distortions and targeting the subsidy grant more towards small farmers to generate more welfare by saving a sizeable amount from the subsidy for investment in the wellbeing of the farmers in rural Balochistan.

Keywords: distortion, policy distortion, socio-cultural distortion, social welfare, subsidy

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Authors: Khalid Al Mutairi, Mashhor Mansor, Magdy El-Bana, Saud L. Al-Rowaily, Asyraf Mansor

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The present study was carried out in 20 islands of Farasan Archipelago in Saudi Arabia to describe the biogeography patterns of plants. A total of 191 species belonging to 129 genera and 53 families were identified. Following island biogeography theory, total plant species richness and their ecological groups were positively influenced by island size, number of habitats,elevation and were not affected by isolation. The high level of nestedness, the strong effect of area on total plant species richness and ecological groups, and the similarity of vegetation composition on the islands has several implications for conservation. In conclusion the large and richest islands in Farasan Archipelago such as Farasan Alkbir would conserve higher diversity than several smaller islands. This island also includes rare habitats like coral rocks and rare species. The invasion of the unique habitats such as wadi channels and water catchments in this island by the exotic tree Prosopis juliflora should be managed to conserve the native biodiversity. The protection of such critical habitats is very important on the other large island (e.g. Zufaf), due to their limited distribution in the country.

Keywords: island biogeography, conservation, farasan archipelago, saudi arabia, plant diversity

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Authors: Nopsarun Vannasirikul

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The purposes of this research paper were to study the current situations of community development, women’s potentials, women’s participation, network, and government policy as well as to study the factors influencing women’s potentials, women’s participation, network, and government policy that have on the community development. The population included the women age of 18 years old who were living in the communities of Bangkok areas. This study was a mix research method of quantitative and qualitative method. A simple random sampling method was utilized to obtain 400 sample groups from 50 districts of Bangkok and to perform data collection by using questionnaire. Also, a purposive sampling method was utilized to obtain 12 informants for an in-depth interview to gain an in-sight information for quantitative method.

Keywords: community development, participation, network, women’s right, management

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Authors: Baljit Soroya

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Transnational communities are as a consequence of greater mobility of people, globalization and digitization have had a major impact on international relations and diasporas in the context of external conflicts. To a significant extent conflicts are becoming deterritorialised and informed by both internal (state politics) and external (foreign policy) players such as in Iraq and Syria leading to forced migration of unprecedented levels within the last two decades. The situation of forced migrants has, it is suggested, worsened as a consequence of the neo-liberal policies and requirements of organizations such as the European Bank. A case example of this being that of Greece, and the exacerbation of insecurity for Greek nationals and the demonization of refugees seeking sanctuary. This has been as a consequence, in part, of the neoliberal dogma of the European Bank. The article analyses the complex intersection of the real and perceived threats of international terrorism and the manner in which UK migration policy and Practice is unfolding. The policy and practice developments are explored in the context of the shift in politics in both the UK and wider Europe to the far right and the drift of main stream political parties to the right. In many cases, the mainstream political groupings, have co-opted the fears as presented by far right organization for political their own political gains, such as in the UK and France In its analysis it will be argued that, whilst international terrorism is an issue of concern, however in the context of the UK it is not of the same scale as the effects of climate change or indeed domestic violence. Given that, the question has to be asked why the threat of international terrorism is having such an impact on UK migration policy and practice and, specifically refugees. Furthermore, it is argued that this policy and practice are being formulated within a narrative that portrays migrants as the problem both in relation to terrorism and the disenfranchisement of ‘ordinary white communities’. The intersectionality of social, economic inequalities, fear of international terrorism, increase in conflicts and the political climate have contributed to a lack of trust of political establishments that have in turn sought to impress the public with their anti-immigrant rhetoric and policy agendas. The article ends by suggesting that whilst politics and political affiliations have become fractured there are nevertheless spaces for collective action, particularly in relation to issues of refugees.

Keywords: international terrorism, migration policy, conflict, media, community, politics

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Authors: En-Tzu Wang, Ting-Ann Wang, Yi-Hui Shen, Yu-Min Chou, Chi-Tai Fang, Chin-Hui Yang

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Background and purpose: A mass varicella immunization program was established to provide free 1-dose vaccination for all 1-year-old children throughout Taiwan since 2004. The epidemiological characteristics and disease burden of varicella from 2000 to 2012 was investigated and the results will be essential to refine the national immunization policy. Method: We included patients (n = 17,838–164,245) with ICD-9-CM codes 052 (chickenpox) from the 2000 to 2012 National Health Insurance Database. The age, period, and cohort-specific incidence of varicella were calculated. The hospital admission rate, medical costs and indirect costs from the societal perspective of varicella including travel costs to the medical facility, registration fee, productivity losses of the patients and caregivers were also estimated. Result: There were 979,252 patients for medical treatment due to varicella from 2000 to 2012 in Taiwan. The implementation of a routine childhood varicella vaccination program has resulted in 87% decline in morbidity (881.49 to 115.17 per 100,000). The average age of patients increased from 7.9 years to 16.3 years. The overall varicella-related hospital admission rate was 15.5 per 1000 patients, and peaked in the groups of infants younger than 1 year, adults aged from 20 to 39 years and elders over 70 years. Among patients admitted to hospital, 33.5% of them had one or more complications. Patients with underlying diseases had higher admission rate (241.6 per 1,000) and longer duration of hospital stay (6.61 days vs. 4.76 days). The annual varicella-related medical expense declined after 2002 and the proportion of medical costs for admission has increased to 42%. The annual indirect costs from the societal perspective of varicella were 5.29 to 9.63 times higher than varicella-related medical costs. Every one dollar invested in the varicella immunization program, 2.97 dollars of medical and social costs were saved on average. Conclusion: The dramatic decline in morbidity, hospitalization, medical and social costs of varicella can be directly attributed to the implementation of the mass immunization program. Two-dose vaccination is recommended for both children with underlying diseases and susceptible adults to prevent serious complications and hospitalizations.

Keywords: disease burden, epidemiology, medical and social costs, varicella, varicella vaccine

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