Search results for: disease diagnosis

Authors: Denise Ben-Porath, Tracy Masterson

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In the past, individuals who struggled with and sought treatment for mental health difficulties were stigmatized. However, the current generation holds more open attitudes around mental health issues. Indeed, public figures such as Demi Lovato, Naomi Osaka, and Simone Biles have taken to social media to break the silence around mental health, discussing their own struggles and the benefits of treatment. Thus, there is considerable reason to believe that this generation would hold fewer stigmatizing attitudes toward mental health difficulties and treatment compared to previous ones. In this study, we explored possible changes in stigma on mental health diagnosis and treatment seeking behavior between two generations: Gen Z, the current generation, and Gen X, those born between 1965-1980. It was hypothesized that Gen Z would hold less stigmatizing views on mental illness than Gen X. To examine possible changes in stigma attitudes between these two generations, we conducted a cross-generational cohort design by using the same methodology employed 20 years ago from the Ben-Porath (2002) study. Thus, participants were randomly assigned to read one of the following four case vignettes employed in the Ben-Porath (2002) study: (a) “Tom” who has received psychotherapy due to depression (b) “Tom” who has been depressed but received no psychological help, (c) “Tom” who has received medical treatment due to a back pain, or (d) “Tom” who had a back pain but did not receive medical attention. After reading the vignette, participants rated “Tom” on various personality dimensions using the IFQ Questionnaire and answered questions about their frequency of social media use and willingness to seek mental health treatment on a scale from 1-10. Identical to the results 20 years prior, a significant main effect was found for diagnosis with “Tom” being viewed in more negative terms when he was described as having depression vs. a medical condition (back pain) [F (1, 376) = 126.53, p < .001]. However, in the study conducted 20 years earlier, a significant interaction was found between diagnosis and help-seeking behavior [F (1, 376) = 8.28, p < .005]. Specifically, “Tom” was viewed in the most negative terms when described as depressed and seeking treatment. Alternatively, the current study failed to find a significant interaction between depression and help seeking behavior. These findings suggest that while individuals who hold a mental health diagnosis may still be stigmatized as they were 20 years prior, seeking treatment for mental health issues may be less so. Findings are discussed in the context of social media use and its impact on destigmatization.

Keywords: stigma, mental illness, help-seeking, social media

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Authors: Qiannan Zhuo, Wanglin Yan

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Minamata City and its citizens have been suffered from Minamata Disease, one of the worst environmental problems in Japan, since 1956. To mitigate the bad images brought by Minamata Disease, Minamata City has started a series of environmental friendly activities from 60 years ago. Garbage separation is the very beginning one. It has been already done for more than 20 years since Minamata citizens started to separate their garbage into more than 20 categories. In this research, the author evaluated the effectiveness of the waste management policy in Minamata city by analyzing the recycle rate and the landfill amount., and also pointed out the problems brought by it through the qualitative survey.

Keywords: Minamata City, households waste, garbage separation, recycle reduce reuse

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Authors: Liudmila Garzanova, Lidia Ananyeva, Olga Koneva, Olga Ovsyannikova, Oxana Desinova, Mayya Starovoytova, Rushana Shayahmetova, Anna Khelkovskaya-Sergeeva

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Abstract Objectives. Rituximab (RTX) shown a positive effect in the treatment of systemic sclerosis (SSc). But there is still not enough data on comparing the effectiveness of RTX with immunosuppressants (IS). The aim of our study was to compare changes of lung function and skin score in SSc between two groups of patients (pts) - on RXT therapy (prescribed after ineffectiveness of previous therapy with IS) and on therapy with IS only. Methods. This study included 103 pts received RTX as an addition to previous therapy (group 1) and 65 pts received therapy with IS and prednisolone (group 2). The mean follow-up period was 12.6±10.7months. In group 1 the mean age was 47±12.9 years, female – 88 pts (84%), the diffuse cutaneous subset of the disease had 55 pts (53%). The mean disease duration was 6.2±5.5 years. 82% pts had interstitial lung disease (ILD) and 92% were positive for ANA, 67% of them were positive for antitopoisomerase-1. All pts received prednisolone at a dose of 11.3±4.5 mg/day, IS at inclusion received 47% of them. The cumulative mean dose of RTX was 1.7±0.6 g. In group 2 the mean age was 50.8±13.8 years, female-53 pts (82%), the diffuse cutaneous subset of the disease had 44 pts (68%). The mean disease duration was 8.8±7.7 years. 81% pts had ILD and 88% were positive for ANA, 58% of them were positive for antitopoisomerase-1. All pts received prednisolone at a dose of 8.69±4.28 mg/day, IS received 57% of them. Cyclophosphamide (CP) received 45% of pts. The cumulative mean dose of CP was 10.2±15.1g. D-penicillamine received 30% of pts. Other pts was on mycophenolate mofetil or methotrexate therapy in single cases. The pts of the compared groups did not differ in the main demographic and clinical parameters. The results are presented as delta (Δ) - difference between the baseline parameter and follow up point. Results. In group 1 there was an improvement of all outcome parameters: increased of forced vital capacity, % predicted - ΔFVC=4% (p=0.0004); Diffusing capacity for carbon monoxide, % predicted remained stable (ΔDLCO=0.1%); improvement of the Rodnan skin score-ΔmRss=3.4 (p=0.001); decrease of Activity index (EScSG-AI) - ΔActivity index=1.7 (p=0.001). In group 2 the changes was insignificant: ΔFVC=-2.3%, ΔmRss=0.87, ΔActivity index=0.3. But there was a significant decrease of DLCO: ΔDLCO=-5.1% (p=0.001). Conclusion. The results of our study confirm the data on the positive effect of RTX in complex therapy in pts with SSc (decrease of skin induration, increase of FVC, stabilization of DLCO). Meantime, pts on IS and prednisolone therapy shown the worsening of lung function and insignificant changes of other clinical parameters. RTX could be considered as a more effective option in complex treatment of SSc in comparison with IS therapy

Keywords: immunosuppressants, interstitial lung disease, systemic sclerosis, rituximab

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Authors: Atanu K Samanta, Asim Ali Khan

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Due to the acquisition of huge amounts of brain tumor magnetic resonance images (MRI) in clinics, it is very difficult for radiologists to manually interpret and segment these images within a reasonable span of time. Computer-aided diagnosis (CAD) systems can enhance the diagnostic capabilities of radiologists and reduce the time required for accurate diagnosis. An intelligent computer-aided technique for automatic detection of a brain tumor through MRI is presented in this paper. The technique uses the following computational methods; the Level Set for segmentation of a brain tumor from other brain parts, extraction of features from this segmented tumor portion using gray level co-occurrence Matrix (GLCM), and the Artificial Neural Network (ANN) to classify brain tumor images according to their respective types. The entire work is carried out on 50 images having five types of brain tumor. The overall classification accuracy using this method is found to be 98% which is significantly good.

Keywords: brain tumor, computer-aided diagnostic (CAD) system, gray-level co-occurrence matrix (GLCM), tumor segmentation, level set method

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Authors: David Jurado, Carlos Ávila

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Detection of early signs of breast cancer development is crucial to quickly diagnose the disease and to define adequate treatment to increase the survival probability of the patient. Computer Aided Detection systems (CADs), along with modern data techniques such as Machine Learning (ML) and Neural Networks (NN), have shown an overall improvement in digital mammography cancer diagnosis, reducing the false positive and false negative rates becoming important tools for the diagnostic evaluations performed by specialized radiologists. However, ML and NN-based algorithms rely on datasets that might bring issues to the segmentation tasks. In the present work, an automatic segmentation and detection algorithm is described. This algorithm uses image processing techniques along with the Hough transform to automatically identify microcalcifications that are highly correlated with breast cancer development in the early stages. Along with image processing, automatic segmentation of high-contrast objects is done using edge extraction and circle Hough transform. This provides the geometrical features needed for an automatic mask design which extracts statistical features of the regions of interest. The results shown in this study prove the potential of this tool for further diagnostics and classification of mammographic images due to the low sensitivity to noisy images and low contrast mammographies.

Keywords: breast cancer, segmentation, X-ray imaging, hough transform, image analysis

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Authors: Hsueh Ping Peng

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End-stage renal disease most commonly occurs in the elderly population. Elderly people are approaching the end of their lives, and when facing major life-threatening situations, apart from aggressive medical treatment, they can also choose treatment methods such as hospice care to improve their quality of life. The purpose of this study was to investigate factors associated with the awareness and willingness to sign hospice and palliative care consent forms in elderly with end-stage renal disease. This study used both quantitative, cross-sectional study designs. In the quantitative section, 110 elderly patients (aged 65 or above) with end-stage renal disease receiving conventional hemodialysis were recruited as study participants from a medical center in Taipei City. Data were collected using structured questionnaires. Study tools included basic demographic data, questionnaires on the awareness and perception of hospice and palliative care, etc. After collecting the data, data analysis was conducted using SPSS 20.0 statistical software, including descriptive statistics, chi-square test, logistic regression, and other inferential statistics. The results showed that the average age of participants was 71.6 years old, more males than females, average years of dialysis was 6.1 years and most subjects rated their self-perceived health status as fair. Results of the study are summarized as follows: Elderly people with end-stage renal disease did not have sufficient knowledge and awareness about hospice and palliative care. Influencing factors included level of education, marital status, years of dialysis and age, etc. Demographic factors influencing the signing of consent forms included gender, marital status, and age, which all showed significant impacts. Factors taken into consideration when signing consent forms included awareness of hospice care, understanding the relevant definitions of hospice care, and understanding that consent may be modified or cancelled at any time; it was predicted that people who knew more about ways to receive hospice care or more related definitions were more willing to sign the consent forms. In the qualitative study section, 10 participants who signed the consent form, five male, and 5 female, between the ages of 65-90, have completed the semi-structured interviews. Analysis of the interviews revealed six themes: (1) passing away peacefully, (2) autonomy on arrangements of life and death, (3) unwillingness to increase family and social burden, (4) friends and relatives’ experience influencing the decision to give consent, (5) sharing information to facilitate the giving of consent, (6) facing each day with ease, to reflect the experience and factors of consideration for elderly with end-stage renal disease when signing consent forms. The results of this study provides the awareness, thoughts and feelings of elderly with end-stage renal disease on signing consent forms, and serve as a future reference for the dialysis unit to enhance the promotion of hospice and palliative care and related caregiving measures, thereby improving the quality of life and care for elderly people with end-stage renal disease.

Keywords: end-stage renal disease, hemodialysis, hospice and palliative care, awareness, willingness

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Authors: Sihyun Chae, Ryoto Arai, Waldo Concepcion, Paula Popescu

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The kidneys perform an important role in the human hormones that regulate the blood pressure, produce an active form of vitamin D and control the production of red blood cells. Kidney disease can cause health problems, such as heart disease. Also, increase the chance of having a stroke or heart attack. There are mainly to types of treatments for kidney disease, dialysis, and kidney transplant. For a better quality of life, the kidney transplant is desirable. However, kidney transplant can cause antibody reaction and patients’ body would be attacked by immune system of their own. For solving that issue, patients with transplanted kidney always take immunosuppressive drugs which can hurt kidney as side effects. Patients willing to do a kidney transplant have a waiting time of 3.6 years in average searching to find an appropriate kidney, considering there are almost 96,380 patients waiting for kidney transplant. There is a promising method to solve these issues: bioartificial kidney. Our membrane is specially designed with unique perforations capable to filter the blood cells separating the white blood cells from red blood cells. White blood cells will not pass through the encapsulated kidney preventing the immune system to attack the new organ and eliminating the need of a matching donor. It is possible to construct life-time long encapsulation without needing pumps or a power supply on the cell’s separation method preventing futures surgeries due the Cross-Channel Flow inside the device. This technology allows the possibility to use an animal kidney, prevent cancer cells to spread through the body, arm and leg transplants in the future. This project aims to improve the quality of life of patients with kidney disease.

Keywords: kidney encapsulation, immunosuppression filter, leukocyte filter, leukocyte

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Authors: W. Ling, Mohamed Saufi Bin Awang

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Introduction: Mycobacterium tuberculosis post a major health problem worldwide. Central nervous system (CNS) infection by mycobacterium tuberculosis is one of the most devastating complications of tuberculosis. Although with advancement in medical fields, we are yet to understand the pathophysiology of how mycobacterium tuberculosis was able to cross the blood-brain barrier (BBB) and infect the CNS. CNS TB may present with nonspecific clinical symptoms which can mimic other diseases/conditions; this is what makes the diagnosis relatively difficult and challenging. Public health has to be informed and educated about the spread of TB, and early identification of TB is important as it is a curable disease. Case Report: A young 21-year-old Malay gentleman was initially presented to us with symptoms of ear discharge, tinnitus, and right-sided headache for the past one year. Further history reveals that the symptoms have been mismanaged and neglected over the period of 1 year. Initial investigation reveals features of inflammation of the ear. Further imaging showed the feature of chronic inflammation of the otitis media and atypical right cerebral abscess, which has the same characteristic features and consistency. He further underwent a biopsy, and results reveal positive Mycobacterium tuberculosis of the otitis media. With the results and the available imaging, we were certain that this is likely a case of disseminated tuberculosis causing CNS TB. Conclusion: We aim to highlight the challenge and difficult face in our health care system and public health in early identification and treatment.

Keywords: central nervous system tuberculosis, intracranial tuberculosis, tuberculous encephalopathy, tuberculous meningitis

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Authors: Swarkar Sharma, Ekta Rai, Ankit Mahajan, Parvinder Kumar, Manoj K Dhar, Sushil Razdan, Kumarasamy Thangaraj, Carol Wise, Shiro Ikegawa M.D., K.K. Pandita M.D.

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Rare disorders are poorly understood hence, remain uncharacterized or patients are misdiagnosed and get poor medical attention. A rare mysterious skeletal disorder that remained unidentified for decades and rendered many people physically challenged and disabled for life has been reported in an isolated remote village ‘Arai’ of Poonch district of Jammu and Kashmir. This village is located deep in mountains and the population residing in the region is highly consanguineous. In our survey of the region, 70 affected people were reported, showing similar phenotype, in the village with a population of approximately 5000 individuals. We were able to collect samples from two multi generational extended families from the village. Through Whole Exome sequencing (WES), we identified a rare variation NM_003880.3:c.156C>A NP_003871.1:p.Cys52Ter, which results in introduction of premature stop codon in WISP3 gene. We found this variation perfectly segregating with the disease in one of the family. However, this variation was absent in other family. Interestingly, a novel splice site mutation at position c.643+1G>A of WISP3 gene, perfectly segregating with the disease was observed in the second family. Thus, exploiting WES and putting different evidences together (familial histories and genetic data, clinical features, radiological and biochemical tests and findings), the disease has finally been diagnosed as a very rare recessive hereditary skeletal disease “Progressive Pseudorheumatoid Arthropathy of Childhood” (PPAC) also known as “Spondyloepiphyseal Dysplasia Tarda with Progressive Arthropathy” (SEDT-PA). This genetic characterization and identification of the disease causing mutations will aid in genetic counseling, critically required to curb this rare disorder and to prevent its appearance in future generations in the population. Further, understanding of the role of WISP3 gene the biological pathways should help in developing treatment for the disorder.

Keywords: whole exome sequencing, Next Generation Sequencing, rare disorders

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Authors: Rabab Makki, Deputy Chief Dietitian

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Malnutrition is commonly seen in Liver Disease patients. Prevalence of malnutrition in cirrhosis, is as high as 65-90%. Protein depletion and reduced muscle function are common. There are many mechanisms of malnutrition in liver cirrhosis e.g. insulin resistance, low respiratory quotient, increased glucogenesis etc. Nutrition support improves outcome in patients unable to maintain an intake of 35-40 Kcal/kg and 1.2-1.5 gm/kg/day. Simple methods of assessment such as subjective global assessment, calorie counting, MMC are useful. The value of BCAAs remains uncertain despite a considerable number of studies. Normal protein diets have been given safely to patients with hepatic encephalopathy. Restriction of protein not more than 48 hours pre- and pro-biotic, glutamine, fish oil etc are all part of the latest advanced techniques used.

Keywords: liver cirrhosis, omega 3 for liver disease, nutrition management, malnutrition

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Authors: Fatih Sonmez

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Alzheimer’s disease (AD) is a progressive neurodegenerative disease and it is the most common form of dementia that affects aged people. Acetylcholinesterase is a hydrolase involved in the termination of impulse transmission at cholinergic synapses by rapid hydrolysis of the neurotransmitter ACh in the central and peripheral nervous system. Carvacrol (5-iso-propyl-2-methyl-phenol) is a main bioactive monoterpene isolated from many medicinal herbs, such as Thymus vulgaris, Monarda punctate and Origanum vulgare spp. It is known that carvacrol has been widely used as an active anti-inflammatory ingredient, which can inhibit the isoproterenol induced inflammation in myocardial infarcted rats. In this paper, a series of 12 carvacrol substituted carbamate derivatives (2a-l) was synthesized and their inhibitory activities on AChE and BuChE were evaluated. Among them, 2d exhibited the strongest inhibition against AChE with an IC50 value of 2.22 µM, which was 130-fold more than that of carvacrol (IC50 = 288.26 µM).

Keywords: Acetylcholinesterase, Butyrylcholinesterase, Carbamate, Carvacrol

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Authors: Ben-Caleb Egbide, Omolehinwa O. Eddy, Adeyemi S. Keyinde, Eriabie Sylvester, Ojeka Stephen

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The national budget remains an integral part of the developmental plan of the economy of any country. The budget reflects the fundamental values underlying the government’s economic policies and objectives and whose execution is expected to realize national/public desires. In Nigeria, over three decades budget had failed to deliver the desired benefits, suggesting the existence of infractions, which are yet to be empirically ascertained. This paper attempts a diagnosis of the infractions peculiar to Nigeria budgetary system and their suggested panacea. Data were collected through the administration of questionnaire to a cross section of organizations/institutions representing government agencies and the general public. Mann-Whitney U test was employed to gauge the consistency in perception of the two groups. The result revealed that budget indiscipline, official corruption, allocative inefficiency and poor budget governance are the most influential infractions of budgeting in Nigeria. Consequently, it was suggested that budget transparency, target budgeting, zero tolerance on corruption and budget discipline are the most cogent therapies to the malfunctioning in Nigerian budgetary system.

Keywords: budgeting, budget maladies, budget therapies, Nigeria

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Authors: Saida Haider, Syeda Madiha

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Parkinson’s disease (PD) is a common neurological disorder characterized by motor deficits and loss of dopaminergic neurons. Oxidative stress is said to play a pivotal role in the pathophysiology of the disease. In the present study, PD was induced by injection of rotenone (1.5 mg/kg/day, s.c.) for eight days. Pistachio (800 mg/kg/day, p.o.) was given for two weeks. At the end of treatment brains were dissected out and striatum was isolated for biochemical and neurochemical analysis. Morris water maze (MWM) test and novel object recognition (NOR) task was used to test the memory function while motor behavior was determined by open field test (OFT), Kondziela inverted screen test (KIST), pole test (PT), beam walking test (BWT), inclined plane test (IPT) and footprint (FP) test. Several dietary components have been evaluated as potential therapeutic compounds in many neurodegenerative diseases. Increasing evidence shows that nuts have protective effects against various diseases by improving the oxidative status and reducing lipid peroxidation. Pistachio is the only nut that contains anthocyanin, a potent antioxidant having neuroprotective properties. Results showed that pistachio supplementation significantly restored the rotenone-induced motor deficits and improved the memory performance. Moreover, rats treated with pistachio also exhibited enhanced oxidative status and increased dopamine (DA) and 5-hydroxytryptamine (5-HT) concentration in striatum. In conclusion, to our best knowledge, we have for the first time shown that pistachio nut possesses neuroprotective effects against rotenone-induced motor and cognitive deficits. These beneficial effects of pistachio may be attributed to its high content of natural antioxidant and phenolic compounds. Hence, consumption of pistachio regularly as part of a daily diet can be beneficial in the prevention and treatment of PD.

Keywords: rotenone, pistachio, oxidative stress, Parkinson’s disease

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Authors: Giovanni Duran Polo

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Demonstrate the importance of the stages such as Information, Diagnosis, Management, and Intervention is fundamental to have a historical, live, and quality inhabited center. One of the major actions to take is to promote the concept of the management of a historic center with harmonious development. For that, concerned actors should strengthen the concept that said historic center may be the neighborhood of all and for all. The centers of historical cities, presented as any other urban area, social, environmental issues etc; yet they get added value that have no other city neighborhoods. The equity component, either by the urban plan, or environmental quality offered properties of architectural, landscape or some land uses are the differentiating element, while the tool that makes them attractive face pressure exerted by new housing developments or shopping centers. That's why through the experience of working in historical centers, they are declared the actions in heritage areas. This paper will show how the encounter with each of these places are trying to take the phases of information, to gather all the data needed to be closer to the territory with specific data, diagnosis; which allowed the actors to see what state they were, felt how the heart is related to the rest of the city, show what problems affected the situation and what potential it had to compete in a global market. Also, to discuss the importance of the organization, as it is legal and normative basis for it have an order and a concept, when you know what can and what cannot, in an area where the citizen has many myth or history, when he wanted to intervene in protected buildings. It is also appropriate to show how it could develop the intervention phase, where the shares on the tangible elements and intervention for the protection of the heritage property are executed. The management is the final phase which will carry out all that was raised on paper, it's time to orient, explain, persuade, promote, and encourage citizens to take care of the heritage. It is profitable and also an obligation and it is not an insurmountable burden. It has to be said this is the time to pull all the cards to make the historical center and heritage becoming more alive today. It is the moment to make it more inhabited and to transformer it into a quality place, so citizens will cherish and understand the importance of such a place. Inhabited historical centers, endowments and equipment required, with trade quality, with constant cultural offer, with well-preserved buildings and tidy, modern and safe public spaces are always attractive for tourism, but first of all, the place should be conceived for citizens, otherwise everything will be doomed to failure.

Keywords: development, diagnosis, heritage historic center, intervention, management, patrimony

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Authors: Gagandeep Singh Digra, Pawan Kumar, Mandeep Kaur Sidhu

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INTRODUCTION: Chronic Progressive External Ophthalmoplegia (CPEO), also known as Progressive External Ophthalmoplegia (PEO), is a type of eye disorder characterized by a loss of the muscle functions involved in eye and eyelid movement. CPEO can be caused by mutations in mitochondrial DNA. It typically manifests in young adults with bilateral and progressive ptosis as the most common presentation but can also present with difficulty swallowing (dysphagia) and general weakness of the skeletal muscles (myopathy), particularly in the neck, arms, or legs. CASE PRESENTATION: This is a case discussion of 3 cousins who presented to our clinic. A 23-year-old male with past surgical history (PSH) of ptosis repair 2 years ago presented with a chief complaint of nasal intonation for 1.5 years associated with difficulty swallowing. The patient also complained of nasal regurgitation of liquids. He denied any headaches, fever, seizures, weakness of arms or legs, urinary complaints or changes in bowel habits. Physical Examination was positive for facial muscle weakness, including an inability to lift eyebrows (Frontalis), inability to close eyes tightly (Orbicularis Oculi), corneal reflex absent bilaterally, difficulty clenching jaw (Masseter muscle), difficulty smiling (Zygomaticus major), inability to elevate upper lip (Zygomaticus minor). Another cousin of the first patient, a 25-year-old male with no past medical history, presented with complaints of nasal intonation for 2 years associated with difficulty swallowing. He denied a history of nasal regurgitation, headaches, fever, seizures, weakness, urinary complaints or changes in bowel habits. Physical Examination showed facial muscle weakness of the Frontalis muscle, Orbicularis Oculi muscle, Masseter Muscle, Zygomaticus Major, Zygomaticus Minor and absent corneal reflexes. A 28-year-old male, a cousin of the first two patients, presented with chief complaints of ptosis and nasal intonation for the last 8 years. He also complained of difficulty swallowing and nasal regurgitation of liquids. His physical examination showed facial muscle weakness, including frontalis muscle (inability to lift eyebrows), Orbicularis Oculi (inability to close eyes tightly), absent corneal reflexes bilaterally, Zygomaticus Major (difficulty smiling), and Zygomaticus Minor (inability to elevate upper lip). MRI brain and visual field of all the patients were normal. Differential diagnoses, including Grave’s disease, Myasthenia Gravis and Glioma, were ruled out. Due to financial reasons, muscle biopsy could not be pursued. Pedigree analysis revealed only males were affected, likely due to maternal inheritance, so the clinical diagnosis of CPEO was made. The patients underwent symptomatic management, including ptosis surgical correction for the third patient. CONCLUSION: Chronic Progressive External Ophthalmoplegia (CPEO), a rare case entity, occurs in young adults as a manifestation of mitochondrial myopathy. There are three modes of transmission- maternal transmission associated with mitochondrial point mutations, autosomal recessive, and autosomal dominant. CPEO can sometimes be difficult to diagnose, especially in asymmetric presentation. Therefore, it is crucial to keep it in differential diagnosis to avoid delay in diagnosis.

Keywords: neurology, chronic, progressive, ophthalmoplegia

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Authors: Tariq Abbas, Younus Muhammad, Sayyad Aun Muhammad

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Background : Crimean Congo hemorrhagic fever (CCHF) is a tick born viral zoonotic disease that has been notified from almost all regions of Pakistan. The aim of this study was to investigate spatial distribution of CCHF cases reported to National Institue of Health , Islamabad during year 2013. Methods : Spatial statistics tools were applied to detect extent spatial auto-correlation and clusters of the disease based on adjusted cumulative incidence per million population for each district. Results : The data analyses revealed a large multi-district cluster of high values in the uplands of Balochistan province near Afghanistan border. Conclusion : The cluster included following districts: Pishin; Qilla Abdullah; Qilla Saifullah; Quetta, Sibi; Zhob; and Ziarat. These districts may be given priority in CCHF surveillance, control programs, and further epidemiological research . The location of the cluster close to border of Afghanistan and Iran highlight importance of the findings for organizations dealing with disease at national, regional and global levels.

Keywords: Crimean Congo hemorrhagic fever, Pakistan, spatial autocorrelation, clusters , adjusted cumulative incidence

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Authors: Parul Kulshreshtha, Subrata Sinha, Rakesh Bhatnagar

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This study was conducted by taking B. anthracis as a model pathogen. On infecting a host, B. anthracis secretes three proteins, namely, protective antigen (PA, 83kDa), edema factor (EF, 89 kDa) and lethal factor (LF, 90 kDa). These three proteins are the components of two anthrax toxins. PA binds to the cell surface receptors, namely, tumor endothelial marker (TEM) 8 and capillary morphogenesis protein (CMG) 2. TEM8 and CMG2 interact with LDL-receptor related protein (LRP) 6 for endocytosis of EF and LF. On entering the cell, EF acts as a calmodulin-dependent adenylate cyclase that causes a prolonged increase of cytosolic cyclic adenosine monophosphate (cAMP). LF is a metalloprotease that cleaves most isoforms of mitogen-activated protein kinase kinases (MAPKK/MEK) close to their N-terminus. By secreting these two toxins, B.anthracis ascertains death of the host. Once the systemic levels of the toxins rise, antibiotics alone cannot save the host. Therefore, toxin-specific inhibitors have to be developed. In this wake, monoclonal antibodies have been developed for the neutralization of toxic effects of anthrax toxins. We created hybridomas by using spleen of mice that were actively immunized with rLFn (recombinant N-terminal domain of lethal factor of B. anthracis) to obtain anti-toxin antibodies. Later on, separate group of mice were immunized with rLFn to obtain a polyclonal control for passive immunization studies of monoclonal antibodies. This led to the identification of one cohort of rLFn-immunized mice that harboured disease-enhancing polyclonal antibodies. At the same time, the monoclonal antibodies from all the hybridomas were being tested. Two hybridomas secreted monoclonal antibodies (H8 and H10) that were cross-reactive with EF (edema factor) and LF (lethal factor), while the other two hybridomas secreted LF-specific antibodies (H7 and H11). The protective efficacy of H7, H8, H10 and H11 was investigated. H7, H8 and H10 were found to be protective. H11 was found to have disease enhancing characteristics in-vitro and in mouse model of challenge with B. anthracis. In this study the disease enhancing character of H11 monoclonal antibody and anti-rLFn polyclonal sera was investigated. Combination of H11 with protective monoclonal antibodies (H8 and H10) reduced its disease enhancing nature both in-vitro and in-vivo. But combination of H11 with LETscFv (an scFv with VH and VL identical to H10 but lacking Fc region) could not abrogate the disease-enhancing character of H11 mAb. Therefore it was concluded that for suppression of disease enhancement, Fc portion was absolutely essential for interaction of H10 with H11. Our study indicates that the protective potential of an antibody depends equally on its idiotype/ antigen specificity and its isotype. A number of monoclonal and engineered antibodies are being explored as immunotherapeutics but it is absolutely essential to characterize each one for their individual and combined protective potential. Although new in the sphere of toxin-based diseases, it is extremely important to characterize the disease-enhancing nature of polyclonal as well as monoclonal antibodies. This is because several anti-viral therapeutics and vaccines have failed in the face of this phenomenon. The passive –immunotherapy thus needs to be well formulated to avoid any contraindications.

Keywords: immunotherapy, polyclonal, monoclonal, antibody-dependent disease enhancement

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Authors: Piyarat Parklug, Busaba Supawattanaobodee, Penpat Pinyowattanasilp

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The radioactive iodine thyroid uptake (RAIU) has been widely used to differentiate the cause of thyrotoxicosis and treatment. Twenty-four hours RAIU is routinely used to calculate the dose of radioactive iodine (RAI) therapy; however, 2 days protocol is required. This study aims to evaluate the modification of Penpat Pinyowattanasilp equation application by the exclusion of outlier data, 3 hours RAIU less than 20% and more than 80%, to improve prediction of 24-hour uptake. The equation is predicted 24 hours RAIU (P24RAIU) = 32.5+0.702 (3 hours RAIU). Then calculating separation first and second therapeutic doses in Graves’ disease patients. Methods; This study was a retrospective study at Faculty of Medicine Vajira Hospital in Bangkok, Thailand. Inclusion were Graves’ disease patients who visited RAI clinic between January 2014-March 2019. We divided subjects into 2 groups according to first and second therapeutic doses. Results; Our study had a total of 151 patients. The study was done in 115 patients with first RAI dose and 36 patients with second RAI dose. The P24RAIU are highly correlated with actual 24-hour RAIU in first and second therapeutic doses (r = 0.913, 95% CI = 0.876 to 0.939 and r = 0.806, 95% CI = 0.649 to 0.897). Bland-Altman plot shows that mean differences between predictive and actual 24 hours RAI in the first dose and second dose were 2.14% (95%CI 0.83-3.46) and 1.37% (95%CI -1.41-4.14). The mean first actual and predictive therapeutic doses are 8.33 ± 4.93 and 7.38 ± 3.43 milliCuries (mCi) respectively. The mean second actual and predictive therapeutic doses are 6.51 ± 3.96 and 6.01 ± 3.11 mCi respectively. The predictive therapeutic doses are highly correlated with the actual dose in first and second therapeutic doses (r = 0.907, 95% CI = 0.868 to 0.935 and r = 0.953, 95% CI = 0.909 to 0.976). Bland-Altman plot shows that mean difference between predictive and actual P24RAIU in the first dose and second dose were less than 1 mCi (-0.94 and -0.5 mCi). This modification equation application is simply used in clinical practice especially patient with 3 hours RAIU in range of 20-80% in a Thai population. Before use, this equation for other population should be tested for the correlation.

Keywords: equation, Graves’disease, prediction, 24-hour uptake

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Authors: Mohammad Aladwan

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Alzheimer’s disease (AD) is a widespread dementing illness with a complex and poorly understood etiology. An important role in improving our understanding of the AD process is the modeling of disease-associated changes in tau protein phosphorylation, a protein known to mediate events essential to the onset and progression of AD. A main feature of AD is the abnormal phosphorylation of tau protein and the presence of neurofibrillary tangles. In order to evaluate the respective roles of the microtubule-binding region (MTBR) and alternatively spliced exons in the N-terminal projection domains in AD, we have constructed SHSY-5Y cell lines that stably overexpress four different species of tau protein (4R2N, 4R0N, N(E-2), N(E+2)). Since the toxicity and spreading of tau lesions in AD depends on the interactions of tau with other proteins, we have performed a proteomic analysis of exosome-fraction interactomes for cell lysates and media samples that were isolated from SHSY-5Y cell lines. Functional analysis of tau interactomes based on gene ontology (GO) terms was performed using the String 10.5 database program. The highest number of exosomes proteomes and tau associated proteins were found with 4R2N isoform (2771 and 159) in cell lysate and they have a high strength of connectivity (78%) between proteins, while N(E-2) isoform in the media proteomes has the highest number of proteins and tau associated protein (1829 and 205). Moreover, known AD markers were significantly enriched in secreted interactomes relative to lysate interactomes in the SHSY-5Y cells of tau isoforms lacking exons 2 and 3 in the N-terminal. The lack of exon 2 (E-2) from tau protein can be mediated by tau secretion and spreading to different cells. Enriched functions in the secreted E-2 interactome include signaling and developmental pathways that have been linked to a) tau misprocessing and lesion development and b) tau secretion and which, therefore, could play novel roles in AD pathogenesis.

Keywords: Alzheimer's disease, dementia, tau protein, neurodegenration disease

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Authors: Muhammad Kamran Hanif Khan, Fahad Mushtaq

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Background: In both developed and underdeveloped countries, coronary artery disease (CAD) is a serious cause of death and disability. Cardiovascular disease (CVD) is becoming more prevalent in emerging countries like Pakistan due to the spread and acceptance of Western lifestyles. Material and Methods: An observational cross-sectional investigation was conducted, and data collection relied on a random cluster sampling method. The sample size for this cross-sectional study was calculated using the following factors: estimated true proportion of 17.5%, desired precision of 2%, and confidence interval of 95%. The data for this study was collected from a sample of 1387 adults. Results: The average age of those living in rural areas is 55.24 years, compared to 52.60 years for those living in urban areas. The mean fasting blood glucose of the urban participants is 105.28 mg/dL, which is higher than the mean fasting blood glucose of the rural participants, which is 102.06 mg/dL. The mean total cholesterol of the urban participants is 192.20 mg/dL, which is slightly higher than the mean total cholesterol of the rural participants, which is 191.97 mg/dL. CAD prevalence is greater in urban areas than in rural areas. ECG abnormalities prevalence is 16.1% in females compared to 12.5% in men. Conclusion: The prevalence of CAD is more common in urban areas than in rural ones for all of the measures of CAD used in the study.

Keywords: CVD prevalence, CVD risk factors, rural area, urban area

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Authors: Annet Namusoke, Annet Namayanja, Peter Wasswa, Shakirah Nampijja

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Common bean cultivar G2333 which offers broad resistance for anthracnose has been widely used as a source of resistance in breeding for anthracnose resistance. The cultivar is pyramided with three genes namely CO-4, CO-5 and CO-7 and of these three genes, the CO-4 gene has been found to offer the broadest resistance. The main aim of this work was to identify and validate easily assayable PCR based co-dominant molecular markers for selection of the CO-4 gene in segregating populations derived from crosses of G2333 with RWR 1946 and RWR 2075, two commercial Andean cultivars highly susceptible to anthracnose. Marker sequences for the study were obtained by blasting the sequence of the COK-4 gene in the Phaseolus gene database. Primer sequence pairs that were not provided from the Phaseolus gene database were designed by the use of Primer3 software. PCR conditions were optimized and the PCR products were run on 6% HPAGE gel. Results of the polymorphism test indicated that out of 18 identified markers, only two markers namely BM588 and BM211 behaved co-dominantly. Phenotypic evaluation for reaction to anthracnose disease was done by inoculating 21days old seedlings of three parents, F1 and F2 populations with race 7 of Colletotrichum lindemuthianum in the humid chamber. DNA testing of the BM588 marker onto the F2 segregating population of the crosses RWR 1946 x G 2333 and RWR 2075 x G2333 further revealed that the marker BM588 co-segregated with disease resistance with co-dominance of two alleles of 200bp and 400bp, fitting the expected segregation ratio of 1:2:1. The BM588 marker was significantly associated with disease resistance and gave promising results for marker assisted selection of the CO-4 gene in the breeding lines. Activities to validate the BM211 marker are also underway.

Keywords: codominant, Colletotrichum lindemuthianum, MAS, Phaseolus vulgaris

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Authors: Miroslava Cuperlovic-Culf, Lipu Wang, Ketty Boyle, Nadine Makley, Ian Burton, Anissa Belkaid, Mohamed Touaibia, Marc E. Surrette

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Metabolic changes are one of the major factors in the development of a variety of diseases in various species. Metabolism of agricultural plants is altered the following infection with pathogens sometimes contributing to resistance. At the same time, pathogens use metabolites for infection and progression. In humans, metabolism is a hallmark of cancer development for example. Quantified metabolomics data combined with other omics or clinical data and analyzed using various unsupervised and supervised methods can lead to better diagnosis and prognosis. It can also provide information about resistance as well as contribute knowledge of compounds significant for disease progression or prevention. In this work, different methods for metabolomics quantification and analysis from Nuclear Magnetic Resonance (NMR) measurements that are used for investigation of disease development in wheat and human cells will be presented. One-dimensional 1H NMR spectra are used extensively for metabolic profiling due to their high reliability, wide range of applicability, speed, trivial sample preparation and low cost. This presentation will describe a new method for metabolite quantification from NMR data that combines alignment of spectra of standards to sample spectra followed by multivariate linear regression optimization of spectra of assigned metabolites to samples’ spectra. Several different alignment methods were tested and multivariate linear regression result has been compared with other quantification methods. Quantified metabolomics data can be analyzed in the variety of ways and we will present different clustering methods used for phenotype determination, network analysis providing knowledge about the relationships between metabolites through metabolic network as well as biomarker selection providing novel markers. These analysis methods have been utilized for the investigation of fusarium head blight resistance in wheat cultivars as well as analysis of the effect of estrogen receptor and carbonic anhydrase activation and inhibition on breast cancer cell metabolism. Metabolic changes in spikelet’s of wheat cultivars FL62R1, Stettler, MuchMore and Sumai3 following fusarium graminearum infection were explored. Extensive 1D 1H and 2D NMR measurements provided information for detailed metabolite assignment and quantification leading to possible metabolic markers discriminating resistance level in wheat subtypes. Quantification data is compared to results obtained using other published methods. Fusarium infection induced metabolic changes in different wheat varieties are discussed in the context of metabolic network and resistance. Quantitative metabolomics has been used for the investigation of the effect of targeted enzyme inhibition in cancer. In this work, the effect of 17 β -estradiol and ferulic acid on metabolism of ER+ breast cancer cells has been compared to their effect on ER- control cells. The effect of the inhibitors of carbonic anhydrase on the observed metabolic changes resulting from ER activation has also been determined. Metabolic profiles were studied using 1D and 2D metabolomic NMR experiments, combined with the identification and quantification of metabolites, and the annotation of the results is provided in the context of biochemical pathways.

Keywords: metabolic biomarkers, metabolic network, metabolomics, multivariate linear regression, NMR quantification, quantified metabolomics, spectral alignment

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Authors: Abrahão S. Fontes, Carlos A. V. Cardoso, Levi P. B. Oliveira

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The induction motors are used worldwide in various industries. Several maintenance techniques are applied to increase the operating time and the lifespan of these motors. Among these, the predictive maintenance techniques such as Motor Current Signature Analysis (MCSA), Motor Square Current Signature Analysis (MSCSA), Park's Vector Approach (PVA) and Park's Vector Square Modulus (PVSM) are used to detect and diagnose faults in electric motors, characterized by patterns in the stator current frequency spectrum. In this article, these techniques are applied and compared on a real motor, which has the fault of eccentricity in the air-gap. It was used as a theoretical model of an electric induction motor without fault in order to assist comparison between the stator current frequency spectrum patterns with and without faults. Metrics were purposed and applied to evaluate the sensitivity of each technique fault detection. The results presented here show that the above techniques are suitable for the fault of eccentricity in the air gap, whose comparison between these showed the suitability of each one.

Keywords: eccentricity in the air-gap, fault diagnosis, induction motors, predictive maintenance

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Authors: Son Nguyen, Thanh Van, Ly Le

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Ca2+ - dependent calmodulin kinase IIa (CaMKIIa) has recently been found to associate with protein tau missorting and polymerization in Alzheimer’s Disease (AD). However, there has yet inhibitors targeting CaMKIIa to investigate the correlation between CaMKIIa activity and protein tau polymer formation. Combining virtual screening and our statistics in binding contribution scoring function (BCSF), we rationally identified potential compounds that bind to specific CaMKIIa active site and specificity-affinity distribution of the ligand within the active site. Using molecular dynamics simulation, we identified structural stability of CaMKIIa and potent inhibitors, and site-directed bonding, separating non-specific and specific molecular interaction features. Despite of variation in confirmation of simulation time, interactions of the potent inhibitors were found to be strongly associated with the unique chemical features extracted from molecular binding poses. In addition, competitive inhibitors within CaMKIIa showed an important molecular recognition pattern toward specific ligand features. Our approach combining virtual screening with BCSF may provide an universally applicable method for precise identification in the discovery of compounds.

Keywords: Alzheimer’s disease, Ca 2+ -dependent calmodulin kinase IIa, protein tau, molecular docking

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Authors: Nadia Masood Khan, Muhammad Salman Khan, Gul Muhammad Khan

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Cardiologists perform cardiac auscultation to detect abnormalities in heart sounds. Since accurate auscultation is a crucial first step in screening patients with heart diseases, there is a need to develop computer-aided detection/diagnosis (CAD) systems to assist cardiologists in interpreting heart sounds and provide second opinions. In this paper different algorithms are implemented for automated heart sound classification using unsegmented phonocardiogram (PCG) signals. Support vector machine (SVM), artificial neural network (ANN) and cartesian genetic programming evolved artificial neural network (CGPANN) without the application of any segmentation algorithm has been explored in this study. The signals are first pre-processed to remove any unwanted frequencies. Both time and frequency domain features are then extracted for training the different models. The different algorithms are tested in multiple scenarios and their strengths and weaknesses are discussed. Results indicate that SVM outperforms the rest with an accuracy of 73.64%.

Keywords: pattern recognition, machine learning, computer aided diagnosis, heart sound classification, and feature extraction

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Authors: Phalla Miech, William Leung, Ty Chhay, Sina Vor, Arata Hidano

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Smallholder pig farms (SPFs) are prevalent in Cambodia but are vulnerable to disease impacts, as evidenced by the recent incursion of African swine fever into the region. As part of the ‘PigFluCam+’ project, we sought to provide an updated picture of pig husbandry and biosecurity practices among SPFs in south-central Cambodia. A multi-stage sampling design was adopted to select study districts and villages within four provinces: Phnom Penh, Kandal, Takeo, and Kampong Speu. Structured interviews were conductedbetween October 2020 - May 2021 among all consenting households keeping pigs in 16 target villages. Recruited SPFs (n=176) kept 6.8 pigs on average (s.d.=7.7), with most (88%) keeping cross-bred varieties of sows (77%), growers/finishers (39%), piglets/weaners (22%), and few keeping boars (5%). Chickens (83%) and waterfowl (56%) were commonly raised and could usually contact pigs directly (79%). Pigs were the primary source of household income for 28% of participants. While pigs tended to be housed individually (40%) or in groups (33%), 13% kept pigs free-ranging/tethered. Pigs were commonly fed agricultural by-products (80%), commercial feed (60%), and, notably, household waste (59%). Under half of SPFs vaccinated their pigs (e.g., against classical swine fever, Aujesky’s, and pasteurellosis, although the target disease was often unknown). Among 20 SPFs who experienced pig morbidities/mortalities within the past 6 months, only 3 (15%) reported to animal health workers, and disease etiology was rarely known. Common biosecurity measures included nets covering pig pens (62%) and restricting access to the site/pens (46%). Boot dips (0.6%) and PPE (1.2%) were rarely used. Pig smallholdings remain an important contributor to rural livelihoods. Current practices and biosecurity challenges increase risk pathways for a range of disease threats of both local and global concern. Ethnographic studies are needed to better understand local determinants and develop context-appropriate strategies.

Keywords: smallholder production, swine, biosecurity practices, Cambodia, African swine fever

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Authors: Amani Ashari, Julia Omar, Arif Hashim, Shahrul Hamid

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Apolipoprotein E (APOE) gene polymorphism has influence on serum lipids which relates to cardiovascular risk. The purpose of this study was to determine the frequency distribution of APOE alleles among Malaysian Type 2 Diabetes Mellitus (DM) patients with and without coronary artery disease (CAD) and their association with serum lipid profiles. A total of 115 patients were recruited in which 78 patients had Type 2 DM without CAD and 37 patients had Type 2 DM with CAD. The APOE polymorphism was detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The APOE ɛ3 allele was the most common one in both groups. There was no significant association between the APOE genotypes and the CAD status in Type 2 DM using Pearson χ² test. Further analysis indicated there were no significant differences in all lipid parameters between E2, E3 and E4 subgroups in both groups. The study showed that the E4 allele carriers of Type 2 DM with CAD patients had higher LDL-C level and lower HDL-C level compared to the other allele carriers. However, analyses showed these levels were not statistically different. The study also showed that the Type 2 DM with CAD group with E2 allele had higher triglyceride (TG). In conclusion, further study with larger sample size is needed to confirm role of E4 as a marker of CAD among Type 2 DM patients in Malaysian population.

Keywords: Apolipoprotein E, diabetes mellitus, cardiovascular disease, lipids

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Authors: Shirin Sarejloo

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Background: Electrophysiological-related manifestation of COVID-19 is a matter of debate in the literature nowadays. A wide spectrum of arrhythmias was observed among patients who have been infected with COVID-19. Objectives: This study discussed the prevalence of arrhythmias and conduction system disease in patients with COVID-19. Method: In this retrospective study, demographic and electrocardiographic data of 432 expired COVID-19 patients who had been admitted to Faghihi Hospital of Shiraz University of Medical Sciences from August2020 until December 2020 were reviewed. Results: Atrioventricular nodal block (AVB) was found in 40(9.3%) patients. Furthermore, 28(6.5%) of them suffered from the first degree of AVB, and 12(2.8%) suffered from complete heart block (CHB). Among 189 cases (59.0%), ST-T changes agreed with myocardial infarction or localized myocarditis. Findings of myocardial injury, including fragmented QRS and prolonged QTc were observed among 91 (21.1%) and 28 (6.5%), respectively. In victims of COVID-19, conduction disease was not related to any comorbidities. Fragmented QRS, axis deviation, presence of S1Q3T3, and poor R wave progression were significantly related to conduction system abnormalities in victims of COVID-19 (P-value > 0.05). Conclusion: Our findings can serve in future studies that aim to develop a risk stratification method for susceptible COVID-19 patients. The myocardial injury appears to role significantly in COVID-19 morbidity and mortality. Consequently, we recommend health policymakers consider separate catheterization laboratories that provide service only to COVID-19 patients.

Keywords: COVID-19, conduction system, ECG, atrioventricular block

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Authors: Joao Paulo Matheus, Renan Fangel

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Rheumatoid arthritis is a chronic, inflammatory, systemic and progressive disease that affects the synovial joints bilaterally, causing definitive orthopedic damage. It has a higher prevalence in postmenopausal female patients. It is a disabling disease that causes joint deformities that may compromise the functionality of the affected segment. The aim of this study was to evaluate the influence of low-intensity therapeutic laser on the perception of pain and quality of life in patients with rheumatoid arthritis. This is a randomized clinical study involving 6 women with a mean age of 56.8+6.3 years. Exclusion criteria: patients with acute pain, chronic infectious disease, underlying acute or chronic underlying disease. An AsGaAl laser with 808nm wavelength, 100mW power, beam output area of 0.028cm2, power density of 3.57W/cm2 was used. The laser was applied at pre-defined points in the interphalangeal and metacarpophalangeal joints, totaling 24 points, 2 times a week, for 4 weeks, totaling 8 sessions. The Pain Inventory (IBD) and Visual Analogue Scale (VAS) were used for the analysis of pain and for the WHOQOL-bref quality of life assessment. There was no statistical difference between the onset (5.67±2.66) and the final (4.67±3.78) of treatments (p=0.70). There was also no statistical difference between the beginning (5.67±2.66) and the final (4.67±3.78) of the treatments in the VAS analysis (p=0.68). The overall mean quality of life obtained by the questionnaire at the start of treatment was 42.3±7.6, while at the end of treatment it was 58.5±7.6 (p=0.01) and the domains of the questionnaire with significant differences were: psychological domain 42.9±6.8 and 66.7±12.9 (p=0.004), social domain 39.9±5.7 and 68.1±6.3 (p=0,0005) and environmental domain 36.3±7.3 and 56.3±12.5 (p=0.003). It can be concluded that the low-intensity therapeutic laser did not produce significant changes in the painful period of rheumatoid arthritis patients. However, there was an improvement in patients' quality of life in the psychological, social and environmental aspects.

Keywords: laser therapy, pain, quality of life, rheumatoid arthritis

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Authors: Tri Murti, Muhammad Hanafiah Juni, Hejar Abdul Rahman, Salmiah Binti Said

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The diarrhoeal disease continues to be a leading cause of childhood mortality in countries such as Indonesia, where it is estimated to be responsible for 300,000 deaths annually in children under the age of years. Morbidity survey the Ministry of Health of Indonesia from 2000 to 2010 showed incidence diarrhoea remains a leading cause of infant mortality. Causes of death from diarrhoea is related to poor governance both at home and in health facilities. Despite the improvement of health facilities and government effort to reduce the occurrence of diarrhoea among children and death from diarrhoea, the incidence of diarrhoea among children area still high.

Keywords: management diarrheal disease, practices mother, treatment, diarrhoea among children

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