Search results for: cumulative trauma disorder

Authors: Sharifirad M., Poursaeed A., Lashgarara F., Mirdamadi S. M.

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Introduction: Paddy farming has been reported as one of the most important causes of non-fatal injuries and occupational accidents among farmers. The ignorance of the health of farmers can cause harm to farmers and lead to disability. As a result, these health consequences can result in less exploitation and economic growth in households. Therefore, this study aimed to determine the general health status of paddy field workers in Mazandaran province, Iran. Materials & Methods: This cross-sectional descriptive study evaluated 384 paddy farmers in Mazandaran province, Iran, who were selected using stratified random sampling. The required data were collected using the standard questionnaire of GHQ-28 with four domains of somaticsymptoms, anxiety and insomnia, social dysfunction, and symptoms of depression. The obtained data were then analyzed using SPSS software (version 25) through Spearman, Kendall, Mann-Whitney, and Kruskal-Wallis tests. Findings: The highest number of participants in this study was in the age group of 50-59 years, with a mean age of 46.9 years. According to the results, the total general health score was obtained at 64.3% for the subjects. Moreover, the scores of four areas of general health were determined at 91.1% (depression symptoms), 73.4% (social dysfunction), 48.7% (anxiety symptoms and insomnia), and 47.1% (somatic symptoms) in descending order. Discussions& Conclusions: The general health of the studied population was not in a good range. In addition, the most observed disorder in the general health of paddy farmers was related to the symptoms of depression, followed by somatic symptoms.

Keywords: general-health, mazandaran, paddyfield

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Authors: Amanda Madden

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The purpose of this research was to identify students understanding of well-being and perceptions of the effective components of school-based well-being programs they have participated in during their time in secondary school. With one in four adolescents suffering from some form of mental health disorder, which has the potential to directly impact their academic ability, schools have moved towards a more holistic approach to education, resulting in the growth of school-based well-being programs. There is limited research on the effectiveness of school-based well-being programs, with fewer studies examining students’ perspectives on their well-being. A mixed-method design was utilized, framed by a social constructivist methodology. Quantitative data was collected through a researcher-developed self-report survey, and qualitative data were collected through one-on-one interviews and a semi-structured focus group undertaken with Year 12 students from three independent co-educational schools in Western Australia. Preliminary findings indicate that participants have experienced a minimal impact, either positively or negatively, on their well-being from school-based well-being programs. The data detailed that adolescents consider happiness, positive attitude, good physical health, balance, emotional fulfillment and confidence components of well-being. The findings also highlighted sports, positive family relationships, positive friendships, and pets positively enhanced well-being. This research suggests that researchers and educational leaders should consider students’ understanding of well-being in the development of school-based well-being assessments and interventions. Students are the recipients of school-based well-being programs and are best placed to inform what they will and will not respond to in the determination of appropriate well-being content.

Keywords: wellbeing, school based wellbeing, adolescents, wellbeing interventions

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Authors: Mohanad Moustafa, Julia Sieberer, Rhys Davies

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Background: Orbital compartment syndrome (OCS) is a sight-threatening Ophthalmologic emergency caused by rapidly increasing intraorbital pressure. It is usually caused by a retrobulbar hemorrhage as a result of trauma. If not treated in a timely manner, permanent vision loss can occur. Lateral canthotomy and cantholysis are minor procedures that can be performed bedside with equipment available in the emergency department. The aim of the procedure is to release the attachments between the suspensory ligaments of the eye and the bony orbital wall, leading to a decrease in intraorbital pressure and preventing irreversible loss of vision. As most Ophthalmologists across the UK provide non-resident on-call service, this may lead to a delay in the treatment of OCS and stresses the need for Emergency medical staff to be able to provide this sight-saving procedure independently. Aim: To survey current training, experience, and confidence levels among Emergency Medicine doctors in performing emergency lateral canthotomy and to establish whether these variables change the following teaching from experienced ophthalmologists. RESULTS: Most EM registrars had little to no experience in performing lateral canthotomy and cantholysis. The majority of them showed a significant increase in their confidence to perform the procedure following ophthalmic-led teaching. The survey also showed that the registrars felt such training should be added to/part of the EM curriculum. Conclusion: The involvement of Ophthalmologists in the teaching of EM doctors to recognise and treat OCS independently may prevent delays in treatment and reduce the risk of permanent sight loss. This project showed potential in improving patient care and will lead to a National Survey of EM doctors across the UK.

Keywords: lateral canthotomy, retrobulbar hemorrhage, Ophthalmology, orbital compartment syndrome, sight loss, blindness

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Authors: Passkorn Khanthongthip, John T. Novak

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Many studies have been reported that the nZVI and MgO NPs were often found in waste activated sludge (WAS). However, little is known about the impact of those NPs on WAS stabilization. The aims of this study were to investigate the effects of both NPs on WAS anaerobic digestion for methane production and to examine the change of metanogenic population under those different environments using qPCR. Four dosages (2, 50, 100, and 200 mg/g-TSS) of MgO NPs were added to four different bottles containing WAS to investigate the impact of MgO NPs on methane production during WAS anaerobic digestion. The effects of nZVI on methane production during WAS anaerobic digestion were also conducted in another four bottles using the same methods described above except that the MgO NPs were replaced by nZVI. A bottle of WAS anaerobic digestion without nanoparticles addition was also operated to serve as a control. It was found that the relative amounts, compared to the control system, of methane production in each WAS anaerobic digestion bottle adding 2, 50, 100, 200 mg/gTSS MgO NPs were 98, 62, 28, and 14 %, respectively. This suggests that higher MgO NPs resulted in lower methane production. The data of batch test for the effects of corresponding released Mg2+ indicated that 50 mg/gTSS MgO NPs or higher could inhibit methane production at least 25%. Moreover, the volatile fatty acid (VFA) concentration was 328, 384, 928, 3,684, and 7,848 mg/L for the control and four WAS anaerobic digestion bottles with 2, 50, 100, 200 mg/gTSS MgO NPs addition, respectively. Higher VFA concentration could reduce pH and subsequently decrease methanogen growth, resulting in lower methane production. The relative numbers of total gene copies of methanogens analyzed from samples taken from WAS anaerobic digestion bottles were approximately 99, 68, 38, and 24 % of control for the addition of 2, 50, 100, and 200 mg/gTSS, respectively. Obviously, the more MgO NPs appeared in sludge anaerobic digestion system, the less methanogens remained. In contrast, the relative amount of methane production found in another four WAS anaerobic digestion bottles adding 2, 50, 100, and 200 mg/gTSS nZVI were 102, 128, 112, and 104 % of the control, respectively. The measurement of methanogenic population indicated that the relative content of methanogen gene copies were 101, 132, 120, and 112 % of those found in control, respectively. Additionally, the cumulative VFA was 320, 234, 308, and 330 mg/L, respectively. This reveals that nZVI addition could assist to increase methanogenic population. Higher amount of methanogen accelerated VFA degradation for greater methane production, resulting in lower VFA accumulation in digesters. Moreover, the data for effects of corresponding released Fe2+ conducted by batch tests suggest that the addition of approximately 50 mg/gTSS nZVI increased methane production by 20%. In conclusion, the presence of MgO NPs appeared to diminish the methane production during WAS anaerobic digestion. Higher MgO NPs dosages resulted in more inhibition on methane production. In contrast, nZVI addition promoted the amount of methanogenic population which facilitated methane production.

Keywords: magnesium oxide nanoparticles, methane production, methanogenic population, nano zerovalent iron

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Authors: Deniz Sari, Selahattin İncecik, Nesimi Ozkurt

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Surface ozone, which named as one of the most critical pollutants in the 21th century, threats to human health, forest and vegetation. Specifically, in rural areas surface ozone cause significant influences on agricultural productions and trees. In this study, in order to understand to the surface ozone levels in rural areas we focus on the north-western side of Biga Peninsula which covers by the mountainous and forested area. Ozone concentrations were measured for the first time with passive sampling at 10 sites and two online monitoring stations in this rural area from 2013 and 2015. Using with the daytime hourly O3 measurements during light hours (08:00–20:00) exceeding the threshold of 40 ppb over the 3 months (May, June and July) for agricultural crops, and over the six months (April to September) for forest trees AOT40 (Accumulated hourly O3 concentrations Over a Threshold of 40 ppb) cumulative index was calculated. AOT40 is defined by EU Directive 2008/50/EC to evaluate whether ozone pollution is a risk for vegetation, and is calculated by using hourly ozone concentrations from monitoring systems. In the present study, we performed the trajectory analysis by The Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) model to follow the long-range transport sources contributing to the high ozone levels in the region. The ozone episodes observed between 2013 and 2015 were analysed using the HYSPLIT model developed by the NOAA-ARL. In addition, the cluster analysis is used to identify homogeneous groups of air mass transport patterns can be conducted through air trajectory clustering by grouping similar trajectories in terms of air mass movement. Backward trajectories produced for 3 years by HYSPLIT model were assigned to different clusters according to their moving speed and direction using a k-means clustering algorithm. According to cluster analysis results, northerly flows to study area cause to high ozone levels in the region. The results present that the ozone values in the study area are above the critical levels for forest and vegetation based on EU Directive 2008/50/EC.

Keywords: AOT40, Biga Peninsula, HYSPLIT, surface ozone

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Authors: Sireen Irsheid

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Despite concerted efforts to improve education attainment with progress in recent years, student achievement and attainment remain among the most significant challenges for school districts across the United States. Many scholars have argued that students who do not complete high school do not drop out of school voluntarily but are ‘pushed out’ of schools through multiple mechanisms related to structural and socioeconomic barriers, behavioral health challenges, pedagogical practices, and administrative procedures. Extant literature has shown that living in historically disadvantaged neighborhoods or attending under-resourced schools exacerbates student-level risk factors for grade retention and school pushout. Most efforts to respond to the school pushout phenomenon have focused on individual characteristics of students, with relatively little attention to addressing these multiple system-level characteristics related to perpetuating inequities. This study is built on a growing body of social justice-oriented research concerned with the systemic influences that shape the experiences and mental health challenges of young people. Specifically, this study examined how young people who have been experiencing education inequities make meaning and navigate the structural factors related to neighborhood and school disinvestment and access to resources and supports, and their risk for school pushout. Furthermore, schools as political, cultural, and ideologically reproductive spaces often serve as sites of resistance and can support students who are impacted by educational inequity. Study findings provide education, neighborhood, school psychology, social work practice, and policy considerations.

Keywords: education policy, mental health, school prison nexus, school pushout, structural trauma

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Authors: Wenqian Bai

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Background: In response to the post-pandemic directives of Xi Jinping concerning the new era of ecological civilization, China has embarked on ecological restoration projects across its territorial spaces. This initiative faces challenges such as complex evaluation metrics and subpar informatization standards. Methodology: This research focuses on Mianzhu City, Sichuan Province, to assess its resource and environmental carrying capacities and the appropriateness of land use for development from ecological, agricultural, and urban perspectives. The study incorporates a range of spatial data to evaluate factors like ecosystem services (including water conservation, soil retention, and biodiversity), ecological vulnerability (addressing issues like soil erosion and desertification), and resilience. Utilizing the Minimum Cumulative Resistance model along with the ‘Three Zones and Three Lines’ strategy, the research maps out ecological corridors and significant ecological networks. These frameworks support the ecological restoration and environmental enhancement of the area. Results: The study identifies critical ecological zones in Mianzhu City's northwestern region, highlighting areas essential for protection and particularly crucial for water conservation. The southeastern region is categorized as a generally protected ecological zone with respective ratings for water conservation functionality and ecosystem resilience. The research also explores the spatial challenges of three ecological functions and underscores the substantial impact of human activities, such as mining and agricultural expansion, on the ecological baseline. The proposed spatial arrangement for ecological restoration, termed ‘One Mountain, One Belt, Four Rivers, Five Zones, and Multiple Corridors’, strategically divides the city into eight major restoration zones, each with specific tasks and projects. Conclusion: With its significant ‘mountain-plain’ geography, Mianzhu City acts as a crucial ecological buffer for the Yangtze River's upper reaches. Future development should focus on enhancing ecological corridors in agriculture and urban areas, controlling soil erosion, and converting farmlands back to forests and grasslands to foster ecosystem rehabilitation.

Keywords: ecological restoration, resource and environmental carrying capacity, land development suitability, ecosystem services, ecological vulnerability, ecological networks

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Authors: Zana Llonçari Osmani, Nita Llonçari

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In Kosovo, public rhetoric and popular sentiment position the War of 1998-99 (the war) as central to the formation of contemporary Kosovo's national identity. This period was marked by the forced massive displacement of Kosovo Albanians, the destruction of entire settlements, the loss of family members, and the profound emotional trauma experienced by civilians, particularly those who actively participated in the war as members of the Kosovo Liberation Army (KLA). Amidst these profound experiences, the Prekaz Massacre (The Massacre) is widely regarded as the defining event that preceded the final struggles of 1999 and the long-awaited attainment of independence. This study aims to explore how different visitors perceive the dominant discourse at The Memorial, a site dedicated to commemorating the Prekaz Massacre, and to identify the factors that influence their perceptions. The research employs a comprehensive mixed-method approach, combining online surveys, critical discourse analysis of visitor impressions, and content analysis of media representations. The findings of the study highlight the significant role played by original material remains in shaping visitor perceptions of The Memorial in comparison to the curated symbols and figurative representations interspersed throughout the landscape. While the design elements and physical layout of the memorial undeniably hold significance in conveying the memoryscape, there are notable shortcomings in enhancing the overall visitor experience. Visitors are still primarily influenced by the tangible remnants of the war, suggesting that there is room for improvement in how design elements can more effectively contribute to the memorial's narrative and the collective memory of the Prekaz Massacre.

Keywords: critical discourse analysis, memorialisation, national discourse, public rhetoric, war tourism

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Authors: L. I. Izhar, T. Stathaki, K. Howell

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Analyzing and interpreting of thermograms have been increasingly employed in the diagnosis and monitoring of diseases thanks to its non-invasive, non-harmful nature and low cost. In this paper, a novel system is proposed to improve diagnosis and monitoring of morphoea skin disorder based on integration with the published lines of Blaschko. In the proposed system, image registration based on global and local registration methods are found inevitable. This paper presents a modified normalized gradient cross-correlation (NGC) method to reduce large geometrical differences between two multimodal images that are represented by smooth gray edge maps is proposed for the global registration approach. This method is improved further by incorporating an iterative-based normalized cross-correlation coefficient (NCC) method. It is found that by replacing the final registration part of the NGC method where translational differences are solved in the spatial Fourier domain with the NCC method performed in the spatial domain, the performance and robustness of the NGC method can be greatly improved. It is shown in this paper that the hybrid NGC method not only outperforms phase correlation (PC) method but also improved misregistration due to translation, suffered by the modified NGC method alone for thermograms with ill-defined jawline. This also demonstrates that by using the gradients of the gray edge maps and a hybrid technique, the performance of the PC based image registration method can be greatly improved.

Keywords: Blaschko’s lines, image registration, morphoea, thermal imaging

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Authors: Balaji Devanathan, Gokul G., Abilash S., Abhishek Yadav, Sudhir K. Gupta

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Background: As an alternative to the traditional autopsy, a virtual autopsy is carried out using scanning and imaging technologies, mainly post-mortem computed tomography (PMCT). This facility aims to supplement traditional autopsy results and reduce or eliminate internal dissection in subsequent autopsies. For emotional and religious reasons, the deceased's relatives have historically disapproved such interior dissection. The non-invasive, objective, and preservative PMCT is what friends and family would rather have than a traditional autopsy. Additionally, it aids in the examination of the technologies and the benefits and drawbacks of each, demonstrating the significance of contemporary imaging in the field of forensic medicine. Results: One hundred falls resulting in fatalities was analysed by the writers. Before the autopsy, each case underwent a PMCT examination using a 16-slice Multi-Slice CT spiral scanner. By using specialised software, MPR and VR reconstructions were carried out following the capture of the raw images. The accurate detection of fractures in the skull, face bones, clavicle, scapula, and vertebra was better observed in comparison to a routine autopsy. The interpretation of pneumothorax, Pneumoperitoneum, pneumocephalus, and hemosiuns are much enhanced by PMCT than traditional autopsy. Conclusion. It is useful to visualise the skeletal damage in fall from height cases using a virtual autopsy based on PMCT. So, the ideal tool in traumatising patients is a virtual autopsy based on PMCT scans. When assessing trauma victims, PMCT should be viewed as an additional helpful tool to traditional autopsy. This is because it can identify additional bone fractures in body parts that are challenging to examine during autopsy, such as posterior regions, which helps the pathologist reconstruct the victim's life and determine the cause of death.

Keywords: PMCT, fall from height, autopsy, fracture

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Authors: B. N. Emenyeonu

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Initially identified as sensationalism in the eras of yellow journalism and tabloidization, the inclusion of news which shocks or provokes strong emotional responses among readers, viewers, and browsers has not only remained a persistent feature of journalism but has also seemingly escalated in the current climate of digital and social media. Whether in the relentless revelation of scandals in high places, profiles on people displaced by sporadic wars or natural disasters, gruesome accounts of trucks plowing into pedestrians in a city centre, or the coverage of mourners paying tributes to victims of a mass shooting, mainstream, and digital media are often awash with tragedy, tears, and trauma. While it may aim at inspiring sympathy, outrage, or even remedial reactions, it would appear that the deluge of grief and misery in the news merely generates in the audience a feeling that borders on hearing or seeing too much to care or act. This feeling also appears to be accentuated by the dizzying diffusion of social media news and views, most of whose authenticity is not easily verifiable. Through a survey of 400 regular consumers of news and an in-depth interview of 10 news managers in selected media organizations across the Middle East, this study therefore investigates public attitude to the profusion of bad news in mainstream and digital media. Among other targets, it examines whether the profusion of bad news generates empathy fatigue among the audience and, if so, whether there is any association between biographic variables (profession, age, and gender) and an inclination to empathy fatigue. It also seeks to identify which categories of bad news and media are most likely to drag the audience into indifference. In conclusion, the study discusses the implications of the findings for mass-mediated advocacies such as campaigns against conflicts, corruption, nuclear threats, terrorism, gun violence, sexual crimes, and human trafficking, among other threats to humanity.

Keywords: digital media, empathy fatigue, media campaigns, news selection

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Authors: Irina S. Burashnikova, Dmitriy A. Sychev, Ruslan Y. Kazakov

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Сytochrome P450 CYP2D6 activity affects antipsychotic therapy safety. CYP2D6*4 polymorphism frequency varies among different ethnic groups. We studied CYP2D6*4 polymorphism frequency in Tatar and Russian schizophrenic patients and association of CYP2D6*4 polymorphism and extrapyramidal disorders (EPD) frequency in schizophrenic patients on haloperidol monotherapy in daily doses up to 20 mg. Results: Heterozygous CYP2D6*4 allele carrier frequency among Tatars was lower (23.8% vs 32.4% in Russians), but the differences did not reach statistical significance. CYP2D6*4 allele frequency among Tatars was also lower (11.9% vs 24.3% in Russians), but the difference was not quite significant (p=0.0592). Average daily haloperidol dose in the group without EPD was significantly higher than in the group with EPD (11.35±4.6 vs 13.87±3.3 mg, p=0.0252), but average daily haloperidol dose/weight ratios in the compared groups had no significant differences. Statistically significant association between EPD development and heterozygous CYP2D6*1/*4 genotype and CYP2D6*4 allele carrier frequency was revealed among all schizophrenic patients and among those of Tatar nationality. Further well designed pharmacogenetic studies in different Russian regions are needed to improve psychotropic therapy safety and to establish evidence-based indications for pharmacogenetic testing in clinical practice.

Keywords: antipsychotic, CYP2D6 polymorphism, ethnic differences of CYP2D6*4 allele frequency, extrapyramidal side effects/disorder, schizophrenia, pharmacogenetics, Russians, Tatars

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Authors: Mina Hojat Ansari, Kamran Bagheri Lankarani, Mohammad Reza Fattahi, Ali Reza Safarpour

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Irritable bowel syndrome (IBS) is a common bowel disorder which is usually diagnosed through the abdominal pain, fecal irregularities and bloating. Alteration in the intestinal microbial composition is implicating to inflammatory and functional bowel disorders which is recently also noted as an IBS feature. Owing to the potential importance of microbiota implication in both efficiencies of the treatment and prevention of the diseases, we examined the association between the intestinal microbiota and different bowel patterns in a cohort of subjects with IBS and healthy controls. Fresh fecal samples were collected from a total of 50 subjects, 30 of whom met the Rome IV criteria for IBS and 20 Healthy control. Total DNA was extracted and library preparation was conducted following the standard protocol for small whole genome sequencing. The pooled libraries sequenced on an Illumina Nextseq platform with a 2 × 150 paired-end read length and obtained sequences were analyzed using several bioinformatics programs. The majority of sequences obtained in the current study assigned to bacteria. However, our finding highlighted the significant microbial taxa variation among the studied groups. The result, therefore, suggests a significant association of the microbiota with symptoms and bowel characteristics in patients with IBS. These alterations in fecal microbiota could be exploited as a biomarker for IBS or its subtypes and suggest the modification of the microbiota might be integrated into prevention and treatment strategies for IBS.

Keywords: irritable bowel syndrome, intestinal microbiota, small whole genome sequencing, fecal samples, Illumina

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Authors: Karun Karki

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The Lhotshampa are Bhutanese people of Nepali origin who have been in Bhutan since the early 1600s. A significant number of these people migrated to Bhutan in the nineteenth century. The 1958 Nationality Law of Bhutan granted citizenship to many Lhotshampa people; however, in the late 1970s, the government of Bhutan introduced a series of laws and policies intended for the socio-political and cultural exclusion of the Lhotshampa due to their ancestry. These exclusionary policies and ethnic and racial injustices not only removed the rights and citizenship of the Lhotshampa but also forcibly displaced thousands of families with no choice but to seek refuge in Nepal. In this context, racism becomes a biopolitical tool designed to govern and regulate populations in a way that determines who may live and who must die. The governance and the management of the population, what Stephan Scheel terms as biopolitical bordering, depends on boundaries between residents and non-residents, citizens and non-citizens, and emigrants and immigrants. Drawing on Foucault’s biopolitics and Mbembe’s necropolitics, this paper argues that the concept of racism should be examined within the context of political discourses because it is intertwined with the colonial project, enslavement, and diaspora. This paper critically explores ethnic and racial injustices the Lhotshampa people experienced and the ways in which they negotiated and resisted such injustices in their resettlement processes, including before displacement, in refugee camps, and after the third-country resettlement. Critical examination of these issues helps shed light on the notion of racial difference that justifies dehumanization, discrimination, and racist attitudes against the Lhotshampa people. The study's findings are critical in promoting human rights, social justice, and the health and well-being of the Lhotshampa community in the context of trauma and stressors in their resettlement processes.

Keywords: lhotshampa people, bhutanese refugees, racism, dehumanization, social justice, biopower, necropower

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Authors: Ilja Käch, Abdul R. Jandali, Nadja Zechmann-Müller

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Introduction: We discuss the treatment of two young male patients suffering from scaphoid non-union after a traumatic scaphoid fracture. The currently propagated techniques for treating a scaphoid non-union in children are either the operative reconstruction of the scaphoid or the conservative treatment with splinting in a scaphoid cast. Cases: In the first case, we operated on a 13 years old male patient with a posttraumatic scaphoid non-union in the middle third with a humpback deformity. We resected the middle third of the scaphoid and grafted the defect with an iliac crest bone, and the DISI-Deformity was reduced. Fixation was performed with K-Wires and immobilisation in a scaphoid cast. In the second case a 13 years old male patient also with a posttraumatic scaphoid non-union in the middle third and humpback deformity, DISI-deformity, was treated conservatively. Immobilisation in a scaphoid cast for four months was performed. Results: Operative: One year postoperatively the patient achieved a painless free arc of motion. Flexion/Extension 70/0/60°, Radial-/Ulnarduction 30/0/30° and Pro-/Supination 90/0/90°. The computer tomogram showed complete consolidation and bony fusion of the iliac crest bone. Conservative: Six to eight months after conservative treatment the patient demonstrated painless motion and AROM Flexion/Extension 80/0/80°, Radial-/Ulnarduction and Pro-/Supination in maximum range. Complete consolidation in the computer tomogram with persistent humpback- and DISI deformity. Conclusion: In the literature, both techniques are described, either the operative scaphoid reconstruction or the conservative treatment with splinting. In our cases, both the operative and conservative treatments showed comparable good results. However, the humpback- and DISI deformity can only be addressed with a surgical approach.

Keywords: scaphoid, non-union, trauma, operative vs. non operative

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Authors: Nia McRae, Robert Wright, Ghalib Bello

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Introduction: Postpartum depression is a prevalent mood disorder that is detrimental to the mental and physical health of mothers and their newborns. Lead (Pb) is a toxic metal that is associated with hormonal imbalance and mental impairments. The hormone changes that accompany pregnancy and childbirth may be exacerbated by Pb and increase new mothers’ susceptibility to postpartum depression. To the best of the author’s knowledge, this is the only study that investigates the association between prenatal Pb exposure and postpartum depression. Identifying risk factors can contribute to improved prevention and treatment strategies for postpartum depression. Methods: Data was derived from the Programming Research in Obesity, Growth, Environment and Social Stress (PROGRESS) study which is an ongoing longitudinal birth cohort. Postpartum depression was identified by a score of 13 or above on the 10-Item Edinburg Postnatal Depression Scale (EPDS) 6-months and 12-months postpartum. Pb was measured in the blood (BPb) in the second and third trimester and in the tibia and patella 1-month postpartum. Quantile regression models were used to assess the relationship between BPb and postpartum depression. Results: BPb in the second trimester was negatively associated with the 80th percentile of depression 6-months postpartum (β: -0.26; 95% CI: -0.51, -0.01). No significant association was found between BPb in the third trimester and depression 6-months postpartum. BPb in the third trimester exhibited an inverse relationship with the 60th percentile (β: -0.23; 95% CI: -0.41, -0.06), 70th percentile (β: -0.31; 95% CI: -0.52, -0.10), and 90th percentile of depression 12-months postpartum (β: -0.36; 95% CI: -0.69, -0.03). There was no significant association between BPb in the second trimester and depression 12-months postpartum. Bone Pb concentrations were not significantly associated with postpartum depression. Conclusion: The negative association between BPb and postpartum depression may support research which demonstrates lead is a nontherapeutic stimulant. Further research is needed to verify these results and identify effect modifiers.

Keywords: depression, lead, postpartum, prenatal

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Authors: Poornima Khadanga, Gaurav Pawar, Madhavi Rairikar

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Background: The COVID 19 pandemic, with its unparalleled mental health repercussions, has impacted people globally and has catalyzed a Mental Health pandemic among the youth. The detrimental effects on mental health needs to be pondered at the earliest. Aims: To study the behavioral problems among children and adolescents visiting Psychiatry Outpatient Department Tertiary Health Care during COVID pandemic and its correlation with socio-demographic profiles. Methods: A cross sectional study was conducted by interviewing 120 participants between 4 to 17 years of age and their parents, visiting Psychiatry OPD. Behavioral problems were assessed using the Strength and Difficulties Questionnaire and diagnosed by DSM-5. Statistical analysis was done by SPSS-21. Results: Male participants showed significant association with conduct (t=2.36, p=0.02) and hyperactive problems (t=5.07, p<0.05). Increase in screen time showed a positive correlation with conduct problems (r=0.22. p=0.02). Attention Deficit Hyperkinetic Disorder (18.3%) was the most commonly diagnosed psychiatric illness. Total difficulty score was significantly associated with difficult temperament (F=68.69, p<0.05). Conclusion: The study brings to light the pattern of behavioral problems that emerged during recent times of uncertainties among the young ones, including those with special needs. The increase in disruptive behaviors with increase screen time needs to be addressed at the earliest.

Keywords: behavioral problems, pandemic, screen time, temperament

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Authors: Nik Smits, Stijn Goeminne

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Despite the extensive literature on the relation between crime and migration, not much is known about how crime affects the tax capacity of local communities. This paper empirically investigates whether the Flemish local income tax base yield is sensitive to changes in the local crime level. The underlying assumptions are threefold. In a Tiebout world, rational voters holding the local government accountable for the safety of its citizens, move out when the local level of security gets too much alienated from what they want it to be (first assumption). If migration is due to crime, then the more wealthy citizens are expected to move first (second assumption). Looking for a place elsewhere implies transaction costs, which the more wealthy citizens are more likely to be able to pay. As a consequence, the average income per capita and so the income distribution will be affected, which in turn, will influence the local income tax base yield (third assumption). The decreasing average income per capita, if not compensated by increasing earnings by the citizens that are staying or by the new citizens entering the locality, must result in a decreasing local income tax base yield. In the absence of a higher level governments’ compensation, decreasing local tax revenues could prove to be disastrous for a crime-ridden municipality. When communities do not succeed in forcing back the number of offences, this can be the onset of a cumulative process of urban deterioration. A spatial panel data model containing several proxies for the local level of crime in 306 Flemish municipalities covering the period 2000-2014 is used to test the relation between crime and the local income tax base yield. In addition to this direct relation, the underlying assumptions are investigated as well. Preliminary results show a modest, but positive relation between local violent crime rates and the efflux of citizens, persistent up until a 2 year lag. This positive effect is dampened by possible increasing crime rates in neighboring municipalities. The change in violent crimes -and to a lesser extent- thefts and extortions reduce the influx of citizens with a one year lag. Again this effect is diminished by external effects from neighboring municipalities, meaning that increasing crime rates in neighboring municipalities (especially violent crimes) have a positive effect on the local influx of citizens. Crime also has a depressing effect on the average income per capita within a municipality, whereas increasing crime rates in neighboring municipalities increase it. Notwithstanding the previous results, crime does not seem to significantly affect the local tax base yield. The results suggest that the depressing effect of crime on the income basis has to be compensated by a limited, but a wealthier influx of new citizens.

Keywords: crime, local taxes, migration, Tiebout mobility

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Authors: Akeem Akinboro, Bala Alhaj Kegun

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Haemoglobinopathy is a genetic disorder that has the potentiality to cause death of individuals in whom both the alpha (α) and beta (β) globin chains of the haemoglobin molecule are defective due to mutations in their genes. The haemoglobin genotype variants among some residents of Niger state, Nigeria, were determined using the secondary data available at Bida, Minna and Kotangora general hospitals of the state. A total of 1,639 data, representing 434, 655 and 550, collected from the outside patients who visited the medical laboratory units of the three general hospitals, respectively, over five years period (2015-2020) were analyzed into gene frequency, sex and age to determine their haemoglobin genotypes status. More males (51.6 – 58.7%) than females (41.3 – 48.4%) visited the three hospitals during the period covered and most of the patients were between 11 - 20 years old. The frequency of HbA allele in the human population was 0.72, 0.65, 0.68 for Bida, Minna and Kotangora, respectively, while it was 0.25, 0.29 and 0.28 for HbS allele. The HbC allele was prevalent at 0.03, 0.06 and 0.05 among the human population in Bida, Minna and Kotangora cities of Niger state. In overall, the prevalence of HbA, HbS and HbC alleles in Niger state of Nigeria was 0.68, 0.28 and 0.05. Minna being the capital city of Niger state and the most populous among the three cities in the state seems to have influx of more people who are carriers of abnormal haemoglobin genotypes which has resulted to higher frequency of HbS and HbC than those of the other two cities in this study. These results show that the pattern of haemoglobin genotypes frequency of Kontagora could be a prediction for the whole of Niger state. It is therefore necessary and important to take screening of blood for haemoglobin genotype serious among intending couples to prevent and reduce the possibility of having increase in the number of people with abnormal haemoglobin genotypes in the state.

Keywords: haemoglobin, genotype, niger state, gene frequency, general hospitals

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Authors: Ibrahim Nadeem, Mohammed Rahman, Yasser Ad-Dab’Bagh, Mahmood Akhtar

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Depression is one of the most prevalent mental illnesses and is often associated with various other medical disorders. In this review, we aim to evaluate existing systematic reviews that investigate the use of probiotics as a treatment for depressive symptoms. Five online databases were searched for relevant studies up to December 2017. Systematic reviews that included randomized controlled trials assessing the efficacy of probiotics in the treatment of depressive symptoms were included. Seven systematic reviews met the inclusion criteria. Three of these reviews conducted meta-analyses, out of which, two found probiotics to significantly improve depressive symptoms in the sample population. Two meta-analyses conducted subgroup analysis based on health status, and both found probiotics to significantly decrease depressive symptoms in patients with major depressive disorder, but only one review found it to significantly decrease in healthy patients. Another subgroup analysis was conducted based on age, and found probiotics to produce significant effects on subjects under the age of 60, but close to no effect on patients over the age of 65. Out of the four reviews that conducted qualitative analysis, three reviews concluded that probiotics have the potential to be used as a treatment. Due to the differences in clinical trials, a definitive effect of probiotics on depressive symptoms cannot be concluded. Nonetheless, probiotics seem to produce a significant therapeutic effect for subjects with pre-existing depressive symptoms. Further studies are warranted for definitive conclusions.

Keywords: depression, gut-brain axis, gut microbiota, probiotic, psychobiotic

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Authors: Recep Keşli, Onur Türkyılmaz, Hayriye Tokay, Kasım Demir

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Objective: Coeliac disease (CD) is a primary small intestine disorder caused by high sensitivity to gluten which is present in the crops, characterized by inflammation in the small intestine mucosa. The goal of this study was to determine and to compare the sensitivity and specificity values of anti-endomysial IgA (EMA IgA) (IFA) and anti-tissue transglutaminase IgA (anti-tTG IgA) (ELISA) antibodies in the diagnosis of patients suspected with the CD. Methods: One thousand two hundred seventy three patients, who have applied to gastroenterology and pediatric disease polyclinics of Afyon Kocatepe University ANS Research and Practice Hospital were included into the study between 23.09.2010 and 30.05.2016. Sera samples were investigated by immunofluorescence method for EMA positiveness (Euroimmun, Luebeck, Germany). In order to determine quantitative value of Anti-tTG IgA (EIA) (Orgentec Mainz, Germany) fully automated ELISA device (Alisei, Seac, Firenze, Italy) were used. Results: Out of 1273 patients, 160 were diagnosed with coeliac disease according to ESPGHAN 2012 diagnosis criteria. Out of 160 CD patients, 120 were female, 40 were male. The EMA specificity and sensitivity were calculated as 98% and 80% respectively. Specificity and sensitivity of Anti-tTG IgA were determined as 99% and 96% respectively. Conclusion: The specificity of EMA for CD was excellent because all EMA-positive patients (n = 144) were diagnosed with CD. The presence of human anti-tTG IgA was found as a reliable marker for diagnosis and follow-up the CD. Diagnosis of CD should be established on both the clinical and serologic profiles together.

Keywords: anti-endomysial antibody, anti-tTG IgA, coeliac disease, immunofluorescence assay (IFA)

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Authors: Samson F. Agberotimi, Rachel B. Asagba, Choja Oduaran

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Disturbing rate of use of different substances such as cannabis, alcohol, as well as pharmaceutical drugs among Nigerian youth in recent times has been affirmed in the literature. There is, however, a paucity of literature addressing the pattern of usage of such drugs, especially for clinical relevance and intervention planning. The present study investigated the prevalence and pattern of drug usage among youth in Ogbomoso, Nigeria. A cross-sectional survey involving 92 purposively selected participants comprising of 82 males and 10 females aged between 15 and 24 years was conducted. A measure of drug involvement and demographic characteristics was administered to the participants. Descriptive analysis was done using the SPSS v.21. Cannabis (79.4%), alcohol (77.2%), codeine (70.7%), tobacco (65.2%) and tramadol (47.8%) are the five most frequently used substances. However, the majority of the users of tobacco (68.3%) and alcohol (62.0%) are casual users indicating a mild level of use of the substances among the participants. On the other hand, 49.2% of the codeine users, 27.3% of the tramadol users, and 21.9% of the cannabis users reported harmful/intensive levels of use. Furthermore, the results revealed individuals at the pathological level of use as 28.8% for cannabis, 25.0% for tramadol, and 21.6% for codeine, and thus require clinical/therapeutic intervention. In conclusion, cannabis remains the most frequently used substance among youths. However, there appears to be a shift from the use of conventional psychoactive substances to pharmaceutical/prescription drugs such as codeine and tramadol. The findings of this study raised the need for both preventive and therapeutic interventions addressing the problem of substance use disorder among youth in contemporary society.

Keywords: Ogbomoso, pattern of drug use, prevalence of drug use, youth

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Authors: Omar Nouri, Wafa Mnejja, Nejla Fourati, Fatma Dhouib, Wicem Siala, Ilhem Charfeddine, Afef Khanfir, Jamel Daoud

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Background and objective: Induction chemotherapy (IC) followed by concomitant chemo radiotherapy with intensity modulated radiation (IMRT) technique is actually the recommended treatment modality for locally advanced nasopharyngeal carcinomas (NPC). The aim of this study was to evaluate the prognostic factors predicting loco regional relapse with this new treatment protocol. Patients and methods: A retrospective study of 52 patients with NPC treated between June 2016 and July 2019. All patients received IC according to the protocol of the Head and Neck Radiotherapy Oncology Group (Gortec) NPC 2006 (3 TPF courses) followed by concomitant chemo radiotherapy with weekly cisplatin (40 mg / m2). Patients received IMRT with integrated simultaneous boost (SIB) of 33 daily fractions at a dose of 69.96 Gy for high-risk volume, 60 Gy for intermediate risk volume and 54 Gy for low-risk volume. Median age was 49 years (19-69) with a sex ratio of 3.3. Forty five tumors (86.5%) were classified as stages III - IV according to the 2017 UICC TNM classification. Loco regional relapse (LRR) was defined as a local and/or regional progression that occurs at least 6 months after the end of treatment. Survival analysis was performed according to Kaplan-Meier method and Log-rank test was used to compare anatomy clinical and therapeutic factors that may influence loco regional free survival (LRFS). Results: After a median follow up of 42 months, 6 patients (11.5%) experienced LRR. A metastatic relapse was also noted for 3 of these patients (50%). Target volumes coverage was optimal for all patient with LRR. Four relapses (66.6%) were in high-risk target volume and two (33.3%) were borderline. Three years LRFS was 85,9%. Four factors predicted loco regional relapses: histologic type other than undifferentiated (UCNT) (p=0.027), a macroscopic pre chemotherapy tumor volume exceeding 100 cm³ (p=0.005), a reduction in IC doses exceeding 20% (p=0.016) and a total cumulative cisplatin dose less than 380 mg/m² (p=0.0.34). TNM classification and response to IC did not impact loco regional relapses. Conclusion: For nasopharyngeal carcinoma, tumors with initial high volume and/or histologic type other than UCNT, have a higher risk of loco regional relapse. Therefore, they require a more aggressive therapeutic approaches and a suitable monitoring protocol.

Keywords: loco regional relapse, modulation intensity radiotherapy, nasopharyngeal carcinoma, prognostic factors

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Authors: Boris Barbolyas, Kristina Buckova, Tomas Volensky, Cyril Belavy, Ladislav Dedik

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Background: Based on statokinezigram, the human balance control is often studied. Approach to human postural reaction analysis is based on a combination of stabilometry output signal with retroreflective marker data signal processing, analysis, and understanding, in this study. The study shows another original application of Method of Developed Statokinesigram Trajectory (MDST), too. Methods: In this study, the participants maintained quiet bipedal standing for 10 s on stabilometry platform. Consequently, bilateral vibration stimuli to Achilles tendons in 20 s interval was applied. Vibration stimuli caused that human postural system took the new pseudo-steady state. Vibration frequencies were 20, 60 and 80 Hz. Participant's body segments - head, shoulders, hips, knees, ankles and little fingers were marked by 12 retroreflective markers. Markers positions were scanned by six cameras system BTS SMART DX. Registration of their postural reaction lasted 60 s. Sampling frequency was 100 Hz. For measured data processing were used Method of Developed Statokinesigram Trajectory. Regression analysis of developed statokinesigram trajectory (DST) data and retroreflective marker developed trajectory (DMT) data were used to find out which marker trajectories most correlate with stabilometry platform output signals. Scaling coefficients (λ) between DST and DMT by linear regression analysis were evaluated, too. Results: Scaling coefficients for marker trajectories were identified for all body segments. Head markers trajectories reached maximal value and ankle markers trajectories had a minimal value of scaling coefficient. Hips, knees and ankles markers were approximately symmetrical in the meaning of scaling coefficient. Notable differences of scaling coefficient were detected in head and shoulders markers trajectories which were not symmetrical. The model of postural system behavior was identified by MDST. Conclusion: Value of scaling factor identifies which body segment is predisposed to postural instability. Hypothetically, if statokinesigram represents overall human postural system response to vibration stimuli, then markers data represented particular postural responses. It can be assumed that cumulative sum of particular marker postural responses is equal to statokinesigram.

Keywords: center of pressure (CoP), method of developed statokinesigram trajectory (MDST), model of postural system behavior, retroreflective marker data

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Authors: Ahmad Abu-Akel, Emilie De Montpellier, Sophie Von Bentivegni, Lyn Luechinger, Alessandro Ishii, Christine Mohr

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Convergent and divergent thinking are two main components of creativity that have been viewed as complementary. While divergent thinking refers to the fluency and flexibility of generating new ideas, convergent thinking refers to the ability to systematically apply rules and knowledge to arrive at the optimal solution or idea. These creativity components have been shown to be susceptible to variation in subclinical expressions of autistic and schizotypal traits within the general population. Research, albeit inconclusively, mainly linked positive schizotypal traits with divergent thinking and autistic traits with convergent thinking. However, cumulative evidence suggests that these trait dimensions can co-occur in the same individual more than would be expected by chance and that their concurrent effect can be diametric and even interactive. The current study aimed at investigating the concurrent effect of these trait dimensions on tasks assessing convergent and divergent thinking abilities. We predicted that individuals with high positive schizotypal traits alone would perform particularly well on the divergent thinking task, whilst those with high autistic traits alone would perform particularly well on the convergent thinking task. Crucially, we also predicted that individuals who are high on both autistic and positive schizotypal traits would perform particularly well on both the divergent and convergent thinking tasks. This was investigated in a non-clinical sample of 142 individuals (Males = 45%; Mean age = 21.45, SD = 2.30), sufficient to minimally observe an effect size f² ≥ .10. Divergent thinking was evaluated using the Alternative Uses Task, and convergent thinking with the Anagrams Task. Autistic and schizotypal traits were respectively assessed with the Autism Quotient Questionnaire (AQ) and the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE). Regression analyses revealed that the positive association of autistic traits with convergent thinking scores was qualified with an interaction with positive schizotypal traits. Specifically, positive schizotypal traits were negatively associated with convergent thinking scores when AQ scores were relatively low, but this trend was reversed when AQ scores were high. Conversely, the positive effect of AQ scores on convergent thinking progressively increased with increasing positive schizotypal traits. The results of divergent thinking task are currently being analyzed and will be reported at the conference. The association of elevated autistic and positive schizotypal traits with convergent thinking may represent a unique profile of creative thinkers who are able to simultaneously draw on trait-specific advantages conferred by autistic and positively schizotypal traits such as local and global processing. This suggests that main-effect models can tell an incomplete story regarding the effect of autistic and positive schizotypal traits on creativity-related processes. Future creativity research should consider their interaction and the benefits conferred by their co-presence.

Keywords: autism, schizotypy, convergent thinking, divergent thinking, comorbidity

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Authors: Pia Berner Hansson, Robert Murison Anders Lund, Hammar Åsa

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Major Depressive Disorder (MDD) is often associated with high levels of stress and disturbances in the Hypothalamic Pituitary Adrenal (HPA) system, yielding high levels of cortisol, in addition to cognitive dysfunction. Previous studies in this patient group have shown a relationship between cortisol profile and cognitive functioning in the acute phase of MDD and that the patients had significantly less suppression after dexamethasone administration. However, few studies have investigated this relationship over time and in phases of symptom reduction. The aim of the present study was to examine the relationships between cortisol levels after the Dexamethasone Suppression Test (DST) and cognitive function in a long term perspective in MDD patients. Patients meeting the DSM-IV criteria for a MDD were included in the study and tested in symptom reduction. A control group was included. Cortisol was measured in saliva collected with Salivette sampling devices. Saliva samples were collected 4 times during a 24 hours period over two consecutive days: at awakening, after 45 minutes, after 7 hours and at 11 pm. Dexamethasone (1.0 mg) was given on Day 1 at 11 pm. The neuropsychological test battery consisted of standardized tests measuring memory and Executive Functioning (EF). Cortisol levels did not differ significantly between patients and controls on Day 1 or Day 2. Both groups showed significant suppression after Dexamethasone. There were no correlations between cortisol levels or suppression after Dexamethasone and cognitive measures. The results indicate that the HPA-axis functioning normalizes in phases of symptom reduction in MDD patients and that there no relation between cortisol profile and cognitive functioning in memory or EF.

Keywords: depression, MDD, cortisol, suppression, cognitive functioning

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Authors: Karen Hong

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Smart tactile textiles are a series of textile-based products that incorporates smart embedded technology to be utilized as tactile therapeutic applications for 2 main groups of target users. The first group of users will be children with sensory processing disorder who are suffering from tactile sensory dysfunction. Children with tactile sensory issues may have difficulty tolerating the sensations generated from the touch of certain textures on the fabrics. A series of smart tactile textiles, collectively known as ‘Tactile Toys’ are developed as tactile therapy play objects, exposing children to different types of touch sensations within textiles, enabling them to enjoy tactile experiences together with interactive play which will help them to overcome fear of certain touch sensations. The second group of users will be the elderly or geriatric patients who are suffering from deteriorating sense of touch. One of the common consequences of aging is suffering from deteriorating sense of touch and a decline in motoric function. With the focus in stimulating the sense of touch for this particular group of end users, another series of smart tactile textiles, collectively known as ‘Tactile Aids’ are developed also as tactile therapy. This range of products can help to maintain touch sensitivity and at the same time allowing the elderly to enjoy interactive play to practice their hand-eye coordination and enhancing their motor skills. These smart tactile textile products are being designed and tested out by the end users and have proofed their efficacy as tactile therapy enabling the users to lead a better quality of life.

Keywords: smart textiles, embedded technology, tactile therapy, tactile aids, tactile toys

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Authors: Tomohiro Uchida, Noriaki Satake, Toshimichi Nakaho, Akira Inoue, Hidemitsu Saito

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In this study, we assessed the bereavement risk of family caregivers of patients with cancer. In the palliative care unit of Tohoku University Hospital, we conducted a family psychoeducation session to support the family caregivers of patients with cancer. A total of 50 participants (8 males and 42 females; mean age = 62.98 years, SD = 11.10) were assessed after the session for bereavement risk using the Japanese version of the Bereavement Risk Assessment Tool (BRAT-J). According to the BRAT-J scores, eight participants were considered to be having no known risk (Level 1), seventeen had minimal risk (Level 2), twenty had a low risk (Level 3), four had a moderate risk (Level 4), and one had a high risk (Level 5). Of these participants, seven participants had completed the follow-up postal survey that assessed their psychological distress (the Kessler Psychological Distress Scale: K6) to compare the bereavement risk. According to the K6 scores, three-fourth of the individuals, who were considered to be at Level 3 on the BRAT-J, scored higher than the cutoff point (>10) for the detection of depressive disorder. On the other hand, one-third of the individuals, who were considered to be at Level 2 on the BRAT-J, scored higher than the cutoff point. Therefore, it appears that the BRAT-J can predict the likelihood of difficulties or complications in bereaved family caregivers. This research was approved by the Ethics Committee of Tohoku University Graduate School of Medicine and Tohoku University Hospital.

Keywords: palliative care, family caregivers, bereavement risk, BRAT, post-loss psychological distress

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Authors: Chaomeng Liu, Li Li, Xiao Wang, Li Ren, Qinge Zhang

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Late-life depression (LLD) is a prevalent mental disorder among the elderly, frequently accompanied by significant cognitive decline, and has emerged as a worldwide public health concern. Microglia, astrocytes, and peripheral immune cells play pivotal roles in regulating inflammatory responses within the central nervous system (CNS) across diverse cerebral disorders. This review commences with the clinical research findings and accentuates the recent advancements pertaining to microglia and astrocytes in the neuroinflammation process of LLD. The reciprocal communication network between the CNS and immune system is of paramount importance in the pathogenesis of depression and cognitive decline. Stress-induced downregulation of tight and gap junction proteins in the brain results in increased blood-brain barrier permeability and impaired astrocyte function. Concurrently, activated microglia release inflammatory mediators, initiating the kynurenine metabolic pathway and exacerbating the quinolinic acid/kynurenic acid imbalance. Moreover, the balance between Th17 and Treg cells is implicated in the preservation of immune homeostasis within the cerebral milieu of individuals suffering from LLD. The ultimate objective of this review is to present future strategies for the management and treatment of LLD, informed by the most recent advancements in research, with the aim of averting or postponing the onset of AD.

Keywords: neuroinflammation, late-life depression, microglia, astrocytes, central nervous system, blood-brain barrier, Kynurenine pathway

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Authors: Jamie R. Chua, Christina Irene D. Mejia, Regina P. Berba

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Disseminated tuberculosis is an infectious disease caused by Mycobacterium tuberculosis involving two or more non-contiguous sites identified through bacteriologic confirmation or clinical diagnosis. Over the five year period included in the study, the UP-PGH TB DOTS clinic had total of 3,967 referrals, and the prevalence of disseminated tuberculosis is 1% (68/3967). The mean age was 33.9 years (range 19-64 years) with a male: female ratio of 1:1. 67% (52 patients) had no predisposing comorbid illness or immune disorder. The most common presenting symptoms were abdominal pain (19%), back pain (13%), abdominal enlargement (11%) and mass (10.2%). Anemia, leukocytosis, hypoalbuminemia, and high-normal serum calcium were common biochemical and hematologic findings. Around 36% (25) of patients were diagnosed clinically with disseminated tuberculosis despite lacking bacteriologic evidence of multi-organ involvement. The lungs (86%) is still the most commonly involved site, followed by intestinal (22%), vertebral/Pott’s (27%), and pelvic/genital (19%). The mean time from presentation to initiation of therapy was 22 days (SD 32.7). Only 18 patients (29.3%) were properly recorded to have been referred to local TB DOTs facilities. Of the 68 patients, only 16% (11 patients) continued follow-up at PGH, and all had documented treatment completion. Treatment outcomes of the remaining were unknown. Due to the variety of involved sites, a high index of suspicion is required. Knowledge on clinical features, common radiographic findings, and histopathologic characteristics of disseminated TB is important as bacteriologic evidence of infection is not always apparent.

Keywords: disseminated tuberculosis, Mycobacterium tuberculosis, miliary tuberculosis, tuberculosis

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