Search results for: neck circumference

Authors: Vladyslav Povoroznyuk, Larysa Martynyuk, Iryna Syzonenko, Liliya Martynyuk

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Osteoporosis is one of the important problems in postmenopausal women due to an increased risk of sudden and unexpected fractures. This study is aimed to determine the connection between bone mineral density (BMD) and trabecular bone score (TBS) in Ukrainian women suffering from metabolic syndrome. Participating in the study, 566 menopausal women aged 50-79 year-old were examined and divided into two groups: Group A included 336 women with no obesity (BMI ≤ 29.9 kg/m²), and Group B – 230 women with metabolic syndrome (diagnosis according to IDF criteria, 2005). Dual-energy X-ray absorptiometry was used for measuring of lumbar spine (L1-L4), femoral neck, total body and forearm BMD and bone quality indexes (last according to Med-Imaps installation). Data were analyzed using Statistical Package 6.0. A significant increase of lumbar spine (L1-L4), femoral neck, total body and ultradistal radius BMD was found in women with metabolic syndrome compared to those without obesity (p < 0.001) both in their totality and in groups of 50-59 years, 60-69 years, and 70-79 years. TBS was significantly higher in non-obese women compared to metabolic syndrome patients of 50-59 years and in the general sample (p < 0.05). Analysis showed significant positive correlation between body mass index (BMI) and BMD at all levels. Significant negative correlation between BMI and TBS (L1-L4) was established. Despite the fact that BMD indexes were significantly higher in women with metabolic syndrome, the frequency of vertebral and non-vertebral fractures did not differ significantly in the groups of patients.

Keywords: bone mineral density, trabecular bone score, metabolic syndrome, fracture

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Authors: Mehdi Nematimoez

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Head posture is paramount to retaining gaze and balance in many activities; its control is thus important in many activities. However, little information is available about the effects of head movement restriction on other spine segment kinematics and movement patterns during lifting and lowering tasks. The aim of this study was to examine the effects of head movement restriction on relative angles and their derivatives using the stepwise segmentation approach during lifting and lowering tasks. Ten healthy men lifted and lowered a box using two styles (stoop and squat), with two loads (i.e., 10 and 20% of body weight); they performed these tasks with two instructed head postures (1. Flexing the neck to keep contact between chin and chest over the task cycle; 2. No instruction, free head posture). The spine was divided into five segments, tracked by six cluster markers (C7, T3, T6, T9, T12, and L5). Relative angles between spine segments and their derivatives (first and second) were analyzed by a stepwise segmentation approach to consider the effect of each segment on the whole spine. Accordingly, head posture significantly affected the derivatives of the relative angles and manifested latency in spine segments movement, i.e., cephalad-to-caudad or caudad-to-cephalad patterns. The relative angles for C7-T3 and T3-T6 increased over the cycle of all lifting and lowering tasks; nevertheless, in lower segments increased significantly when the spine moved into upright standing. However, these effects were clearer during lifting than lowering. Conclusively, the neck flexion can unevenly increase the flexion angles of spine segments from cervical to lumbar over lifting and lowering tasks; furthermore, stepwise segmentation reveals potential for assessing the segmental contribution in spine ROM and movement patterns.

Keywords: head movement restriction, spine kinematics, lifting, lowering, stepwise segmentation

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Authors: Maierhaba Mijiti

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Objective：The aim is to understand the relationship between the expression level of the long-non-coding RNA LINC AC008063 and the clinicopathological parameters of patients with head and neck squamous cell carcinoma (HNSCC), and to clarify the biological function of LINC AC008063 in HNSCC cells. Moreover, it provides a potential biomarker for the diagnosis, treatment, and prognosis evaluation of HNSCC. Methods: The expression level of LINC AC008063 in the HNSCC was analyzed using transcriptome sequencing data from the TCGA (The cancer genome atlas) database. The expression levels of LINC AC008063 in human embryonic lung diploid cells 2BS, human immortalized keratinocytes HACAT, HNSCC cell lines CAL-27, Detroit562, AMC-HN-8, FD-LSC-1, FaDu and WSU-HN30 were determined by real-time quantitative PCR (qPCR). RNAi (RNA interference) was introduced for LINC AC008063 knockdown in HNSCC cell lines, the localization and abundance analysis of LINC AC008063 was determined by RT-qPCR, and the biological functions were examined by CCK-8, clone formation, flow cytometry, transwell invasion and migration assays, Seahorse assay. Results: LINC AC008063 was upregulated in HNSCC tissue (P<0.001), and verified b CCK-8, clone formation, flow cytometry, transwell invasion and migration assays, Seahorse assayy qPCR in HNSCC cell lines. The survival analysis revealed that the overall survival rate (OS) of patients with high LINC AC008063 expression group was significantly lower than that in the LINC AC008063 expression group, the median survival times for the two groups were 33.10 months and 61.27 months, respectively (P=0.002). The clinical correlation analysis revealed that its expression was positively correlated with the age of patients with HNSCC (P<0.001) and positively correlated with pathological state (T3+T4＞T1+T2, P=0.03). The RT-qPCR results showed that LINC AC008063 was mainly enriched in cytoplasm (P=0.01). Knockdown of LINC AC008063 inhibited proliferation, colony formation, migration and invasion; the glycolytic capacity was significantly decreased in HNSCC cell lines (P＜0.05). Conclusion: High level of LINC AC008063 was associated with the malignant progression of HNSCC as well as promoting the important biological functions of proliferation, colony formation, migration and invasion; in particular, the glycolytic capacity was decreased in HNSCC cells. Therefore, LINC AC008063 may serve as a potential biomarker for HNSCC and a distinct molecular target to inhibit glycolysis.

Keywords: head and neck squamous cell carcinoma, oncogene, long non-coding RNA, LINC AC008063, invasion and metastasis

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Authors: Vinti Davar

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Background: Worldwide, at least 2.8 million people die each year as a result of being overweight or obese, and 35.8 million (2.3%) of global DALYs are caused by overweight or obesity. Obesity is acknowledged as one of the burning public health problems reducing life expectancy and quality of life. The body composition analysis of the university population is essential in assessing the nutritional status, as well as the risk of developing diseases associated with abnormal body fat content so as to make nutritional recommendations. Objectives: The main aim was to determine the prevalence of obesity and overweight in University students using Anthropometric analysis and BIA methods Material and Methods: In this cross-sectional study, 283 university students participated. The body composition analysis was undertaken by using mainly: i) Anthropometric Measurement: Height, Weight, BMI, waist circumference, hip circumference and skin fold thickness, ii) Bio-electrical impedance was used for analysis of body fat mass, fat percent and visceral fat which was measured by Tanita SC-330P Professional Body Composition Analyzer. The data so collected were compiled in MS Excel and analyzed for males and females using SPSS 16.Results and Discussion: The mean age of the male (n= 153) studied subjects was 25.37 ±2.39 year and females (n=130) was 22.53 ±2.31. The data of BIA revealed very high mean fat per cent of the female subjects i.e. 30.3±6.5 per cent whereas mean fat per cent of the male subjects was 15.60±6.02 per cent indicating a normal body fat range. The findings showed high visceral fat of both males (12.92±3.02) and females (16.86±4.98). BMI, BF% and WHR were higher among females, and BMI was higher among males. The most evident correlation was verified between BF% and WHR for female students (r=0.902; p<0.001). The correlation of BFM and BF% with thickness of triceps, sub scapular and abdominal skin folds and BMI was significant (P<0.001). Conclusion: The studied data made it obvious that there is a need to initiate lifestyle changing strategies especially for adult females and encourage them to improve their dietary intake to prevent incidence of non communicable diseases due to obesity and high fat percentage.

Keywords: anthropometry, bioelectrical impedance, body fat percentage, obesity

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Authors: Nadiya Zahra Karimi, Amir Ghiami Rad

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The physical health of students from an early age and the proper formation of the musculoskeletal system of their body is part of the overall health of these people. Most chronic musculoskeletal problems and pains can be controlled and reduced with education at an early age. Therefore, with the correct and timely diagnosis of these abnormalities, we can play an important role in their proper treatment and control, and in a way, raise the level of quality of life and positive self-concept in students. The aim of this study was to investigate the relationship between erectile dysfunctions of the upper limbs (head and neck, shoulder, thoracic and lumbar) and the quality of life and self-concept of male students aged 7 to 10 years. The statical population of the study consists of 227 students of shahadat boys’ primary school in khajeh city. Due to the corona pandemic conditions, the research samples were identified after screening and available according to the entrance criteria of the study. To validate the quality of life, the valid WHOQOL-BREF questionnaire will be used for self-concept variables, Dolatabadi, Fatemeh (2007) questionnaire, and for physical screening, a checkerboard, plumb line, and flexible ruler will be used. There is a negative and significant relationship between the dimensions of upper limb anomalies and quality of life factors, and also there is a negative and significant relationship between the dimensions of upper limb anomalies and self-concept factors. The results showed that there is a negative and significant relationship between head and neck abnormalities with quality of life and self-concept factors, with a significance level of less than 0.05 in male students aged 7 to 10 years.

Keywords: upper limb erectile dysfunction, quality of life, self-concept, erectile abnormalities

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Authors: Samir El-Gendy, Doaa Zaghloul

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The current study dealt with the gross and microscopic anatomy of the integument of male ostrich in addition to the histological features of different areas of skin by light and SEM. The ostrich skin is characterized by prominent feather follicles and bristles. The number of feather follicles was determined per cm2 in different regions. The integument of ostrich had many modifications which appeared as callosities and scales, nail and toe pads. They were sternal, pubic and Achilles tendon callosities. The vacuolated epidermal cells were seen mainly in the skin of legs and to a lesser extent in the skin of back and Achilles areas. Higher lipogenic potential was expressed by epidermis from glabrous areas of ostrich skin. The dermal papillae were found in the skin of feathered area of neck and back and this was not a common finding in bird's skin which may give resistance against shearing forces in these regions of ostrich skin. The thickness of the keratin layer of ostrich varied, being thick and characteristically loose in the skin at legs, very thin and wavy at neck, while at Achilles skin area, scale and toe pad were thick and more compact, with the thickest very dense and wavy keratin layer at the nail. The dermis consisted of superficial layer of dense irregular connective tissue characterized by presence of many vacuoles of different sizes just under the basal lamina of the epithelium of epidermis and deep layer of dense regular connective tissue. This result suggested presence of fat droplets in this layer which may be to overcome the lack of good barrier of cutaneous water loss in epidermis.

Keywords: ostrich, light microscopy, scanning electron microscopy, integument, skin modifications

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Authors: Amany Ragab, Nashwa Khairat Abousamra, Omayma Saleh, Asmaa Higazy

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Insulin resistance syndrome has been shown to be associated with many coagulation and fibrinolytic proteins and these associations suggest that some coagulation and fibrinolytic proteins have a role in atherothrombotic disorders. This study was conducted to determine the levels of some of the haemostatic parameters in subjects having metabolic syndrome and to correlate these values with the anthropometric and metabolic variables associated with this syndrome. The study included 46 obese non diabetic subjects of whom 28 subjects(group1) fulfilled the ATP III criteria of the metabolic syndrome and 18 subjects (group2) did not have metabolic syndrome as well as 14 lean subjects (group 3) of matched age and sex as a control group. Clinical and laboratory evaluation of the study groups stressed on anthropometric measurements (weight, height, body mass index, waist circumference, and sagittal abdominal diameter), blood pressure, and laboratory measurements of fasting plasma glucose, fasting insulin, serum lipids, tissue plasminogen activator (t-PA), antithrombin III activity (ATIII), protein C and von Willebrand factor (vWf) antigen. There was significant increase in the concentrations of t-PA and vWf antigens in subjects having metabolic syndrome (group 1) in comparison to the other groups while there were non-significant changes in the levels of protein C antigen and AT III activity. Both t-PA and vWf showed significant correlation with HOMA-IR as a measure of insulin sensitivity. The t-PA showed also significant correlation with most of the variables of metabolic syndrome including waist circumference, BMI, systolic blood pressure, fasting plasma glucose, fasting insulin, and HDL cholesterol. On the other hand, vWf showed significant correlations with fasting plasma glucose, fasting insulin and sagital abdominal diameter, with non-significant correlations with the other variables. Haemostatic and fibrinolytic parameters should be included in the features and characterization of the insulin resistance syndrome. t-PA and vWf antigens concentrations were increased in subjects with metabolic syndrome and correlated with the HOMA-IR measure of insulin sensitivity. Taking into consideration that both t-PA and vWf are mainly released from vascular endothelium, these findings could be an indicator of endothelial dysfunction in that group of subjects.

Keywords: insulin resistance, obesity, metabolic syndrome, coagulation

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Authors: Nursyafiq Ali Shibramulisi, Nor Farah Fauzi, Nur Azniza Zawin Anuar, Nurul Atikah Azmi, Janice Hew Pei Fang

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Background: Work related musculoskeletal disorders (WRMD) among dental personnel have been underestimated and under-reported worldwide and specifically in Malaysia. The problem will arise and progress slowly over time, as it results from accumulated injury throughout the period of work. Several risk factors, such as repetitive movement, static posture, vibration, and adapting poor working postures, have been identified to be contributing to WRMSD in dental practices. Dental personnel is at higher risk of getting this problem as it is their working nature and core business. This would cause pain and dysfunction syndrome among them and result in absence from work and substandard services to their patients. Methodology: A cross-sectional study involving 19 government dental clinics in Perak was done over the period of 3 months. Those who met the criteria were selected to participate in this study. Malay version of the Self-Reported Nordic Musculoskeletal Discomfort Form was used to identify the prevalence of WRMSD, while the intensity of pain in the respective regions was evaluated using a 10-point scale according to ‘Pain as The 5ᵗʰ Vital Sign’ by MOH Malaysia and later on were analyzed using SPSS version 25. Descriptive statistics, including mean and SD and median and IQR, were used for numerical data. Categorical data were described by percentage. Pearson’s Chi-Square Test and Spearman’s Correlation were used to find the association between the prevalence of WRMSD and other socio-demographic data. Results: 159 dentists, 73 dental therapists, 26 dental lab technicians, 81 dental surgery assistants, and 23 dental attendants participated in this study. The mean age for the participants was 34.9±7.4 and their mean years of service was 9.97±7.5. Most of them were female (78.5%), Malay (71.3%), married (69.6%) and right-handed (90.1%). The highest prevalence of WRMSD was neck (58.0%), followed by shoulder (48.1%), upper back (42.0%), lower back (40.6%), hand/wrist (31.5%), feet (21.3%), knee (12.2%), thigh 7.7%) and lastly elbow (6.9%). Most of those who reported having neck pain scaled their pain experiences at 2 out of 10 (19.5%), while for those who suffered upper back discomfort, most of them scaled their pain experience at 6 out of 10 (17.8%). It was found that there was a significant relationship between age and pain at neck (p=0.007), elbow (p=0.027), lower back (p=0.032), thigh (p=0.039), knee (p=0.001) and feet (p=0.000) regions. Job position also had been found to be having a significant relationship with pain experienced at the lower back (p=0.018), thigh (p=0.011), knee, and feet (p=0.000). Conclusion: The prevalence of WRMSD among dental personnel in Perak was found to be high. Age and job position were found to be having a significant relationship with pain experienced in several regions. Intervention programs should be planned and conducted to prevent and reduce the occurrence of WRMSD, as all harmful or unergonomic practices should be avoided at all costs.

Keywords: WRMSD, ergonomic, dentistry, dental

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Authors: Mohamed Gomaa Mohamed

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Background and purpose: Ideal posture involves a minimal amount of stress or strain on various body segments which are aligned and worked in harmony to protect the body from injury or progressive deformity. One of most common faulty posture encountered in clinical setting is forward head posture (FHP) that was considered one of the main predictors for neck pain. Furthermore, FHP may predispose to thoracic outlet syndrome, temporomandibular joint dysfunction, shoulder pain and headache. The large financial burden related to neck disorders management raises the need to improve the quality of assessment and rehabilitation of FHP. So, the purpose of the study is to compare between measurements of FHP as indicated with craniovertebral (CVA) and gaze angles assessed from dominant and non-dominant sides in football players who extensively use their dominant side and non-athletic subjects. Participants: Twenty-four subjects were divided into 12 football players and 12 non-athletic subjects. Methods: CVA and gaze angles were assessed through photogrammetric method. Photos were taken from dominant and non-dominant sides of the subjects while assuming standing position. Paired t-test was used to assess angles differences between dominant and non-dominant sides of the subjects. Since there were no statistical differences between CVA and gaze angles measured from dominant and non-dominant sides in each group, we pooled data together to become 24 measurements for each group (12 from dominant and 12 from non-dominant). Independent t-test was used to assess angles differences between football players and non-athletic subjects. Results: No significant differences were found between CVA and gaze angles measured from dominant and non-dominant sides of both groups (P>0.05). Also, there were no significant differences between CVA and gaze angles measured from football players and non-athletic subjects (P>0.05). Conclusion: FHP can be assessed from dominant or non-dominant sides interchangeably either in football players or non-athletic subjects. Furthermore, playing football has no impact on measurements of FHP when compared to non-athletic subjects.

Keywords: dominant side, forward head posture, football players, non-dominant side

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Authors: Faiz N. K. Yusufi, Aquil Ahmed, Jamal Ahmad

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Diabetes in India is growing at an alarming rate and the complications caused by it need to be controlled. Coronary heart disease (CHD) is one of the complications that will be discussed for prediction in this study. India has the second most number of diabetes patients in the world. To the best of our knowledge, there is no CHD risk score for Indian type 2 diabetes patients. Any form of CHD has been taken as the event of interest. A sample of 750 was determined and randomly collected from the Rajiv Gandhi Centre for Diabetes and Endocrinology, J.N.M.C., A.M.U., Aligarh, India. Collected variables include patients data such as sex, age, height, weight, body mass index (BMI), blood sugar fasting (BSF), post prandial sugar (PP), glycosylated haemoglobin (HbA1c), diastolic blood pressure (DBP), systolic blood pressure (SBP), smoking, alcohol habits, total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), physical activity, duration of diabetes, diet control, history of antihypertensive drug treatment, family history of diabetes, waist circumference, hip circumference, medications, central obesity and history of CHD. Predictive risk scores of CHD events are designed by cox proportional hazard regression. Model calibration and discrimination is assessed from Hosmer Lemeshow and area under receiver operating characteristic (ROC) curve. Overfitting and underfitting of the model is checked by applying regularization techniques and best method is selected between ridge, lasso and elastic net regression. Youden’s index is used to choose the optimal cut off point from the scores. Five year probability of CHD is predicted by both survival function and Markov chain two state model and the better technique is concluded. The risk scores for CHD developed can be calculated by doctors and patients for self-control of diabetes. Furthermore, the five-year probabilities can be implemented as well to forecast and maintain the condition of patients.

Keywords: coronary heart disease, cox proportional hazard regression, ROC curve, type 2 diabetes Mellitus

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Authors: Wael Salah Shendy, Moataz Mohamed EL Semary, Hosam Salah Murad, Adham A. Mohamed

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Background: Cervicogenic headache is a major problem in many people suffering from upper cervical dysfunction with a great conflict in its physical therapy management. Objectives: To determine the effect of C1-C2 Mulligan SNAGs mobilizations on cervicogenic headache and associated dizziness symptoms. Methods: Forty-eight patients with cervicogenic headache included in the study; from the outpatient clinic of Faculty of Physical Therapy, Cairo University, and New Cairo outpatient clinics, were randomly assigned into three equal groups; group A ( Headache SNAG), group B (C1-C2 SNAG rotation) and group C (combined). Their mean age was (29.37 ± 2.6), (29.31 ± 2.54) and (29.68 ± 2.65). Neck Disability Index used to examine neck pain intensity and CEH symptoms. 6 Items Headache Impact test '6-HIT' scale used to examine headache severity and its adverse effects on social life and functions. Flexion-Rotation Test 'FRT' also used to assess rotation ROM at the level of C1-C2 by 'CROM' device. Dizziness Handicap Inventory 'DHI' scale was used to evaluate dizziness symptoms. Evaluation is done pre and post treatment, and comparison between groups was quantified. Correlations between the examined parameters were also measured. Headache SNAG and C1-C2 Rotation SNAGs were done separately in group (A- B) and combined in group C as a treatment intervention. Results: Group C has Significant improvement in whole parameters compared to group A and B, positive correlation was found between NDI and 6-HIT scores compared to negative correlation between NDI and DHI scores. Conclusion: SNAGs mobilizations used in the study were effective in reducing cervicogenic headache and dizziness symptoms in all groups with a noticeable improvement in the combined group.

Keywords: cervicogenic headache, cervical headache snag, cervical snag half rotation, cervical dizziness

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Authors: R. S. Dinesh Madhavan, M. Logaraj

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Background: Recent studies have documented an increase in the risk of cardiovascular diseases (CVD) and a high rate of progression to hypertension in persons with pre hypertension. The risk factors for the growing burden of cardiovascular diseases especially hypertension, diabetes, overweight or obesity and waist hip ratio are increasing. Much study has not been done on cardiovascular risk factors associated with blood pressure (BP) among college students in Indian population. Objectives: The objective of our study was to estimate the prevalence of prehypertension among male students and to assess the association between prehypertension and risk factors for cardiovascular diseases. Material and Methods: A cross-sectional study was conducted among students of a university situated in the suburban area of Chennai. A total of 403 students was studied which included 200 medical and 203 engineering students. The information on selected socio-demographic variables were collected with the help of pre tested structured questionnaire. Measurements of height, weight, blood pressure and postprandial blood glucose were carried out as per standard procedure. Results: The mean age of the participants was 19.56 ± 1.67years. The mean systolic and diastolic blood pressure were 125.80±10.03 mm of Hg and 78.96 ±11.75mm of Hg. The average intake of fruits and vegetable per week were 4.34 ±3.47days and 6.55±4.39 days respectively. Use of smoke and smokeless tobacco were 27.3% and 3% respectively. About 30.3% of the students consume alcohol. Nearly 45.9 % of them did not practice regular exercise. About 29 % were overweight and 5.7% were obese, 24.8% were with waist circumference above 90 centimeters. The prevalence of pre hypertension and hypertension was 49.6% and 19.1% among male students. The prevalence of pre hypertension was higher in medical students (51.5%) compared to engineering students (47.8%). Higher risk of being pre hypertensive were noted above the age of 20 years (OR=4.32), fruit intake less than 3 days a week (OR= 1.03), smokers (OR= 1.13), alcohol intake (OR=1.56), lack of physical exercise (OR=1.90), BMI of more than 25 kg/m2 (OR=1.99). But statistically significant difference was noted between pre hypertensive and normotensive for age (p<0.0001), lack of physical exercise (p=0.004) and BMI (p=0.015). Conclusion: In conclusion nearly half of the students were pre hypertensive. Higher prevalence of smoking, alcohol intake, lack of physical exercise, overweight and increased waist circumference and postprandial blood sugar more than 140 mg/dl was noted among pre-hypertensive compared to normotensive.

Keywords: cardiovascular diseases, prehypertension, risk factors, undergraduate Students

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Authors: Saba Amreen Syeda, Summaiah Asim, Syeda, Hafsa, Essam Quraishi

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Mantle Cell Lymphoma (MCL) is a relatively uncommon type of lymphoma that comprises approximately 7 percent of non hodgkin's lymphomas (NHL), Classic MCL presents mostly in lymph nodes and occasionally in extranodal sites. About 26 % of MCL is present primarily in the Gastrointestinal tract. While both the upper GI tract and the lower GI tract could be involved, it is rare to present with concurrent upper and lower GI involvement with MCL. We present the case of a 51-year-old Asian Indian male that presented to our clinic with complaints of chronic diarrhea for the last one year, progressively worsening over the past three months. The Patient also reported black stool as well as bright red blood per rectum. Patient reported severe fatigue on minimal exertion. On a physical exam, the patient was noted to have matted lymphadenopathy in the neck. Patient was noted to be anemic with a hemoglobin to be 8 g/dl. Esophagogastroduodenoscopy and colonoscopy was performed. EGD showed a large 4 cm ulcer in the gastric antrum with thick heaped up edges. There was bleeding on contact. Colonoscopy showed a large 35 mm multilobulated polyp in the ascending colon, which was biopsied. The patient was also noted to have nodular proctitis in the mid rectum. This was localized and extended to about 5 cm. This area was biopsied as well. Biopsies from the stomach, colon, as well as the rectum, returned with findings of mantle cell lymphoma on pathology. Lymphoid cells in the biopsy were stained strongly positive for CD 20, cyclin D1, and CD 5. There was the absence of stain for CD 3 and CD 10. The IHC stain for CD 23 was negative. Biopsies from neck LAD were obtained and were also positive for MCL. The patient was referred to oncology for staging and treatment.

Keywords: mantle cell lymphoma, GI bleed, diarrhea, gastric ulcer, colon polyp

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Authors: Jong Yeop Kim, In Kyong Yi, Hyun Jeong Kwak, Sook Young Lee, Sung Yong Park

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Background: Several video laryngoscopes (VLs) were used to facilitate tracheal intubation in the normal and potentially difficult airway, especially by novice personnel. The aim of this study was to compare tracheal intubation performance regarding the time to intubation, glottic view, difficulty, and dental click, by a novice using McGrath VL, Pentax Airway Scope (AWS) and Macintosh laryngoscope in normal and cervical immobilized manikin models. Methods: Thirty-five anesthesia nurses without previous intubation experience were recruited. The participants performed endotracheal intubation in a manikin model at two simulated neck positions (normal and fixed neck via cervical immobilization), using three different devices (McGrath VL, Pentax AWS, and Macintosh direct laryngoscope) at three times each. Performance parameters included intubation time, success rate of intubation, Cormack Lehane laryngoscope grading, dental click, and subjective difficulty score. Results: Intubation time and success rate at the first attempt were not significantly different between the 3 groups in normal airway manikin. In the cervical immobilized manikin, the intubation time was shorter (p = 0.012) and the success rate with the first attempt was significantly higher (p < 0.001) when using McGrath VL and Pentax AWS compared with Macintosh laryngoscope. Both VLs showed less difficulty score (p < 0.001) and more Cormack Lehane grade I (p < 0.001). The incidence of dental clicks was higher with McGrath VL than Macintosh laryngoscope in the normal and cervical immobilized airway (p = 0.005, p < 0.001, respectively). Conclusion: McGrath VL and Pentax AWS resulted in shorter intubation time, higher first attempt success rate, compared with Macintosh laryngoscope by a novice intubator in a cervical immobilized manikin model. McGrath VL could be reduced the risk of dental injury compared with Macintosh laryngoscope in this scenario.

Keywords: intubation, manikin, novice, videolaryngoscope

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Authors: Ammaarah Gamieldien

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Depression is a very common and serious mental illness that has a significant impact on both the social and economic aspects of sufferers worldwide. This study aimed to investigate the association between body mass index (BMI), blood pressure, and lipid profiles with mental health symptoms in university students. Secondary objectives included the associations between the variables (BMI, blood pressure, and lipids) with themselves, as they are key factors in cardiometabolic disease. Sixty-three (63) students participated in the study. Thirty-two (32) were assigned to the control group (minimal-mild depressive symptoms), while 31 were assigned to the depressive group (moderate to severe depressive symptoms). Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI) were used to assess depressive scores. Anthropometric measurements such as weight (kg), height (m), waist circumference (WC), and hip circumference were measured. Body mass index (BMI) and ratios such as waist-to-hip ratio (WHR) and waist-to-height ratio (WtHR) were also calculated. Blood pressure was measured using an automated AfriMedics blood pressure machine, while lipids were measured using a CardioChek plus analyzer machine. Statistics were analyzed via the SPSS statistics program. There were no significant associations between anthropometric measurements and depressive scores (p > 0.05). There were no significant correlations between lipid profiles and depression when running a Spearman’s rho correlation (P > 0.05). However, total cholesterol and LDL-C were negatively associated with depression, and triglycerides were positively associated with depression after running a point-biserial correlation (P < 0.05). Overall, there were no significant associations between blood pressure measurements and depression (P > 0.05). However, there was a significant moderate positive correlation between systolic blood pressure and MADRS scores in males (P < 0.05). Depressive scores positively and strongly correlated to how long it takes participants to fall asleep. There were also significant associations with regard to the secondary objectives. This study indicates the importance of determining the prevalence of depression among university students in South Africa. If the prevalence and factors associated with depression are addressed, depressive symptoms in university students may be improved.

Keywords: depression, blood pressure, body mass index, lipid profiles, mental health symptoms

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Authors: D. Maryama AG. Daud, Zuliana Bacho, Stephanie Chok, DG. Mashitah PG. Baharuddin, Mohd Hatta Tarmizi, Nathira Abdul Majeed, Helen Lasimbang

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Lifestyle, physical activity, food intake, genetics and medication are contributing factors for people getting obese. Which in some of the obese people were a low or non-responder to exercise. And obesity is very common clinical feature in women affected by Polycystic Ovarian Syndrome (PCOS). Labisia pumila var. alata (LP) is a local herb which had been widely used by Malay women in treating menstrual irregularities, painful menstruation and postpartum well-being. Therefore, this study was carried out to investigate the effect of LP with a structured exercise program on anthropometric, body composition and physical fitness performance of PCOS patients. By using a single blind and parallel study design, where by subjects were assigned into a 16-wk structured exercise program (3 times a week) interventions; (LP and exercise; LPE, and exercise only; E). All subjects in the LPE group were prescribed 200mg LP; once a day, for 16 weeks. The training heart rate (HR) was monitored based on a percentage of the maximum HR (HRmax) achieved during submaximal exercise test that was conducted at wk-0 and wk-8. The progression of aerobic exercise intensity from 25–30 min at 60 – 65% HRmax during the first week to 45 min at 75–80% HRmax by the end of this study. Anthropometric (body weight, Wt; waist circumference, WC; and hip circumference, HC), body composition (fat mass, FM; percentage body fat, %BF; Fat Free Mass, FFM) and physical fitness performance (push up to failure, PU; 1-minute Sit Up, SU; and aerobic step test, PVO2max) were measured at wk-0, wk-4, wk-8, wk-12, and wk-16. This study found that LP does not have a significant effect on body composition, anthropometric and physical fitness performance of PCOS patients underwent a structured exercise program. It means LP does not improve exercise responses of PCOS patients towards anthropometric, body composition and physical fitness performance. The overall data shows exercise responses of PCOS patients is by increasing their aerobic endurance and muscle endurance performances, there is a significant reduction in FM, PBF, HC, and Wt significantly. Therefore, exercise program for PCOS patients have to focus on aerobic fitness, and muscle endurance.

Keywords: polycystic ovarian syndrome, Labisia pumila var. alata, body composition, aerobic endurance, muscle endurance, anthropometric

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Authors: Petr Daniel Kovarik, Matt Kennedy, James Adams, Ajay Wilson, Andy Burns, Charles Kelly, Malcolm Jackson, Rahul Patil, Shahid Iqbal

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Introduction: Osteoradionecrosis (ORN) is a recognised toxicity of radiotherapy (RT) for head and neck cancer (HNC). Existing literature lacks any generally accepted definition and staging system for this toxicity. Objective: The objective is to analyse the outcome of the surgical and nonsurgical treatments of ORN. Material and Method: Data on 2303 patients treated for HNC with radical or adjuvant RT or RT-chemotherapy from January 2010 - December 2021 were retrospectively analysed. Median follow-up to the whole group of patients was 37 months (range 0–148 months). Results: ORN developed in 185 patients (8.1%). The location of ORN was as follows; mandible=170, maxilla=10, and extra oral cavity=5. Multiple ORNs developed in 7 patients. 5 patients with extra oral cavity ORN were excluded from treatment analysis as the management is different. In 180 patients with oral cavity ORN, median follow-up was 59 months (range 5–148 months). ORN healed in 106 patients, treatment failed in 74 patients (improving=10, stable=43, and deteriorating=21). Median healing time was 14 months (range 3-86 months). Notani staging is available in 158 patients with jaw ORN with no previous surgery to the mandible (Notani class I=56, Notani class II=27, and Notani class III=76). 28 ORN (mandible=27, maxilla=1; Notani class I=23, Notani II=3, Notani III=1) healed spontaneously with a median healing time 7 months (range 3–46 months). In 20 patients, ORN developed after dental extraction, in 1 patient in the neomandible after radical surgery as a part of the primary treatment. In 7 patients, ORN developed and spontaneously healed in irradiated bone with no previous surgical/dental intervention. Radical resection of the ORN (segmentectomy, hemi-mandibulectomy with fibula flap) was performed in 43 patients (all mandible; Notani II=1, Notani III=39, Notani class was not established in 3 patients as ORN developed in the neomandible). 27 patients healed (63%); 15 patients failed (improving=2, stable=5, deteriorating=8). The median time from resection to healing was 6 months (range 2–30 months). 109 patients (mandible=100, maxilla=9; Notani I=3, Notani II=23, Notani III=35, Notani class was not established in 9 patients as ORN developed in the maxilla/neomandible) were treated conservatively using a combination of debridement, antibiotics and Pentoclo. 50 patients healed (46%) with a median healing time 14 months (range 3–70 months), 59 patients are recorded with persistent ORN (improving=8, stable=38, deteriorating=13). Out of 109 patients treated conservatively, 13 patients were treated with Pentoclo only (all mandible; Notani I=6, Notani II=3, Notani III=3, 1 patient with neomandible). In total, 8 patients healed (61.5%), treatment failed in 5 patients (stable=4, deteriorating=1). Median healing time was 14 months (range 4–24 months). Extra orally (n=5), 3 cases of ORN were in the auditory canal and 2 in mastoid. ORN healed in one patient (auditory canal after 32 months. Treatment failed in 4 patients (improving=3, stable=1). Conclusion: The outcome of the treatment of ORN remains in general, poor. Every effort should therefore be made to minimise the risk of development of this devastating toxicity.

Keywords: head and neck cancer, radiotherapy, osteoradionecrosis, treatment outcome

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Authors: Mustafa M. Donma, Orkide Donma, Murat Aydin, Muhammet Demirkol, Burcin Nalbantoglu, Aysin Nalbantoglu, Birol Topcu

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Childhood obesity is an ever increasing global health problem, affecting both developed and developing countries. Accurate evaluation of obesity in children requires difficult and detailed investigation. In our study, obesity in children was evaluated using new body fat ratios and indices. Assessment of anthropometric measurements, as well as some ratios, is important because of the evaluation of gender differences particularly during the late periods of obesity. A total of 239 children; 168 morbid obese (MO) (81 girls and 87 boys) and 71 normal weight (NW) (40 girls and 31 boys) children, participated in the study. Informed consent forms signed by the parents were obtained. Ethics Committee approved the study protocol. Mean ages (years)±SD calculated for MO group were 10.8±2.9 years in girls and 10.1±2.4 years in boys. The corresponding values for NW group were 9.0±2.0 years in girls and 9.2±2.1 years in boys. Mean body mass index (BMI)±SD values for MO group were 29.1±5.4 kg/m² and 27.2±3.9 kg/m² in girls and boys, respectively. These values for NW group were calculated as 15.5±1.0 kg/m² in girls and 15.9±1.1 kg/m² in boys. Groups were constituted based upon BMI percentiles for age-and-sex values recommended by WHO. Children with percentiles >99 were grouped as MO and children with percentiles between 85 and 15 were considered NW. The anthropometric measurements were recorded and evaluated along with the new ratios such as trunk-to-appendicular fat ratio, as well as indices such as Index-I and Index-II. The body fat percent values were obtained by bio-electrical impedance analysis. Data were entered into a database for analysis using SPSS/PASW 18 Statistics for Windows statistical software. Increased waist-to-hip circumference (C) ratios, decreased head-to-neck C, height ‘to’ ‘two’-‘to’-waist C and height ‘to’ ‘two’-‘to’-hip C ratios were observed in parallel with the development of obesity (p≤0.001). Reference value for height ‘to’ ‘two’-‘to’-hip ratio was detected as approximately 1.0. Index-II, based upon total body fat mass, showed much more significant differences between the groups than Index-I based upon weight. There was not any difference between trunk-to-appendicular fat ratios of NW girls and NW boys (p≥0.05). However, significantly increased values for MO girls in comparison with MO boys were observed (p≤0.05). This parameter showed no difference between NW and MO states in boys (p≥0.05). However, statistically significant increase was noted in MO girls compared to their NW states (p≤0.001). Trunk-to-appendicular fat ratio was the only fat-based parameter, which showed gender difference between NW and MO groups. This study has revealed that body ratios and formula based upon body fat tissue are more valuable parameters than those based on weight and height values for the evaluation of morbid obesity in children.

Keywords: anthropometry, childhood obesity, gender, morbid obesity

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Authors: Faiz N. K. Yusufi, Aquil Ahmed, Jamal Ahmad

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Predicting the risk of diabetic retinopathy (DR) in Indian type 2 diabetes patients is immensely necessary. India, being the second largest country after China in terms of a number of diabetic patients, to the best of our knowledge not a single risk score for complications has ever been investigated. Diabetic retinopathy is a serious complication and is the topmost reason for visual impairment across countries. Any type or form of DR has been taken as the event of interest, be it mild, back, grade I, II, III, and IV DR. A sample was determined and randomly collected from the Rajiv Gandhi Centre for Diabetes and Endocrinology, J.N.M.C., A.M.U., Aligarh, India. Collected variables include patients data such as sex, age, height, weight, body mass index (BMI), blood sugar fasting (BSF), post prandial sugar (PP), glycosylated haemoglobin (HbA1c), diastolic blood pressure (DBP), systolic blood pressure (SBP), smoking, alcohol habits, total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), physical activity, duration of diabetes, diet control, history of antihypertensive drug treatment, family history of diabetes, waist circumference, hip circumference, medications, central obesity and history of DR. Cox proportional hazard regression is used to design risk scores for the prediction of retinopathy. Model calibration and discrimination are assessed from Hosmer Lemeshow and area under receiver operating characteristic curve (ROC). Overfitting and underfitting of the model are checked by applying regularization techniques and best method is selected between ridge, lasso and elastic net regression. Optimal cut off point is chosen by Youden’s index. Five-year probability of DR is predicted by both survival function, and Markov chain two state model and the better technique is concluded. The risk scores developed can be applied by doctors and patients themselves for self evaluation. Furthermore, the five-year probabilities can be applied as well to forecast and maintain the condition of patients. This provides immense benefit in real application of DR prediction in T2DM.

Keywords: Cox proportional hazard regression, diabetic retinopathy, ROC curve, type 2 diabetes mellitus

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Authors: Deepa Vasudevan, Thomas Northrup, Angela Stotts, Michelle Klawans

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To date, we have conducted three studies on this subject. The research done to date is through three studies. The initial study was to document that modified criteria independently identified higher numbers of overweight/obese South Asian Indians. The second study was to document physician knowledge of appropriate diagnosis of obesity among South Asian Indians. The final study was an intervention to evaluate the efficacy of a training module on improving physician diagnosis and counseling of overweight/obese Asian patients.

Keywords: South Asian Indians, obesity, physicians, BMI and waist circumference

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Authors: F. Christie, M. Staber

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Malnutrition is a predictor of poor clinical outcome in the elderly. Up to 60% of hip fracture patients are clinically malnourished on admission. This study assessed the perioperative nutritional state of patients admitted with a proximal femoral fracture and examined if adequate nutritional support was achieved. Methods: Prospective, the observational audit of 30 patients, admitted with a proximal femoral fracture, over a one-month period. We recorded: patient demographics; surgical delay; nutritional state on admission; documentation of Malnutrition Universal Screening Tool (MUST) score; dietician input and daily calorie intake through food charts. The nutritional state was re-assessed weekly and at discharge. The outcome was measured by the length of hospital stay and thirty-day mortality. Results: Mean age 87, M:F 1:2 and all patients were ASA three or four. Five patients (17%) had a prolonged ( >24 hours) fasting period. All patients had a MUST score completed on admission, 27% were underweight and 30% were high risk for malnutrition. Twenty-six patients (87%) were appropriately assessed for dietician referral. Thirteen patients had food charts; on average, hospital meals provided 1500kcal daily. No patient achieved > 75% of the provided calories with 69% of patients achieving 50% or less. Only three patients were started on nutritional supplements. Twenty-three patients (77%) lost weight, averaging 6% weight loss during admission. Mean length of stay (LOS) was 23 days and 30-day mortality 9%. Four patients (13%) gained weight, their mean LOS was 17 days and 30-day mortality 0%. Discussion: Malnutrition in the elderly originates in the community. Following major trauma it’s difficult to reverse nutritional deficits in hospitals. It’s therefore concerning that no high-risk patient achieved their recommended calorie intake. Perioperative optimisation needs to include early nutritional intervention, early anaesthetic review and adjusted anaesthetic techniques to support feeding.

Keywords: trauma, nutrition, neck of femur fracture

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Authors: Shivani Thakur, Jasmin Dominguez Cervantes, Ahmed Zabiba, Fatima Zabiba, Sandhini Agarwal, Kamalpreet Kaur, Hussein Maatouk, Shae Chand, Omar Madriz, Tiffany Huang, Saloni Bansal

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The prevalence of lymphedema in women in rural communities highlights the importance of developing effective treatment and prevention methods. Subjects with secondary lymphedema in California’s Central Valley were surveyed at 6 surgical clinics to assess demographics and symptoms of lymphedema. Additionally, subjects on semaglutide treatment for obesity and/or T2DM were monitored for their diabetes management, weight loss progress, and lymphedema symptoms compared to subjects who were not treated with semaglutide. The subjects were followed for 12 months. Subjects who were treated with semaglutide completed pre-treatment questionnaires and follow-up post-treatment questionnaires at 3, 6, 9, 12 months, along with medical assessment. The untreated subjects completed similar questionnaires. The questionnaires investigated subjective feelings regarding lymphedema symptoms and management using a Likert-scale; quantitative leg measurements were collected, and blood work reviewed at these appointments. Paired difference t-tests, chi-squared tests, and independent sample t-tests were performed. 50 subjects, aged 18-75 years, completed the surveys evaluating secondary lymphedema: 90% female, 69% Hispanic, 45% Spanish speaking, 42% disabled, 57 % employed, 54% income range below 30 thousand dollars, and average BMI of 40. Both treatment and non-treatment groups noted the most common symptoms were leg swelling (x̄=3.2, ▁d= 1.3), leg pain (x̄=3.2, ▁d=1.6 ), loss of daily function (x̄=3, ▁d=1.4 ), and negative body image (x̄=4.4, ▁d=0.54). Subjects in the semaglutide treatment group >3 months of treatment compared to the untreated group demonstrated: 55% subject in the treated group had a 10% weight loss vs 3% in the untreated group (average BMI reduction by 11% vs untreated by 2.5%, p<0.05) and improved subjective feelings about their lymphedema symptoms: leg swelling (x̄=2.4, ▁d=0.45 vs x̄=3.2, ▁d=1.3, p<0.05), leg pain (x̄=2.2, ▁d=0.45 vs x̄= 3.2, ▁d= 1.6, p<0.05), and heaviness (x̄=2.2, ▁d=0.45 vs x̄=3, ▁d=1.56, p<0.05). Improvement in diabetes management was demonstrated by an average of 0.9 % decrease in A1C values compared to untreated 0.1 %, p<0.05. In comparison to untreated subjects, treatment subjects on semaglutide noted 6 cm decrease in the circumference of the leg, knee, calf, and ankle compared to 2 cm in untreated subjects, p<0.05. Semaglutide was shown to significantly improve weight loss, T2DM management, leg circumference, and secondary lymphedema functional, physical and psychosocial symptoms.

Keywords: diabetes, secondary lymphedema, semaglutide, obesity

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Authors: Beverly Wang

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Background: Rosai-Dorfman disease (RDD), aka sinus histiocytosis with massive lymphadenopathy, is a rare, idiopathic histiocytic proliferative disorder. Although RDD can be seen involving the head and neck lymph nodes, rarely it can affect other extranodal sites. It present 3 unique cases of RDD affecting the nasal cavity, paranasal sinuses, and ear canal. The initial clinical presentation on two cases mimicked a malignant neoplasm. The 3rd case of RDD co-existed with a cholesteatoma of the ear canal. The clinical presentation, histology and immunohistochemical stains, and radiographic findings are discussed. Design: An overview of 3 cases of RDD affected sinonasal cavity and ear canal from UCI Medical Center was conducted. Case 1: A 61 year old male complaining of breathing difficulty presented with bilateral polypoid sinonasal masses and severe nasal obstruction. The masses elevated the nasal floor, and involved the anterior nasal septum to lateral wall. It was endoscopically excised. At intraoperative consultation, frozen section reported a pleomorphic spindle cell neoplasm with scattered large atypical spindle cells, resembling a high grade sarcoma. Case 2: A 46 year old male presented with recurrent bilateral maxillary chronic sinusitis with mass formation, clinically suspicious for malignant lymphoma. Excisional tissue sample showed large irregular spindled histiocytes with abundant granular and vacuolated cytoplasm. Case 3: A 36 year old female with a history of asthma initially presented with left-sided chronic otalgia, occasional nausea, vertigo, and fluctuating pain exacerbated by head movement and temperature changes. CT scan revealed an external auditory canal mass extending to the middle ear, coexisting with a small cholesteatoma. Results: The morphology of all cases revealed large atypical spindled histiocytes resembling fibrohistiocytic or myofibroblastic proliferative neoplasms. Scattered emperipolesis was seen. All 3 cases were confirmed as extranodal sinus RDD, confirmed by immunohistochemistry. The large atypical cells were positive for S100, CD68, and CD163. No evidence for malignancy was identified. Case 3 showed concurrent RDD co-existing with a cholesteatoma. Conclusion: Due to its rarity and variable clinical presentations, the diagnosis of RDD is seldom clinically considered. Extranodal sinus RDD morphologically can be pitfall as mimicker of spindly neoplasm, especially at intraoperative consultation. It can create diagnostic and therapeutic challenges. Correlation of radiological findings with histologic features will help to reach the diagnosis.

Keywords: head and neck, extranodal, rosai-dorfman disease, mimicker, immunohistochemistry

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Authors: Abiodun Afolabi, Rufus Adesoji Adedoyin

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This study investigated and compared the effects of gym-based exercise programme (GEBP) and audio-visual guided home-based exercise programme (AVGHBEP) on selected Anthropometric variables (Weight (W), Body Mass Index (BMI), Waist Circumference (WC), Hip Circumference (HC), Thigh Circumference (TC), Waist-Hip-Ratio (WHR), Waist-Height-Ratio (WHtR), Waist-Thigh-Ratio (WTR), Biceps Skinfold Thickness (BSFT), Triceps Skinfold Thickness (TSFT), Suprailliac Skinfold Thickness (SISFT), Subscapular Skinfold Thickness (SSSFT) and Percent Body Fat (PBF)); and Cardiovasular variables (Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Heart Rate (HR)) of overweight and obese students of Federal College of Education (Special), Oyo, Oyo State, Nigeria, with a view to providing information and evidence for GBEP and AVGHBEP in reducing overweight and obesity for promoting cardiovascular fitness. Eighty overweight and obese students (BMI ≥ 25 Kg/m²) were involved in this pretest-posttest quasi experimental study. Participants were randomly assigned into GBEP (n = 40) and AVGBBEP (n = 40) groups. Anthropometric and cardiovascular variables were measured using a weighing scale, height meter, tape measure, skinfold caliper and electronic sphygmomanometer following standard protocols. GBEP and AVGHBEP were implemented following a circuit training (aerobic and resistance training) pattern with a duration of 40-60 minutes, thrice weekly for twelve weeks. GBEP consisted of gymnasium supervised exercise programme while AVGHBEP is a Visual Display guided exercise programme conducted at the home setting. Data were analyzed by Descriptive and Inferential Statistics. The mean ages of the participants were 22.55 ± 2.55 and 23.65 ± 2.89 years for the GBEP group and AVGHBEP group, respectively. Findings showed that in the GBEP group, there were significant reductions in anthropometric variables and adiposity measures of Weight, BMI, BSFT, TSFT, SISFT, SSSFT, WC, HC, TC, WHtR, and PBF at week 12 of the study. Similarly, in the AVGHBEP group, there were significant reductions in Weight, BMI, BSFT, TSFT, SISFT, SSSFT, WC, HC, TC, WHtR and PBF at the 12th week of intervention. Comparison of the effects of GEBP and AVGHBEP on anthropometric variables and measures of adiposity showed that there was no significant difference between the two groups in weight, BMI, BSFT, TSFT, SISFT, SSSFT, WC, HC, TC, WHR, WHtR, WTR and PBF between the two groups at week 12 of the study. Furthermore, findings on the effects of exercise on programmes on cardiovascular variables revealed that significant reductions occurred in SBP in GBEP group and AVGHBEP group respectively. Comparison of the effects of GBEP and AVGHBEP on cardiovascular variables showed that there was no significant difference in SBP, DBP and HR between the two groups at week 12 of the study. It was concluded that the Audio-Visual Guided Home-based Exercise Programme was as effective as the Gym-Based Exercise Programme in causing a significant reduction in anthropometric variables and body fat among college students who are overweight and obese over a period of twelve weeks. Both Gymnasium-Based Exercise Programme and Audio-Visual Guided Home-Based Exercise Programme led to significant reduction in Systolic Blood Pressure over a period of weeks. Audio-Visual Guided Home-Based Exercise Programme can, therefore, be used as an alternative therapy in the non-pharmacological management of people who are overweight and obese.

Keywords: gym-based exercises, audio-visual guided home-based exercises, anthropometric parameters, cardiovascular parameters, overweight students, obese students

Procedia PDF Downloads 37

Authors: Francis Nanda Prakash Monteiro, Shyna Quadras, Tanush Shetty

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The association between human physique and morbidity and mortality resulting from coronary artery disease has been studied extensively over several decades. Multiple studies have also been done on the correlation between grade of atherosclerosis, coronary artery diseases and anthropometrical measurements. However, the number of autopsy-based studies drastically reduces this number. It has been suggested that while in living subjects, it would be expensive, difficult, and even harmful to subject them to imaging modalities like CT scans and procedures involving contrast media to study mild atherosclerosis, no such harm is encountered in study of autopsy cases. This autopsy-based study was aimed to correlate the anthropometric measurements and indices of obesity, such as waist circumference (WC), hip circumference (HC), body mass index (BMI) and waist hip ratio (WHR) with the degree of atherosclerosis in the right coronary artery (RCA), main branch of the left coronary artery (LCA) and the left anterior descending artery (LADA) in 95 South Indian origin victims of both the genders between the age of 18 years and 75 years. The grading of atherosclerosis was done according to criteria suggested by the American Heart Association. The study also analysed the correlation of the anthropometric measurements and indices of obesity with the number of coronaries affected with atherosclerosis in an individual. All the anthropometric measurements and the derived indices were found to be significantly correlated to each other in both the genders except for the age, which is found to have a significant correlation only with the WHR. In both the genders severe degree of atherosclerosis was commonly observed in LADA, followed by LCA and RCA. Grade of atherosclerosis in RCA is significantly related to the WHR in males. Grade of atherosclerosis in LCA and LADA is significantly related to the WHR in females. Significant relation was observed between grade of atherosclerosis in RCA and WC, and WHR, and between grade of atherosclerosis in LADA and HC in males. Significant relation was observed between grade of atherosclerosis in RCA and WC, and WHR, and between grade of atherosclerosis in LADA and HC in females. Anthropometric measurements/indices of obesity can be an effective means to identify high risk cases of atherosclerosis at an early stage that can be effective in reducing the associated cardiac morbidity and mortality. A person with anthropometric measurements suggestive of mild atherosclerosis can be advised to modify his lifestyle, along with decreasing his exposure to the other risk factors. Those with measurements suggestive of higher degree of atherosclerosis can be subjected to confirmatory procedures to start effective treatment.

Keywords: atherosclerosis, coronary artery disease, indices, obesity

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Authors: Mohiuddin Ahsanul Kabir Chowdhury, Ahmed Ehsanur Rahman, Nazia Binte Ali, Abdullah Nurus Salam Khan, Afrin Iqbal, Mohammad Mehedi Hasan, Salma Morium, Afsana Bhuiyan, Shams El Arifeen

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Violence against women has been treated as a global epidemic which is as fatal as any serious disease or accidents. Like many other low-income countries it is also common in Bangladesh. In spite of existence of a few documented evidences in some other countries, in Bangladesh, domestic violence against women (DVAW) is not considered as a factor for malnutrition in children yet. Hence, the aim of the study was to investigate the association between DVAW and the nutritional status of their under-5 children in the context of slum areas of Chittagong, Bangladesh. A Cross-sectional survey was conducted among 87 women of reproductive age having at least one child under-5 years of age and staying with husband for at least last 1 year in selected slums under Chittagong City Corporation area. Data collection tools were structured questionnaire for the study participants and mid-upper arm circumference (MUAC) to measure the nutritional status of the under-5 children. The data underwent descriptive and regression analysis. Out of 87 respondents, 50 (57.5%) reported to suffer from domestic violence by their husband during last one year. Physical violence was found to be significantly associated with age (p=0.02), age at marriage (p=0.043), wealth score (p=0.000), and with knowledge regarding law (p=0.017). According to the measurement of mid-upper arm circumference (MUAC) 21% children were suffering from severe acute malnutrition (SAM) and the same percentage of children were suffering from moderate acute malnutrition (MAM). However, unadjusted odds ratio suggested that there was negative association with domestic violence and nutritional status. But, the logistic regression confounding for other variable showed significant association with total family income (p=0.006), wealth score (p=0.031), age at marriage (p=0.029) and number of child (p=0.006). Domestic violence against women and under nutrition of the children, both are highly prevalent in Bangladesh. More extensive research should be performed to identify the factors contributing to the high prevalence of domestic violence and malnutrition in urban slums of Bangladesh. Household-based intervention is needed to limit this burning problem. In a nutshell, effective community participation, education and counseling are essential to create awareness among the community.

Keywords: Bangladesh, cross sectional survey, domestic violence against women, nutritional status, under-5 children, urban slums

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Authors: Mustafa Metin Donma

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Metabolic syndrome (MetS) is characterized by a series of biochemical, physiological and anthropometric indicators and is a life-threatening health problem due to its close association with chronic diseases such as diabetes mellitus, hypertension, cancer and cardiovascular diseases. The syndrome deserves great interest both in adults and children. Central obesity is the indispensable component of MetS. Particularly, children, who are morbidly obese have a great tendency to develop the disease, because they are under the threat in their future lives. Preventive measures at this stage should be considered. For this, investigators seek for an informative scale or an index for the purpose. So far, several, but not many suggestions come into the stage. However, the diagnostic decision is not so easy and may not be complete particularly in the pediatric population. The aim of the study was to develop a MetS index capable of predicting MetS, while children are at the morbid obesity stage. This study was performed on morbid obese (MO) children, which were divided into two groups. Morbid obese children, who do not possess MetS criteria comprised the first group (n=44). The second group was composed of children (n=42) with MetS diagnosis. Parents were informed about the signed consent forms, which are required for the participation of their children in the study. The approval of the study protocol was taken from the institutional ethics committee of Tekirdag Namik Kemal University. Helsinki Declaration was accepted prior to and during the study. Anthropometric measurements including weight, height, waist circumference (WC), hip C, head C, neck C, biochemical tests including fasting blood glucose (FBG), insulin (INS), triglycerides (TRG), high density lipoprotein cholesterol (HDL-C) and blood pressure measurements (systolic (SBP) and diastolic (DBP)) were performed. Body fat percentage (BFP) values were determined by TANITA’s Bioelectrical Impedance Analysis technology. Body mass index and MetS indices were calculated. The equations for MetS index (MetSI) and advanced Donma MetS index (ADMI) were [(INS/FBG)/(HDL-C/TRG)]*100 and MetSI*[(SBP+DBP/Height)], respectively. Descriptive statistics including median values, compare means tests, correlation-regression analysis were performed within the scope of data evaluation using the statistical package program, SPSS. Statistically significant mean differences were determined by a p value smaller than 0.05. Median values for MetSI and ADMI in MO (MetS-) and MO (MetS+) groups were calculated as (25.9 and 36.5) and (74.0 and 106.1), respectively. Corresponding mean±SD values for BFPs were 35.9±7.1 and 38.2±7.7 in groups. Correlation analysis of these two indices with corresponding general BFP values exhibited significant association with ADMI, close to significance with MetSI in MO group. Any significant correlation was found with neither of the indices in MetS group. In conclusion, important associations observed with MetS indices in MO group were quite meaningful. The presence of these associations in MO group was important for showing the tendency towards the development of MetS in MO (MetS-) participants. The other index, ADMI, was more helpful for predictive purpose.

Keywords: body fat percentage, child, index, metabolic syndrome, obesity

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Authors: Anne N. Heirman, Lisette van der Molen, Richard Dirven, Gyorgi B. Halmos, Michiel W.M. van den Brekel

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Background: Due to the rising incidence of oropharyngeal squamous cell cancer (OPSCC), many patients are challenged with choosing between transoral(robotic) surgery and radiotherapy, with equal survival and oncological outcomes. Also, functional outcomes are of little difference over the years. With this study, the wants and needs of patients and caregivers are identified to develop a comprehensible patient decision aid (PDA). Methods: The development of this PDA is based on the International Patient Decision Aid Standards criteria. In phase 1, relevant literature was reviewed and compared to current counseling papers. We interviewed ten post-treatment patients and ten doctors from four head and neck centers in the Netherlands, which were transcribed verbatim and analyzed. With these results, the first draft of the PDA was developed. Phase 2 beholds testing the first draft for comprehensibility and usability. Phase 3 beholds testing for feasibility. After this phase, the final version of the PDA was developed. Results: All doctors and patients agreed a PDA was needed. Phase 1 showed that 50% of patients felt well-informed after standard care and 35% missed information about treatment possibilities. Side effects and functional outcomes were rated as the most important for decision-making. With this information, the first version was developed. Doctors and patients stated (phase 2) that they were satisfied with the comprehensibility and usability, but there was too much text. The PDA underwent text reduction revisions and got more graphics. After revisions, all doctors found the PDA feasible and would contribute to regular counseling. Patients were satisfied with the results and wished they would have seen it before their treatment. Conclusion: Decision-making for OPSCC should focus on differences in side-effects and functional outcomes. Patients and doctors found the PDA to be of great value. Future research will explore the benefits of the PDA in clinical practice.

Keywords: head-and-neck oncology, oropharyngeal cancer, patient decision aid, development, shared decision making

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Authors: Rozeena Baig, R. Rehana Rehman, Rifat Ahmed

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Background: Osteoporosis, characterized by low bone mineral density, poses a global health concern. Diagnosis increases the likelihood of developing osteoporosis, a multifactorial disorder marked by low bone mass, elevating the risk of fractures in the lumbar spine, femoral neck, hip, vertebras, and distal forearm, particularly in postmenopausal women due to bone loss influenced by various pathophysiological factors. Objectives: The aim is to investigate the association of serum cytokine, bone turnover marker, bone mineral density and TLR4 gene polymorphism in pre and post-menopausal women and to find if any of these can be the potential predictor of osteoporosis in postmenopausal women. Material and methods: The study participants consisted of Group A (n=91) healthy pre-menopausal women and Group B (n=102) healthy postmenopausal women having ≥ 5 years’ history of menopause. ELISA was performed for cytokine (TNFα) and bone turnover markers (carboxytelopeptides), respectively. Bone Mineral Density (BMD)was measured through a dual X-ray absorptiometry (DEXA) scan. Toll-like Receptors 4 (TLR4) gene polymorphisms (A896G; Asp299Gly) and (C1196T; Thr399Ile) were investigated by PCR and Sanger sequencing. Results: Statistical analysis reveals a positive correlation of age and BMI with T scores in the premenopausal group, whereas in post-menopausal group found a significant negative correlation between age and T-score at hip (r = - 0.352**), spine (r = - .306**), and femoral neck (r = - 0.344**) and a significant negative correlation of BMI with TNF-α (- 0.316**). No association and significant differences were observed for TLR4 genotype and allele frequencies among studied groups However, both SNPs exhibited significant association with each other. Conclusions: This study concludes that BMI, BMD and TNF-α are the potential predictors of osteoporosis in post-menopausal women. However, CTX and TLR4 gene polymorphism did not appear as potential predictors of bone loss in this study and apparently cannot help in predicting bone loss in post-menopausal women.

Keywords: osteoporosis, post-menopausal, pre-menopausal woemn, genetics mutaiont, TLR4 genepolymorphsum

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Authors: Kamrun Nahar Koly, Saimul Islam

Abstract:

Overweight and obesity is increasing at an alarming rate and a leading risk factor for morbidity throughout the world. In a country like Bangladesh where under nutrition and overweight both co-exist at the same time, but this issue has been underexplored as expected. The aim of the present study was to assess the knowledge, attitudes and identify the barriers of the physicians regarding overweight and obesity management on an urban hospital of Dhaka city in Bangladesh. A simple cross sectional study was conducted at two selected government and two private hospital to assess the knowledge, attitude and common barriers regarding overweight and obesity management among healthcare professionals. One hundred and fifty five physicians were surveyed. A standard questionnaire was constructed in local language and interview was administrated. Among the 155 physicians, majority 53 (34.20%) were working on SMC, 36 (23.20%) from DMC, 33 (21.30%) were based on SSMC and the rest 33 (21.30%) were from HFRCMH. Mean age of the study physicians were 31.88±5.92. Majority of the physicians 80 (51.60%) were not able to answer the correct prevalence of obesity but also a substantial number of them 75(48.40%) could mark the right answer. Among the physicians 150 (96.77%) reported BMI as a diagnostic index for overweight and obesity, where as 43 (27.74%) waist circumference, 30 (19.35%) waist hip ratio and 26 (16.77%) marked mid-arm circumference. A substantial proportion 71 (46.70%) of the physicians thought that they do not have much to do controlling weight problem in Bangladesh context though it has been opposed by 42 (27.60%) of the physicians and 39(25.70%) was neutral to comment. The majority of them 147 (96.1%) thought that a family based education program would be beneficial followed by 145 (94.8%) physicians mentioned about raising awareness among mothers as she is the primary caregiver. The idea of a school based education program will also help to early intervene referred by 142 (92.8%) of the physicians. Community based education program was also appreciated by 136 (89.5%) of the physicians. About 74 (47.7%) of them think that the patients still lack in motivation to maintain their weight properly at the same time too many patients to deal with can be a barrier as well assumed by 73 (47.1%) of them. Lack of national policy or management guideline can act as an obstacle told by 60 (38.7%) of the physicians. The relationship of practicing as a part of the general examination and chronic disease management was statistically significant (p<0.05) with physician occupational status. As besides, perceived barriers like lack of parents support, lack of a national policy was statistically significant (p<0.05) with physician occupational status. For the young physician, more training programme will be needed to transform their knowledge and attitude into practice. However, several important barriers interface for the physician treatment efforts and need to address.

Keywords: obesity management, physician, awareness, barriers, Bangladesh

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