Search results for: mortality

Authors: Nooshin La'l Mohamadi

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Due to the fact that in the new century customers tend to express globally increasing demands, networks of interconnected businesses have been established in societies and the management of such networks seems to be a major key through gaining competitive advantages. Supply chain management encompasses such managerial activities. Within a supply chain, a critical role is played by quality. QFD is a widely-utilized tool which serves the purpose of not only bringing quality to the ultimate provision of products or service packages required by the end customer or the retailer, but it can also initiate us into a satisfactory relationship with our initial customer; that is the wholesaler. However, the wholesalers- cooperation is considerably based on the capabilities that are heavily dependent on their locations and existing circumstances. Therefore, it is undeniable that for all companies each wholesaler possesses a specific importance ratio which can heavily influence the figures calculated in the House of Quality in QFD. Moreover, due to the competitiveness of the marketplace today, it-s been widely recognized that consumers- expression of demands has been highly volatile in periods of production. Apparently, such instability and proneness to change has been very tangibly noticed and taking it into account during the analysis of HOQ is widely influential and doubtlessly required. For a more reliable outcome in such matters, this article demonstrates the application viability of Analytic Network Process for considering the wholesalers- reputation and simultaneously introduces a mortality coefficient for the reliability and stability of the consumers- expressed demands in course of time. Following to this, the paper provides further elaboration on the relevant contributory factors and approaches through the calculation of such coefficients. In the end, the article concludes that an empirical application is needed to achieve broader validity.

Keywords: Analytic Network Process, Quality Function Deployment, QFD flaws, Supply Chain Management

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Authors: Marjan Mahdavi-Roshan, Arsalan Salari, Mahbobeh Gholipour

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Hypertension is one of the important reasons of morbidity and mortality in countries, including Iran. It has been shown that hypertension is a consequence of the interaction of genetics and environment. Nutrients have important roles in the controlling of blood pressure. We assessed dietary habit and anthropometric status in patients with hypertension in the north of Iran, and that have special dietary habit and according to their culture. This study was conducted on 127 patients with newly recognized hypertension and the 120 normotensive participants. Anthropometric status was measured and demographic characteristics, and medical condition were collected by valid questionnaires and dietary habit assessment was assessed with 3-day food recall (two weekdays and one weekend). The mean age of participants was 58 ± 6.7 years. The mean level of energy intake, saturated fat, vitamin D, potassium, zinc, dietary fiber, vitamin C, calcium, phosphorus, copper and magnesium was significantly lower in the hypertensive group compared to the control (p < 0.05). After adjusting for energy intake, positive association was observe between hypertension and some dietary nutrients including; Cholesterol [OR: 1.1, P: 0.001, B: 0.06], fiber [OR: 1.6, P: 0.001, B: 1.8], vitamin D [OR: 2.6, P: 0.006, B: 0.9] and zinc [OR: 1.4, P: 0.006, B: 0.3] intake. Logistic regression analysis showed that there was not significant association between hypertension, weight and waist circumference. In our study, the mean intake of some nutrients was lower in the hypertensive individuals compared to the normotensive individual. Health training about suitable dietary habits and easier access to vitamin D supplementation in patients with hypertension are cost-effective tools to improve outcomes in Iran.

Keywords: Hypertension, dietary intake, weight, waist circumference, North of Iran.

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Authors: Omowunmi E. Isafiade, Isaac O. Osunmakinde, Antoine B. Bagula

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Robots- visual perception is a field that is gaining increasing attention from researchers. This is partly due to emerging trends in the commercial availability of 3D scanning systems or devices that produce a high information accuracy level for a variety of applications. In the history of mining, the mortality rate of mine workers has been alarming and robots exhibit a great deal of potentials to tackle safety issues in mines. However, an effective vision system is crucial to safe autonomous navigation in underground terrains. This work investigates robots- perception in underground terrains (mines and tunnels) using statistical region merging (SRM) model. SRM reconstructs the main structural components of an imagery by a simple but effective statistical analysis. An investigation is conducted on different regions of the mine, such as the shaft, stope and gallery, using publicly available mine frames, with a stream of locally captured mine images. An investigation is also conducted on a stream of underground tunnel image frames, using the XBOX Kinect 3D sensors. The Kinect sensors produce streams of red, green and blue (RGB) and depth images of 640 x 480 resolution at 30 frames per second. Integrating the depth information to drivability gives a strong cue to the analysis, which detects 3D results augmenting drivable and non-drivable regions in 2D. The results of the 2D and 3D experiment with different terrains, mines and tunnels, together with the qualitative and quantitative evaluation, reveal that a good drivable region can be detected in dynamic underground terrains.

Keywords: Drivable Region Detection, Kinect Sensor, Robots' Perception, SRM, Underground Terrains.

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Authors: Shahad Nagoor, Lucy Hederman, Kevin Koidl, Annalina Caputo

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Doctors’ notes reflect their impressions, attitudes, clinical sense, and opinions about patients’ conditions and progress, and other information that is essential for doctors’ daily clinical decisions. Despite their value, clinical notes are insufficiently researched within the language processing community. Automatically extracting information from unstructured text data is known to be a difficult task as opposed to dealing with structured information such as physiological vital signs, images and laboratory results. The aim of this research is to investigate how Natural Language Processing (NLP) techniques and machine learning techniques applied to clinician notes can assist in doctors’ decision making in Intensive Care Unit (ICU) for coronavirus disease 2019 (COVID-19) patients. The hypothesis is that clinical outcomes like survival or mortality can be useful to influence the judgement of clinical sentiment in ICU clinical notes. This paper presents two contributions: first, we introduce COVID_ICU_BERT, a fine-tuned version of a clinical transformer model that can reliably predict clinical sentiment for notes of COVID patients in ICU. We train the model on clinical notes for COVID-19 patients, ones not previously seen by Bio_ClinicalBERT or Bio_Discharge_Summary_BERT. The model which was based on Bio_ClinicalBERT achieves higher predictive accuracy than the one based on Bio_Discharge_Summary_BERT (Acc 93.33%, AUC 0.98, and Precision 0.96). Second, we perform data augmentation using clinical contextual word embedding that is based on a pre-trained clinical model to balance the samples in each class in the data (survived vs. deceased patients). Data augmentation improves the accuracy of prediction slightly (Acc 96.67%, AUC 0.98, and Precision 0.92).

Keywords: BERT fine-tuning, clinical sentiment, COVID-19, data augmentation.

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Authors: C. A. Oloo, C. Ojwang

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The performances of small and medium enterprises have stagnated in the last two decades. This has mainly been due to the emergence of HIV / Aids. The disease has had a detrimental effect on the general economy of the country leading to morbidity and mortality of the Kenyan workforce in their primary age. The present study sought to establish the economic impact of HIV / Aids on the micro-enterprise development in Obunga slum – Kisumu, in terms of production loss, increasing labor related cost and to establish possible strategies to address the impact of HIV / Aids on microenterprises. The study was necessitated by the observation that most micro-enterprises in the slum are facing severe economic and social crisis due to the impact of HIV / Aids, they get depleted and close down within a short time due to death of skilled and experience workforce. The study was carried out between June 2008 and June 2009 in Obunga slum. Data was subjected to computer aided statistical analysis that included descriptive statistic, chi-squared and ANOVA techniques. Chi-squared analysis on the micro-enterprise owners opinion on the impact of HIV / Aids on depletion of microenterprise compared to other diseases indicated high levels of the negative effects of the disease at significance levels of P<0.01. Analysis of variance on the impact of HIV / Aids on the performance and productivity of micro-enterprises also indicated a negative effect on the general performance of micro-enterprise at significance levels of P<0.01. Therefore reducing the negative impacts of HIV/Aids on micro-enterprise development, there is need to improve the socioeconomic environment, mobilize donors and stake holders in training and funding, and review the current strategies for addressing the disease. Further conclusive research should also be conducted on a bigger scale.

Keywords: Entrepreneurship, HIV-AIDS, Micro-enterprise, Poverty.

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Authors: S. I. V. Sousa, F.G. Martins, M. C. Pereira, M. C. M. Alvim-Ferraz, H. Ribeiro, M. Oliveira, I. Abreu

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Exposure to ambient air pollution has been linked to a number of health outcomes, starting from modest transient changes in the respiratory tract and impaired pulmonary function, continuing to restrict activity/reduce performance and to the increase emergency rooms visits, hospital admissions or mortality. The increase of allergenic symptoms has been associated with air contaminants such as ozone, particulate matter, fungal spores and pollen. Considering the potential relevance of crossed effects of nonbiological pollutants and airborne pollens and fungal spores on allergy worsening, the aim of this work was to evaluate the influence of non-biological pollutants (O3 and PM10) and meteorological parameters on the concentrations of pollen and fungal spores using multiple linear regressions. The data considered in this study were collected in Oporto which is the second largest Portuguese city, located in the North. Daily mean of O3, PM10, pollen and fungal spore concentrations, temperature, relative humidity, precipitation, wind velocity, pollen and fungal spore concentrations, for 2003, 2004 and 2005 were considered. Results showed that the 90th percentile of the adjusted coefficient of determination, P90 (R2aj), of the multiple regressions varied from 0.613 to 0.916 for pollen and from 0.275 to 0.512 for fungal spores. O3 and PM10 showed to have some influence on the biological pollutants. Among the meteorological parameters analysed, temperature was the one that most influenced the pollen and fungal spores airborne concentrations. Relative humidity also showed to have some influence on the fungal spore dispersion. Nevertheless, the models for each pollen and fungal spore were different depending on the analysed period, which means that the correlations identified as statistically significant can not be, even so, consistent enough.

Keywords: Air pollutants, meteorological parameters, biologicalpollutants, multiple linear correlations.

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Authors: Mustafa M. Donma, Sule G. Kacmaz, Ahsen Yilmaz, Savas Guzel, Orkide Donma

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Obesity, as excessive fat accumulation in the body, is a global health problem. The prevalence of obesity and its complications increase due to easy access to high-energy food and decreased physical activity. Cardiovascular diseases (CVDs) constitute a significant part of obesity-related morbidity and mortality. Since the effects of obesity on cardiovascular system may start during childhood without clinical findings, elucidating the mechanisms of cardiovascular changes associated with childhood obesity became more important. In this study, we aimed to investigate some biochemical parameters which may be involved in obesity-related pathologic processes of CVDs. One hundred and seventy-seven children were included in the study, and they were divided into four groups based upon WHO criteria and presence of the metabolic syndrome (MetS): children with normal-BMI, obesity, morbid obesity, and MetS. High-sensitive cardiac troponin T (hs-cTnT), cardiac myosin binding protein C (cMyBP-C), trimethylamine N-oxide (TMAO), soluble tumor necrosis factor-like weak inducer (sTWEAK), chromogranin A (CgA), multimerin-2 levels, and other biochemical parameters were measured in serum samples. Anthropometric measurements and clinical findings of the children were recorded. Statistical analyses were performed. Children with normal-BMI had significantly higher CgA levels than children with obesity, morbid obesity, and MetS (p < 0.05). Cardiac MyBP-C levels of children with MetS were significantly higher than of children with normal-BMI and OB children (p < 0.05). There was no significant difference in hs-cTnT, sTWEAK, TMAO and multimerin-2 between the groups (p>0.05). These results suggested that cMyBP-C and CgA molecules may be involved in the pathogenesis of obesity-related CVDs.

Keywords: biomarker, cardiovascular diseases, children, obesity

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Authors: El-Said. I. Shabana, Mohammad S. Tayeb, Maher M. T. Qutub, Abdulraheem A. Kinsara

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Usually, phosphate deposits contain ²³⁸U and ²³²Th in addition to their decay products. Due to their different pathways in the environment, the ²³⁸U/²³²Th activity concentration ratio usually found to be greater than unity in phosphate sediments. The presence of these radionuclides creates a potential need to control exposure of workers in the mining and processing activities of the phosphate minerals in accordance with IAEA safety standards. The greatest dose to workers comes from exposure to radon, especially ²²²Rn from the uranium series, and has to be controlled. In this regard, radon (²²²Rn) was measured in the atmosphere (indoor and outdoor) of Al-Jalamid phosphate-mines working area using a portable radon-measurement instrument RAD7, in a purpose of radiation protection. Radon was measured in 61 sites inside the open phosphate mines, the phosphate upgrading facility (offices and rooms of the workers, and in some open-air sites) and in the dwellings of the workers residence-village that lies at about 3 km from the mines working area. The obtained results indicated that the average indoor radon concentration was about 48.4 Bq/m³. Inside the upgrading facility, the average outdoor concentrations were 10.8 and 9.7 Bq/m³ in the concentrate piles and crushing areas, respectively. It was 12.3 Bq/m³ in the atmosphere of the open mines. These values are comparable with the global average values. Based on the average values, the annual effective dose due to radon inhalation was calculated and risk estimates have been done. The average annual effective dose to workers due to the radon inhalation was estimated by 1.32 mSv. The potential excess risk of lung cancer mortality that could be attributed to radon, when considering the lifetime exposure, was estimated by 53.0x10^-4. The results have been discussed in detail.

Keywords: Dosimetry, environmental monitoring, phosphate deposits, radiation protection, radon-22.

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Authors: Mehdi Gheibi, Shahram Hesami

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Scolothrips longicornis Priesner is one of the important predators of tetranychid mites with a wide distribution throughout Iran. Life table and population growth parameters of S. longicornis feeding on two-spotted spider mite, Tetranychus turkestani Ugarov & Nikolski were investigated under laboratory condition (26±1ºC, 65±5% R.H. and 16L: 8D). To carry of these experiments, S. longicornis collections reared on cowpea infested with T. turkestani were prepared. The eggs with less than 24 hours old were selected and reared. The emerged larvae feeding directly on cowpea leaf discs which were infested with T. turkestani. Thirty females of S. longicornis with 24 hours age were selected and released on infested leaf discs. They replaced daily to a new leaf disc and the laying eggs have counted. The experiment continued till the last thrips had died. The result showed that the mean age mortality of the adult female thrips were between 21-25 days which is nearly equal life expectancy (ex) at the time of adult eclosion. Parameters related to reproductive table including gross reproductive rate, net reproductive rate, intrinsic rate of natural increase and finite rate of increase were 48.91, 37.63, 0.26 and 2.3, respectively. Mean age per female/day, mean fertile egg per female/day, gross hatch rate, mean net age fertility, mean net age fecundity, net fertility rate and net fecundity rate were 2.23, 1.76, 0.87, 13.87, 14.26, 69.1 and 78.5, respectively. Sex ratio of offspring also recorded daily. The highest sex ratio for females was 0.88 in first day of oviposition. The sex ratio decreased gradually and reached under 0.46 after the day 26 and the oviposition rate declined. Then it seems that maintenance of rearing culture of predatory thrips for mass rearing later than 26 days after egg-laying commence is not profitable.

Keywords: Tetranychus, Scolothrips, Demography, Life table, Reproductive table

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Authors: Dwitya Elvira, Raveinal Masri, Rohayat Bilmahdi

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Human Immunodeficiency Virus (HIV) pandemic increased significantly worldwide. The rise in cases of HIV/AIDS was also followed by an increase in the incidence of opportunistic infection, with tuberculosis being the most opportunistic infection found in HIV/AIDS and the main cause of mortality in HIV/AIDS patients. Diagnosis of tuberculosis in HIV/AIDS patients is often difficult because of the uncommon symptom in HIV/AIDS patients compared to those without the disease. Thus, diagnostic tools are required that are more effective and efficient to diagnose tuberculosis in HIV/AIDS. CXCL-10/IP-10 is a chemokine that binds to the CXCR3 receptor found in HIV/AIDS patients with a weakened immune system. Tuberculosis infection in HIV/AIDS activates chemokine IP-10 in urine, which is used as a marker for diagnosis of infection. The aim of this study was to prove whether IP-10 urine can be a biomarker diagnosis of active lung tuberculosis in HIV-AIDS patients. Design of this study is a cross sectional study involving HIV/AIDS patients with lung tuberculosis as the subject of this study. Forty-seven HIV/AIDS patients with tuberculosis based on clinical and biochemical laboratory were asked to collect urine samples and IP-10/CXCL-10 urine being measured using ELISA method with 18 healthy human urine samples as control. Forty-seven patients diagnosed as HIV/AIDS were included as a subject of this study. HIV/AIDS were more common in male than in women with the percentage in male 85.1% vs. 14.5% of women. In this study, most diagnosed patients were aged 31-40 years old, followed by those 21-30 years, and > 40 years old, with one case diagnosed at age less than 20 years of age. From the result of the urine IP-10 using ELISA method, there was significant increase of the mean value of IP-10 urine in patients with TB-HIV/AIDS co-infection compared to the healthy control with mean 61.05 pg/mL ± 78.01 pg/mL vs. mean 17.2 pg/mL. Based on this research, there was significant increase of urine IP-10/CXCL-10 in active lung tuberculosis with HIV/AIDS compared to the healthy control. From this finding, it is necessary to conduct further research into whether urine IP-10/CXCL-10 plays a significant role in TB-HIV/AIDS co-infection, which can also be used as a biomarker in the early diagnosis of TB-HIV.

Keywords: Chemokine, IP-10 urine, HIV/AIDS, Tuberculosis.

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Authors: Mohammadjavad Mehrabanpour, Maryam Ranjbar Bushehri, Dorsa Mehrabanpour

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Respiratory diseases are the most important problems in the country’s poultry industry, particularly when it comes to broiler flocks. Ornithobacterium rhinotracheale (ORT) is a species that causes poor performance in growth rate, egg production, and mortality. This pathogen causes a respiratory infection including pulmonary alveolar inflammation, and pneumonia of birds throughout the world. Newcastle disease (ND) is a highly contagious disease in poultry, and also, it causes considerable losses to the poultry industry. The aim of this study was to evaluate the simultaneous occurrence of ORT and ND and NDV isolation by inoculation in embryonated eggs and confirmed by RT-PCR in broiler chicken flocks in Fars province. In this study, 318 blood and 85 tissue samples (brain, trachea, liver, and cecal tonsils) were collected from 15 broiler chicken farms. Survey serum antibody titers against ORT by using a commercial enzyme-linked immunosorbent assay (ELISA) kit performed. Evaluation of antibody titer against ND virus is performed by hemagglutination inhibition test. Virus isolation with chick embryo eggs 9-11 and RT-PCR method were carried out. A total of 318 serum samples, 135 samples (42.5%) were positive for antibodies to ORT and titer of HI antibodies against NDV in 122 serum samples (38/4%) were 7-10 (log2) and 61 serum samples (19/2%) had occurrence antibody titer against Newcastle virus and ORT. Results of the present study indicated that 20 tissue samples were positive in embryonated egg and in rapid hemagglutination (HA) test. HI test with specific ND positive serum confirmed that 6 of 20 samples. PCR confirmed that all six samples were positive and PCR products of samples indicated 535-base pair fragments in electrophrosis. Due to the great economic importance of these two diseases in the poultry industry, it is necessary to design and implement a comprehensive plan for prevention and control of these diseases.

Keywords: ELISA, Newcastle disease, Ornithobacterium rhinotracheale, seroprevalence.

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

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Medical, social, and economic relevance of osteoporosis is caused by reducing quality of life, increasing disability and mortality of the patients as a result of fractures due to the low-energy trauma. This study is aimed to examine the associations of metabolic syndrome components, bone mineral density (BMD) and trabecular bone score (TBS) in menopausal women with non-vertebral fractures. 1161 menopausal women aged 50-79 year-old were examined and divided into three groups: A included 419 women with increased body weight (BMI - 25.0-29.9 kg/m²), B – 442 females with obesity (BMI >29.9 kg/m²)i and C – 300 women with metabolic syndrome (diagnosis according to IDF criteria, 2005). BMD of lumbar spine (L1-L4), femoral neck, total body and forearm was investigated with usage of dual-energy X-ray absorptiometry. The bone quality indexes were measured according to Med-Imaps installation. All analyses were performed using Statistical Package 6.0. BMD of lumbar spine (L1-L4), femoral neck, total body, and ultradistal radius was significant higher in women with obesity and metabolic syndrome compared to the pre-obese ones (p<0.001). TBS was significantly higher in women with increased body weight compared to obese and metabolic syndrome patients. Analysis showed significant positive correlation between waist circumference, triglycerides level and BMD of lumbar spine and femur. Significant negative association between serum HDL level and BMD of investigated sites was established. The TBS (L1-L4) indexes positively correlated with HDL (high-density lipoprotein) level. Despite the fact that BMD indexes were better in women with metabolic syndrome, the frequency of non-vertebral fractures was significantly higher in this group of patients.

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

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Authors: Nadia H. Mohammed, Anmar Al-Taie, Fadia H. Al-Sultany

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Although breast cancer prevalence continues to increase, mortality has been decreasing as a result of early detection and improvement in adjuvant systemic therapy. Nevertheless, this disease required further efforts to understand and identify the associated potential risk factors that could play a role in the prevalence of this malignancy among Iraqi women. The objective of this study was to assess the perception of certain predictive risk factors on the prevalence of breast cancer types among a sample of Iraqi women diagnosed with breast cancer. This was a retrospective observational study carried out at National Cancer Research Center in College of Medicine, Baghdad University from November 2017 to January 2018. Data of 100 patients with breast cancer whose biopsies examined in the National Cancer Research Center were included in this study. Data were collected to structure a detailed assessment regarding the patients’ demographic, medical and cancer records. The majority of study participants (94%) suffered from ductal breast cancer with mean age 49.57 years. Among those women, 48.9% were obese with body mass index (BMI) 35 kg/m². 68.1% of them had positive family history of breast cancer and 66% had low parity. 40.4% had stage II ductal breast cancer followed by 25.5% with stage III. It was found that 59.6% and 68.1% had positive oestrogen receptor sensitivity and positive human epidermal growth factor (HER2/neu) receptor sensitivity respectively. In regard to the impact of prediction of certain variables on the incidence of ductal breast cancer, positive family history of breast cancer (P < 0.0001), low parity (P< 0.0001), stage I and II breast cancer (P = 0.02) and positive HER2/neu status (P < 0.0001) were significant predictive factors among the study participants. The results from this study provide relevant evidence for a significant positive and potential association between certain risk factors and the prevalence of breast cancer among Iraqi women.

Keywords: Ductal breast cancer, hormone sensitivity, Iraq, risk factors.

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Authors: Chimaobi V. Okolo, Kenneth A. Okpala, Johnbull S. Ogboi

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A teeming set of doctors that graduated from various universities within and outside Nigeria with the hope of practicing in the country, has their hope shattered because of poor financing, lack of medical equipments and a very weak healthcare systems. Such hydra headed challenges, allows room for quackery which increasingly contributes to the cause of mortality in Nigeria. With a view of reversing the challenges of healthcare delivery and financing in Nigeria, African Health Market for Equity (AHME), a project funded by the Bill and Melinda Gates foundation [With contribution from Department For International Development (DFID)] and currently implemented in three African Countries (Nigeria, Kenya and Ghana) over a Five (5) year period supports the healthcare sector via Medical credit fund (MCF). The study examines the impact of credit policy and medical credit funding on Nigerian health market. Ordinary least square analysis, correlation and granger causality tests were employed to measure the extent to which the Nigerian healthcare market has been influenced. Medical credit fund significantly and positively influenced average monthly turnover of private healthcare providers and Commercial bank’s lending rate had a weak relationship with access to credit/approved loans (13.46%). The programme has so far made 13.91% progress, which is very poor, considering the minimum targeted private health care providers (437.6) and expected number of loan approvals (180.4) for the two years. Medical credit policy in Nigeria should be revised to include private healthcare providers in rural area for more positive impact and increased returns. Good brand advert and sensitization of the programme to stakeholders and health pressure group, and an extension of the programme beyond five years is necessary to better address the issues raised in the study.

Keywords: Credit, health market, medical credit facility, policy.

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Authors: Syed Dawood Md. Taimur, Md. Hasanur Rahman, Syeda Fahmida Afrin, Farzana Islam

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The concept of myocardial injury, although first recognized from animal studies, is now recognized as a clinical phenomenon that may result in microvascular damage, no-reflow phenomenon, myocardial stunning, myocardial hibernation and ischemic preconditioning. The final consequence of this event is left ventricular (LV) systolic dysfunction leading to increased morbidity and mortality. The typical clinical case of reperfusion injury occurs in acute myocardial infarction (MI) with ST segment elevation in which an occlusion of a major epicardial coronary artery is followed by recanalization of the artery. This may occur spontaneously or by means of thrombolysis and/or by primary percutaneous coronary intervention (PCI) with efficient platelet inhibition by aspirin (acetylsalicylic acid), clopidogrel and glycoprotein IIb/IIIa inhibitors. In recent years, percutaneous coronary intervention (PCI) has become a well-established technique for the treatment of coronary artery disease. PCI improves symptoms in patients with coronary artery disease and it has been increasing safety of procedures. However, peri- and post-procedural myocardial injury, including angiographical slow coronary flow, microvascular embolization, and elevated levels of cardiac enzyme, such as creatine kinase and troponin-T and -I, has also been reported even in elective cases. Furthermore, myocardial reperfusion injury at the beginning of myocardial reperfusion, which causes tissue damage and cardiac dysfunction, may occur in cases of acute coronary syndrome. Because patients with myocardial injury is related to larger myocardial infarction and have a worse long-term prognosis than those without myocardial injury, it is important to prevent myocardial injury during and/or after PCI in patients with coronary artery disease. To date, many studies have demonstrated that adjunctive pharmacological treatment suppresses myocardial injury and increases coronary blood flow during PCI procedures. In this review, we highlight the usefulness of pharmacological treatment in combination with PCI in attenuating myocardial injury in patients with coronary artery disease.

Keywords: Coronary artery disease, Percutaneous coronary intervention, Myocardial injury, Pharmacology.

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Authors: Zahraa Albasry, Hadeel D. Najim, Anmar Al-Taie

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Background: Hypertension is considered as one of the most important causes of cardiovascular complications and one of the leading causes of worldwide mortality. Identifying the potential risk factors associated with this medical health problem plays an important role in minimizing its incidence and related complications. The objective of this study is to explore the prevalence of receptor sensitivity regarding assess and understand the perception of specific predictive confounding factors on the prevalence of hypertension (HT) among a sample of Iraqi population in Baghdad, Iraq. Materials and Methods: A randomized cross sectional study was carried out on 100 adult subjects during their visit to the outpatient clinic at a certain sector of Baghdad Province, Iraq. Demographic, clinical and health records alongside specific screening and laboratory tests of the participants were collected and analyzed to detect the potential of confounding factors on the prevalence of HT. Results: 63% of the study participants suffered from HT, most of them were female patients (P < 0.005). Patients aged between 41-50 years old significantly suffered from HT than other age groups (63.5%, P < 0.001). 88.9% of the participants were obese (P < 0.001) and 47.6% had diabetes with HT. Positive family history and sedentary lifestyle were significantly higher among all hypertensive groups (P < 0.05). High salt and fatty food intake was significantly found among patients suffered from isolated systolic hypertension (ISHT) (P < 0.05). A significant positive correlation between packed cell volume (PCV) and systolic blood pressure (SBP) (r = 0.353, P = 0.048) found among normotensive participants. Among hypertensive patients, a positive significant correlation found between triglycerides (TG) and both SBP (r = 0.484, P = 0.031) and diastolic blood pressure (DBP) (r = 0.463, P = 0.040), while low density lipoprotein-cholesterol (LDL-c) showed a positive significant correlation with DBP (r = 0.443, P = 0.021). Conclusion: The prevalence of HT among Iraqi populations is of major concern. Further consideration is required to detect the impact of potential risk factors and to minimize blood pressure (BP) elevation and reduce the risk of other cardiovascular complications later in life.

Keywords: Correlation, hypertension, Iraq, risk factors.

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Authors: Samy A. Selim, Nashwa I. Hagag

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Abstract–The objectives of the current study are to determine the prevalence, etiological agents, drug susceptibility pattern and plasmid profile of Acinetobacter baumannii isolates from Hospital-Acquired Infections (HAI) at Community Hospital, Al Jouf Province, Saudi Arabia. A total of 1890 patients had developed infection during hospital admission and were included in the study. Among those who developed nosocomial infections, 15(9.4), 10(2.7) and 118 (12.7) had respiratory tract infection (RTI), blood stream infections (BSI) and urinary tract (UTI) respectively. A total of 268 bacterial isolates were isolated from nosocomial infection. S. aureus was reported in 23.5% for of the total isolates followed by Klebsiella pneumoniae (17.5%), E. coli (17.2%), P. aeruginosa (11.9%), coagulase negative staphylococcus (9%), A. baumannii (7.1%), Enterobacter spp. (3.4%), Citrobacter freundii (3%), Proteus mirabilis (2.6%), and Proteus vulgaris and Enterococcous faecalis (0.7%). Isolated organisms are multi-drug resistant, predominantly Gram-positive pathogens with a high incidence of methicillin-resistant S. aureus, extended spectrum beta lactamase and vancomycin resistant enterococci organisms. The RFLP (Fragment Length Polymorphisms) patterns of plasmid preparations from isolated A. baumannii isolates had altered RFLP patterns, possibly due to the presence of plasmid(s). Five A. baumannii isolates harbored plasmids all of which were not less than 2.71kbp in molecular weight. Hence, it showed that the gene coding for the isolates were located on the plasmid DNA while the remaining isolates which have no plasmid might showed gene coding for antibiotic resistance being located on chromosomal DNA. Nosocomial infections represent a current problem in Community Hospital, Al Jouf Province, Saudi Arabia. Problems associated with SSI include infection with multidrug resistant pathogens which are difficult to treat and are associated with increased mortality.

Keywords: Hospital-Acquired Infections, Acinetobacter baumannii, antibiotic resistance, plasmid profile, RFLP patterns, Al Jouf Province, Saudi Arabia

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Authors: W. Suksombat, P. Suksombat, R. Mirattanaphrai

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The effects of commercial or bovine yeasts on the performance and blood variables of broiler chickens intoxicated with aflatoxin were investigated in broilers. Four hundred eighty broilers (Arbor Acres; 3-wk-old) were randomly assigned to 4 groups. Each group (120 broiler chickens) was further randomly divided into 6 replicates of 20 chickens. The treatments were control diet without additives (treatment 1), 250 ppb AFB1 (treatment 2), commercial yeast, Saccharomyces cerevisiae, (CY 2.5 x 107 CFU/g) + 250 ppb AFB1 (treatment 3) and bovine yeast, Saccharomyces cerevisiae, (BY 2.5 x 107 CFU/g + 250 ppb AFB1 (treatment 4). Complete randomized design (CRD) was used in the experiment. Feed consumption and body weight were recorded at every five-day period. On day 42, carcass compositions were determined from 30 birds per treatment. While chicks were sacrificed, 3-4 ml blood sample was taken and stored frozen at (-20°C) for serum chemical analysis to determine effects of consumption of diets on blood chemistry (total protein, albumin, glucose, urea, cholesterol and triglycerides). There were no significant differences in ADFI among the treatments(P>0.05). However, BWG, FCR and mortality were highly significantly different (P<0.01) between treatments. ADG was significantly reduced (P<0.05) by aflatoxin but was unaffected by aflatoxin supplemented with either commercial or bovine yeasts (P>0.05). In terms of carcass portions, percentage of carcass was unaffected by the treatments, however, percentages of drumstick were reduced by aflatoxin and aflatoxin supplemented commercial yeast. Abdominal fat was significantly reduced (P<0.01) when commercial or bovine yeasts were added to the aflatoxin contaminated diets. Percentage of liver were significantly increased by aflatoxin contamination but were unaffected when yeasts were added to the diets. Blood chemical parameters, i.e. albumin, blood urea nitrogen and glucose were unaffected the treatments, while total protein, cholesterol and triglycerides were significantly decreased by aflatoxin. When yeasts were supplemented, such effect was not differed from the control. It is clearly indicated in the present study that supplementation of either commercial or bovine yeasts had beneficial effects on performance of broiler chickens intoxicated with aflatoxins.

Keywords: Aflatoxin, Commercial yeast, Bovine yeast, Growth performance, Blood chemical parameters, Broilers

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Authors: Ibrahim M. S. Shnawa, Bashar A. H. E. Alsadi, Kalida K. Alniaem

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In the immunologic sense, clinical infection is a state of failure of the immune system to combat the pathogenic weapon of the bacteria invading the host. A motile gram negative vibroid organism associated with marked mono and poly nuclear cell responses was traced during the examination of a clinical material from an infected common carp Cyprinus carpio. On primary plate culture, growth was shown to be pure, dense population of an Aeromonas-like colony morphotype. The pure isolate was found to be; Aerobic, facultatively anaerobic, non-halophilic, grew at 0C, and 37C, oxidase positive utilizes glucose through fermentative pathway, resist 0/129 and novobiocin, produces alanine and lysine decarboxylases but non-producing ornithine dehydrolases. Tests for the in vitro determinants of pathogenicity has shown to be; Betahaemolytic onto blood agar, gelatinase, casienase and amylase producer. Three in vivo determinants of pathogenicity were tested as, the lethal dose fifty, the pathogenesis and pathogenicity. It was evident that 0.1 milliliter of the causal bacterial cell suspension of a density 1 x 107 CFU/ml injected intramuscularly into an average of 100gms fish toke five days incubation period, then at the day six morbidity and mortality were initiated. LD50 was recorded at the day 12 post-infection. Use of an LD50 doses to study the pathogenicity, reveals mononuclear and polynuclear cell responses, on examining the stained direct films of the clinical materials from the experimentally infected fish. Re-isolation tests confirm that the reisolant is same. The course of the infection in natural case was shown manifestation of; skin ulceration, haemorrhage and descaling. On evisceration, the internal organs were shown; congestion in the intestines, spleen and, air sacs. The induced infection showed a milder form of these manifestations. The grading of the virulence of this organism was virulent causing chronic course of infections as indicated from the pathogenesis and pathogenicity studies. Thus the infectious bacteria were consistent with Aeromonas hydrophila, and the infection was chronic.

Keywords: Piscan, inflammatory respnonse, pure culture, pathogen, chronic, infection.

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Authors: Ola A. Nassr, Ali M. Abd Alridha, Rua A. Naser, Rasha S. Abbas

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Background: Excessive and inappropriate use of antimicrobial agents among hospitalized patients remains an important patient safety and public health issue worldwide. Not only does this behavior incur unnecessary cost but it is also associated with increased morbidity and mortality. The objective of this study is to obtain an insight into the prescribing patterns of antibiotics in surgical and medical wards, to help identify a scope for improvement in service delivery. Method: A simple point prevalence survey included a convenience sample of 200 patients admitted to medical and surgical wards in a government teaching hospital in Baghdad between October 2017 and April 2018. Data were collected by a trained pharmacy intern using a standardized form. Patient’s demographics and details of the prescribed antibiotics, including dose, frequency of dosing and route of administration, were reported. Patients were included if they had been admitted at least 24 hours before the survey. Patients under 18 years of age, having a diagnosis of cancer or shock, or being admitted to the intensive care unit, were excluded. Data were checked and entered by the authors into Excel and were subjected to frequency analysis, which was carried out on anonymized data to protect patient confidentiality. Results: Overall, 88.5% of patients (n=177) received 293 antibiotics during their hospital admission, with a small variation between wards (80%-97%). The average number of antibiotics prescribed per patient was 1.65, ranging from 1.3 for medical patients to 1.95 for surgical patients. Parenteral third-generation cephalosporins were the most commonly prescribed at a rate of 54.3% (n=159) followed by nitroimidazole 29.4% (n=86), quinolones 7.5% (n=22) and macrolides 4.4% (n=13), while carbapenems and aminoglycosides were the least prescribed together accounting for only 4.4% (n=13). The intravenous route was the most common route of administration, used for 96.6% of patients (n=171). Indications were reported in only 63.8% of cases. Culture to identify pathogenic organisms was employed in only 0.5% of cases. Conclusion: Broad-spectrum antibiotics are prescribed at an alarming rate. This practice may provoke antibiotic resistance and adversely affect the patient outcome. Implementation of an antibiotic stewardship program is warranted to enhance the efficacy, safety and cost-effectiveness of antimicrobial agents.

Keywords: Acute care, antibiotic misuse, Iraq, prescribing.

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Authors: Ingrid Ruzbarska, Martin Zvonar, Piotr Oleśniewicz, Julita Markiewicz-Patkowska, Krzysztof Widawski, Daniel Puciato

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Obese children will probably become obese adults, consequently exposed to an increased risk of comorbidity and premature mortality. Body weight may be indirectly determined by continuous development of coordination and motor skills. The level of motor skills and abilities is an important factor that promotes physical activity since early childhood. The aim of the study is to thoroughly understand the internal relations between motor coordination abilities and the somatic development of prepubertal children and to determine the effect of excess body weight on motor coordination by comparing the motor ability levels of children with different body mass index (BMI) values. The data were collected from 436 children aged 7–10 years, without health limitations, fully participating in school physical education classes. Body height was measured with portable stadiometers (Harpenden, Holtain Ltd.), and body mass—with a digital scale (HN-286, Omron). Motor coordination was evaluated with the Kiphard-Schilling body coordination test, Körperkoordinationstest für Kinder. The normality test by Shapiro-Wilk was used to verify the data distribution. The correlation analysis revealed a statistically significant negative association between the dynamic balance and BMI, as well as between the motor quotient and BMI (p<0.01) for both boys and girls. The results showed no effect of gender on the difference in the observed trends. The analysis of variance proved statistically significant differences between normal weight children and their overweight or obese counterparts. Coordination abilities probably play an important role in preventing or moderating the negative trajectory leading to childhood overweight and obesity. At this age, the development of coordination abilities should become a key strategy, targeted at long-term prevention of obesity and the promotion of an active lifestyle in adulthood. Motor performance is essential for implementing a healthy lifestyle in childhood already. Physical inactivity apparently results in motor deficits and a sedentary lifestyle in children, which may be accompanied by excess energy intake and overweight.

Keywords: Childhood, KTK test, Physical education, Psychomotor competence.

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Authors: Abdel-Samad M. Ali, Ali A. Hadi Al-Shawi

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Discrimination against women and girls impairs progress in all domains of development articulated either in the framework of Millennium Development Goals (MDGs) or in the Post-2015 Development Agenda. Paper aspires to create greater awareness among researchers and policy makers of the challenges posed by gender gaps and the opportunities created by reducing them within the Arab region. The study reveals how Arab countries are closing in on gender-oriented targets of the third and fifth MDGs. While some countries can claim remarkable achievements particularly in girls’ equality in education, there is still a long way to go to keep Arab’s commitments to current and future generations in other countries and subregions especially in the economic participation or in the political empowerment of women. No country has closed or even expected to close the economic participation gap or the political empowerment gap. This should provide the incentive to keep moving forward in the Post-2015 Agenda. Findings of the study prove that while Arab states have uneven achievements in reducing maternal mortality, Arab women remain at a disadvantage in the labour market. For Arab region especially LDCs, improving maternal health is part of the unmet agenda for the post-2015 period and still calls for intensified efforts and procedures. While antenatal care coverage is improving across the Arab region, progress is marginal in LDCs. To achieve proper realization of gender equality and empowerment of women in the Arab region in the post-2015 agenda, the study presents critical key challenges to be addressed. These challenges include: Negative cultural norms and stereotypes; violence against women and girls; early marriage and child labour; women’s limited control over their own bodies; limited ability of women to generate their own income and control assets and property; gender-based discrimination in law and in practice; women’s unequal participation in private and public decision making autonomy; and limitations in data. However, in all Arab states, gender equality must be integrated as a goal across all issues, particularly those that affect the future of a country.

Keywords: Gender, equity, millennium development goals, post-2015 development agenda.

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Authors: Vladyslav Povoroznyuk, Nataliia Dzerovych, Larysa Martynyuk, Tetiana Kovtun

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Obesity and osteoporosis are the two diseases whose increasing prevalence and high impact on the global morbidity and mortality, during the two recent decades, have gained a status of major health threats worldwide. Obesity purports to affect the bone metabolism through complex mechanisms. Debated data on the connection between the bone mineral density and fracture prevalence in the obese patients are widely presented in literature. There is evidence that the correlation of weight and fracture risk is sitespecific. This study is aimed at determining the connection between the bone mineral density (BMD) and trabecular bone score (TBS) parameters in Ukrainian women suffering from obesity. We examined 1025 40-89-year-old women, divided them into the groups according to their body mass index: Group A included 360 women with obesity whose BMI was ≥30 kg/m2, and Group B – 665 women with no obesity and BMI of <30 kg/m2. The BMD of total body, lumbar spine at the site L1-L4, femur and forearm were measured by DXA (Prodigy, GEHC Lunar, Madison, WI, USA). The TBS of L1- L4 was assessed by means of TBS iNsight® software installed on our DXA machine (product of Med-Imaps, Pessac, France). In general, obese women had a significantly higher BMD of lumbar spine, femoral neck, proximal femur, total body and ultradistal forearm (p<0.001) in comparison with women without obesity. The TBS of L1-L4 was significantly lower in obese women compared to nonobese women (p<0.001). The BMD of lumbar spine, femoral neck and total body differed to a significant extent in women of 40-49, 50- 59, 60-69 and 70-79 years (p<0.05). At same time, in women aged 80-89 years the BMD of lumbar spine (p=0.09), femoral neck (p=0.22) and total body (p=0.06) barely differed. The BMD of ultradistal forearm was significantly higher in women of all age groups (p<0.05). The TBS of L1-L4 in all the age groups tended to reveal the lower parameters in obese women compared with the nonobese; however, those data were not statistically significant. By contrast, a significant positive correlation was observed between the fat mass and the BMD at different sites. The correlation between the fat mass and TBS of L1-L4 was also significant, although negative. Women with vertebral fractures had a significantly lower body weight, body mass index and total body fat mass in comparison with women without vertebral fractures in their anamnesis. In obese women the frequency of vertebral fractures was 27%, while in women without obesity – 57%.

Keywords: Bone mineral density, trabecular bone score, obesity, women.

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Authors: Michael Russelle S. Alvarez, Noel S. Quiming, Francisco M. Heralde

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This study aims to: a) obtain ethanolic (95% EtOH) and aqueous extracts of Selaginella elmeri, Christella dentata, Elatostema sinnatum, Curculigo capitulata, Euphorbia hirta, Murraya koenigii, Alpinia speciosa, Cymbopogon citratus, Eucalyptus globulus, Jatropha curcas, Psidium guajava, Gliricidia sepium, Ixora coccinea and Capsicum frutescens and screen them for larvicidal activities against Aedes aegypti (Linn.) and Aedes albopictus (Skuse) larvae; b) to fractionate the most active extract and determine the most active fraction; c) to determine the larvicidal properties of the most active extract and fraction against by computing their percentage mortality, LC50, and LC90 after 24 and 48 hours of exposure; and d) to determine the nature of the components of the active extracts and fractions using phytochemical screening. Ethanolic (95% EtOH) and aqueous extracts of the selected plants will be screened for potential larvicidal activity against Ae. aegypti and Ae. albopictus using standard procedures and 1% malathion and a Piper nigrum based ovicide-larvicide by the Department of Science and Technology as positive controls. The results were analyzed using One-Way ANOVA with Tukey’s and Dunnett’s test. The most active extract will be subjected to partial fractionation using normal-phase column chromatography, and the fractions subsequently screened to determine the most active fraction. The most active extract and fraction were subjected to dose-response assay and probit analysis to determine the LC50 and LC90 after 24 and 48 hours of exposure. The active extracts and fractions will be screened for phytochemical content. The ethanolic extracts of C. citratus, E. hirta, I. coccinea, G. sepium, M. koenigii, E globulus, J. curcas and C. frutescens exhibited significant larvicidal activity, with C. frutescens being the most active. After fractionation, the ethyl acetate fraction was found to be the most active. Phytochemical screening of the extracts revealed the presence of alkaloids, tannins, indoles and steroids. A formulation using talcum powder–300 mg fraction per 1 g talcum powder–was made and again tested for larvicidal activity. At 2 g/L, the formulation proved effective in killing all of the test larvae after 24 hours.

Keywords: Larvicidal activity screening, partial purification, dose-response assay, Capsicum frutescens.

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Authors: D. Hilton

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The importance and significance of this research is based upon the fundamental knowledge reported in the scientific literature that physical activity is inversely associated with obesity. In addition, it is recognized there is a global epidemic of sedentariness while at the same time it is known that morbidity and mortality are associated with physical inactivity and as a result of overweight or obesity. Hence this small study in school students is an important area of research in our community. An application submitted in 2005 for the inaugural Public Health Education Research Trust [PHERT] Post Graduate Research Scholarship scheme organized by the Public Health Association of Australia [PHAA] was awarded 3rd place within Australia. The author and title was: D. Hilton, Methods to increase physical activity in school aged children [literature review, a trial using pedometers and a policy paper]. Third place is a good result, however this did not secure funding for the project, as only first place received $5000 funding. Some years later within Australia, a program commenced called the Global Children's Challenge [GCC]. Given details of the 2005 award above were included an application submission prepared for Parkhill Primary School [PPS] which is located in Victoria, Australia was successful. As a result, an excited combined grade 3/ 4 class at the school [27 students] in 2012 became recipients of these free pedometers. Ambassadors for the program were Mrs Catherine Freeman [OAM], Olympic Gold Medalist – Sydney 2000 [400 meters], while another ambassador was Mr Colin Jackson [CBE] who is a Welsh former sprint and hurdling athlete. In terms of PPS and other schools involved in 2012, website details show that the event started on 19th Sep 2012 and students were to wear the pedometer every day for 50 days [at home and at school] aiming for the recommended 15,000 steps/day recording steps taken in a booklet provided. After the finish, an analysis of the average step count for this school showed that the average steps taken / day was 14, 003 [however only a small percentage of students returned the booklets and units] as unfortunately the dates for the program coincided with school holidays so some students either forgot or misplaced the units / booklets. Unfortunately funding for this program ceased in 2013, however the lasting impact of the trial on student’s knowledge and awareness remains and in fact becomes a good grounding for students in how to monitor basic daily physical activity using a method that is easy, fun, low cost and readily accessible.

Keywords: Walking, exercise, physical activity [motor activity].

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Authors: Natasha Bhate

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Contraception is important in helping to reduce maternal and infant mortality rates by allowing women to control the number and spacing in-between their children. It also reduces the need for unsafe abortions. Women worldwide use contraception; however, the contraceptive prevalence rate is still relatively low in Central American countries like Guatemala. There is also an unmet need for contraception in Guatemala, which is more significant in rural, indigenous women due to barriers preventing contraceptive use. The study objective was to investigate and analyse the current barriers women face, in Guatemala, Panajachel and the surrounding areas, in using contraception, with a view of identifying ways to overcome these barriers. This included exploring the contraceptive barriers women believe exist and the influence of males in contraceptive decision making. The study took place at a charity in Panajachel, Guatemala, and had a cross-sectional, qualitative design to allow an in-depth understanding of information gathered. This particular study design was also chosen to help inform the charity with qualitative research analysis, in view of their intent to create a local reproductive health programme. A semi-structured interview design, including photo facilitation to improve cross-cultural communication, with interpreter assistance, was utilized. A pilot interview was initially conducted with small improvements required. Participants were recruited through purposive and convenience sampling. The study host at the charity acted as a gatekeeper; participants were identified through attendance of the charity’s women’s-initiative programme workshops. 20 participants were selected and agreed to study participation with two not attending; a total of 18 participants were interviewed in June 2017. Interviews were audio-recorded and data were stored on encrypted memory sticks. Framework analysis was used to analyse the data using NVivo11 software. The University of Leeds granted ethical approval for the research. Religion, language, the community, and fear of sickness were examples of existing contraceptive barrier themes recognized by many participants. The influence of men was also an important barrier identified, with themes of machismo and abuse preventing contraceptive use in some women. Women from more rural areas were believed to still face barriers which some participants did not encounter anymore, such as distance and affordability of contraceptives. Participants believed that informative workshops in various settings were an ideal method of overcoming existing contraceptive barriers and allowing women to be more empowered. The involvement of men in such workshops was also deemed important by participants to help reduce their negative influence in contraceptive usage. Overall, four recommendations following this study were made, including contraceptive educational courses, a gender equality campaign, couple-focused contraceptive workshops, and further qualitative research to gain a better insight into men’s opinions regarding women using contraception.

Keywords: Barrier, contraception, machismo, religion.

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Authors: Z. Nurzaireena, K. Azalea, T. Azirawaty, S. Jameela, G. Muralitharan

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The aim of this study is the review of the management practices of sickle cell disease patients during pregnancy, as well as the maternal and neonatal outcome at Ampang Hospital, Selangor. The study consisted of a review of pregnant patients with sickle cell disease under follow up at the Hematology Clinic, Ampang Hospital over the last seven years to assess their management and maternal-fetal outcome. The results of the review show that Ampang Hospital is considered the public hematology centre for sickle cell disease and had successfully managed three pregnancies throughout the last seven years. Patients’ presentations, managements and maternal-fetal outcome were compared and reviewed for academic improvements. All three patients were seen very early in their pregnancy and had been given a regime of folic acid, antibiotics and thrombo-prophylactic drugs. Close monitoring of maternal and fetal well being was done by the hematologists and obstetricians. Among the patients, there were multiple admissions during the pregnancy for either a painful sickle cell bone crisis, haemolysis following an infection and anemia requiring phenotype- matched blood and exchange transfusions. Broad spectrum antibiotics coverage during and infection, hydration, pain management and venous-thrombolism prophylaxis were mandatory. The pregnancies managed to reach near term in the third trimester but all required emergency caesarean section for obstetric indications. All pregnancies resulted in live births with good fetal outcome. During post partum all were nursed closely in the high dependency units for further complications and were discharged well. Post partum follow up and contraception counseling was comprehensively given for future pregnancies. Sickle cell disease is uncommonly seen in the East, especially in the South East Asian region, yet more cases are seen in the current decade due to improved medical expertise and advance medical laboratory technologies. Pregnancy itself is a risk factor for sickle cell patients as increased thrombosis event and risk of infections can lead to multiple crisis, haemolysis, anemia and vaso-occlusive complications including eclampsia, cerebrovasular accidents and acute bone pain. Patients mostly require multiple blood product transfusions thus phenotype-matched blood is required to reduce the risk of alloimmunozation. Emphasizing the risks and complications in preconception counseling and establishing an ultimate pregnancy plan would probably reduce the risk of morbidity and mortality to the mother and unborn child. Early management for risk of infection, thromboembolic events and adequate hydration is mandatory. A holistic approach involving multidisciplinary team care between the hematologist, obstetricians, anesthetist, neonatologist and close nursing care for both mother and baby would ensure the best outcome. In conclusion, sickle cell disease by itself is a high risk medical condition and pregnancy would further amplify the risk. Thus, close monitoring with combine multidisciplinary care, counseling and educating the patients are crucial in achieving the safe outcome.

Keywords: Anemia, haemoglobinopathies, pregnancy, sickle cell disease.

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Authors: Chau-Kuang Chen, Juanita Buford, Colette Davis, Raisha Allen, John Hughes, Jr., James Tyus, Dexter Samuels

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During the post-Civil War era, the city of Nashville, Tennessee, had the highest mortality rate in the United States. The elevated death and disease rates among former slaves were attributable to lack of quality healthcare. To address the paucity of healthcare services, Meharry Medical College, an institution with the mission of educating minority professionals and serving the underserved population, was established in 1876. Purpose: The social ecological framework and partial least squares (PLS) path modeling were used to quantify the impact of socioeconomic status and adverse health outcome on primary care professionals serving the disadvantaged community. Thus, the study results could demonstrate the accomplishment of the College’s mission of training primary care professionals to serve in underserved areas. Methods: Various statistical methods were used to analyze alumni data from 1975 – 2013. K-means cluster analysis was utilized to identify individual medical and dental graduates in the cluster groups of the practice communities (Disadvantaged or Non-disadvantaged Communities). Discriminant analysis was implemented to verify the classification accuracy of cluster analysis. The independent t-test was performed to detect the significant mean differences of respective clustering and criterion variables. Chi-square test was used to test if the proportions of primary care and non-primary care specialists are consistent with those of medical and dental graduates practicing in the designated community clusters. Finally, the PLS path model was constructed to explore the construct validity of analytic model by providing the magnitude effects of socioeconomic status and adverse health outcome on primary care professionals serving the disadvantaged community. Results: Approximately 83% (3,192/3,864) of Meharry Medical College’s medical and dental graduates from 1975 to 2013 were practicing in disadvantaged communities. Independent t-test confirmed the content validity of the cluster analysis model. Also, the PLS path modeling demonstrated that alumni served as primary care professionals in communities with significantly lower socioeconomic status and higher adverse health outcome (p < .001). The PLS path modeling exhibited the meaningful interrelation between primary care professionals practicing communities and surrounding environments (socioeconomic statues and adverse health outcome), which yielded model reliability, validity, and applicability. Conclusion: This study applied social ecological theory and analytic modeling approaches to assess the attainment of Meharry Medical College’s mission of training primary care professionals to serve in underserved areas, particularly in communities with low socioeconomic status and high rates of adverse health outcomes. In summary, the majority of medical and dental graduates from Meharry Medical College provided primary care services to disadvantaged communities with low socioeconomic status and high adverse health outcome, which demonstrated that Meharry Medical College has fulfilled its mission. The high reliability, validity, and applicability of this model imply that it could be replicated for comparable universities and colleges elsewhere.

Keywords: Disadvantaged Community, K-means Cluster Analysis, PLS Path Modeling, Primary care.

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