This study assessed the perceived health-related quality of life (HRQoL) of 139 non-insulin dependent diabetic patients attending the diabetes clinic at Kenyatta National Hospital in Kenya. The majority of patients were female, between 40-60 years old, and had diabetes for less than 5 years. Most patients had poor blood sugar control and multiple complications. Using the WHOQoL-Bref assessment tool, the study found that 84% of patients reported a good overall HRQoL. However, their physical and psychological domains were most affected. Factors like income, employment, healthcare funding, diabetes duration and complications had a significant association with patients' HRQoL scores. The study concluded that diabetes impacts patients' HRQo
Teenage pregnancy is pregnancy in human females under the age of 20. A pregnancy can take place after the start of puberty before the first menstrual period but usually occurs after the onset. In well-nourished girls, menarche usually takes place around the age of 12 or 13.
Pregnant teenagers face many of the same obstetrics issues as other women. There are, however, additional medical concerns for mothers aged below 15 years of age. For mothers aged 15–19, risks are associated more with socioeconomic factors than with the biological effects of age. Risks of low birth weight, premature labor, anemia, and pre-eclampsia are connected to the biological age itself, as it was observed in teen births even after controlling for other risk factors (such as utilization of antenatal care etc.).
In developed countries, teenage pregnancies are often associated with social issues, including lower educational levels, higher rates of poverty, and other poorer life outcomes in children of teenage mothers. Teenage pregnancy in developed countries is usually outside of marriage, and carries a social stigma in many communities and cultures. By contrast, teenage parents in developing countries are often married, and their pregnancies welcomed by family and society. However, in these societies, early pregnancy may combine with malnutrition and poor health care to cause medical problems.
Teenage pregnancies appear to be preventable by comprehensive sex education and access to birth control. Abstinence-only sex education does not appear to be effective.
Through generations teenage pregnancy has converted into one of the Philippines' most challenging social issues. Becoming pregnant at such an early age brings multiple obstacles such as, lower expectations of finishing high school, not attending college, and less success in the job industry. Not only do these obstacles regard the teenage parents but harm their unborn child in academic and health issues, for instance tending to score less optimally on assessments of cognitive development and academic achievement, and also tend to exhibit more problem behaviors than other children. Other than social dilemmas there are certain health issues that are more likely to appear in a teenage pregnancy for example the baby is more likely to have a low birth weight, to be born before term, and have developmental delay.
The issue we focus on is premarital sex among teenager that results to teenage pregnancy. Further explanation will be discussed in the parts to follow.
Teenage pregnancy is pregnancy in human females under the age of 20. A pregnancy can take place after the start of puberty before the first menstrual period but usually occurs after the onset. In well-nourished girls, menarche usually takes place around the age of 12 or 13.
Pregnant teenagers face many of the same obstetrics issues as other women. There are, however, additional medical concerns for mothers aged below 15 years of age. For mothers aged 15–19, risks are associated more with socioeconomic factors than with the biological effects of age. Risks of low birth weight, premature labor, anemia, and pre-eclampsia are connected to the biological age itself, as it was observed in teen births even after controlling for other risk factors (such as utilization of antenatal care etc.).
In developed countries, teenage pregnancies are often associated with social issues, including lower educational levels, higher rates of poverty, and other poorer life outcomes in children of teenage mothers. Teenage pregnancy in developed countries is usually outside of marriage, and carries a social stigma in many communities and cultures. By contrast, teenage parents in developing countries are often married, and their pregnancies welcomed by family and society. However, in these societies, early pregnancy may combine with malnutrition and poor health care to cause medical problems.
Teenage pregnancies appear to be preventable by comprehensive sex education and access to birth control. Abstinence-only sex education does not appear to be effective.
Through generations teenage pregnancy has converted into one of the Philippines' most challenging social issues. Becoming pregnant at such an early age brings multiple obstacles such as, lower expectations of finishing high school, not attending college, and less success in the job industry. Not only do these obstacles regard the teenage parents but harm their unborn child in academic and health issues, for instance tending to score less optimally on assessments of cognitive development and academic achievement, and also tend to exhibit more problem behaviors than other children. Other than social dilemmas there are certain health issues that are more likely to appear in a teenage pregnancy for example the baby is more likely to have a low birth weight, to be born before term, and have developmental delay.
The issue we focus on is premarital sex among teenager that results to teenage pregnancy. Further explanation will be discussed in the parts to follow.
Background: Oral Health (OH) is an essential component of general health, oral diseases have a negative social impact and
adverse consequences on the quality of life, while their treatment places a considerable economic burden on individuals, communities and countries. Oral diseases are related to a number of risk factors and determinants that are common to Diabetes Mellitus (DM) which have oral implications. This study aimed to know DMFT index among type 2 diabetic patients attending UNRWA health centers in Gaza Governorates. Method: An analytical cross-sectional study of 406 patients with type 2 DM selected through systematic random sampling from 5 UNRWA health centers. The World Health Organization’s basic methods tools were used to collect data and assess OH.
Prevalence and predictors of mental health among farmworkers in Southeastern ...Agriculture Journal IJOEAR
Abstract—
Background: Mental health problems represent a major component of the global burden of disease. The primary objective of this study was to assess the prevalence and predictors of psychological wellbeing among farmworkers and to evaluate their mental health services need for in rural primary health care settings.
Methods: The study sample comprised 1855 farmworkers (918 women, and 937 men) who were selected using probability cluster sampling method at 95% confidence interval (87.6 % response rate). The 12-item General Health Questionnaire (GHQ-12) and socio-demographic information form were used to data collection.
Results: The overall prevalence of mental health problems was 31.5%; the prevalence among women was 1.4 times that of men (35%, females; 28.2%, males). Logistic regression analyses revealed that poor general health, as well as presence of chronic diseases and exposure to traumatic life events predicted mental ill health among both sex. Poor economic situation, being seasonal migrant farmworker, and pesticide exposure history affected male mental health problems; while type of settlement, history of having disabled child at birth, and not having a family physician were significant predictors of female mental ill health (P < 0.05).
Conclusions: These findings highlight the need for systematic development of community-based mental health services in conjunction with rural primary health care center and an integrated approach to health care of farmworkers. These include screening, early identification and treatment of mental health problems, development of non-communicable disease (NCD) control program, maternal health services and urgent measures to improve farmworkers’ work safety and pesticide applications.
Factors contributing to malnutrition among HIV positive children aged between...iosrjce
The objective of the study was to identify factors contributing to malnutrition among HIV positive
children aged between 6 and 60 months. The study utilized a non experimental descriptive design. It was a
hospital based study conducted at Parirenyatwa Group of Hospital pediatric wards. A total of 30 children and
30 caregivers were recruited through convenience sampling. The children had a confirmed diagnosis of
malnutrition, confirmed HIV positive, aged between 6 and 60 months and had to have a present caregiver
during data collection. There were no dropouts. The main outcome measure were anthropometric measurements
of the children namely; height, weight and mid upper arm circumference and the various stressors contributing
to malnutrition. Twenty-two (73.33%) children were males and 8 (26.66%) were females. Contributing factors
to malnutrition identified were presence other illnesses such as diarrhea, pneumonia, tuberculosis and
kwashiorkor, 19 (63.33%), low socioeconomic status (earned less than USD$100 dollars per month), 16
(53.33%), coming from a family with more than 5 dependants 11 (36.67%), not being on ART 15 (50%), and
birth weight below or equal to 2500g 6 (20%). The major contributing factors to malnutrition were
extrapersonal stressors (54.83) interpersonal stressors (30.28%) and intrapersonal stressors (29.76%).
Abstract—Sexual health (SH) and sexual behavior of young people have become a growing public concern. But few studies have been conducted to investigate the prevalence and psychosocial correlates of this phenomenon.
Purpose: To understand college students’ sexual knowledge (SK), sexual attitudes (SA), sexual desire (SD) and sexual behavior (SB).
Methods: A self-reported questionnaire survey on SK, SA, SD, and SB was conducted among 520 university students. Their demographic data, SK, SA, SD, and SB were assessed.
Results: A total of 500 students completed the questionnaire. The SKS total score had a mean of 23.05; 105 (21.0%) subjects had had premarital sex; 121 (24.2%) had a partner; 117 (23.4%) had a medical educational background. The results demonstrated an increased risk of premarital sex amongst males and subjects with the risk factors of smoking, drinking, having a partner, and having higher levels of SD and SK and more open SA.
Conclusions: This study provides support for the idea that university students lack SK (especially regarding contraception knowledge), even though the students had a medical educational background. Additionally, a considerable amount of them engaged in premarital SB. Our findings also suggest that university students need sex education, particularly in combining sexuality with their life, in relating to others maturely as a sexual individual, in employing contraception, and in preventing sexually transmitted diseases (STDs). Our study suggests that interventions aimed at expanding university students’ SK and other related skills are required.
The Burden of Disease ( BOD) analysis describes in details the uses and effects of BOD. How to measure it. Special emphasis has been given in understanding HALY, DALY and QALY.
N.B: 1. Please download the ppt first, as the animations will act better then
2. There are few hidden slides in the presentation, which you may explore too.
ABSTRACT- Background: Malnutrition constitutes a major public health concern worldwide and serves as an indicator
of hospitalized patient’s prognosis. Nutritional support is an essential aspect of the clinical management of children
admitted to hospital. Malnutrition has been long associated with poor quality, poor diet and inadequate access to health
care, and it remains a key global health issue that both stems from and contributes to weakness, with 50% of childhood
deaths due to principal under nutrition.
Methods: The present hospital based cross sectional study was conducted in April to Dec 2015 among 300 rural
adolescents of 9-18 years age (146 boys and 154 girls) attending the outpatient department at Patna Medical College and
Hospital, Bihar, India, belonging to the all caste communities. The nutritional status was assessed in terms of under
nutrition (weight-for-age below 3rd percentile), stunting (Height-for-age below 3rd percentile) and thinness (BMI-for-age
below 5th percentile). Diseases were accepted as such as diagnosed by pediatrician, skin specialist and medical officer.
Results: The prevalence of underweight, stunting and thinness were found to be 31%, 22.3% and 30.7% respectively. The
maximum prevalence of malnutrition was observed among early adolescents (23% - 54%) and the most common
morbidities were diarrhoea (16.7%), carbuncle / furuncle (16.7%) and scabies (12%).
Conclusion: Malnutrition among hospitalized under five children and around suffers moderately high rates of
malnutrition. Present nutrition programs attention on education for at risk children and referral to regional hospitals for
malnourished children. Screening tools to classify children at risk of developing malnutrition might be helpful.
Key-words- Malnutrition, Hospitalized children, Morbidities, Prevalence, Stunting
Levels of Anxiety and Quality of Life in Overweight Individuals Under Nutriti...CrimsonPublishersIOD
Levels of Anxiety and Quality of Life in Overweight Individuals Under Nutritional Monitoring by Géssika Dutra de Andrade Reis, Virginia Souza Santos* and Martha Elisa Ferreira de Almeida in Interventions in Obesity & Diabetes
Background: Diabetes affects millions of people each year, it is one of the leading causes of mortality and morbidity worldwide.
Periodontal disease has recently been recognized as the “sixth complication” of diabetes mellitus, the relationship between diabetes and periodontal disease is actually bi-directional. Generally, poor oral hygiene, a long history of diabetes, greater age, and poor metabolic control are associated with more severe periodontal disease. Method: The study is an analytical cross-sectional study, 406 patients with type 2 diabetes mellitus selected through systematic random sampling from 5 UNRWA health centers. The World Health Organization’s basic methods tools were used to collect data and assess oral health.
This study only looks at the social and economic part of the disease and does not take an account of natural science. In addition, this analysis is carried only to estimate the effect of people living with epilepsy and nodding syndrome on social exclusion. Moreover, the main research question lays on do people with epilepsy and nodding syndrome have access to education, health care, and food security, and livelihood?
Knowledge and Perception on Noncommunicable diseases (NCDs) among Health Prof...MatiaAhmed
The rapid rise of Noncommunicable diseases represents one of the major
health challenges to global development in the 21st century. Among the 20 Grand
Challenges in Chronic NCDs the priority focuses of area is to explore the level of knowledge
and perception among health professionals and its determinants
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv...CrimsonpublishersCJMI
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv-1 DNA Quantification by Tuofu Zhu in Cohesive Journal of Microbiology & Infectious Disease
Compliance, concordance and empowerment in patients with type two diabetes me...NiyotiKhilare
This presentation compares the traditional model that focuses on compliance of the patient, with the new model which focuses on empowering the patient. The presentation will also focus elaborately on empowerment as an intervention for improved medical adherence in diabetic patients.
Explore and analyse concordance as a concept and empowerment as a strategic intervention to improve patient outcomes in diabetes.
Sulphasalazine Induced Toxic Epidermal Necrolysis A Case Reportiosrphr_editor
Toxic Epidermal Necrolysis (TEN) is a rare and life threatening mucocutaneous reaction
characterized by extensive necrosis and detachment of epidermis. The Worldwide incidence of TEN is 0.9 to 1.4
per million populations per year [1]. Here we have discussed a case of Toxic Epidermal Necrolysis secondary
to Sulfasalazine managed with fluid replacement, analgesics, anti-infective therapy aggressive nutritional
support and intravenous high dose steroid therapy.
Keywords- Toxic Epidermal Necrolysis, Sulfasalazine
The Comprehensive Review on Fat Soluble Vitaminsiosrphr_editor
This review article deals with brief description of fat soluble vitamins with figures and tables
showing statistical analytical data duly quoting the references wherever necessary. The word “soluble” actually
means “able to be dissolved.” Whether a vitamin is classified as 'fat-soluble' or 'water-soluble' has to do with
how the vitamin is absorbed, stored and removed from the body. Vitamins are tiny organic compounds with a
huge impact on the health and well-being of the body. The body needs a small amount of fat soluble vitamins in
order to stay in optimal health. Fat soluble vitamins play an important role in keeping the body healthy and
functioning from immune system and muscle and heart function, easy flow and clotting of blood as well as eye
health. They are critical to health and wellness–particularly reproductive health and wellness. Low-fat, no-fat
and vegan diets are woefully lacking in fat soluble vitamins. However a diet based on traditional foods can
naturally provide these vitamins. Science is still learning about many of the functions of vitamins. "Too much
vitamin A, D, or K can lead to increased levels that are unhealthy and can cause serious health consequences.
Diseased conditions leading to decreased fat absorption leads to decreased absorption of vitamins. The fatsoluble
vitamins work most safely and effectively when obtained them from natural foods within the context of a
diet rich in all their synergistic partners. If fat soluble vitamins are stored for lengthy time they generate threat
for toxicity than water soluble vitamins and such situation even aggravated, provided they are consumed in
excess. Vitamin products, above the legal limits are not considered food supplements and must be registered as
prescription or non-prescription (over-the-counter drugs) due to their potential side effects. Vitamin A and E
supplements do not provide health benefits for healthy individuals, instead they may enhance mortality, and it is
held proved that beta-carotene supplements can be harmful to smokers
Background: Oral Health (OH) is an essential component of general health, oral diseases have a negative social impact and
adverse consequences on the quality of life, while their treatment places a considerable economic burden on individuals, communities and countries. Oral diseases are related to a number of risk factors and determinants that are common to Diabetes Mellitus (DM) which have oral implications. This study aimed to know DMFT index among type 2 diabetic patients attending UNRWA health centers in Gaza Governorates. Method: An analytical cross-sectional study of 406 patients with type 2 DM selected through systematic random sampling from 5 UNRWA health centers. The World Health Organization’s basic methods tools were used to collect data and assess OH.
Prevalence and predictors of mental health among farmworkers in Southeastern ...Agriculture Journal IJOEAR
Abstract—
Background: Mental health problems represent a major component of the global burden of disease. The primary objective of this study was to assess the prevalence and predictors of psychological wellbeing among farmworkers and to evaluate their mental health services need for in rural primary health care settings.
Methods: The study sample comprised 1855 farmworkers (918 women, and 937 men) who were selected using probability cluster sampling method at 95% confidence interval (87.6 % response rate). The 12-item General Health Questionnaire (GHQ-12) and socio-demographic information form were used to data collection.
Results: The overall prevalence of mental health problems was 31.5%; the prevalence among women was 1.4 times that of men (35%, females; 28.2%, males). Logistic regression analyses revealed that poor general health, as well as presence of chronic diseases and exposure to traumatic life events predicted mental ill health among both sex. Poor economic situation, being seasonal migrant farmworker, and pesticide exposure history affected male mental health problems; while type of settlement, history of having disabled child at birth, and not having a family physician were significant predictors of female mental ill health (P < 0.05).
Conclusions: These findings highlight the need for systematic development of community-based mental health services in conjunction with rural primary health care center and an integrated approach to health care of farmworkers. These include screening, early identification and treatment of mental health problems, development of non-communicable disease (NCD) control program, maternal health services and urgent measures to improve farmworkers’ work safety and pesticide applications.
Factors contributing to malnutrition among HIV positive children aged between...iosrjce
The objective of the study was to identify factors contributing to malnutrition among HIV positive
children aged between 6 and 60 months. The study utilized a non experimental descriptive design. It was a
hospital based study conducted at Parirenyatwa Group of Hospital pediatric wards. A total of 30 children and
30 caregivers were recruited through convenience sampling. The children had a confirmed diagnosis of
malnutrition, confirmed HIV positive, aged between 6 and 60 months and had to have a present caregiver
during data collection. There were no dropouts. The main outcome measure were anthropometric measurements
of the children namely; height, weight and mid upper arm circumference and the various stressors contributing
to malnutrition. Twenty-two (73.33%) children were males and 8 (26.66%) were females. Contributing factors
to malnutrition identified were presence other illnesses such as diarrhea, pneumonia, tuberculosis and
kwashiorkor, 19 (63.33%), low socioeconomic status (earned less than USD$100 dollars per month), 16
(53.33%), coming from a family with more than 5 dependants 11 (36.67%), not being on ART 15 (50%), and
birth weight below or equal to 2500g 6 (20%). The major contributing factors to malnutrition were
extrapersonal stressors (54.83) interpersonal stressors (30.28%) and intrapersonal stressors (29.76%).
Abstract—Sexual health (SH) and sexual behavior of young people have become a growing public concern. But few studies have been conducted to investigate the prevalence and psychosocial correlates of this phenomenon.
Purpose: To understand college students’ sexual knowledge (SK), sexual attitudes (SA), sexual desire (SD) and sexual behavior (SB).
Methods: A self-reported questionnaire survey on SK, SA, SD, and SB was conducted among 520 university students. Their demographic data, SK, SA, SD, and SB were assessed.
Results: A total of 500 students completed the questionnaire. The SKS total score had a mean of 23.05; 105 (21.0%) subjects had had premarital sex; 121 (24.2%) had a partner; 117 (23.4%) had a medical educational background. The results demonstrated an increased risk of premarital sex amongst males and subjects with the risk factors of smoking, drinking, having a partner, and having higher levels of SD and SK and more open SA.
Conclusions: This study provides support for the idea that university students lack SK (especially regarding contraception knowledge), even though the students had a medical educational background. Additionally, a considerable amount of them engaged in premarital SB. Our findings also suggest that university students need sex education, particularly in combining sexuality with their life, in relating to others maturely as a sexual individual, in employing contraception, and in preventing sexually transmitted diseases (STDs). Our study suggests that interventions aimed at expanding university students’ SK and other related skills are required.
The Burden of Disease ( BOD) analysis describes in details the uses and effects of BOD. How to measure it. Special emphasis has been given in understanding HALY, DALY and QALY.
N.B: 1. Please download the ppt first, as the animations will act better then
2. There are few hidden slides in the presentation, which you may explore too.
ABSTRACT- Background: Malnutrition constitutes a major public health concern worldwide and serves as an indicator
of hospitalized patient’s prognosis. Nutritional support is an essential aspect of the clinical management of children
admitted to hospital. Malnutrition has been long associated with poor quality, poor diet and inadequate access to health
care, and it remains a key global health issue that both stems from and contributes to weakness, with 50% of childhood
deaths due to principal under nutrition.
Methods: The present hospital based cross sectional study was conducted in April to Dec 2015 among 300 rural
adolescents of 9-18 years age (146 boys and 154 girls) attending the outpatient department at Patna Medical College and
Hospital, Bihar, India, belonging to the all caste communities. The nutritional status was assessed in terms of under
nutrition (weight-for-age below 3rd percentile), stunting (Height-for-age below 3rd percentile) and thinness (BMI-for-age
below 5th percentile). Diseases were accepted as such as diagnosed by pediatrician, skin specialist and medical officer.
Results: The prevalence of underweight, stunting and thinness were found to be 31%, 22.3% and 30.7% respectively. The
maximum prevalence of malnutrition was observed among early adolescents (23% - 54%) and the most common
morbidities were diarrhoea (16.7%), carbuncle / furuncle (16.7%) and scabies (12%).
Conclusion: Malnutrition among hospitalized under five children and around suffers moderately high rates of
malnutrition. Present nutrition programs attention on education for at risk children and referral to regional hospitals for
malnourished children. Screening tools to classify children at risk of developing malnutrition might be helpful.
Key-words- Malnutrition, Hospitalized children, Morbidities, Prevalence, Stunting
Levels of Anxiety and Quality of Life in Overweight Individuals Under Nutriti...CrimsonPublishersIOD
Levels of Anxiety and Quality of Life in Overweight Individuals Under Nutritional Monitoring by Géssika Dutra de Andrade Reis, Virginia Souza Santos* and Martha Elisa Ferreira de Almeida in Interventions in Obesity & Diabetes
Background: Diabetes affects millions of people each year, it is one of the leading causes of mortality and morbidity worldwide.
Periodontal disease has recently been recognized as the “sixth complication” of diabetes mellitus, the relationship between diabetes and periodontal disease is actually bi-directional. Generally, poor oral hygiene, a long history of diabetes, greater age, and poor metabolic control are associated with more severe periodontal disease. Method: The study is an analytical cross-sectional study, 406 patients with type 2 diabetes mellitus selected through systematic random sampling from 5 UNRWA health centers. The World Health Organization’s basic methods tools were used to collect data and assess oral health.
This study only looks at the social and economic part of the disease and does not take an account of natural science. In addition, this analysis is carried only to estimate the effect of people living with epilepsy and nodding syndrome on social exclusion. Moreover, the main research question lays on do people with epilepsy and nodding syndrome have access to education, health care, and food security, and livelihood?
Knowledge and Perception on Noncommunicable diseases (NCDs) among Health Prof...MatiaAhmed
The rapid rise of Noncommunicable diseases represents one of the major
health challenges to global development in the 21st century. Among the 20 Grand
Challenges in Chronic NCDs the priority focuses of area is to explore the level of knowledge
and perception among health professionals and its determinants
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv...CrimsonpublishersCJMI
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv-1 DNA Quantification by Tuofu Zhu in Cohesive Journal of Microbiology & Infectious Disease
Compliance, concordance and empowerment in patients with type two diabetes me...NiyotiKhilare
This presentation compares the traditional model that focuses on compliance of the patient, with the new model which focuses on empowering the patient. The presentation will also focus elaborately on empowerment as an intervention for improved medical adherence in diabetic patients.
Explore and analyse concordance as a concept and empowerment as a strategic intervention to improve patient outcomes in diabetes.
Sulphasalazine Induced Toxic Epidermal Necrolysis A Case Reportiosrphr_editor
Toxic Epidermal Necrolysis (TEN) is a rare and life threatening mucocutaneous reaction
characterized by extensive necrosis and detachment of epidermis. The Worldwide incidence of TEN is 0.9 to 1.4
per million populations per year [1]. Here we have discussed a case of Toxic Epidermal Necrolysis secondary
to Sulfasalazine managed with fluid replacement, analgesics, anti-infective therapy aggressive nutritional
support and intravenous high dose steroid therapy.
Keywords- Toxic Epidermal Necrolysis, Sulfasalazine
The Comprehensive Review on Fat Soluble Vitaminsiosrphr_editor
This review article deals with brief description of fat soluble vitamins with figures and tables
showing statistical analytical data duly quoting the references wherever necessary. The word “soluble” actually
means “able to be dissolved.” Whether a vitamin is classified as 'fat-soluble' or 'water-soluble' has to do with
how the vitamin is absorbed, stored and removed from the body. Vitamins are tiny organic compounds with a
huge impact on the health and well-being of the body. The body needs a small amount of fat soluble vitamins in
order to stay in optimal health. Fat soluble vitamins play an important role in keeping the body healthy and
functioning from immune system and muscle and heart function, easy flow and clotting of blood as well as eye
health. They are critical to health and wellness–particularly reproductive health and wellness. Low-fat, no-fat
and vegan diets are woefully lacking in fat soluble vitamins. However a diet based on traditional foods can
naturally provide these vitamins. Science is still learning about many of the functions of vitamins. "Too much
vitamin A, D, or K can lead to increased levels that are unhealthy and can cause serious health consequences.
Diseased conditions leading to decreased fat absorption leads to decreased absorption of vitamins. The fatsoluble
vitamins work most safely and effectively when obtained them from natural foods within the context of a
diet rich in all their synergistic partners. If fat soluble vitamins are stored for lengthy time they generate threat
for toxicity than water soluble vitamins and such situation even aggravated, provided they are consumed in
excess. Vitamin products, above the legal limits are not considered food supplements and must be registered as
prescription or non-prescription (over-the-counter drugs) due to their potential side effects. Vitamin A and E
supplements do not provide health benefits for healthy individuals, instead they may enhance mortality, and it is
held proved that beta-carotene supplements can be harmful to smokers
Chest sonography images in neonatal r.d.s. And proposed gradingiosrphr_editor
BACKGROUND : Lung sonography has been used to monitor the patients of R.D.S. in
N.I.C.U. in recent times.
AIMS : To Describe and Grade the changes of R.D.S. by lung sonography.
SETTING & DESIGN : Tertiary care institutional set up in a rural medical college.
STUDY DURATION : September 2014 to May 2015. Follow-up variable, upto 2 weeks.
PROSPECTIVE, ANALYTICAL STUDY.
MATERIALS AND METHODS -This was a single institute study approved by the institutional ethics
committee. Prior informed consent was obtained from the parents. 100 consecutive patients admitted in
N.I.C.U. WITH gestational age < 36 weeks with respiratory complaints were enrolled. Chest x-ray was
obtained within few hours of admission and lung sonography was performed within 24 hours. Follow – up
sonography was performed as and when necessary. Sonography image was graded and correlated with chest
xray and clinical picture
Analytical Study of Urine Samples for Epidemiology of Urinary Tract Infection...iosrphr_editor
The current study was carried out in District Abbottabad aimed to determine the common urinary
tract infections in local community to determine the epidemiology of significant diseases in asymptomatic patients
of renal disorder. In this study a total of 1000 urine samples were examined during 3rd February to 1st April 2015
from patients attending Ayub Teaching Hospital Abbottabad by using dipstick and microscopic analysis of urine.
There were 638 females and 362 males patients examined during this period. The range of age groups is between
1.5 years to 80 years. Results of this study was reported as Pyuria 11%, Proteinuria 21.1%, Hematuria 10.4%,
Epithelial Cells 8.2%, pH 7.8 %, Granular casts 7.3%, Triple phosphate 6.6%, Calcium oxalate 6.4%, Glycosuria
6.3%, Bacteria 6.2% and mucous 4.1%. This study concludes that routing urinalysis should be performed for all
individuals to diagnose the asymptomatic diseases that will help in simple therapeutic measurements as urinalysis
is a simple step to determine the root of Urinary tract disorders.
Correlation of Estrogen and Progesterone Receptor expression in Breast Canceriosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
“Hemodynamic and recovery profile with Dexmedetomidine and Fentanyl in intrac...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Congenital Agenesis Of The Corpus Callosum With Intracerebral Lipoma And Fron...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a co-ordinated and integrated plan for treatment and long-term follow up
Crimson Publishers: The Impact of Chronic Diseases on Patients and Their Fami...CrimsonGastroenterology
The Impact of Chronic Diseases on Patients and Their Families: Case of Ulceratice Colitis and Crohn’s Disease by Maria Tsoukka in Gastroenterology Medicine & Research: Bowel Disease
Background: The purpose of the study is to identify the potential psychological effects of ulcerative colitis and Crohn’s disease on patients and their family environment.Aim: The objective aims of this current research are to identify the causal factors creating psychological problems among patients and their family members, exploring ways to eliminate them and create a general picture for their psychological condition in relation to the diseases at a Pancyprian level.Methods: The Greek translation of the Hospital Anxiety and Depression Scale (HADS) and the Greek translation of the Health Survey (SF-12) will be used for evaluating the psychological effects of ulcerative colitis and Crohn disease on patients and their families. In addition, the Greek translation of the inflammatory Bowel Disease Questionnaire will be used only on the patients. The questionnaires will be handed out to the patients and their attendants in Gastroenterology dispensaries all over Cyprus. Conclusion: In the context of improving health care quality, it was indicated that multifaceted interventions are more effective than simpler interventions and that the insistence on change requires a multi-layered approach. A major focus of health policy is the effective management of long term diseases both for reducing the burden on patients and professionals as well as of the health services also. Studying the Group of patients with IBD could be an important example of study as the patients themselves are chronic patients with 20 years being the peak age onset of the diseases and life expectancy of healthy individuals.
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...JohnJulie1
The purpose of this study was to examine contextual factors associated with physical and mental health-related quality of life (HRQOL) in older adult cancer survivors.
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...EditorSara
The purpose of this study was to examine contextual factors associated with physical and mental health-related quality of life (HRQOL) in older adult cancer survivors.
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...EditorSara
This study is a secondary data analysis of the 2014 Behavioral Risk Factor Surveillance System. Only adults age 65 and older who had a cancer history in the Cancer Survivorship module were included (n=3,846).
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...semualkaira
The purpose of this study was to examine contextual factors associated with physical and mental health-related quality of life (HRQOL) in older adult cancer survivors.
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...semualkaira
This study is a secondary data analysis of the 2014 Behavioral Risk Factor Surveillance System. Only adults age 65 and older who had a cancer history in the Cancer Survivorship module were included (n=3,846).
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...semualkaira
The purpose of this study was to examine contextual
factors associated with physical and mental health-related quality
of life (HRQOL) in older adult cancer survivors.
Abstract—Diabetes is a disease which is on continuous increase specialy in country like India. It involve is a multisystem so intend to affect quality of life of patients. So this study was conducted on 250 Diabetes Mellitus patients to observe their quality of life on various domains viz Physical, Mental, Social and environmental through WHOQOL-Bref questionnaire. It was found that 54.4% were unable to level their quality of life, they say neither good nor bad. But 23.2% were feeling bad and 22.4 % were feeling good about their quality of life. Whereas regarding patient's satisfaction about their health 39.2% were unable to level their quality of life and 35.6% were dissatisfied and 25.2 % were satisfied with their health. Significantly more cases were unable to understand about their quality of life than their satisfaction to their health. It was also found that Physical quality of life was affected most followed by environmental, psychological and social dimension of quality of life.
Prevalence and Determinants of Distress Among Residents During COVID Crisispateldrona
Residents are predisposed to develop distress, burnout, and depression. With COVID-19, new stressful working conditions were imposed. This study aims to assess the impact of COVID-19 on residents’ wellbeing in France.
Prevalence and Determinants of Distress Among Residents During COVID Crisisclinicsoncology
Residents are predisposed to develop distress, burnout, and depression. With COVID-19, new stressful working conditions were imposed. This study aims to assess the impact of COVID-19 on residents’ wellbeing in France.
Prevalence and Determinants of Distress Among Residents During COVID Crisisgeorgemarini
Residents are predisposed to develop distress, burnout, and depression. With COVID-19, new stressful working conditions were imposed. This study aims to assess the impact of COVID-19 on residents’ wellbeing in France.
Prevalence and determinants of distress among residents during COVID crisiskomalicarol
Residents completed an online survey assessing the sociodemographic characteristics, the workload, the work environment, the
burden, and the psychological impact of the pandemic. Wellbeing, burnout, and depression were assessed using respectively the
Residents and fellows’ wellbeing index (RSWBI), the abbreviated
Maslach Burnout Inventory (aMBI) and the PHQ-9 questionnaire.
Analysis was done on SPSS 25. Variables were significantly
associated with the outcomes if p value ≤ 0.05.
Evaluation the efficacy of IVIgG in treatment of Hemolytic Disease of Newborniosrphr_editor
Hemolytic disease of newborn (HDN) is an important cause of hyperbilirubinemia in the
neonatal period,and delayed diagnosis and treatment may lead to permanent brain damage. Traditional
neonatal treatment of HDN is intensive phototherapy and exchange transfusion.Intravenous
immunoglobulin(IVIgG) has been introduced as an alternative therapy to exchange transfusion. This study was
conducted to assess the effect of IVIG in HDN .
FIBROLIPOMATOUS HAMARTOMA OF ULNAR NERVE: A RARE CASE REPORT.iosrphr_editor
Nervous fibrolipomatous hamartoma is said to be a rare tumor-like condition involving the peripheral
nerves,in which the epineurium and perineurium are enlarged and distorted by excess of fatty and fibrous tissue
s that infiltrate between and around nerve boundaries. The median nerve is more likely to develop a hamartoma
than other nerves with a predilection for the carpal tunnel.
A fibrolipomatous hamartoma – is a rare, benign, congenital lesion most commonly found in the median nerve,
usually at the level of the wrist or hand.
We report a case of this rare condition in ulnar nerve.
SELF MEDICATION PRACTICES FOR ORAL HEALTH PROBLEMS AMONG DENTAL PATIENTS IN B...iosrphr_editor
Introduction: Self‑ medication is commonly practiced all over the world. Self-medication is defined as the use
of medication by a patient on his own initiative or on the advice of a pharmacist or a lay person instead of
consulting a medical practitioner. The present study was aimed to estimate the prevalence of self-medication for
oral health problems among dental patients in Bengaluru city; to identify triggering factors that could influence
self-medication practices; to identify sources of medications used; to identify sources of information about
medications used; and to identify reasons for self-medication.Study Design: A Cross sectional Study.Methods:A
survey was conducted among 175 subjects among dental patients in Bengaluru city. Data were collected
through a specially designed proforma using a closed‑ ended, self‑ administered questionnaire containing 15
questions, in five sections.
Results: The prevalence of
Clinico-haematological Profile of Falciparum Malaria in a Rural Hospital of T...iosrphr_editor
Aim: To study the clinico-haematological profile malaria in a rural hospital of Tripura.
Material and methods: A cross-sectional hospital-based study was done from at Kulai District
Hospital,Tripura. This hospital based cross sectional study was done on 60 confirmed cases of falciparum
malaria (either by peripheral smear or rapid diagnostic test) admitted in Kulai District Hospital. A case sheet
proforma was prepared and data (demographic profile,clinical feature, investigation, treatment, and
complication) from all indoor patients was collected and analyzed.
Result: Out of 60 patients, 40(66.6%) were males and 20 (33.4%) were females. Most of the patients were
between the age group 21-40 years with the highest prevalence between the age group of 21-30. Fever was the
most common symptom. Anemia was present in 42(70%) patients, out of which 6(10%) patients had severe
anemia. Thrombocytopenia was present in 36(60%) patients.Abnormal liver function tests were observed in
26(43.3%) subjects while abnormal kidney function tests were observed in16(26.6%) patients. All the 60
patients received Artemisinin based antimalarial drugs.
Conclusion: Early detection, prompt management, and adequate supportive therapy may reduce mortality due
to falciparum cerebral malaria.
Indonesian Wild Ginger (Zingiber sp) Extract: Antibacterial Activity against ...iosrphr_editor
Lempuyang gajah (Zingiber zerumbet (L.) Smith), lempuyang pahit (Zingiber amaricans BL.), and
lempuyang wangi (Zingiber aromaticum Vahl.) are used as traditional medicine (jamu) in Indonesia. It is also
used for treatment of microbial infections, helps to increase appetite and stimulate digestion in chickens.
Information on their uses are available, but only limited in the scientific data on their bioactivity. The study was
conducted on the antibacterial effect of organic extracts of these plants with Mycoplasma gallisepticum as the
agent of chronic respiratory disease in chickens. Juice and extracts of fresh and dried rhizome are evaluated
through the disc diffusion assay and minimum inhibitory concentration. Oxytetracyclin (30 µg) are used as
standards. All extracts are individually exhibited as antibacterial activity against Mycoplasma gallisepticum (7
± 0.11 mm to 21 ± 0.86 mm). The minimum inhibitory concentration (MIC) determination of plants extracts are
ranged from 7.8 mg/ml to 31.2 mg/ml. The preliminary results suggested promising antibacterial properties of
wild ginger from Indonesia, and probably could be used in management of chronic respiratory disease in
chickens.
A case of allergy and food sensitivity: the nasunin, natural color of eggplantiosrphr_editor
Abstract: Allergies and food sensitivities can both be considered as "adverse reactions individualistic" to food.
Are pathological and individual forms because they affect a few individuals in way rather serious; immediate
or delayed reactions occur instead with simple effects histamine, or, in severe cases with respiratory and
anaphylactic shock
The eggplant (Solanum melongena L.) is known to cause food allergies in some Asian countries, but detailed
studies on allergies caused by eggplant are lacking, however, it was highlighted the presence of allergens in
edible parts of eggplant with preponderance in the peel .
The purpose of this study was to propose an extraction method rapid, efficient and cost of natural dye from
waste products from the food industry, such as the peels of eggplant, from which it was extracted, isolated and
purified the nasunin,a colored molecule in red-fuchsia.
Nasusin was tested on 58 patients to evaluate the potential sensitizing effect on the skin. The results demonstrate
that allergenic effects are negligible and therefore the nasunin can be used as a colorant in various industrial
sectors with a certain safety margin
Complete NMR Assignment of MogrosidesII A2, II E andIII A1Isolated from Luo H...iosrphr_editor
NMR analysis allowed complete assignments of three known mogrol glycosides, Mogroside IIA2 (1),
II E (2)and IIIA1 (3), isolated from the extracts of Luo Han Guo. Herein, complete 1H and 13C NMR
assignmentsof all threemogrosidesare described based on NMR experiments (1H NMR, 13C NMR, COSY,
HSQC-DEPT, HMBC, NOESY and 1DTOCSY) and mass spectral data.
Nanoemulsion and Nanoemulgel as a Topical Formulationiosrphr_editor
: Nanoemulsion is referred type of emulsion with uniform and extremely small droplet size in the range
of 20-200 nm. Nanoemulsion provides numerous advantages over other carrier such as polymeric nanoparticle
and liposomes, including low cost preparation procedure, high hydrophilic and lipophilic drug loading system
to enhance the longer shelf live upon preserving the therapeutic agents. Incorporating the preparation of
nanoemulsion with hydrogel matrix to produce nanoemulgel exhibited by the two separate systems that forming
it. Nanoemulgel possesses the properties of thixotropic, non-greasy, effortlessly spreadable, easily be removed,
emollient, not staining, soluble in water, longer shelf life, bio-friendly, translucent and agreeable appearance.
Pharmacokinetics of High-Dose Methotrexate in Egyptian Children with Acute Ly...iosrphr_editor
Aim:Since several factors have been shown to influence the clearance of methotrexate, the purpose of this study
was to identify potential relationships between patient covariates and the methotrexate clearance estimates and
deduce a pharmacokinetic model for the estimation of methotrexate clearance in Egyptian pediatric ALL
patients that may help dosage adjustment and achieve target steady-state plasma concentrations in a similar
sittings.
Patients and methods: A total of 94 pediatric patients with B-cell ALL, of whom 70 were the studied population
and 24 were the test population, were treated with four courses of HDMTX doses 2.5 gm/m2
(low-risk arm) or 5
gm/m2
(standard-/high-risk arm) given every other week by intermittent intravenous infusions over 24 hours as
a part of their treatment protocol. Patients were monitored for the 24 hour MTX concentration and the systemic
methotrexate clearance was calculated for each methotrexate dose
Epidemiology of Tuberculosis (TB) in Albania 1998-2009iosrphr_editor
Abstract : In Albania, many people erroneously think that tuberculosis (TB) is a disease of the past-an illness
that no longer constitutes a public health threat. Surveillance is an integral part of tuberculosis (TB) control.
Albania has a highTB notification rate and there are doubts about underreporting. The evolution of the
incidence of tuberculosis is presented, together with more detailed figures over the period 1998-2009. These
figures were obtained by the monthly forms (called 14/Sh) compared with the individual notification data.
Objective: To examine the distribution and sources of increased tuberculosis (TB) morbidity and reporting
system deficiencies in the Albania from 1998 through 2009. Metodology: The study is descriptive one conductet
during the period 1998-2009. The statistical analysis is based on data reported from regional level (regional
epidemiological departments) to the central level (Public Health Institute). Results: The main findings were:
discordance between the collected data (individual form) and reported data (monthly form); tuberculosis
incidence rate shows little oscillations which ranges from 6.67 to 9.2 cases/100.000 population; 50% of the
regions show a lack of information on the confirmation of diagnosis and laboratory examination type used for
confirmation. Conclusion: TB disease in high-risk populations where it is difficult to detect, diagnose, and treat;
limitations of current control measures and the need for new tests and treatments, including an effective
vaccine; improving information system, regulation of individual form and personnel training.
Total Phenol and Antioxidant from Seed and Peel of Ripe and Unripe of Indones...iosrphr_editor
Study on total phenol and antioxidantactivity ofsugar apple fruits of various solvent, part of fruits, and level of ripening. Solvent extraction used were 80% (v/v) methanol, 50% (v/v) acetone, boiling water, and 50% (v/v) ethanol. Part of fruits thatbeen used for samples were seed and peel which are normally by products of sugar apple processing, level of ripening were unripe, and ripe sugar apple fruits. Total phenol was determined by Folin-ciocalteau method. Total antioxidant was quantified by 1,1-diphenyl-2-picrylhydrazyl(DPPH) method.Therewas a difference in type of solvent, part of fruits, and level of ripeningon total phenol and antioxidant concentration of sugar apple fruits. Seeds have higher total phenol concentration than peels of this fruits. Unripe sugar apple fruits have higher total phenol and antioxidant than ripe fruit. The best solvent for phenol extraction was ethanol 50%butthe best solvent for antioxidant extraction was acetone 50%.
A Review on Step-by-Step Analytical Method Validationiosrphr_editor
When analytical method is utilized to generate results about the characteristics of drug related samples it is essential that the results are trustworthy. They may be utilized as the basis for decisions relating to administering the drug to patients. Analytical method validation required during drug development and manufacturing and these analytical methods are fit for their intended purpose. To comply with the requirements of GMP pharmaceutical industries should have an overall validation policy which documents how validation will be performed. The purpose of this validation is to show that processes involved in the development and manufacture of drug, production and analytical testing can be performed in an effective and reproducible manner. This review article provides guidance on how to perform validation characteristics for the analytical method which are utilized in pharmaceutical analysis.
A Cross Sectional Study of Ethnic Differences in Occurrence and Severity of A...iosrphr_editor
Non-steroidal anti-inflammatory drugs are the most widely used "over the counter" medication all over the world despite their complications in different major organs. Present studies envisaged for knowing the occurrence and severity of adverse drug reactions from NSAIDs in different ethnic communities of Sikkim. A cross sectional study was undertaken in the medicine outpatients department of a secondary and tertiary care hospital. The patients belonging to Nepalese, Bhutias, Lepchas ethnic communities and others community (settlers from other parts of India) were included to analyzed the data based on the age and gender, ethnicity and ADRs, drugs and ADRs. Severity assessment was done using Hartwing and Siegel scale and causality assessment by Naranjo scale. Total 109 cases of ADRs, predominating in female were detected. Nepalese were the most affected and Gastrointestinal tract (GIT) being the most affected organ in them. Diclofenac showed maximum number of ADRs in all the communities. Maximum number of cases occurred on single day use (40.36%) of drugs. All the cases were belonging to the "possible category" and the maximum being the mild (72.48%) in nature. It is advisable to consider the ethnic/racial differences equally with other factors, to improve the safety and efficacy of a drug.
Hematological and biochemical alterations in malaria and their correlation wi...iosrphr_editor
Malaria is a major health problem in India with 1.04 million cases reported in 2012 leading to 504 deaths. The clinical spectrum depends on the infecting species, level of parasitemia and the immune status of the host. Malaria pathogenesis is based on extensive changes in hematological and biochemical parameters. The objective of this study was to study the clinical features, hematological and biochemical parameters in malaria patients and correlate them with the parasitic index (PI). Material and methods: We conducted a study on 300 malaria patients. The frequency of various symptoms and signs of malaria caused by various plasmodium species were determined. The degree of anemia, WBC count, platelet count serum bilirubin, liver enzymes and serum creatinine levels were studied and their variation depending on the parasitic index was documented. Results: 197 patients had vivax malaria, 76 patients had falciparum malaria and 27 patients had mixed infection. 171 patients had a PI of less than 2%, 100 patients had PI between 2 to 5%, 23 patients had PI between 5 to 10% and only 6 patients had PI of more than 10%. 72.3% of patients had thrombocytopenia, 46.66% had anaemia, 25% had increased bilirubin 29.66% showed increased liver enzymes and 7.66% had increased creatinine levels. Conclusion: There was a correlation between degree of parasitemia and severity of malaria in majority of cases. Derangements in hematological and biochemical parameters were more frequently seen in patients with higher PI. Hence PI can be used as an indicator by the clinician to know the severity of infection and plan appropriate treatment.
Treatment of Uthiravatha Suronitham (Rheumatoid Arthritis) with a Siddha Comp...iosrphr_editor
Uthiravathasuronitham, a vatha disease described by Sage Yugi can be correlated to Rheumatoid arthritis. A 53 year old lady diagnosed as Uthiravathasuronitham was treated with Siddha medicines Karpoora Chindhamani Mathirai and MannennaiKalavaiThylam. A single case study of Uthiravathasuronitham is detailed in this article.The patient presented with pain and swelling in minor joints of hand, wrist, ankle, shoulder joints and morning stiffness. The RA factor, CRP was positive at the time of enrollment. She was admitted in the IPD of Sirappu Maruthuvam Department of National Institute of Siddha for 45 days. The treatment outcome was encouraging. Hence further clinical studies can be carried out.
An analysis of the incidence and causes of road traffic accident in Kisii, Ce...iosrphr_editor
Background: Road traffic accidents (RTAs) are an emerging public health problem. It is estimated that more than 5 million people between 17-40 years of age die annually as a result of RTAs worldwide. Currently, RTA is the tenth leading cause of disease burden in the developing countries, especially in the Sub-Saharan African countries. The objective of the study was to analyze the proportion of accidents by vehicle, as well as investigate group of people vulnerable to RTA.
D-002 treatment attenuates esophagitis in a model of chronic gastro-esophagea...iosrphr_editor
To investigate the effects of D-002 (beeswax alcohols) on esophagitis induced by chronic gastroesophageal reflux (c-GER) in rats. Rats were randomized into a sham and five groups subjected to c-GER: a positive vehicle control, three D-002 (50, 100 and 200 mg/kg), and one omeprazole (20 mg/kg) group, all treated orally for seven days. cGER was induced by ligation of the junction between the forestomach and the duodenal side of the pylorus. Esophageal lesions index (ELI), esophageal malondialdehyde (MDA) and sulfhydril groups (SHG) concentrations were assessed. The positive control group exhibited macroscopically signs of esophageal injury assessed in term of ELI, which was significantly higher than in the negative control. D-002 (50, 100 and 200 mg/kg) reduced the ELI, showing 30.5, 72.9 and 76.4% protection, respectively; and also significantly attenuated the increased MDA (37.4, 63.6 and 94.2%, respectively) and SHG (16.6, 41.6 and 72.9%, respectively) esophageal concentrations versus the positive control. Omeprazole decreased the ELI (80.2%), MDA (99.3%) and SH (85.4%) esophageal concentrations. As conclusions, this study suggest that repeated oral administration with D-002 protects against reflux esophagitis and decreases esophageal lipid peroxidation and protein oxidation markers in rats with c-GER.
Reducing Uveitic Glaucoma: therapeutic judgement is the keyiosrphr_editor
Abstract: Background: Uveitic glaucoma (UG) due to disease and /or therapeutics is an important reason for reduced vision. Different therapeutic regimen employed in uveitis can alter the course of UG. Purpose: Evaluation of prevalence of UG with different commonly used therapy. Study design: Randomised prospective hospital based study Study Period: 2007-2012 Methods: Baseline IOP; Field and optic nerve head photographs were recorded. Three groups were randomised: 1.topical steroid 2.Systemic steroid +gr 1, 3.Topical synthetic steroids, cycloplegic and periorbital triamcinolone injection. Outcome measure: IOP more than 22 mm/4 mm increase from baseline is marker.
Studying the Analgesic, Anti-inflammatory and Antipyretic Properties of The A...iosrphr_editor
The aqueous extract of Parsley ( Petroselinum crispum ) were investigated for anti-inflammatory, analgesic and antipyretic activity at the doses of 2 , 5 , and 10 g/kg, of body weight. The experimental paradigms used were carrageenan, dextran, histamine induced pedal edema and cotton pellet induced granuloma for anti-inflammatory activity, while hot plate and acetic acid induced writhing methods were used to assess analgesic activity. Yeast-induced hyperpyrexia was used to evaluate the antipyretic activity. In acute phase inflammation, a maximum inhibition 50.6% (P < 0.05), 51.1% (P < 0.05) and 52.3% (P < 0.05) were noted at the dose of 10 g/kg after 3 h of treatment with methanol extract of Parsley ( Petroselinum crispum ) in carrageenan, dextran and histamine induced pedal edema , respectively. In the chronic model (cotton pellet induced granuloma) , the parsley (10 g/kg) and standard drug (Indomethacin 10 mg/kg) showed decreased formation of granuloma tissue by 51.8% (P < 0.05) and 56.6% (P < 0.05) , respectively. The extract also produced significant (P < 0.01) analgesic activity in both paradigms. In addition, the aqueous extract of parsley potentiated the morphine and aspirin induced analgesia. A significant (P < 0.01) reduction in hyperpyrexia in rat was also produced by the extract. This study exhibits that methanol extracts of leaves of parsley possess anti-inflammatory, analgesic and antipyretic activities.
Physician-Pharmacist Comanagement of Postoperative Pain in Egyptian Patients:...iosrphr_editor
Introduction:Patientcontrolled analgesia (PCA) is an interactive method of self drug administrationthat requires proper education to ensure safe and effective use. Morphine is the most popular opioid used for postoperative pain management using PCA; however it has many adverse effects. Nalbuphine, a mixed opioid agonist antagonist, is known to be safer than morphine. Ketorolac produce excellent analgesia when used alone or with opioids. Multimodal analgesicapproach using morphine or nalbuphine combined with ketorolac for PCA administration has not been compared before. The study aimed to compare the clinical efficacy, adverse effects of multimodal analgesia using PCA and the effect of patient education regarding PCA use on patients' outcomes. Patients and methods: AdultEgyptian patients ASA I and II whounderwent different surgical procedures were selected and randomized either to receive PCA of morphine or nalbuphine combined with ketorolac. Patients from each drug group were further randomly selected to receive additional preoperative PCA education beside the usual care for pain management. Visual analogue scale (VAS), hemodynamic parameters,adverse effects and patient satisfaction were compared between groups. Results: Of the total of 60 patients enrolled, 45 patients completed the study: 22 patients for morphine group(M) and 23 for nalbuphine group (N). VAS score was significantly lower in group(M)than group (N)at certain time points. Nalbuphineshowed a significant lower incidence of itching than morphine(P: 0.03*). Pain control and overall satisfactionswerebetter in the intervention groups (M2, N2) than in the control groups (M1, N1). Conclusion:Morphine coadministerd with ketorolac provides more potent analgesia than with nalbuphine. Preoperative patient education regarding PCA is crucial for proper postoperative pain control.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
1. IOSR Journal Of Pharmacy
(e)-ISSN: 2250-3013, (p)-ISSN: 2319-4219
www.iosrphr.org Volume 4, Issue 3 (March 2014), PP.15-21
15
Assessment of the Perceived Quality of Life of Non insulin
Dependent Diabetic patients attending the Diabetes Clinic in
Kenyatta National Hospital
Genga E.K, Otieno C.F, Ogola E.N Maritim M.C
Department of Clinical Therapeutics and Medicine, University of Nairobi.
BACKGROUND: Diabetes Mellitus is a common and demanding health related problem that has a wide effect
on every day‟s life of the patients. It can have a profound effect on quality of life in terms of social and
psychological well-being as well as physical ill-health. It is one of the most psychologically demanding of the
chronic diseases; with psychosocial factors pertinent to nearly every aspect of the disease and its treatment.
OBJECTIVE: To Assess the perceived Health-related quality of life of diabetic patients not on insulin therapy
using the WHOQoL-Bref (World Health Organization Quality of Life – Brief).
STUDY DESIGN: This was a cross-sectional study.
STUDY SITE: The study was conducted on patients attending the Diabetic clinic at Kenyatta National
Hospital.
RESULTS: Study recruited 139 patients with type2 diabetes not on insulin therapy. The study population was
predominantly female (61%) , majority were 40-60yrs, having had diabetes for less than 5yrs, 75% having more
than one complication. Most (75%) of the study participants were poorly controlled with HbA1C mean score of
8.04% .Majority of the study participants( 84%) achieved a good score on the HRQoL scale using the
WHOQoL-Bref tool. The determinants of HRQoL in our study were: age of study participants, duration of
diabetes, presence of complications and income related factors. Age of the study subjects had significant
association only in the social domain of HRQoL with a p-value of 0.037. Level of income had a significant
association with overall HRQoL score (p-value of 0.029), psychological domain (p value of 0.023) and in the
social domain (p-value of 0.029). Health care financing was significantly associated with psychological domain
(p-value 0.006) and environmental domain (p-value 0f 0.04) and overall score (p-value 0.011). There was an
association between employment status and HRQoL. Having a job improved the scores in physical domain (p-
value of 0.013) and social domain (p value of 0.020). Duration with diabetes had significant association with
physical domain where the p value was 0.007. The HRQoL of the study subjects was associated significantly
with the number of complications. Indeed the association of complications with the HRQoL involved physical
domain (p-value of <0.0001) and psychological domain (p-value of 0.041) which directly impacted on the
overall total score (p value of 0.041).
CONCLUSION: The results of this study show that diabetes affected HRQoL of our study participants. There is
a need for interventions programs to improve glycemic control and inclusion of HRQoL assessment as part of
patients on follow up. Age and duration of disease are not modifiable but complications can be reduced by better
health care initiaves. Income-related factors can be modifiable through poverty alleviation and pooled health
care financing.
I. INTRODUCTION
Diabetes Mellitus is a common and demanding health related problem that has a wide effect on every
day‟s life of the patients 1
. Diabetes mellitus is a chronic illness and the most common endocrine disease,
although the disease is prevalent worldwide, there is significant difference frequency among countries2, 3
and the
major public health problem for both developed and developing countries 4
. The increasing number of
individual with type 2 diabetes indicates a global epidemic. Prevalence of the disease was estimated to be 2.8%
in 2000 and is predicted to increase to 4.4% by the year 20305
. The prevalence of diabetes is rising in Africa and
the Third world countries due to adaptation of the western lifestyle and diet6.
In Africa, the traditional rural
communities still have low prevalence of 1-2% (except in specific high risk groups) while 1-13% or more adults
in urban communities have diabetes with Kenya having an estimated prevalence of between 3.3% 7
. Diabetes
can have a profound effect on quality of life in terms of social and psychological well-being as well as physical
ill-health. It is one of the most psychologically demanding of the chronic diseases; with psychosocial factors
pertinent to nearly every aspect of the disease and its treatment5
. In a longitudinal study the psychosocial impact
2. Assessment of the perceived quality….
16
of diabetes was found to be one of the five strongest predictors of mortality in diabetic patients, stronger than
many clinical and physiological variables8
.
The health-related quality of life (HRQoL) deficits reported by people with diabetes are generally
attributed to the disease itself, its restrictive treatment regimens including diet, and its associated co morbidities.
Living with diabetes has financial, social and psychological handicaps though the patient is encouraged to lead a
“normal life”. The treatment is demanding and often complex. The patient is expected to bear much of the
responsibility for making decisions which affect his/her health, both in the short- and long-term. HRQoL will
help evaluate the efficacy, cost effectiveness, and net benefits of current programs and interventions. There is a
paucity of data in developing countries with deteriorating economic environment compounded with social and
cultural influences and its impact on patients and care of disease.
Measuring QoL changes usually involves soliciting peoples‟ self-reported feelings, behaviors and
attitudes through interviewing or evaluating responses to questionnaires. A variety of instruments has been used
to measure HRQoL in diabetes. Examples include WHO-QoL BREF tool, SF-36 tool, QWB-SA (Quality of
Well-Being Questionnaire), EuroQoL (European Quality of Life) or EQ-5D (Euro-QoL 5-Dimensions),
DQLCTQ-R (Diabetes Quality of Life Clinical Trials Questionnaire Revised), ADDQoL (Audit of Diabetes
Dependent QoL) instrument etc we chose WHOQoL-BREF because it has good to excellent psychometric
properties of reliability and validity. It has been validated in people with type 2 diabetes 9
.
II. PATIENT METHODS:
The study was performed in the diabetic clinic at the Kenyatta National Hospital which serves
approximately 400 patients per month. This the biggest referral hospital in Kenya based in Nairobi the capital
City of Kenya.
Patients
The sample population will be obtained from the Diabetic clinic at the KNH which runs from Monday
to Friday. The main clinic is on Friday which sees on average 40 patients per session whilst the mini clinic
which runs from Monday to Thursday sees on average 20 patients per day. Consecutive sampling was used until
minimum sample of 129, in total 139 patients were recruited based on the following:
Inclusion criteria:
[1.] DM patient diagnosed via WHO criteria aged between 18yrs and 70yrs
[2.] Known diabetic for 1year
[3.] Stable disease-no admissions in past 3months
[4.] Informed consent
Exclusion criteria
[1.] History of cognitive impairment
[2.] History of substance abuse
[3.] History of concomitant disease that could affect the nervous system or independently affect the quality
of life.
[4.] Gestational diabetes
[5.] Diabetic patients on insulin
III. STUDY INSTRUMENT
Instrument consisted of social demographic Questionnaire and WHOQoL-Bref Questionnaire. The
WHO-QoL tool has 4domains. The four domain scores denote an individual‟s perception of quality of life in
each particular domain which are: physical, psychological, social and environment, through a set of 26 items
that can be self-administered. Responses to the questions use a 5-point Likert scale, inquiring „how much‟, „how
satisfied‟ or „how completely‟ the respondent felt in relation to the domain being investigated.
The mean score of items within each domain is used to calculate the domain score. Mean scores are
then multiplied by 4 in order to make domain scores comparable with the scores used in the WHOQoL-100
(Higher scores denote higher quality of life). When more than 20% of data is missing from assessment, the
assessment was discarded. Where an item was missing, the mean of other items in the domain is substituted but
when more than two items were missing from the domain, the domain score was not calculated (with the
exception of domain 3, where the domain should only be calculated if < 1 item is missing). Thereafter, raw scale
scores were deduced and were finally transformed to a scale of 0−100. The WHOQoL-Bref Questionnaire was
either self answered or administered by the investigating team.
3. Assessment of the perceived quality….
17
IV. RESULTS
The study population was aged mainly between 40-60 years, with a mean of 56.37 years, most were
females 61.3 %( n=84). 57.6% of the sample population were married with the remainder classified as single
(widowed/ divorced/ separated/ single). The population was a well-educated group with up to 90% having
received a minimum of primary school education though majority of study patients needed help in filling the
questionnaire. Up to 60 % of the sample population had some employment whether part or full time with 58.4%
having a combined income of more than 50,000 a year. 87% of the population was personally responsible for
their house meaning either owned the house or paid rent. Another 80% were able to pay for their own
healthcare. Majority of the study patients (52.5%) had diabetes for less than 5yrs and at least 75% had 3 or more
complications .80% were rated as overweight and obese as per WHO standards with a mean BMI of 29.1 kg/m2
,
The mean HbA1C was 8.04% this translated to 24.5% meeting the recommended target level of <7%. 52.5% of
the patients had been diabetic for less than 5years, with up to 57.6% of the patients with more than three
complications. Neuropathy (41%) affected the most of the patients. 35-40% of our study patients rated their life
as good and was satisfied with their health but when it came to the overall QoL score 84% scored as good QoL.
All the domains were affected with physical and psychological most affected. There was association between
age and HRQoL in the social domain where the older the patient the worse the score with a p-value of 0.037.The
correlation between the HRQoL and level of income was found to be significant especially in the psychological
domain ( p-value of 0.023) and in the social domain ( p-value of 0.029) There was an association between the
overall HRQoL and mode of health care funding with patients with private insurance scoring highest, then self
paying, government assistance and last patients on family support with a p-value of 0.011. The domains affected
were psychological (p-value 0.006) and environmental (p-value 0f 0.04). There was a significant association
between employment status and HRQoL. Having a job improved the scores in physical (p-value of 0.013) and
social domains (p-value of 0.020). There was a significant association between HRQoL and duration of diabetes
as evident in the physical domain where the p value was 0.007. Also a significant association between HRQoL
and duration of diabetes was seen as evidenced in the physical domain where the p-value was 0.007.There was a
significant association between HRQoL and number of complications where as the number of complications
increased the worse the HRQoL score which was evidenced in physical domain (p-value of <0.0001) and
psychological domain (p-value of 0.041) which directly impacted on the overall total score (p-value of 0.041)
TABLE 1- Socio-demographic characteristics of the study population
Characteristic Category %
Gender Male
Female
38.7%
61.3%
Level of education None
Primary
High School
College
8.7%
44.9%
34.1%
12.3%
Marital status Single
Married
42.4%
57.6%
Housing not personally responsible
personally responsible
12.9%
87.1%
Employment Unemployed
Employed
39.9%
60.1%
Total combined family
income for the past 12
months
Less than ksh5,000
Ksh5,000 - Ksh19,999
Ksh20,000 - Ksh49,999
Ksh50,000 - Ksh99,999
Ksh100,000 - Ksh149,999
More than Ksh150,000
15.1%
9.4%
17.0%
15.1%
12.3%
31.1%
4. Assessment of the perceived quality….
18
Table 2 HRQoL domain scores of the study subjects
Table 3 overall HRQoL scores of the study subject
HRQoL scores Categories of HRQoL
scores
N %
Total Scores
Maximum 100
<=40(poor) 1 0.7%
41-60(fair) 21 15.2%
>60(good) 117 84.1%
Table 4 Health Satisfaction and Self rating of HRQoL of the study subjects
Self-Rating of quality of life % Health satisfaction %
Very poor
Poor
Neither poor nor good
Good
Very good
6.5%
15.8%
37.4%
33.8%
6.5%
Very dissatisfied
Dissatisfied
Neither dissatisfied nor satisfied
Satisfied
Very satisfied
7.9%
30.2%
25.9%
34.5%
1.4%
Table 5 Association between HRQoL domains and determinants
p- values
variable total
score
physical psychological Social environmental
Age 0.609 0.470 0.937 0.037 0.136
gender 0.955 0.094 0.825 0.579 0.308
Marital status 0.712 0.405 0.309 0.126 0.803
Income 0.029* 0.507 0.023* 0.029* 0.153
Education level 0.753 0.358 0.826 0.390 0.701
Health care funding 0.011* 0.082 0.006 0.138 0.040*
employment 0.078 0.013* 0.366 0.020* 0.941
DM Duration 0.300 0.007* 0.218 0.763 0.281
Complications 0.041* <0.0001* 0.041* 0.876 0.103
BMI 0.574 0.573 0.235 0.806 0.810
HbA1C 0.515 0.772 0.800 0.304 0.136
V. DISCUSSION
This study sought to determine the overall quality of life in ambulatory patients with type 2 diabetes on
oral hypoglycemic agents and made important observations and findings. Of the consented interviewed 139
subjects majority were female (61.3%). This is consistent with other studies from Nigeria, India and Thailand 10-
12
.Probable reasons for the female predominance were likely because this was a hospital-based study where
access to care is selected by affordability, referral, proximity and severity of illness. The main age group of the
N Mean Median % score Minimu
m
Maximum Standard
Deviation
DOM1: Physical Health 139 14.01 14.86 70.1% 7.00 20.00 3.23
DOM2: Psychological 139 14.58 14.67 72.9% 6.40 20.00 2.76
DOM3: Social relationships 139 14.75 14.67 73.8% 8.00 20.00 3.09
DOM4: Environmental 139 13.66 13.50 68.3% 6.50 20.00 2.83
Total Domain Scores 139 56.94 57.90 72.4% 30.76 78.86 9.54
5. Assessment of the perceived quality….
19
study population was between 40 and 60 years with a mean of 56.37 years. These ages are important because
that is an age-group bracket of active economic activity for both self-care and family. This was confirmed as
60% the study participants had a source of employment. The quality of life of the study subjects was good with
approximately 84% scored above fair on the overall quality of life scale. This is comparable with other studies
done in Nigeria and Kuwait 10, 13.
These two studies were cross-sectional studies using similar tool used in this
study. This contrasts with studies done in South Africa where diabetes was found to have negative impact on
HRQoL of majority of the study subjects though important to note they used a different tool and also had a
smaller sample size 14
. A minority (40%) of the subjects rated their health as good and equally low proportion
(35%) were satisfied with their health status. This is disturbing as we know that diabetes is a chronic disease and
can be a difficult condition to live with for many patients. The demand of self-care can be burdensome,
frustrating and overwhelming both in terms of commitment to self-care and resource consumption (medication,
monitoring and attending hospital). All the domains of HRQoL were affected with social and physical domains
most affected.
Poor quality of life was significantly associated with age, level of income and health care financing,
employment status, duration of diabetes and its complications. Age of the participants emerged as a significant
association with quality of life, on the social domain and not in the three other domains. A plausible
interpretation is that interactions of aging-related disabilities with complications of diabetes seem to have
influence on the social domain of the study patients. The peak age of type2 diabetes in this study is a relatively
younger age group (35 -55 years) in this country as compared to the developed world of (55-75 years) 15
.Aging
overlaps with duration of diabetes in patients, and this is compounded by complication loading (which is a
factor of genes, quality of care and metabolic control). It is therefore not surprising that duration of diabetes,
number of complications per person were significantly associated with quality of life of the study participants.
This is similar to other studies done in Nigeria, Thailand, South Africa and by the Zodiac group10, 12, 14, 16
.
Diabetes as a chronic disease is demanding in both self-care commitment and resource consumption
(medication, monitoring and attending hospital). It is therefore imperative that ability to meet these requirements
may affect one‟s own quality of life. Majority of the study population are in the bracket of active economic
activity for both self-care and family. It is known that diabetes on its own can affect income generation directly
and indirectly through complications e.g. neuropathy, retinopathy etc. thus quality of life studies are important
in the context of one‟s personal well-being and the ability to work and earn a living. This study found that
employment status, ability to purchase own health care and high annual income levels were significantly
associated with physical, psychological and social domains of quality of life as shown in tables 5. Studies in
Nigeria, South Africa, India and Thailand have made similar observations though the context of health care
provision of patients, organizations of diabetes care and financing may vary in environments within which these
studies were conducted 10, 11, 12, 14
.
Just about half of the study patients (52.5%) had diabetes for less than 5yrs and at least 3 out of 4 study
subjects had 3 or more complications. The most common complication was neuropathy with 41 % of the study
population. This finding is similar in other studies that have found neuropathy as the most common
complication with Jacobson et al.17
reported that 48.8% of their subjects had neuropathy; Mayou and Bryant
found 20% with neuropathy 18
; and Weinberger et al reported 24% with neuropathy19
. Duration of diabetes and
complication loading affected the physical, social and psychological domains which compares to most of the
studies done on quality of life in Nigeria10
, Kuwait13
, Sweden14
, CODE-study20
and South Africa21
. This study
found that complications such as neuropathy (40%) and retinopathy affected physical and psychological
domains. It also found that others like erectile dysfunction adversely affected the psychological domain. New
onset erectile dysfunction has been shown to be a marker of complications (macrovascular and neuropathy) and
worsening quality of life of diabetic patients22
. Duration of diabetes, complications (retinopathy, neuropathy,
erectile dysfunction, diabetic foot etc.) as well as advancing in age also contributed as Increase affected their
social lives, income generating activities and increase amount spent on diabetes health care. This was reflected
in poor scores in physical and social domains. Jacobson et al studied both type 1 and 2 diabetes and found that
quality of life decreased in relation to the number of complications of their study patients 17
. Rubin et al noted
that the presence of co-morbid conditions and unfavorable socio-economic characteristics can further interact
with the severity of diabetes and its complications to strongly influence different domains of quality of
life23
.This has been partially demonstrated in this study.
Glycemic control in this group was poor as only 1 in 4 of the study subjects attained the target HbA1C
level of <7% and the mean was 8.04%. This is comparable to an earlier study done in this clinic on glycemic
control by Otieno C et al24
. The poor metabolic control may be explained by multiple probable reasons that
include irregularity of testing due to various reasons including adequate financing for diabetic healthcare, lack
of adequate knowledge by patients on diabetes self-care, medication and relevance of regular testing of HbA1C
6. Assessment of the perceived quality….
20
(actually majority (90%) had no idea what HbA1C was). The quality of glycemic control by HbA1c did not
influence the HRQoL and its domains in this study. ZODIAC-2 study also made a similar finding in their study
of quality of life of patients with type 2 diabetes 16
. The serial blood sugars may have been a better tool to use
because of the symptoms of both hyperglycemia (polyuria, poor vision etc.) and hypoglycemia (loss of
consciousness etc.) would have had a larger impact on the quality of life especially over a two week duration
rather than HbA1C which is more of a historical assessment. The absence of hyperglycemic symptoms in
relation to the level of HbA1c as shown by the ZODIAC-216
and QUED22
study groups may have some
explanation. These two studies found that poor glycemic control led to more hyperglycemic symptoms which
impacted on the quality of life thus underscoring the importance of symptoms in determination of one‟s quality
of life. Similar results were seen in a study done in Thailand though they used random blood sugar instead of
HbA1C used in our study 12
.This contrasts with study done in South Africa where they showed that glycemic
control it does impact the quality of life though they used a different tool to measure the quality of life14
.
However, marital status, gender and level of education of our study participants were not significantly
associated with their quality of life. Marital status of study participants did not affect quality of life. This is
surprising because one would expect better psychosocial support in the married ones as seen in studies from
India and Sweden11, 20
. Possible explanations are gender bias may have skewed the results and good support
from family and extended family may have contributed but still difficult to conclude. Level of education had no
impact on quality of life which is surprising because diabetes treatment is demanding and often complex, the
patient is expected to bear much of the responsibility for making decisions which effect his/her health, both in
the short- and long-term. Plausible explanation is that majority (90%) had received minimum primary
education. This contrasts with other study done in India though it used a different tool and had a larger sample
size11
.
VI. CONCLUSIONS AND RECOMMENDATIONS
There is reduced quality of life in our patients with diabetes. This is compounded by a small percentage
of the study subjects (35-40%) satisfied with their health. There was poor metabolic control as evidenced by
large number having multiple complications and poor HbA1C despite having had diabetes for a short duration
of time. The determinants of HRQoL in the study patients in our study were: age of study participants, duration
of diabetes, presence of complications and income related factors- employment status, amount of income, mode
of health care financing. Factors that were not associated with HRQoL in our diabetic population were: gender,
marital status, level of education, BMI and HbA1C. This study was able to show that being an older age, having
had diabetes for a longer duration with multiple complications and inability to afford health care are likely to
have poor HRQoL scores.
Issues raised included: poor Glycemic control, overweight and obesity, complication profile in our
patients despite a large majority of our patients having been diagnosed with diabetes less than 5 years ago. Other
issues raised in our study were socio-economic support for our patients as this impacted heavily on the overall
quality of life and all the domains. In conclusion this study has added information about diabetes care in Kenya
and a follow up study on the same population maybe in the future to see if the quality of life has changed, if
interventions have been implemented to see the effect and do comparative study in the various provinces and see
its relation to our study.
Limitations:
1. Recall bias
2. Response bias – it was administered by the investigator and some of the questions were too personal this
may have led to a response bias
3. Life events and psychiatric disorders in previous time beyond 2 weeks which could affect subjective
QOL could not be ruled out
4. Hospital based study: Lack of generalisability to the rest of the diabetic population in Kenya
5. Lack of insulin arm amongst the study participants to act as a comparison group.
REFERENCES
[1] Faro B. (1999). The effect of diabetes on adolescent quality of life. Pedi Nurs. 25 (247-254).
[2] American Diabetes Association. Clinical practice Recommendations. (2002) Diabetes care. 25 (suppl.1)
[3] Qari F.A. (2005). Glycemic and Good Target Control among Diabetics at a university and Erfan private hospital. Turkish journal of
Endocrinology and Metabolism. (2), 49-54.
[4] K. Inoue, M. Masatoshi Matsumoto, Y. kobayashi, (2007). The combination of fasting plasma glucose and glycosylated hemoglobin
predicts type 2 diabetes in Japanese workers. Diab. Res. Clin.Pract. 1-8.
[5] Cox WM, Blount JP, Crowe PA, Singh SP. (1996). Diabetic patients‟ alcohol use and quality of life: Relationships with prescribed
treatment compliance among older males. Clin Exp; 20: Res (20), 327-331.
[6] Sobngwi E,, Maurvais-Jarvis, F, Mbanya, J.C. (2007) Diabetes in Africa: epidemiology and clinical specifities.
[7] Kenya Diabetes Study Group 2011.
[8] Davis WK, Hess GE, Van Harrison R, Hiss RG. (1998) Psychosocial correlates of survival in diabetes. Diabetes Care; 11: 538-545.
7. Assessment of the perceived quality….
21
[9] Skevington, S. M, Lotfy, M, & O'Connell, K. A. (2004). The World Health Organization's WHOQOL-BREF quality of life
assessment: psychometric properties and results of the international field trial. A Report from the WHOQOL Group. Quality of Life
Research; 13 (2), 299- 310.
[10] B A Issa, O Baiyewu. (2006) Quality of life of patients with diabetes in a Nigerian Teaching Hospital. Hong Kong J Psychiatry, 16(1)
:27-33
[11] Gautam Y, Sharma AK, Agarwal AK, Bhatna-gar MK, Trehan RR.(2009). A cross-sectional study of QOL of diabetic patients at
tertiary care hospitals in Delhi. Indian J Community Med 34(4):346-50.
[12] Natchaporn P, Wisit C. (2011). Self-care activities and quality of life among Type-2 diabetic patients. J Sci Technol MSU 30(1): 74-
83.
[13] W Bani-Issa. (2011). Evaluation of the health-related quality of life of Emirati people with diabetes: integration of socio-demographic
and disease-related variables United Arab Emirates East Mediterr Health J 17:825-30
[14] Katzenellenbogen, Leanne. (Stellenbosch: University of Stellenbosch University, 2008-12). Assessment of perceived impact of
diabetes on quality of life in group of South African diabetic patients.
[15] WHO- “Diabetes Action Now” booklet 2011
[16] Kleefstra N, Ubink-Veltmaat LJ, Houweling ST, Groenier KH, Meyboom-de Jong B, Bilo HJ.(2005) Cross-sectional relationship
between glycaemic control, hyperglycaemic symptoms and quality of life in type 2 diabetes (ZODIAC-2). Neth J Med. Jun;63(6):215-
21.
[17] Jacobson A M. (2004). Impact of improved Glycemic control on QOL in patients with diabetes. Endocrin Pract 10:502-08
[18] Weinberger M, Kirkman MS, Samsa GP, Cowper PA, Shortliffe EA, Simel DL, Feussner JR. (1994). The relationship between
glycaemic control and health-related quality of life in patients with non-insulin-dependent diabetes mellitus. Med Care 32 (12):1173-
81
[19] Mayour R, Bryant B, Turner R. (1990). Quality of life of non-insulin dependent diabetics and a comparison with insulin dependent
diabetic J Pyschosom Res 34:1-11.
[20] Wredling R, Stalhammar J, Adamson U, Berne C, Larsson Y, Ostman J.(1995) Well-being and treatment satisfaction in adults with
diabetes: a Swedish population-based study. Qual Life Res 4:515–522
[21] Koopmanschap MA (2002). (On behalf of theCode-2 advisory board): Coping with type 2 diabetes: quality of life. Diabetologia 45(7):
S5-S12.
[22] De Berardis G, Pellegrini F, Franciosi M, Belfiglio M, Di Nardo B, Greenfield S et al. (2005). Longitudinal assessment of quality of
life in patients with type 2 diabetes and self-reported erectile dysfunction. QuED (Quality of Care and Outcomes in Type 2 Diabetes)
Study Group. Diabetes Care, 28(11):2637- 2643.
[23] Rubin RR, Peyrot M. Quality of life and diabetes.(1999). Diabetes Metab Res Rev 15 (3): 205-18.
[24] Otieno CF, Kariuki M, Nganga L. Quality of glycaemic control in ambulatory diabetics at the outpatient clinic of at Kenyatta National
Hospital, Nairobi. East Afr Med J. 2003; 80:406–10.