European Journal of Medical and Health Sciences

Decision on Preserving Ankle Joint Function in Neglected Neck Talus Fracture Hawkins Type IV

IW Subawa — 2023-06-02

Introduction: Talus fractures are rare injuries to the hindfoot that still challenging in treatment. Accounting for <1% of foot and ankle fractures, and approximately 50% of them occur at the level of the neck. The anastomotic ring of blood supply is likely to be damaged in neck talus fractures, which disrupt the blood flow and cause significant problems affecting fracture healing and its complication.

Case Illustration: We follow the progress of the illness from a 47 years old female complain pain on her left ankle after falling down 6 months before outpatient. Patient diagnosed as neglected close fracture left neck talus Hawkins type IV. Then patient undergo an ankle arthroscopy to evaluate the ankle joint in decision to preserve the tibiotalar joint, while arthrodesis performed in subtalar and talonavicular joints in this patient. This procedure achieved a good result in preserve ankle alignment, stability and soft tissue damage reduction. Improvement of VAS and AOFAS Score from 5 and 39 preoperative to 0 and 81 in follow-up of 3 months after surgery with good compliance of the patient.

Discussion: Arthroscopy is safe procedure obtaining anatomical joint surface and reduce tissue damage. Therefore, a clear articular surface must be found during arthroscopy in deciding to preserve the joint function. While subtalar arthrodesis also another option that can enhance blood supply to encourage union, although loss of some ankle motion has significant effect on ambulation.

Semaglutide-induced Subclinical Hypothyroidism: A Case Report

Elias E. Mazokopakis — 2023-05-26

Introduction/Background: Drug-induced hypothyroidism is well established in the literature. I describe the first case of symptomatic subclinical hypothyroidism (SCH) in a thyroidectomy woman with diabetes mellitus 2 receiving therapy with per os levothyroxine and sc semaglutide (Ozempic).

Case Presentation: A 37-year-old overweight and thyroidectomy woman with diabetes mellitus 2 was admitted to our hospital with complaints of increasing fatigue, weakness and shortness of breath. She received levothyroxine (150 μcg per day), sc semaglutide (1 mg per week the last six months), and rosuvastatin (20 mg per day). A detailed clinical examination and laboratory tests revealed, among others, an elevated TSH serum level (92-98 mIU/L) with normal serum FT3 and FT4 levels on first and next measurements. Based on the possible diagnosis of semaglutide-induced SCH, semaglutide was withdrawn. Thyroid dysfunction was restored (serum TSH: 1.8 mIU/L) after two months with a significant improvement in symptoms.

Conclusion: An influence of sc semaglutide on thyroid function is possible. Thyroid function tests are suggested in patients receiving both per os levothyroxine and sc semaglutide.

Idiopathic Small Bowel Volvulus: A Case Report

Abdelillah El Bakouri — 2023-05-31

Idiopathic small bowel volvulus is a rare cause of acute intestinal obstruction by strangulation in adults and is defined by the twisting of a segment of the small bowel around its mesenteric axis with no obvious underlying congenital or acquired cause.

This article reports the case of a 56-year-old patient, chronic smoker and cannabis user, who was admitted with febrile occlusive syndrome and generalized abdominal contracture.

The abdominal CT scan showed a distension of the small intestines upstream of a probable small bowel volvulus, associated with signs of digestive distress.

Surgical exploration revealed a large peritoneal effusion of distressed fluid, with a volvulus of the distal small bowel causing 1.80 m of small bowel and coecum necrosis from 2.20 ADJ without rotational abnormality or docking defect.

Laryngeal NK/T Cell Lymphoma, Nasal Type: Case Report and Literature Review

Tarik Chekrine — 2023-06-02

Extranodal Natural Killer T-cell lymphoma, nasal type represent a rare and aggressive entity of the non-Hodgkin's lymphomas. Laryngeal localization is rare and has a poor prognosis. We report the case of a 66-year-old patient who consulted for dyspnea, dysphonia and dysphagia. Endoscopic examination revealed an endo-laryngeal lesion. Anatomopathological study with immunohistochemistry concluded to a peripheral T NK/T-cell lymphoma nasal type. The extension workup was without abnormalities. Induction chemotherapy without anthracyclines was administered followed by conformal radiotherapy with intensity modulation in arctotherapy. Significant advances have been made over the past decade including better clarification of clinical heterogeneity, more accurate classification using imaging modalities, establishment of new prognostic models, and sequential use of anthracycline-free radiotherapy and chemotherapy in early stages and risk-adapted first-line treatment strategies in advanced stages.

Ocrelizumab-induced Psoriasis in A Patient with Relapsing-Remitting Multiple Sclerosis

Sara Esmaeili — 2023-05-02

Background: Ocrelizumab is widely used as a Disease Modifying Drug (DMD) in Multiple sclerosis. The complete side effects are yet not known.

Materials and Methods: We describe a 34-year-old female with longstanding relapsing-remitting Multiple Sclerosis for whom Ocrelizumab was started as an escalation therapy. She reported severe itchy and patchy lesions two months after the first full dose of Ocrelizumab. Pathohistological findings revealed the diagnosis of guttate psoriasis. Psoriasis continued to flare against treatment with topical steroids, and UV therapy and progressed to developed arthritis psoriasis.

Results: Treatment escalated to an IL-17 antagonist (Secukinumab), with a favorable outcome. Ocrelizumab was discontinued. After one year of follow-up, the patient remained stable from an MS standpoint.

Conclusion: This is the third report showing the possible cutaneous side effect of Ocrelizumab.

Acute Abdominal Pain Caused by Hemorrhagic Corpus Lutheum in Reproductive-Aged Women: A Case Series

Agnes Indah Nugraheni — 2023-05-17

Hemorrhage of corpus luteum is a rare condition in women of reproductive age. It is possible for a woman's corpus luteum to have asymptomatic hemorrhaging as a result of blood vessel penetration through the wall of the corpus luteum during the second half of her menstrual cycle. There have been very few occurrences of it growing to be too large and then rupturing. Those who suffer from polycystic ovarian syndrome (PCOS) are at risk for developing this condition. Polycystic ovarian syndrome is characterized by an inflammation of the body's hormonal function, which results in the development of larger ovaries that also include a number of small follicular cysts. The development of cysts on the ovaries, which contribute to the appearance of larger ovaries, is brought on by an abundance of androgen hormones in the body. In a minority of cases, this enlargement also has the potential to rupture, which is an additional concern. The predominant symptom that presented clinically was sharp pain in the lower abdomen. Because to the fact that HCL may present similarly to other conditions, diagnosis might be difficult. We present and discuss three cases of young female patients who presented with acute abdominal pain, large-volume of hemoperitoneum, and anemia. Laparoscopic examination in each case showed a hemorrhagic corpus luteal cyst.

Community Health of Children and Adolescents in Sub-Saharan Africa

Victoria Bell — 2023-06-03

Health is central to the development of any country. Despite the efforts and goodwill of the United Nations, the goals established have not been successfully achieved and people in Sub-Saharan Africa (SSA) continue to strive with the same burdens of poverty, employment, malnutrition or hunger, inequality, environmental crisis, access to energy, conflicts and injustice. All these determinants drawback factors may be cause or consequence of a never-ending cycle with enormous impact on individual and community health. In SSA, policy makers, donors, healthcare providers, and academics have paid less attention to chronic diseases than to acute, communicable diseases. Despite severe dysfunctions, Public Health in this region, distinct from immediate medical services, is now engaged in endless struggles, against pathogens, modelling human behaviors, and searching for financing. Parental education, health and welfare, substandard literacy and language communication, access to material assets and other factors may all affect their ability to interpret hazards and risks in key areas of health and nutrition. While some 70% of deaths in Africa result from infectious and parasitic diseases, mortality rates from chronic diseases are higher in SSA than in other parts of the world. Children and adolescents in SSA in their livelihoods experience slow physical growing, inadequate observation and physical development, and a series of biological impairments that amplifies their risk of non-communicable diseases as they mature. Integrated strategies of sound health leadership and community-adapted initiatives are needed and probably engaged constructively with the private sector. Some ambitious new health goals take longer to achieve, but progress can be achieved in stages.

Thyroid Dysfunction in Pregnancy: A Literature Review

Evert Solomon Pangkahila — 2023-06-02

Due to structural similarities between HCG and thyroid-stimulating hormone, thyroid stimulation during pregnancy starts in the first trimester (TSH). The volume of thyroid hormone distribution increases along with placental metabolism, maternal thyroxine transport, and estrogen-mediated changes in thyroxine-binding globulin (TBG), all of which cause a 20–40% rise in early pregnancy thyroid hormone demand. Due to the human chorionic gonadotropin alpha subunit's cross-reactivity with the TSH receptor, the reference range of laboratory values for TSH is lower. High serum protein levels may alter estimates rather than direct measurements of free thyroxine (FT4), leading to reported results that are inaccurate. The clinical range of thyroid dysfunction during pregnancy can include both hyperthyroidism (Graves' disease and transitory gestational thyrotoxicosis) and hypothyroidism (overt hypothyroidism, subclinical hypothyroidism, and autoimmune thyroid disease). The risk of preterm and infant respiratory distress syndrome is increased by this malfunction.

Curcumin, Diallyl Sulphide, Quercetin and Gallic Acid Uses as Anticancer and Therapeutic Agents for Breast Cancer: Current Strategies and Future Perspectives

Md. Sadikuj Jaman — 2023-06-03

Globally, Breast cancer is a complex and common disease. 12.5 % of all new annual cancer cases worldwide. In 2020 there were 2.3 million women with breast cancer diagnosed and 685,000 died globally. For long time, breast cancer treatments options include surgery, chemotherapy, hormone therapy and radiotherapy. However adverse effects from treatment options are frequently reported and multidrug resistance, fever, weakness, allergy and the absence of treatment for metastasis are the main issues with breast cancer treatment. Due to their safety, dietary bioactive molecules have become effective tools for the treatment and prevention of cancer cell lines and animal models in recent years. It has been demonstrated that the compunds curcumin, diallyl sulfide, quercetin and gallic acid which are used as Indian spice and widely consumed fruits, suppress the growth of breast cancer cells and trigger apoptosis. The effects of curcumin, diallyl sulfide, quercetin and gallic acid in the combat against breast cancer are covered in this review. These agents have been shown to have effects both in vitro and in vivo.

Obesity in Pregnant Women and Its Impact on Maternal and Neonatal Morbidity

Glenn Kristie Wanaditya — 2023-06-02

Obesity in pregnancy is currently a health problem that is associated with increased maternal and neonatal morbidity. Along with the times and lifestyles that are more modern, the incidence of obesity is also increasing. Clinically, obesity is defined as the condition of having excess adipose tissue. Obesity is related to insulin resistance and chronic inflammation. This makes obesity a risk factor for various non-contagious diseases such as cardiovascular disease, hypertension, diabetes mellitus, and cancer. The health consequences of maternal obesity are based on low-grade, chronic (meta-inflammatory) inflammation that occurs as a result of changes in the immune system and proinflammatory cytokines in maternal obesity and pregnancy. Obesity can have a negative impact on maternal, neonatal and labor outcomes. Several maternal complications that can occur due to obesity (BMI 30-34.9) and morbid obesity (BMI ≥ 35) are hypertension during pregnancy (10.2-12.3%), preeclampsia (3-6.3%), gestational diabetes (6.3-9.5%). Risks that can occur to the fetus, such as the occurrence of macrosomia (15.4-17.2%), preterm birth (4-5.5%) and impaired fetal growth (1-0.8%). Maternal obesity is also associated with an increased risk of neural tube defects (NTD) in babies, as well as a higher risk of abortion (1.70-3.11%). Obesity also has an impact on the delivery process. Mothers with obesity have a higher rate of vaginal operative procedures (8.5-11.1%), labor induction and longer duration of labor. The increase in caesarean section deliveries is caused by the occurrence of complications due to maternal obesity, namely the occurrence of preeclampsia, fetal distress, macrosomia, and induction failure.

COVID-19 Vaccination Uptake in Kenya

Emily Machuma Walumbe Wamalwa — 2023-05-05

SARS-CoV-2 virus is the major cause of viral disease, COVID-19 which is highly infectious, WHO did its roll out for coordination, policy and technical guidance. About 64.5% of the population globally have had one dose of COVID-19 vaccine. Close to vaccines have been administered with 18.3 million daily. In low middle Countries, approximately 14.5% have received atleast a single dose. A number of researches have come up with vaccines to curb COVID-19 disease. A researches conducted among the exposed people -60 years and above, who are frontline workers, health care workers, persons with comorbidities. Different researches have been carried out in different cities like Quantitative data presented descriptively and qualitative, thematically. A number of factors dictated the willingness to take up the vaccine, these included confidence in the vaccine, more than personal factors of participants. The respondents revealed mistrust from most people both in developed and non-developed countries, believe in God’s protection and ignorance in vaccine development. On the other hand, peer pressure and effectiveness of the vaccination programmes among childhood diseases contributed to low uptake of the vaccine.

Conclusion: attention ought to be given to factors promoting vaccine uptake and misconceptions should be expelled concerning the disease.

Recommendations: Strengthen disease surveillance at all stages and regularly updating of COVID-19 data to national level by vaccinating counties, Counties are required to increase researches on more about the disease, use COVID-19 data for decision making in terms of curbing the disease and give refresher course on health care workers surveillance.

Trigeminal Neuralgia: A Brief Review

Nurci Efrilia Safitri — 2023-05-05

Trigeminal neuralgia is a facial pain syndrome that occurs repeatedly and chronically on one side of the face following the distribution of the trigeminal nerve branches. Trigeminal neuralgia is estimated to be around 0.16%-0.3%, with an incidence rate of 4-29 people per 100,000 people/year, with a higher incidence in women than men (ratio 3:2). The incidence rate increases with age. The causes of trigeminal neuralgia are divided into two types, classic and symptomatic. The main mechanism of trigeminal neuralgia is compression by the intracranial blood vessels which causes damage to the protective covering of the nerves or is known as the process of demyelination. Treatment of trigeminal neuralgia is pharmacotherapy, non-pharmacotherapy, surgery should be considered if treatment is ineffective, and preventive education.

Comparison between Figo and Nichd Criteria in Assessing Fetal Heart Rate

I Gde Sastra Winata — 2023-05-17

Assessing the fetal heart rate (FHR) is one of the most important aspects of antenatal care and delivery. Fetal heart rate is one indicator of fetal well-being. Assessing FHR can be done by auscultation or by using a cardiotocography (KTG) device, also known as an Electronic Fetal Monitor (EFM). In interpreting the results of the cardiotocography examination, there are two criteria used to interpret the condition of the fetus, namely the criteria issued by the International Federation of Gynecology and Obstetrics (FIGO) and the National Institute of Child Health and Human Development (NICHD).

Differences in Carrying Angle, Baumann’s Angle, Anterior Humeral Line and Dash Score between Children in the Age Group of Less than 5 Years and over 5 Years at 3 Months Post Open Reduction Internal Fixation Criss-Cross Wire Fracture Supracondylar Humerus Gartland Type III

Surya Abigamika — 2023-05-17

Introduction: Supracondylar humerus fracture is one of the most found fractures in children. In addition to adequate fixation, the role of age differences in the clinical outcomes of operative treatment of supracondylar humeral fractures is still a matter of debate. This study aimed to compare the clinical and radiological outcome of surgery in cases of Gartland type III supracondylar humerus fracture.

Materials and Methods: This study used a cross-sectional design on the population of patient with Gartland type III supracondylar fracture. Patients were divided into 2 groups: age <5 years old (Group 1) and >5 years old (Group 2). The evaluation was carried out 3 months after surgery with open reduction internal fixation crisscross wire. The parameters assessed were Baumann’s angle, carrying angle, and anterior humeral line, and Disabilities of the Arm, Shoulder, and Hand (DASH) Score. Difference between group were analyzed using the chi-square test.

Results: There were a total of 34 patients included in this study. Patients >5 years old had a 1.85 times greater chance to have a post-operative carrying angle of >15^o (95% CI 0.993-3.474; p = 0.037) and 2.75 times greater chance to result in post-operative Baumann’s angle >80^o (95% CI 1,089-6,943, p=0.037). There were no significant differences in anterior humeral line (p=1) and DASH score (p=0.244) between groups.

Conclusion: The result of surgery in supracondylar fracture of the humerus over 5 years old tend to have worse radiological outcome (carrying angle and Baumann’s angle) than patient younger than 5 years old. Thus, treatment of supracondylar fractures of the humerus aged more than 5 years requires more attention with adequate reduction and vigilance against complications that can affect the bone growth of pediatric patients.

Intravesical Prostatic Protrusion as A Predictor of Need for Surgical Therapy in Benign Prostatic Hyperplasia Patients

Balantine U. Eze — 2023-05-17

Intravesical prostatic protrusion (IPP) can predict disease progression and development of complications in benign prostatic hyperplasia (BPH). The aim was to determine if IPP at initial evaluation can predict need for surgical therapy in BPH patients. A retrospective study of BPH patients at ESUT Teaching Hospital, Enugu. Patients were involved in a previous prospective study in which they had abdominal ultrasonography measurement of IPP and prostate volume (TPV). IPP was measured in millimeter and divided into < 10 mm and ≥ 10 mm. The clinicians were blinded about the patients’ IPP while making decision for therapy. After at least a 24-month follow up period, biodata, IPP, TPV, IPSS and therapy given/recommended were retrieved and analyzed. The odds ratio of having/awaiting surgery at IPP cut-off of 10 millimeters was calculated. P < 0.05 was considered significant. One hundred patients’ records were reviewed. Forty-four patients (44%) were still on medical therapy, 20 (20%) were awaiting surgery and 36 (36%) had prostatectomy. Eight (19.05%) of 42 patients with IPP < 10 mm had or were recommended for surgical therapy while 48 (82.76%) of 58 patients with IPP ≥ 10 mm had or were recommended for surgical therapy (p=0.000). There was a statistically significant odd for surgical therapy when IPP at initial evaluation was ≥ 10mm (OR=20.40, 95% CI [7.30,57.04]). IPP at initial evaluation ≥ 10 mm is a significant predictor of needing surgical therapy in BPH patients.

Characteristics of Cervical Pre-Cancerous Lesions at Sanjiwani General Hospital in January-December 2022

Pande Made Ngurah Geriawan — 2023-06-02

Pre-cancerous lesions are cell changes that start on the surface of the cervix near the squamocolumnar junction (SCJ). Cervical cancer can be prevented through early identification and treatment. These pre-cancerous lesions can be identified through methods such as pap smears, visual inspection with acetic acid (VIA), and human papillomavirus (HPV) DNA tests. This study aims to determine the characteristics of cervical pre-cancerous lesions at Sanjiwani General Hospital. This is a descriptive observational study design with a cross-sectional approach at Sanjiwani General Hospital from January to December 2022. The inclusion criteria were patients who had pap smear screening and were recorded entirely in the examination data archive at the Anatomical Pathology Laboratory of Sanjiwani General Hospital in 2022. The exclusion criteria were Pap smear results with inadequate pap smears to be evaluated. The result was obtained from secondary data from patient medical records, determined by the total sampling technique, and will be processed using the IBM SPSS Statistics Version 26 application. In total, 35 samples met the research criteria. All samples (100%) showed positive findings on the VIA test. The most found on the pap smear screening was 15 samples (42.9%) with NILM and followed in succession by eight samples (22.9%) with ASC-US, seven samples (20%) with ASC-H, three samples (8.5%) LSIL, and two samples (5.7%) with findings of HSIL. Most patients with Pap smears at Sanjiwani General Hospital in 2022 will be in the age group of 41-50. Based on obstetric and gynecological history, most respondents had parity ≥ 3, age at sexual intercourse ≥20 years, number of sexual partners was only one, and had not experienced menopause. Most patients use hormonal contraception, have no family history of cervical cancer, and have never been vaccinated or screened for HPV. Most of the pap smear findings were NILM, with the most abnormalities found being ASCUS.

Impact of COVID-19 Pandemic on Magnitude, Cause and Manner of Medico-legal Cases in A Tertiary Care Hospital, New Delhi

Rajesh Kumar — 2023-06-02

Nature and magnitude of medico-legal cases vary from hospital to hospital and from area to area and from time to time. Analysis of medico-legal cases can give an insight into the behaviours and activities of the people in and around the area. The present study was conducted at SSKH, Lady Hardinge Medical College, New Delhi from 1^st January, 2021 till 31^st June, 2022 to evaluate the impact of Covid-19 pandemic on the magnitude and nature of medico-legal cases. The number of MLCs were found reduced by 24% in the year 2020 (due to Omicron variant of Covid virus) and reduced further by 54% in the year 2021 (due to deadlier Delta variant of Covid virus) than the year 2019. In the year 2019, daily average of MLCs was 7.07. During the Covid-19 pandemic years 2020 and 2021, the daily average of the MLCs was dropped to 5.34. and 3.19 respectively. During the nation-wide complete lockdown in India from 24^th March, 2020 till 14^th April, 2020, the daily average of the MLCs had dropped to the minimum i.e. 1.5. Though the magnitude of MLCs reduced to great extent during lockdown days and pandemic years, however, no significant variations were noticed in nature (cause and manner) of medico-legal cases. Homicidal blunt force trauma, accidental road traffic collision and suicidal poisoning remained three major causes of medico-legal cases respectively in the years 2019, 2020 and 2021, almost in same proportions.

Evaluationg the role of Nutraceuticals in Primary Prevention

Santiago De Dios — 2023-06-02

Prevention has become a main factor in the management of cardiovascular diseases. There are many options to control the LDL-Cholesterol levels, which reduction has been widely proved to diminish cardiovascular events rate. Despite the many pharmacological options, an important percentage of the patients do not reach the control target. Among other factors, the available drugs present tolerance problems that limit their use, emerging the necessity to develop new options of treatment that combine efficacy and security. In this field arise the nutraceuticals, which may become an alternative, in selected patients, especially in primary prevention, where the necessity of LDL-cholesterol reduction is not so ambitious, and tolerance and security are essential to achieve the patient adherence to the treatment.

The objective of the study is to demonstrate that the new formulation of Lipok®(a nutraceutical based in red yeast rice and berberine) adapting the concentration of monacolines to the new European regulation, is effective in the lipidic profile control.

97 patients in primary prevention that present LDL-Cholesterol levels over the guidelines objective (116mg/dL) where included. Security and effectiveness of adding Lipok® 6 months to the treatment was evaluated. We observed a statistically significant reduction in the TCH values (-34.3mg/dL), LDL-C (-33,8mg/dL) and triglycerides (-29,3mg/dL) at 6 months’ treatment. No variation in the levels of HDL-C was observed. No relevant side effects were reported (constipation <2%, no myalgias). There were mild reductions (that even reached statistical significance) in creatinine, GPT and glycosylated hemoglobin. No patient discontinued treatment in the 6 months. NO patient discontinued the treatment during the study.

New formulation of Lipok® has proved to be effective in the control of the LDL-Cholesterol levels without relevant side effects. Considering the significant reduction shown in this study, it may become an alternative to other pharmacological treatments in the management of dyslipidaemia in primary prevention where adherence to the treatment is fundamental.

Outcome of Typhoid Intestinal Perforation Management in a Tertiary Hospital, North-Central Nigeria

Abdussemee Idowu Abdurrazzaaq — 2023-06-02

Background: Typhoid intestinal perforation is the most common surgical complication and a significant cause of morbidity and mortality in typhoid fever.

Aim: To determine the treatment outcome of patients with typhoid intestinal perforation.

Methods: A single-centre retrospective study involving retrieving case notes of all consecutive patients who had surgeries for peritonitis secondary to typhoid intestinal perforation from October 2016 to September 2017. Data were collected with a designed case report form and analysed.

Results: Sixty-nine patients had surgeries for typhoid intestinal perforation, of which forty-five (65.2%) were males. The median (range) age of the participants was 10(4-44) years. The commonest complications were surgical site infections 49 (71%) and wound dehiscence 17 (24.6%). The median (range) post-operative hospital stay among the survivors was 13 (7 – 50) days. Enterocutaneous fistula and wound dehiscence were responsible for prolonged hospital stay (x²= 30.126, p value< 0.001 and x²= 45.777, p value< 0.001 respectively). The overall mortality rate was 19 (27.5%). Under-five children had the highest mortality rate 5/15 (33.3%). Mortality was found to be more common among females though the association was not statistically significant (p value = 0.052). Mortality was significantly associated with extended surgical procedures (p value= 0.027).

Conclusion: The reported cases of typhoid intestinal perforations at the study centre were high but the mortality rate was comparable to other similar studies in Nigeria. Mortality from typhoid perforation remains high, and the pathology is best prevented

Diseases of the Entero-Mammary Circle: A New Clinical Entity

Aderbal Sabrá — 2023-06-02

Background: Gastrointestinal malabsorption of proteins from the diet of the mother can induce diseases in breast fed infants. The malfunction of the gastrointestinal tract (GI) of the mother is the basic process causing this disease. This new entity is under the scope of “diseases of the entero-mammary circle” (DEMC). Proteins different from homologues proteins of the breast milk, present in breast milk offered to the infant develops food allergy with clinical manifestation in different organs of the newborn and infant. Here we describe the most relevant clinical symptoms associated to this new entity the DEMC.

Methods: From January 2015 to January 2021, 100 charts from infants, age 0 to 6 months, were randomly selected from our clinic of Pediatric Gastroenterology and Food Allergy at Santa Casa da Misericordia do Rio de Janeiro, Rio de Janeiro, Brazil. The inclusion criteria were: 1) To be exclusively breast fed since birth and 2) Diagnosis of food allergy through strict diet to the mother without cow's milk, egg, soy and wheat protein and subsequent oral challenge with ingestion of the seafood by the mothers and recurrence of gastrointestinal, respiratory or dermal symptoms by oral challenge positive. The exclusion criteria were the use of other any food besides the breast milk.

Results: The onset of symptoms in the patients studied starts early in life. In the GI system the prevalent clinical symptoms were blood in stool, gastro-esophageal reflux, abdominal distention, abdominal pain, diarrhea, constipation, bulky stools, flatus and vomiting, colic’s and nauseas and hiccups. In the respiratory system of the patients, the clinical disturbance was snoring and rhinitis, sinusitis, excess of mucus, chronic cough, and asthma. In the skin system, was prevalent the pallor, atopic eczema, eczema of folds, erythema of the cheeks, per oral erythema and seborrheic dermatitis. Related to the central nervous system we found sleep disorder, insomnia, irritability, and lethargy.

Conclusion: The present study was developed to explore the broad spectrum of the DEMC, presented as different clinical pictures in infants, exclusively breast fed, compromising all systems such the GI tract, the skin, the respiratory system, and the central nervous system.

Lifestyle Modification Determinants of Blood Pressure Status Awareness amongst Traders in A Market Community North Central Nigeria

David Aondona Daniel — 2023-06-03

Background: Hypertension has increasingly become a public health concern in developing countries. Awareness of blood pressure status in the light of lifestyle modification knowledge and practices is cardinal in the prevention and control of hypertension. Lack of blood pressure status awareness is associated with delayed recognition of hypertension related complications.

Aim: This study assessed the determinants of blood pressure status awareness and educated the participants on lifestyle modification practices to prevent hypertension.

Method: This was a descriptive cross-sectional study of 103 consecutive consenting adult participants in a market outreach carried out to mark World Family Physicians Day. The questionnaires were interviewer administered. Analysis of data was done with SPSS version 20 and the level of significance was at a p-value of 0.05.

Result: Their mean age was 42.4 ± 12.4 years. There were more females 58(56.3%) than males and most of the participants were married, 72(69.9%). Those that had secondary education were 47(45.6%) and most, 95(92.2%) earned a monthly income of ≤₦49.999. Only 37.9% of the participants were aware of their blood pressure status. There was a statistically significant association between those that were not aware of their blood pressure status and those that lack knowledge of lifestyle modification practices, those that do not correctly practice lifestyle modification and those that have negative perception towards hypertension prevention. Furthermore, the participants with above mentioned attributes were less likely to know their blood pressure status.

Conclusion: The level of blood pressure status awareness was low, those that lacked knowledge of lifestyle modification, do not practice lifestyle modification and have negative perception toward hypertension prevention were less likely to be aware of their blood pressure status.

Sedentary Behavior and Cardiometabolic Risk Factors in Middle-aged Adults Living in A Brazilian Eastern Amazon City: A Cross Sectional Study

Kliver A. Marin — 2023-06-03

This study investigated the association of self-reported daily time in sedentary behavior with cardiometabolic risk factors in middle-aged adults living in a Brazilian eastern Amazon city. Middle-aged public civil servant living in Palma’s city participated in this cross-sectional study. Daily sedentary behavior and physical activity were measured, and anthropometric parameters and blood biochemical biomarkers were obtained. The results showed that total daily time in sedentary behavior measured using International Physical Activity Questionnaire associated positively with waist to height ratio [β = 0.008 (95% CI = 0.001; 0.016), p = 0.023] and body adiposity index [β = 0.570 (95% CI = 0.110; 1.020), p = 0.016]; and the time spent in passive transport measured using Longitudinal Aging Study Amsterdam - Sedentary Behavior Questionnaire was positively associated with neck [β = 4.420 (95% CI = 1.360; 7.480), p = 0.005) and waist circumference [β = 7.990 (95% CI = 3.490; 12.500), p = 0.005], waist to hip ratio [β = 0.060 (95% CI = 0.030; 0.100), p = 0.001), conicity index [0.050 (95% CI = 0.010; 0.080), p = 0.002], and the concentrations of triglycerides [β =38.500 (95% CI = 6.640; 70.390), p = 0.019] and insulin [β = 2.490 (95% CI = 1.030; 3.950), p = 0.001]. In conclusion, self-reported sedentary behavior is associated with anthropometric and biochemical risk factors for cardiometabolic diseases in the studied individuals.

Determinants of Antenatal Consultation in The Health Districts of Kolda and Sédhiou (Senegal)

Alioune Badara Tall — 2023-05-26

Introduction: The ANC plays an important role in monitoring the health status of the fetus but also in the monitoring of the mother, by allowing the tracking of several conditions. It makes it possible to retain the woman with the health structure, thus promoting childbirth in ideal conditions. The objective of this study was to identify the determinants of ANC in the Kolda and Sédhiou regions.

Method: It was a descriptive and analytical cross-sectional survey. The study focused on women who gave birth between February 2013 and January 2014. Sampling was two-stage random. The data collected during an individual interview focused on the socio-demographic characteristics, knowledge and practices of the women surveyed. The data was analyzed using the R software.

Results: A total of 1216 women were surveyed. The results of the study show that 62.3% had no level of education, 48% had no IGA, 57.6% were within 5 km of a health facility and 44.1% were multiparous. Participation in awareness-raising activities involved 53% of women. The percentage of women who had completed their ANC was 24% while 34% had completed ANC₁ on time. The results of the multivariate analysis showed that timely ANC₁ practice was related to proximity to the health facility (1.7 [1.31-2.2)], simple multiparity (1.46 [1.14-1.89]) and participation in the awareness programme (1.4 [1.08-1.81]). Completion of all ANCs was associated with schooling (79 [1.34-2.39]), knowledge of the number and importance of ANC and the fact that the woman lived within 15 minutes of the structure (1.52 [1.14-2.04]).

Conclusion: The results of the study show that the useof reproductive health services for ANC was linked to environmental, economic, cultural and structural factors. Improving the accessibility of these services requires joint actions by the government, NGOs, community actors and the involvement of the population.