International Research Journal of Medicine and Medical Sciences

73-78

Authors: Henrique Meirelles Boldori, Wendel Mombaque dos Santos, Izabel Cristina Hoffmann, Caroline Mombaque dos Santos, Francisco Maximiliano Pancich Gallarreta, Stela Maris de Mello Padoin and Sonia Maria Oliveira de Barros

The purpose of this study was to evaluate risk factors associated with miscarriage (defined as the interruption of pregnancy before the 20th week of gestation) and perinatal mortality (defined as fetal death from the 21st week of pregnancy until neonatal stage, occurring until the first week of life) in HIV-infected pregnant women. This retrospective, cross-sectional study included HIV-infected pregnant women from Brazil aged between 18 and 47 years, who had miscarriage, vaginal delivery, or delivery by cesarean section. Data on miscarriage or perinatal mortality, sociodemographic characteristics, clinical conditions, and treatment were obtained. Statistical analyses included the use of binary logistic regression. In this cohort, the prevalence of miscarriage was 6.1% and the perinatal mortality rate was 4.0%. Risk factors for miscarriage included drug use (OR = 6.23; CI = 0.5 to 73.1), multiple gestation (OR = 3.06; CI = 0.9 to 10.9), and lack of prenatal care (OR = 18.42; IC = 3.9 to 87.6). Moreover, risk factors for perinatal mortality included drug use (OR = 1.03; IC = 0.9 to 1.1), vaginal delivery (OR = 5.56; CI = 1.2 to 26.1), and the absence of antiretroviral use during labor (OR = 17.77; CI = 3.9 to 81.8). In order to reduce the rates of miscarriage and perinatal mortality in HIV-infected pregnant women, actions aimed at eliminating drug use during pregnancy, ensuring adequate prenatal care, performing elective cesarean section delivery, and using antiretroviral medications during labor should be prioritized. Keywords: Pregnant women, abortion, miscarriage, perinatal mortality, risk factors.

84-90

Authors: Hanan A. Madani, Hafez M. Bazaraa and Hanaa Rady

The pathogenesis of idiopathic nephrotic syndrome (INS) is associated with Th1 and Th2 cytokines imbalance. Cytokines act as mediators of inflammation in childhood NS. The objectives are to investigate the role of cytokine genes polymorphisms (IL6-G174C, IL4-C590T, and TNFα-G308A and the response to corticosteroid therapy in children with INS in Egypt. 90 children were included in this study, they divided into 3 groups: 30 children with steroid sensitive nephrotic syndrome (SSNS), 30 children with steroid resistant nephrotic syndrome (SRNS) and 30 age and sex matched healthy control children. Polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) were used to assess IL6-G174C, IL4-C590T, and TNFα-G308A polymorphisms. A significant association was found between the CC genotype and the C allele in IL6-G174C and INS group when compared to the control group (P = 0.003 and 0.009, OR = 4.3 and 2.67 respectively), also, they were significantly associated with SRNS compared to SSNS groups (P = 0.008 and 0.000, OR = 4.93 and 5.82 respectively). Also, TNF-α G308A AA genotype A allele were significantly associated with INS group compared to the control group (P = 0.045 and 0.014, OR = 3.5 and 3.51 respectively) and on comparing SRNS to SSNS groups TNF-α G308A A allele was only significantly associated with SSNS group (p = 0.032, OR = 2.83). IL4-C590T showed no significant difference in the genotypes or the allele distribution between the studied groups. In conclusion, IL6-G174C and TNFα-G308A polymorphisms may affect response to steroid therapy in childhood INS. Keywords: Idiopathic nephrotic syndromes, IL-4, IL-6, TNF-α gene polymorphism, steroid response.

56-62

Authors: Muhammad Akbar Malik and Hamza Malik

Children with epilepsy are known to be prone to educational underachievement as a result of learning and behavioural problems. Identification of these comorbidities and their early intervention will go a long way in improving quality of life of children with epilepsy. The objective of this paper is to study the incidence of behavioural disorders (BD) and school underachievement (SU) in newly diagnosed generalized idiopathic epileptic children, and to determine association of behavioural disorders and school underachievement with different antiepileptic drugs. The design is prospective observational cohort study. Settings and duration is private multidisciplinary neuropaediatric clinics, from 1st September 2010 to 31st August 2013. 305 school going (7 to 16 years) children, 205 children with newly diagnosed idiopathic generalized epilepsy (study group) and 100 non-epileptic peers (50 siblings of epileptic children and 50 healthy children without family history of seizures or other chronic neurological illness (control group) were evaluated for BD and SU for over a period of four years. Chi Square Test was used for statistical analysis. The prevalence of BD and SU were present simultaneously in most of the patients. BD and SU were 11% in the study group, 10% in siblings of epileptic children, while in the control group without family history of epilepsy was 6% and this was statistically significant (p < 0.05). All epileptic children and their siblings have higher incidence of BD and SU as compared to their normal counterparts. These are associated with all currently used antiepileptic drugs (AEDs) in children. A holistic approach, comprising medical, educational and psychosocial counselling of families and placement of the child both in society and school should form integral part of management of idiopathic generalized childhood epilepsy (IGCE). Keywords: Antiepileptic drugs, cognition, epilepsy, medication, neuropsychology, behavioural disorders, school underachievement.

67-72

Authors: Mohammed-Durosinlorun Amina, Akinlusi Fatimat, Adesiyun Adebiyi, Rabiu Kabiru, Ojabo Augustine and Kolawole Abimbola

Physicians with gynaecological training often have correct information about contraceptive technologies, their effects and benefits. Their personal choices may affect their practice. The objectives of this study are to find out what contraceptives Nigerian trainee gynaecologists use, and if this affects the way they counsel their clients. This was a cross-sectional survey. Participation was voluntary and 150 trainees were to fill out a pretested, self-administered questionnaire eliciting general demographic information, academic post and years of training, information on personal contraceptive use and choices, and how it may influence their practices. Analysis was done using the statistical package for social science (SPSS) computer software, version 20. Descriptive analysis was performed, using frequency tables. Chi-square test was used to compare variables and assess significance. P value of <0.05 was considered significant. There was a response rate of 62%. About 25.8% of respondents were not currently using any form of contraception and 53% were currently using modern methods of contraception, most commonly barrier methods and intrauterine devices. There was poor uptake of male sterilization. Twenty four respondents (25.8%) had several objections to contraceptive use. The choice of contraception used was significantly associated with gender. Sixteen respondents (17.2%) felt their personal choices may affect how they counsel patients and prescribe contraceptive agents. The level of respondents and number of children significantly affected counseling practices. In conclusion, trainees prefer to use natural forms of contraception. However, larger studies will be required to verify that personal objections to contraceptives introduce bias to contraceptive counseling practices. Keywords: Contraception, personal choices, gynaecologists, counseling practices.

20-39

Authors: Revocatus Twinomuhangi, Ron N. Buliung, Mable T. Nakitto and Ronald Lett

Injury is a major international public health concern internationally, contributing to population morbidity and mortality and related social and economic costs. While several national injury survey initiatives have been conducted in Uganda in the past, none have explicitly incorporated geographical aspects of injury. Injury surveillance should include location data, with a view to ultimately understanding and explaining the geography of injury risk and prevalence. This paper documents a GIS method developed for a national injury surveillance pilot study in Uganda, Africa. The study’s primary goal was to assess the feasibility of using GIS in injury surveillance in Uganda. A trauma registry form was designed and used to capture spatial and non-spatial (socio-economic status of injured persons, injury type/cause) factors of injury events. The trauma registry was piloted for 30 days at two referral hospitals (Mulago and Mubende) in Central Uganda. Spatial patterns of injury pilot data were studied by injury source, and socio-demographic characteristics. The study demonstrated the utility of GIS for injury surveillance and analysis in the Ugandan context. The addition of GIS-based surveillance and mapping capacity may become an important approach to treating the prevalence of different types of injury in Uganda, over the longer term. Keywords: Geographic information systems, injury surveillance, spatial analysis.

44-50

Authors: Ergie P. Inocian, Edsel P. Inocian and Elsie I. Ysatam

This study compared the dependency needs of the nursing home residents and community-dwelling elderly in the performance of Basic and Instrumental Activities of Daily Living (ADL). It was also correlated to their age, educational attainment, cognitive status, and health-related conditions. It was conducted in one community and in four (4) Geriatric Homes in Cebu, Philippines. There were 120 respondents of the study, aged 65 years old and above. To measure their cognitive status, the standardized Mini Mental Status Examination by Folstein et al. (1975) was used. The dependency needs in performing ADLs were assessed using the Katz Index of Independence (1963) and Lawton Instrumental ADL Scale (1969). The elderly from the home for the age needed assistance in basic ADL and are dependent on the performing instrumental ADL, while the community-dwelling elderly were independent in both basic and instrumental ADL. Age, educational attainment, co-morbidities and cognitive status were found to have significant relationships in the performance of basic and instrumental ADL among the Filipino elderly. Moreover, there was a significant difference in the ADL performance between the nursing home residents and community-dwelling elderly. With functional decline as person ages, it is essential to support the health needs of the elderly. Keywords: Activities of daily living, cognitive status, community-dwelling elderly, dependency needs, Filipino elderly, functional status, health-related conditions, nursing home residents.

1-5

Authors: Hesham M. Elmazar and Amna B. Essa

The purpose of the paper is to study the role of some Environmental and Dietary Factors affecting the progression of Type 2 Diabetic Retinopathy in Aljabal Algharby, Libya. A prospective non-comparative study was conducted from September 2012 to July 2013 at the Ophthalmology Department in Gharian Central Teaching hospital, Gharian, Aljabal Algharbi, Libya. Thirty cases with medical history of uncontrolled Type 2 diabetes lasting more than 10 years and no other systemic diseases were collected. Complete ophthalmic clinical examination including dilated fundus examination and laboratory investigations as Random Blood Glaucose (RBG) level and Glycosylated Hemoglobin (HgA1c) besides Complete Blood Count (CBC) were carried out to all cases. The cohort included 30 cases 15 males (50%) and 15 females (50%). Their mean age was 55.29 ± 2.46 years (range, 48 years to 66 years: males; 53.39 ± 3.03 years and females; 56.67 ± 3.75 years). The duration of Type 2 diabetes mellitus ranged from 10 years up to 16 years with a mean 13.17 ± 2.16 years. All the cases were diagnosed with either normal or mild non-prolifrative stage of diabetic retinopathy. Thirty cases (100%) were having Random Blood Glucose (RBG) above 200 mg/ml and +ve Glycosylated Hemoglobin (HgA1c) results above 7% indicating the uncontrolled state of diabetes. Twenty six cases (86.7%) gave a history of regular intake of Virgin Olive Oil (VOO) in their diet. Twenty three cases (76.7%) had Secondary Polycythemia with a mean Red Blood Cells (RBC) Count 6.2 ± 0.5 million cells/mcL associated with a mean Hemoglobin (Hg) level 13.73 ± 1.32 g/dl in their blood picture which correlated with history of prolonged living at high altitude. In conclusion, the regular dietary intake of Virgin Olive Oil (VOO) which is a main component of the Mediterranean diet was proved to have a beneficial effect on the reduction of progression of type 2 diabetic retinopathy. On the other hand, the prolonged hypoxia exposure and associated Secondary Polycithemia may play a role in a process of tissue adaptation that results in a lower tissue response to the ischemic state responsible for type 2 diabetic retinopathy. Keywords: Type 2 diabetic retinopathy, prolonged hypoxia, virgin olive oil.

11-19

Authors: Ayat R. Abdallah and Hala M. Gabr

Medical students repeatedly experience different stresses which render them more vulnerable to psychological problems that may affect their emotional, psychosocial and physical health. This study has been conducted to determine the prevalence of depression, anxiety and stress among first year medical students at Menoufiya University and to identify their associated factors. This was a cross-sectional study where two self administered questionnaires have been used, the first is a structured one for identifying demographic characteristics and risk factors of psychological illness among 1st year medical students, and the second is the Arabic version of Depression Anxiety Stress Scale (DASS21). The participation rate was 90%. The mean age of participants was 18.02 ± 0.26 years, and more than half (52%) were females. The prevalence of depression, anxiety, and stress among students was 63.6, 78.4 and 57.8%, respectively. Symptoms of moderate severity were the predominant among students with the studied psychological illnesses. Multiple social, demographic, behavioral and educational factors have been significantly (p < 0.05) associated with most of the studied psychological illnesses, including: gender, residence, perceived socioeconomic standard, feeling loneliness, the inability to share in families' social activities, presence of insomnia and chronic physical illnesses, studying in English language, problems with exams' criteria, lack of communication with staff members, and the organization of lectures' timetable. In conclusion, a substantial proportion of first year medical students had ongoing psychiatric problems that were associated with multiple social, demographic, behavioral, and educational factors. Interventions addressing the mental health of medical students should be initiated. Keywords: Depression, anxiety, stress, medical students, medical education, Egypt.