Attending Private Clinics Research Articles

Risk factors associated with Helicobacter pylori infection among patients attending private clinics in Borama district, Somaliland

ABSTRACT Risk factors associated with Helicobacter pylori infection among patients attending private clinics in Borama district, Somaliland, are studied. We specifically investigated the association among the use of non-steroidal anti-inflammatory drugs, the users’ socioeconomic status, and the household hygiene practice of people with H. pylori infection attending the Borama private clinic. Helicobacter pylorus (H. pylori) is a Gram-negative spiral-shaped bacterium that infects gastric-type epithelium, and it is probably the most common bacterial agent in humans after Streptococcus mutans, which causes dental caries. H. pylori infection is now recognized as a worldwide problem and it is the most common cause of chronic gastritis and is strongly linked to peptic ulcer disease and gastric cancer. The prevalence of H. pylori infection is high in less-developed Asian countries like India, Bangladesh, Pakistan, and Thailand, and is acquired at an earlier age than in the more developed Asian countries like Japan and China. H. pylori infection is a global public health problem, affecting over 50% of the population worldwide.

Assessment of Interleukin 6 and Interleukin 8 in type 2 Diabetic patients recovered from SARS_COV_2 induced Covid 19 infection in Kirkuk City, Iraq

This study aimed to measure the levels of interleukin 8 and interleukin 6 in type 2 diabetic patients who were infected with Covid-19 and recovered and to compare them with diabetic patients who did not have Covid-19 and healthy people. The patients were divided into three groups. The first group was for diabetic patients recovering from Covid and the total number of samples included 41 samples. In addition, 18 samples were taken from diabetics who were not infected with Covid-19 as a second group and a third group was also taken with the number of samples as 25 from healthy people not infected with the Corona virus or diabetes or any other disease. For the period from September 2022 - February 2023, their ages ranged between 39-64 years. Samples were obtained from patients attending private clinics and hospitals in Kirkuk Governorate. Patients were diagnosed with diabetes according to WHO criteria. This study excluded patients with hypertension, cardiovascular disease, kidney disease, smokers and those taking any other treatment except diabetes treatment: metformin and glimepiride. The results of the current study with regard to blood sugar level showed that there were statistically significant differences at a significance level of p<0.05 between the second and third group. As for the first and second group, there was a slight increase, but not significant, p>0.05. The results of the study also showed that there was a significant difference (p<0.01) between the first group and the third group. As for the level of interleukin 8, there was a significant difference at the significance level of p<0.05 between the three groups.

Modeling Consumer Choice between Public and Private Health Care in Russia

Demand for public and private health care services is formed through consumer decision-making in two situations: to seek or not to seek medical help and which medical institution to attend. Theory suggests that choices in these situations occur sequentially and are explained by Andersen's behavioral model. This study tests these theoretical assumptions using three econometric approaches on the Russian National Health Telephone Survey 2022 data: (1) two separate probit regressions, (2) sample selection probit, and (3) nested logit. Nested logit confirmed the relevance of all demand-side characteristics (Andersen's model factors). Being male, older, and having health problems were associated with decreased probability of seeking health care and choosing private clinics. Being married, having a high level of education, being employed, having a medium or high monthly income, and living in larger cities were associated with increased probability of seeking health care and attending private clinics. Robustness check of the nested logit model accounted for the varying levels of availability of health care facilities in different cities. Despite the differences in the availability of public and private medical organizations, trends in consumer behavior remained the same. The author proposes to expand the practice of using nested logit models to analyze the behavior of consumers of medical services using data from Russia and other countries. Recommendations for increasing the efficiency of the Russian health care system and reducing inequality in its use by different consumer groups include transforming attitudes of Russians to their own health and promoting the accessibility of health care.

Anthropometric Indicators and Dietary Intake in Toddlers Aged from 12 to 24 Months Who Attended Private Clinics in the Metropolitan Area of Guadalajara.

The objective was to evaluate the anthropometric indicators and dietary intake of toddlers attending private clinics in Guadalajara. In a cross-sectional study, 101 toddlers aged 12 to 24 months were included. They were born full term, had an adequate weight for gestational age, and attended private clinics in Guadalajara. Two 24 h dietary recalls were administered. Anthropometric measurements were taken, and anthropometric indices were estimated. Student's t test or the Mann-Whitney U test, chi-square test, and odds ratio were used for quantitative or qualitative variables. Males had lower Z scores for the weight/age index than females. During the week, energy intake was excessive in males [OR = 5.5 (95% CI 1.4, 20.8)], and cholesterol intake was insufficient in females [OR = 3.03 (95% CI 1.2, 7.1)]. On weekends, energy [OR = 2.5 (95% CI 1.1, 5.7)] and fiber intake [OR = 3.1 (95% CI 1.2, 7.8)] were insufficient in females. Most of the toddlers who attend the private clinics in the upper-middle socioeconomic stratum of the Guadalajara Metropolitan Area had excessive protein intake, excessive consumption of added sugars was frequent, and there was insufficient intake of vitamin D and calcium. Sex was shown to be a factor influencing nutrient intake in these toddlers aged 12-24 months. Males had a Z-score of weight/age lower than females, suggesting nutritional risk.

Differences in parental vaccine confidence and attitudes by health system in Guatemala and their impact on immunization timeliness.

The objectives of this study were to evaluate parental confidence and attitudes towards immunization in urban Guatemala between private versus public health systems and their impact on vaccination timeliness in their children. A cross-sectional survey was conducted in parents 6-18-month-old children who attended well-child outpatient clinics from two health systems (public employee-based insurance and private health care) in Guatemala City from November 2017 through August 2018. Parental demographics, household characteristics, food insecurity, vaccine hesitancy using the WHO SAGE Vaccine Hesitancy Scale, and information on parental use of social media platforms and vaccine information sources were collected. Five hundred-three parents were surveyed, most of them mothers. Only 9 parents reported they had previously refused a vaccine for their child: 8 (3.2%) from private clinics and 1 (0.4%) from the public clinic (p=0.02). Significantly more children attending private clinics (226, 90.4%) were shown to have a delay in any of their vaccines scheduled for the first 2years of life compared to those in the public clinic (169, 66.8%; p<0.01). Children of parents having a college degree (84.5 vs 70.1%; p<0.001), earning more than US$ 1,000 per month (81.5 vs 70.7%; p<0.001), and having a computer at home (81.4 vs 70.2; p=0.007) were more likely to have any delays in the scheduled vaccines. Parents seeking care at private clinics were 1.14 times more at risk of delaying a vaccine compared to those at the public clinic, adjusted for other covariates (p=0.03, 95% CI: 1.01, 1.28). In Guatemala, children receiving immunizations at private clinics were significantly more likely than those attending public clinics to be delayed in their immunization schedule and to remain more days without the recommended protection, especially for third doses of the primary vaccine series.

The Utility of Internet-Enabled Antibiotic Self-Medication and Its Associated Factors Among Patients Attending Private Clinics in Kawempe Division in Kampala Capital City, Uganda: Community-Based Cross-Sectional Study.

The expanding practice of internet-based antibiotic self-medication raises public health concerns as it increases antibiotic resistance and introduces avoidable risks. This study aims to examine the utility of internet-enabled antibiotic self-medication and its associated factors among patients attending private clinics in Kawempe division in Kampala Capital City, Uganda. This was an analytical cross-sectional study that enrolled participants attending private clinics in Kawempe Division's randomly selected zones. These were interviewed using a structured questionnaire, and the data were analyzed using STATA version 12 software. Logistic regression analysis was used, and variables with p ≤ 0.05 were considered as significantly associated with internet-enabled antibiotic self-medication. Out of the 313 respondents, 246 (79%) reportedly had ever used internet sources to self-medicate with antibiotics. Factors such as being male; single; had knowledge of antibiotics; believed that Internet should be used for antibiotic self-medication; Distance to the nearest medical center/hospital from your residence/workplace of about 5 km and residing near a drug shop/pharmacy that gives antibiotics without a prescription increased internet-enabled antibiotic self-medication. Furthermore, the variables of more than three household members; common practice of antibiotic self-medication in a household; did not agree that one can recover from the illness without a doctor's prescription and medical workers who did not explain adequately the antibiotics medication given for the illness decreased internet-enabled antibiotic self-medication. This study found that internet-enabled antibiotic self-medication practice is highly utilized and is associated with a variety of individual, household, and healthcare system factors. This necessitates strict adherence to national drug policy regulations governing antibiotic use. Furthermore, community health education is critical in combating such medication practices.

Association of Title X clinic status with receipt of person-centered contraceptive counseling: A population-based study

To describe receipt of person-centered contraceptive counseling among reproductive-aged women in the United States who sought contraceptive care at Title X clinics, non-Title X public clinics, and private clinics. We conducted a secondary analysis of the 2017-2019 wave of the National Survey of Family Growth (NSFG). The sample included female respondents ages 15-49 who received contraceptive services in the past year and completed the Person-Centered Contraceptive Counseling (PCCC) measure, a quality metric evaluating interpersonal quality of the care received. We used multivariable logistic regression to estimate the predicted probability of receiving person-centered contraceptive counseling by source of care, adjusted for individual-level characteristics. Of 2225 (weighted n=26,599,620) eligible respondents, 6.9% received care at a Title X clinic, 8.2% at a non-Title X public clinic, and 84.9% at a private clinic. The adjusted predicted probability of receiving person-centered contraceptive counseling among respondents attending private clinics was 50.6% (95% CI 46.3%-54.8%) compared with 51.3% (95% CI 40.4%-62.3%) at Title X clinics and 52.4% (95% CI 44.0%-60.7%) at other public clinics. Respondents with incomes ≥300% above the federal poverty level (FPL) had higher odds of reporting receipt of person-centered counseling compared to those with incomes below 100% of the FPL (aOR=2.12; 95% CI 1.47-3.06). Non-Latina Black respondents had lower odds of receiving person-centered contraceptive counseling (aOR=0.69; 95% CI 0.51-0.94), compared to non-Latina white respondents. Title X clinics perform as well as the private sector in delivering person-centered contraceptive counseling. Title X clinics provide quality person-centered contraceptive counseling on par with the private sector, despite serving populations that are often less likely to report high quality care. Broad implementation of the PCCC measure will permit tracking person-centered contraceptive care across diverse practice settings and populations.

Improving stigma and psychosocial outcomes among post-abortion Kenyan women attending private clinics: A randomized controlled trial of a person-centered mobile phone-based intervention.

ObjectivesThe objective of this study was to evaluate a person-centered abortion care mobile-based intervention on perceived social stigma, social support, mental health and post-abortion care experiences among Kenyan women who received abortion services at private clinics.MethodsThis randomized controlled study enrolled women who obtained an abortion from private clinics in Nairobi county, Kenya and randomized them into one of three study arms: 1) standard of care (follow-up by service provider call center); 2) post-abortion phone follow-up by a peer counselor (a woman who has had an abortion herself and is trained in person-centered abortion care); or 3) post-abortion phone follow-up by a nurse (a nurse who is trained in person-centered abortion care). All participants were followed-up at two- and four-weeks post-abortion to evaluate intervention effects on mental health, social support, and abortion-related stigma scores. A Kruskal-Wallis one-way ANOVA test was used to assess the effect of each intervention compared to the control group. In total, 371 women participated at baseline and were each randomized to the study arms.ResultsUsing Kruskal-Wallis tests, the nurse arm improved mental health scores from baseline to week two; however this was only marginally significant (p = 0.059). The nurse arm also lowered stigma scores from baseline to week four, and this was marginally significant (p = 0.099). No other differences were found between the study arms. This person-centered mobile phone-based intervention may improve mental health and decrease perceived stigma among Kenyan women who received abortion services in private clinics.ConclusionsNurses trained in person-centered abortion care, in particular, may improve women’s experiences post-abortion and potentially reduce feelings of shame and stigma and improve mental health in this context.

Interventive psychodiagnosis of children through online orientation of parents in a University Clinical Practice in Brazil: an alternative for underserved populations during the COVID-19 pandemic

IntroductionA private university in Santos offers a free psychological service for assessing and intervening in chilhood psychological problems through a internship program which had to be delivered online due to the COVID-19 pandemic. The interns were only allowed to attend their parents online, instead of their children.ObjectivesEvaluating this new online service is the aim of this work.Methods 24 parents of 34 children aged 4-10 years were attended by pairs or trios of 52 interns. The were modules made up of assessment, intervention and feedback, using different instruments such as interviews, screening questionnaires and the observation of 5-minute free play in domestic environment and of a family collage through a video recorded by parents. Feedback and intervention happened in various moments. The interns created a storybook using metaphoric narrative as a feedback tool in which a synthesis of the psychodiagnostic process and orientation was presented to the children.ResultsThere was progress and decrease or elimination of symptons in 19 of the 34 children. Among the children who did not improve, one of them did not present any difficulties; 7 of them had many absences and the other 7 were referred to further assessment for reasons related to the complexity of their difficulties or a probable unsuitability of the online orientation.ConclusionsThe orientation was helpful for 55,89% of the children, showing to be a valid alternative for families who do not have financial resources for attending private clinics or fail to access public health services or even during social distance measures.DisclosureNo significant relationships.

Frequency and characterization of self-medication for dental manifestations in patients attending private clinics in Lima in 2021

The self-medication is the use of drugs without health professionals' prescription that many times, instead of helping, aggravate the patient's health. Dental pain is the main reason for performing this act in the area of odontology. It is important to know if patients self-medicate in order to develop strategies to reduce the misuse of drugs and avoid this practice. Establish the frequency and characterization of self-medication in patients who visit to the three private dental clinics between the months of march to July in the year 2021. Cross-sectional observational study with a sample of 450 patients from three dental clinics in the city of Lima. The assessment tool was a 13-question quiz about the main characteristics of self-medication. The 85,8% of patients use drugs without medical prescription. 41.5% of the patients self-medicated did it with old prescriptions made by the dentist. The age group that more self-medicated was 26-35 years old with 35.5%. The most frequent type of disease was dental pain with 45.6%, The degree of instruction with the highest percentage was complete university superior with 32.9%. The frequency of self-medication of the patients who visited the three dental centers is considerably high.

Prognosis of impacted canines according to their position in the upper maxillary using different radiographic analyzes

Canine impaction is an anomaly in which the tooth is prevented from erupting. It occurs when eruption has been delayed and there is radiographic evidence. To determine the prognosis of impacted canines according to their position in the maxilla by means of different analyses: Ericson & Kurol, Warford and Power & Short; in patients attending private clinics in the city of Asuncion from 2015 to 2020. The design is observational descriptive, cross-sectional, using panoramic radiograph measurements. Results: The sample consisted of 37 patients and the 48 canines. It was found that the presence of impacted canines was more frequent in women (69.44%), with unilateral location (70.27%) and palatal position (68.75%). In more than half of the cases the prognosis was unfavorable, however, the concordance was only 75%. There was greater concordance in Warford's prognosis with that of Power & Short (95.91%), while the concordance was lower with that of Ericson & Kurol (81.25%). The frequency of impacted canines in a Paraguayan sample was higher in females, unilaterally located and positioned by palatine. Being unfavorable in more than half of the cases. It is suggested to combine the analyses for projection.

Impact of governmental support to the IVF clinical pregnancy rates: differences between public and private clinical settings in Kazakhstan—a prospective cohort study

ObjectivesInfertility rates have been increasing in low-income and middle-income countries, including Kazakhstan. The need for accessible and affordable assisted reproductive technologies has become essential for many subfertile women. We aimed...

Epidemiological Study of Vitamin D Deficiency among Libyan Patients

Background: Vitamin D deficiency (VDD) is not only common globally but is more rampant in Libya. Assessment and management of it can help prevent many other conditions and serious diseases. Objective: This stuay aimed to study the prevalence of VDD among patients attending private clinics in Zawia city of Libya. Methods: A Cross-sectional study was carried out among 71 apparently healthy patients from different private clinics laboratory, Zawia city, Libya. After obtaining informed consent and confirming the willingness of the patients to give the blood samples, the data were recorded in the pre-designed, pre-tested, and semi-structured study questionnaire. Variables such as age and sex were recorded. Vitamin D status was ascertained for all included participants in the present study. Results: Female participants were more than male participants in the present study (63.4% vs. 36.6%). Majority (45.1%) belonged to the age group of 41–64 years followed by 1–18 years of age (39.4%). The mean value of Vitamin D among females (19.8 ± 2 nmol/L) was significantly lower when compared to males (25.7 ± 3 nmol/L). The mean value of Vitamin D was significantly lower in the age group of 41–64 years and more than 64 years of age compared to 1–40 years of age (P &lt; 0.05). Conclusion: The prevalence of VDD was more in females compared to males. The values decreased with increasing age.

Oral Hygiene Practices and Associated Factors among Patients Visiting Private Dental Clinics at Hawassa City, Southern Ethiopia, 2018.

Introduction A poor oral hygiene is associated with dental caries, gingivitis, periodontal diseases, bad breath, respiratory and cardiovascular diseases, and chronic kidney diseases. Moreover, a poor oral health has psychosocial impacts that diminish a quality of life and restrict activities in school, at work, and home. African regions carry a major burden of oral health problems. However, very few studies highlighted about oral hygiene practices and there is also paucity of information in Ethiopia. This study was, therefore, designed to identify an oral hygiene practice on patients/clients visiting dental clinics in Hawassa City, Southern Ethiopia. Objective To assess oral hygiene practices and associated factors among patients/clients visiting private dental clinics, Hawassa City, Southern Ethiopia. Methods Institution-based cross-sectional study was employed among patients/clients attending private clinics in Hawassa City from January 27 to February 8, 2018. Systematic random sampling technique was used to select 403 study participants. Data were entered into EpiData 3.1, cleaned, and analyzed by SPSS 20. A multivariable logistic regression analysis was performed to assess the association between independent and outcome variables. Crude and adjusted OR with 95% confidence level was estimated, and variables having P value ≤0.05 in multivariable analysis were considered as significant. Results 393 study participants participated making a response rate of 97.52%. A median age of respondents was 27 ± 10.9. About 153 (39.9%) of the study participants had poor oral hygienic practice. Male (AOR: 1.63, 95% CI: (1.053, 2.523)), rural residence (AOR: 3.79, 95% CI: (1.724, 8.317)), and poor knowledge about oral hygiene (AOR: 2.38, 95% CI: (1.402, 4.024)) were independently associated to poor oral hygienic practice. Conclusion More than one-third of the study participants had poor oral hygienic practice. Providing health information regarding oral hygiene for the patients/clients in the facilities with a special focus from rural areas is recommended.

Knowledge and Practice of Pregnant Iraqi Women about COVID-19 Preventive Measures

Background: Pregnant women with SARS-CoV-2 infection must be identified and treated early becausethey are a group susceptible to higher risk as more cases of infection appear, the timely diagnosis will allowus to select which patients merit maternal surveillance. Much closer fetal and/or timely hospital admissionwith an immediate impact on emergency clinical practiceObjective: To assess the knowledge and practice of pregnant Iraqi women about COVID-19 preventivemeasures.Patients and Method: A cross sectional study conducted at the Private clinics for Gynecology andObstetrics in Baghdad/Iraq for two months, from 1 of May 2020 to the end of Jun 2020. The study sampleis 400 pregnant women that are attending private clinics for antenatal care, studying their knowledge aboutCOVID-19 infection and their approach.Results: The Knowledge score level were found Inadequate in (72%) of the participant and adequate in(28%), the main source of information about the COVID-19 prevention in multiple answers question wasTV, which presented in 338 (84.5%), then 234 (58.5%) from family and friends, 229 (57.25%) and 103(25.75%) mentioned that their information from HCWs. 2/3rd of the participants were presented with poorpractice (67.25%) while less than 1/3rd (32.75%) with good practice.Conclusion: Knowledge score level were found Inadequate in (72%) of the participant and 2/3rd of theparticipants were presented with poor practice (67.25%) while less than 1/3rd (32.75%) with good practice.

Assessment of self-reported adherence to ART and patient's virological/CD4 response in a tertiary care clinic and government free ART clinic.

Introduction:Treatment adherence to antiretroviral treatment (ART) is critical in reducing morbidity, mortality, and improving the survival in HIV patients. ART is a life-long commitment, and the variety of factors can influence treatment adherence. We studied the factors affecting treatment adherence in the private sector and public sector outdoor clinic in Ahmedabad, India. The primary objective of this study is to compare the level of adherence and factors that influence adherence to ART in patients attending government run free ART program and private setup.Methods:We conducted a cross-sectional study of 8 weeks among HIV-infected patients who were receiving ART from private clinic and free ART center from July 2019 to September 2019. We enrolled all consecutive patients >18 years of age attending both clinics. Statistical analysis was carried out using the SPSS software version 25.0. Multiple logistic regression was used to identify the factors that were independently associated with adherence to ART.Results:The study enrolled 306 patients, 151 (49.34%) from the outpatient department of private hospital, and 155 (50.65%) from the free ART center. Patients attending private clinics were more likely to have been diagnosed with HIV since ≥10 years compared to free ART center. Higher opportunistic infection rates were found in free ART center (64.51%). Treatment adherence was significantly lower in the patients attending free ART center (P = 0.004). Patients taking concomitant medications for other comorbid conditions (≥4 pills/day) were more likely to exhibit inadequate adherence ([odds ratio] 1.216, 95% confidence interval 1.0171–1.454). Univariate analysis showed that age, education, habits of alcohol, tobacco, number of pills, and duration of disease played a significant role in predicting adherence to ART (P < 0.05).Conclusions:Patients attending private clinic are surviving longer with HIV diagnosis, have fewer opportunistic infections, and have better treatment adherence compared to free ART clinic.

Ancestría genética y estratificación social en Montevideo, Uruguay

Diversos estudios genéticos han demostrado que la población uruguaya es trihíbrida, formada por europeo/mediterráneos, indígenas y africanos, cuyo aporte varía en distintas regiones del país. Pese a que Montevideo es la capital de la República, hay escasos estudios sobre los orígenes de su población, que pueden diferir de otras regiones. En este trabajo se propone indagar sobre estos orígenes a partir de información genética en una muestra derivada de una previamente publicada, profundizando en algunas características para determinar su posible influencia en la estimación de la ancestría. Se consideró una muestra de 269 mujeres (casos y controles de un estudio de cáncer de mama) en quienes se analizaron haplogrupos y secuencias de las regiones hipervariables del ADN mitocondrial (ADNmt) y marcadores individuales de ancestría (AIMs) del ADN nuclear. Se observó que había diferencias en los porcentajesde ancestría cuando se analizaban separadamente las personas que se atendían en el sistema público de salud en relación a las que lo hacían en el sistema mutual, con diferencias significativas para el aporte indígena y el europeo/mediterráneo. Luego de corregidos los valores por lugar de atención de salud, se estimaron los siguientes aportes: 24.6% indígena, 67,7% europeo/mediterráneo y 7,7% africano para herencia materna, y de 11,1% indígena, 81,4% europeo/mediterráneo, y 7,5% africano para la herencia biparental. Se analizaron particularmente los aportes indígena y africano y se discutieron los resultados con relación a otros estudios. Debido a las diferencias encontradas relacionadas con la heterogeneidad de la población montevideana, se alerta sobre el muestreo y valores de referencia para estudios poblacionales futuros.

Prevalence and Antimicrobial Susceptibility Patterns of Neisseria gonorrhoeae among Suspected Patients Attending Private Clinics in Jimma, Ethiopia.

Background In most African countries including Ethiopia, Neisseria gonorrhoeae infections were diagnosed clinically and its antibiotic susceptibility was rarely tested. This study aimed to determine the prevalence and antimicrobial susceptibility patterns of N. gonorrhoeae among suspected patients attending private clinics in Jimma, Ethiopia. Methods Institution-based cross-sectional study was conducted to determine the prevalence and antimicrobial susceptibility pattern of N. gonorrhoeae isolated from urogenital specimens. Urogenital samples were collected aseptically and then transported using Amie's transport media and processed in a microbiology laboratory following the standard protocol. Results Of the total 315 samples examined, 31 (9.8%) were confirmed to have gonococcal infection. Of these, 30 (96.7%) were females. High proportion of culture confirmed cases (18 (12.5%)) were observed in the 20–24 age group. All of the identified organisms were susceptible to ceftriaxone and had high resistance to penicillin (80.6%) and tetracycline (54.8%). Conclusion The prevalence of gonococcal infection is high. In the current study, participants who have no information about sexually transmitted infection were more likely to be infected by N. gonorrhoeae. According to our study, ciprofloxacin is effective against gonococcal infection.

Reliability of Mandibular Canine Maturation Stages in Predicting Pubertal Growth Spurt in a Sample of Egyptian Orthodontic Patients

Objective: to investigate the reliability of mandibular canine maturation stages in predicting pubertal growth spurt in a sample of Egyptian orthodontic patients. Materials and Methods: A retrospective, cross-sectional study was carried out on the radiographic records (left lateral cephalometric, panoramic and left hand and wrist x-rays) obtained from 250 patients who were attending private clinics on Delta area, Egypt. The age was selected between 7 and 18 years. Mandibular canine calcification stages (MCC) were assessed according to Demirjian’s method for dental maturity assessment. Skeletal maturity was assessed by the ossification stages of the middle phalanx of the third finger (MP3) using Hagg and Taranger method and the cervical vertebrae maturation index (CVMI) was evaluated using Hassel and Farman method. MCC stages were statistically correlated to both MP3 stages and CVMI stages. The significance level was set at P ≤ 0.05. Statistical analysis was performed with IBM® SPSS® Statistics Version 20 for Windows. Results: Chi-square tests have shown highly significant associations between the mandibular canine calcification stages (MCC) and both CVMI and MP3 maturation stages (p < 0.001). MCC stage F had shown a moderate correlation with MP3 FG and CVMI 2 that corresponded to the onset of pubertal growth. Conclusions: MCC stage F can be used for prediction of the onset of pubertal growth, while prediction of the peak or the post peak periods using MCC method may be unreliable. Key words: Pubertal growth, MP3 stages, CVMI stages, MCC stages.

Direct effect of the 13-valent pneumococcal conjugate vaccine use on pneumococcal colonization among children in Brazil

BackgroundThe 13-valent pneumococcal conjugate vaccine (PCV13) has been commercially available in Brazil since 2010. We investigated the carriage prevalence, capsular types, and antimicrobial resistance among pneumococci isolated from children immunized with PCV13 in Brazil. MethodsWe analyzed 500 children < 6 years old attending public (n = 270) and private (n = 230) clinics in Niterói/RJ, Brazil, in 2014. We determined the antimicrobial susceptibility and capsular types for all isolates. ResultsThirty-eight (7.6%) of 500 children had received at least one PCV13 dose. Since only two (0.7%) of 270 children at the public clinic were vaccinated with PCV13, major analyses focused on 36 (15.7%) of 230 children attending private clinics. Nine (25%) of 36 children were pneumococcal carriers. Characteristics associated with carriage were age ≥ 2 years, cough/expectoration, and childcare center attendance (p ≤ 0.01). The capsular types found were 15B/C (n = 2), 6C, 11A/D, 16F, 23A, and 23F. Two isolates were non-typeable (NT). Three (33.3%) isolates were multidrug resistant. We found four (44.4%) penicillin non-susceptible pneumococci, with penicillin and ceftriaxone MICs ranging from 0.12 to 4.0 µg/ml and 0.023–0.5 µg/ml, respectively. We also detected two (22.2%) erythromycin-resistant isolates (MICs of 3.0 and 256 µg/ml). ConclusionsColonization with PCV13 serotype was rare among the vaccinated children. Increasing PCV13 coverage might help reduce the frequency of major serotypes currently associated with invasive pneumococcal diseases in Brazil, such as 3 and 19A. The isolation of multidrug-resistant serotype 6C and NT isolates in carriage, however, requires close monitoring.