Cofidence Interval Research Articles

Impairment of health-related quality of life and its determinants among patients with podoconiosis in East Wollega Zone, Oromia Regional State, Ethiopia: institutional-based cross-sectional study

ObjectiveThis study aimed to assess the impairment of health-related quality of life (HRQoL) and its determinants among patients diagnosed with podoconiosis in East Wollega Zone, Oromia Regional State, Ethiopia.MethodsAn institutional-based...

Intimate Partner Violence and its Associated Factors among Women of Reproductive Age in Nepal: Findings from a National Cross-Sectional Survey

Introduction: In Nepal, Intimate partner violence (IPV) is quite common among women. Several factors can play a role for the incidence of intimate partner violence. The aim of the study was to assess the prevalence of lifetime IPV and last 12 months and associated factors among Nepalese women of reproductive age.
 Methods: The Nepal Demographic and Health Survey 2016 data was used for secondary data analysis. In the study, a total of 3,826 women of reproductive age were included. Intimate partner violence was measured as reporting of physical and/ or sexual and/or emotional violence ever experienced in her lifetime as well as in the last 12 months. Descriptive statistics, chi-square test, bivariate and multivariate logistic regression were computed.
 Results: Overall, 25.7% women have experienced lifetime intimate partner violence, with 22.1% physical, 7.8% sexual and 12.7% emotional violence. Findings from multivariate logistic regression showed that women belonging to lower caste (Adjusted Odds Ratio(AOR):1.41, 95% Cofidence Interval(CI)=1.07-1.85), with no education (AOR:1.95, 95%CI=1.36- 2.79), with 3-5 number of children (AOR:1.57,95%CI=1.04-2.35), whose husband had no education (AOR:1.84,95% CI=1.27-2.66), whose husbands drank alcohol (AOR:2.54,95%CI=2.14-3.02) and the women who witness fathers beating their mothers (AOR:2.25,95%CI=1.81-2.78) were more likely suffering from intimate partner violence.
 Conclusion: Intimate partner violence has been linked to socio-demographic factors, substance abuse, and previous experience of witnessing fathers beating their mothers. In Nepal, equal access to education for both men and women, prohibition of caste-based discrimination and prevention of substance abuse may be effective strategies for reducing intimate partner violence.

The value of ultrasonic elastography in the differential diagnosis of choroidal melanoma and choroidal hemangioma

Objective: To explore the role of the scoring and strain ratio methods of ultrasonic elastography in the differential diagnosis of choroidal melanoma and choroidal hemangioma. Methods: A cross-sectional study. Twenty-five patients (25 eyes) with choroidal melanoma treated in the Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University from July to October 2016 were included in this study. There were 13 males and 12 females, with an average age of (48±12) years old. Twenty-five patients (25 eyes) with choroidal hemangioma treated in the same period were selected for differential diagnosis, including 12 males and 13 females, with an average age of (37±13) years. The lesions were examined by ultrasound elastography and scored, and the strain ratio of the tumor to the orbital tissue was measured. Two independent sample t test was used to compare the difference in the elasticity score and strain ratio between choroidal melanoma and choroidal hemangioma. The sensitivity, specificity and area under the receiver operating characteristic (ROC) curve were calculated to analyze the value of the two methods in the differential diagnosis of choroidal melanoma and choroidal hemangioma. Results: The elastography score of choroidal melanoma was (3.48±0.77) points, including 2 points in 3 cases, 3 points in 8 cases, 4 points in 13 cases, and 5 points in 1 case. The elastography score of hemangioma was (2.28±0.46) points, including 2 points in 18 cases and 3 points in 7 cases. The difference in the elasticity score between patients with the two kinds of tumors was statistically significant (t=6.694, P<0.01). The strain ratio was 42.97±15.83 and 12.21±9.24 in the patients with choroidal melanoma and choroidal hemangioma, respectively, and the difference was statistically significant (t=8.392, P<0.01). Using 3 points as the diagnostic critical point of the elastography score, the sensitivity was 88.0%, the specificity was 72.0%, and the area under the ROC curve was 0.80 (95% cofidence interval: 0.663 to 0.900, P<0.01). Using 21.67 as the diagnostic critical point of the strain ratio, the sensitivity was 92.0%, the specificity was 92.0%, and the area under the ROC curve was 0.92 (95% cofidence interval: 0.808 to 0.978, P<0.01). Conclusions: Ultrasound elastography plays a role in the differential diagnosis of choroidal melanoma and choroidal hemangioma. The differential diagnostic value of the strain ratio method is higher than the scoring method. (Chin J Ophthalmol, 2020, 56: 676-680).

Clinical study on the accuracy of dual-energy computed tomography colonography in colorectal neoplasia detection

Objective To compare the accuracy between regular computed tomography colonography (CTC) and dual-energy CTC in lesion detection. Methods Twenty-eight patients with clinical suspicious space occupying lesions of the colon were selected. All patients were underwent dual-energy mode contrast-enhanced CT scan and the data were reconstructed with colonography and dual-energy iodine maps methods. The diameter, enhanced computed tomography (CT) value and iodine value were measured. The results of colonoscopy and pathology were taken as gold standard. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of regular CTC and dual-energy CTC were compared. Variance analysis was performed for measurement data comparison among groups and chi-square test was used for count data analysis. Results Among 28 patients, colorectal lesions were detected in 24 cases by regular CTC, of which four cases were false-positive and one case was false-negative confirmed by colonoscopy and pathology. Colorectal lesions were detected in 20 cases by dual-energy CTC, of which no false-positive and one case was false negative confirmed by colonoscopy and pathology. The contrast enhanced CT value of polyps, adenoma, adenocarcinoma and stool was (38.54±6.82), (49.16±7.31), (52.61±5.93) and (34.00±1.41) Hu, respectively. The enhanced value of adenoma and adenocarcinoma was significantly higher than that of polyps and stool, the differences were statistically significant among groups (F=10.760, P=0.001). There was no significant difference between polyps and stool (t=1.44, P=0.188). The sensitivity of regular CTC and dual-energy CTC in lesion detection was 95.6% (95%cofidence interval(CI): 77.9%–99.2%) and 95.6% (95%CI: 77.9%–99.2%), respectively. The specificity was 42.8% (95%CI: 15.4%–93.5%) and 100.0% (95%CI: 47.9%–100.0%). Conclusion Compared with traditional CTC, dual-energy CTC would distinguish lesions from stool, help differentiate between benign and malignant tumors and further increase the accuracy of CTC diagnosis. Key words: Dual-source CT; Dual-energy; CT colonography; Colonic neoplasia

Randomized comparison of renal denervation versus intensified pharmacotherapy including spironolactone in true-resistant hypertension: six-month results from the Prague-15 study.

This prospective, randomized, open-label multicenter trial evaluated the efficacy of catheter-based renal denervation (Symplicity, Medtronic) versus intensified pharmacological treatment including spironolactone (if tolerated) in patients with true-resistant hypertension. This was confirmed by 24-hour ambulatory blood pressure monitoring after excluding secondary hypertension and confirmation of adherence to therapy by measurement of plasma antihypertensive drug levels before enrollment. One-hundred six patients were randomized to renal denervation (n=52), or intensified pharmacological treatment (n=54) with baseline systolic blood pressure of 159±17 and 155±17 mm Hg and average number of drugs 5.1 and 5.4, respectively. A significant reduction in 24-hour average systolic blood pressure after 6 months (-8.6 [95% cofidence interval: -11.8, -5.3] mm Hg; P<0.001 in renal denervation versus -8.1 [95% cofidence interval: -12.7, -3.4] mm Hg; P=0.001 in pharmacological group) was observed, which was comparable in both groups. Similarly, a significant reduction in systolic office blood pressure (-12.4 [95% cofidence interval: -17.0, -7.8] mm Hg; P<0.001 in renal denervation versus -14.3 [95% cofidence interval: -19.7, -8.9] mm Hg; P<0.001 in pharmacological group) was present. Between-group differences in change were not significant. The average number of antihypertensive drugs used after 6 months was significantly higher in the pharmacological group (+0.3 drugs; P<0.001). A significant increase in serum creatinine and a parallel decrease of creatinine clearance were observed in the pharmacological group; between-group difference were borderline significant. The 6-month results of this study confirmed the safety of renal denervation. In conclusion, renal denervation achieved reduction of blood pressure comparable with intensified pharmacotherapy.

Body mass index and mild cognitive impairment-to-dementia progression in 24 months: a prospective study.

Mild cognitive impairment (MCI), often considered as an early stage of dementia, is heterogeneous, and not all subjects with MCI progress into clinically diagnosed dementia. Low body weight (and body mass index, BMI) as well as losing weight while in MCI stadium have been proposed as possible risk factors of MCI-to-dementia conversion. A prospective, 2-year observation of 102 MCI subjects has been conducted. Data on MCI subtype, somatic and neuropsychiatric co-morbidity and demographic characteristics (including age, gender and education), were collected. In addition, baseline and yearly BMI were calculated. Data of 83 out of the originally included 102 subjects were available after 2 years; 27 of those (32.5%) progressed to dementia. In univariate analysis, multiple-deficit MCI subtype (as compared with pure amnestic), higher age, the presence of diabetes and apathy, and lower baseline BMI (and losing weight on 2-year follow-up) were associated with conversion to dementia. Variables retained in the multivariate backward stepwise logistic regression model for conversion after 24 months of observation included lower baseline BMI (odds ratio, OR (95% cofidence interval, CI): 0.6 (0.4-0.9)), weight loss on 2-year follow-up (OR (95% CI): 1.3 (1.1-1.5)), male gender (OR (95% CI): 0.1 (0.01-0.9)) and presence of apathy (OR (95% CI): 70.7 (5.6-699)). Apathetic subjects had lower BMI and higher weight loss after controlling for potential confounders (age, gender, years of education and baseline ADAS-cog (Alzheimer's Disease Assessment Scale-cognitive subscale) score). MCI subjects presenting with apathy, low initial BMI and losing weight on follow-up have a significantly greater risk of developing dementia. Nutritional and behavioural assessment should be considered as additional tools in evaluating the risk of dementia among MCI subjects.

Role of mass media on knowledge generation and countering misconceptions about tuberculosis transmission in Nepal

ABSTRACT Objective To explore the role of mass media on knowledge generation and counter the misconceptions about tuberculosis (TB) transmission in Nepal. Methods A cross-sectional study was performed in the largest referral hospital in Nepal. The quota sampling technique was used to recruit 283 subjects into the sample. Results A total of 235 (83.0%) respondents correctly replied that TB transmits through air by coughing or sneezing. A total of 29 (10.2%) respondents had correct knowledge about TB transmission without having misconceptions. Similarly, regarding the misconceptions about TB transmission, 157 (55.5%) replied that TB transmits through utensils, 163 (57.6%) respondents replied that TB transmits through sharing clothes/bed sheets/towel, 62 (21.9%) respondents replied that TB transmits through touching a person with TB, 142 (50.2%) respondents replied that TB transmits through food, 88 (31.1%) respondents replied that TB transmits through sexual contact. Respondents who read newspaper (ajusted odd ratio=3.004, cofidence interval=1.208–7.471) and listen to the radio daily (ajusted odd ratio=4.610, cofidence interval=1.738–12.234) were more likely to have correct knowledge on transmission of TB. Conclusions National TB Control Program in Nepal should give priority in disseminating TB related message through newspapers, magazines and radio programs.

Comparison of Paracheck Pf® test with conventional light microscopy for the diagnosis of malaria in Ethiopia

Objective To assess the accuracy of Paracheck Pf® in reference to the conventional light microscopy. Methods A total of 400 patients visiting Awash, Methara and Ziway malaria centers were simultaneously screened with both light microscopy and Paracheck Pf® for the presence of Plasmodium falciparum ( P. falciparum) malaria. Results Of the 190 samples that were negative by light microscope, the Paracheck Pf® showed 11 false positive and 179 true negative results, and from a total of 210 samples positive by light microscope, Paracheck Pf® accurately diagnosed 200 true malaria cases. Taking the light microscopy as a standard test for malaria, the sensitivity, specificity, positive predictive value and negative predictive value of Paracheck Pf® is 95.2% [cofidence interval (CI)=92.4–97.1], 94.2% (CI=91.1–96.3), 94.8% (CI=92.0–96.7) and 94.7% (CI=91.6–96.8), respectively. Conclusions Paracheck Pf® showed good sensitivity and specificity for the diagnosis of P. falciparum malaria, and fulfill the world health organization (WHO) recommendation that requires the sensitivity of rapid diagnostic tests (RDTs) to be greater than 95%. Therefore, Paracheck Pf® can be used as an alternative to the Giemsa stain light microscopy in resource poor set ups.

Aloe Gel Enhances Angiogenesis in Healing of Diabetic Wound

BACKGROUND: Diabetic micro and macroangiophathy lead to the incident of diabetic foot ulcers characterized by an increased number of circulating endothelial cells (CECs) and decreased function of endothelial progenitor cells (EPCs). This fact is correlated with ischemia and diabetic wound healing failure. Aloe vera gel is known to be able to stimulate vascular endothelial growth factor (VEGF) expression and activity by enhancing nitric oxide (NO) production as a result of nitric oxide synthase (NOS) enzyme activity. Aloe vera is a potential target to enhancing angiogenesis in wound healing.OBJECTIVE: The objective of this study was to explore the major role of Aloe vera gel in wound healing of diabetic ulcers by increasing the level of EPCs, VEGF, and endothelial nitric oxide synthase (eNOS), as well as by reducing the level of CECs involved in angiogenesis process of diabetic ulcers healing.METHODS: The experimental groups was divided into five subgroups consisting of non diabetic wistar rats, diabetic rats without oral administration of aloe gel, and treatment subgroup (diabetic rats) with 30, 60 and 120 mg/day of aloe gel doses for 14 days. All subgroups were wounded and daily observation was done on the wounds areas. Measurement of the number of EPCs (CD34), and CECs (CD45 and CD146) was done by flowcytometry, followed by measurement of VEGF and eNOS expression on dermal tissue by immunohistochemical method on day 0 and day 14 after treatment. The quantitative data were analyzed by One-Way ANOVA and Linear Regression, with a cofidence interval 5% and significance level (p&lt;0.05) using SPSS 16 software to compare the difference and correlation between wound diameters, number of EPCs and CECs as well as the levels of VEGF and eNOS.RESULTS: The results of this study showed that aloe gel oral treatment in diabetic wistar rats was able to accelerate the wound healing process. It was shown by significant reduction of wound diameter (0.27±0.02); the increased number of CECs (0.42±0.57), respectively (p&lt;0.05). On the other hand, the wound diameter and eNOS indicators showed significant differences at the dose of 60 mg, while the number of EPCs and CECs and the level of VEGF showed significantly different results at a dose of 120 mg. Aloe gel oral therapy showed a positive indication of wound healing acceleration at the optimum dose range 60-120 mg a day.CONCLUSIONS: Aloe gel is potential to be a herbal therapy candidate for diabetic wound healing through enhancing EPCs homing, decreasing the CECs number, and stimulating the increase of VEGF and eNOS levels,hence proving to be a dominant factor in the angiogenesis process.KEYWORDS: aloe gel, diabetes, wound healing, angiogenesis

Surveillance for Early Silicosis in High Altitude Miners Using Pulse Oximetry

Two cross-sectional studies in a high altitude region of Perú evaluated the role of pulse oximetry for detection of silicosis in high-altitude miners. In study one, exercise pulse oximetry and chest radiographs were used to evaluate 343 silica-exposed miners and 141 unexposed subjects for evidence of silicosis. Study 2 investigated the association between exercise oxygen saturation and silicosis in 32 non-silicotic and 65 silicotic miners. In study one, age (Odds Ratio [OR] 1.10, 95% Cofidence Interval (CI) 1.07-1.12) and resting oxygen saturation (OR 0.95, 95%CI 0.90-0.99) were associated with silicosis. In study two, years of mining employment (OR 1.14, 95%CI 1.05-1.23) and exercise oxygen saturation at 30% maximum heart rate (OR 0.86, 95%CI 0.75-0.99) were associated with silicosis. Hypoxemia at rest and with exercise is associated with silicosis in high altitude miners. Pulse oximetry should be further investigated as a screening tool for silicosis at high altitudes.

P0980 CORRELATION BETWEEN GASTRO-OSEOPHAGEAL REFLUX SYMPTOM SCOREAND MEASURED REFLUX INDEX USING SINGLE OR DOUBLE PH PROBE

Introduction: gastro-oseophageal reflux(gor)is known to be associated with a wide range of clinical presentations and symptoms,however,it may be silent.oseophageal pH monitoring has enabled the latter to be documented but it has its own limitations in terms of being dependant on contents of the stomach being acidic which may pose problems particularly in premature babies and in continously fed patients. the aim of this study was to document whether there was any correlation between clinical symptom scire and measured reflux index (R.I.)using single or dual pH probe. Methods: this study examined 80 children with median age range of 18 months referred to yhe gastrointestinal unit with symptoms suggestive of gor. for each child,detailed history was taken, full examination and basic investigations were done. history included questions about a range of symptoms that are known to be associated with gor and a symptom score was recorded. oseophageal pH monitoring was carried out using dual pH probewith oseophageal probe position checked with x- ray. the mean duration of the study was 22.2±1.47 hours.the recordings were analysed too give 1:the percentage of total time oseophageal ph is less than 4, the traditional R.i(r.i.t).2:the percentage of time oseophageal pH is less than 4 while gastric pH is less than 4,the corrected R.I.(r.i.c).the results were analysed using rank correlation coefficient and spearman. Results: there was some, although poor,correlation between symptoms score and R.I.t (p=0.002and 95%cofidence interval =0.528to0.134)there was no correlation between symptom score and R.I.c(p value=0.059). these results suggest that symptom score is an unreliable indicator of severity of gor, particularly in children whose gastric contents are not acidic for significant periods of time. Conclusion: symptom score cannot be relied on to predict severity of gor especially in children who have significant periods of time when their gasric pH is less than 4.

Significance of diabetes mellitus in patients with acute myocardial infraction receiving thrombolytic theraphy

Objectives. The purpose of this study was to evaluate the risks and benefits associated with thrombolytic theraphy in patients with diabetes presenting with acute myocardial infarction.Background. Diabetes mellitus is associated with adverse risk factors and a hypercoagulable state that may adversely affect the outcome of thrombolytic therapy.Methods. Data were analyzed from 8,055 of the 8,239 patients with acute myocardial infarction who received thrombolytic therapy in the International Tissue plasminogen Activator/Streptokinase Mortality trial (diabetes history was missing for 184 patients).Results. There were 883 patients with and 8,272 patients without diabetes. Among the diabetic patients, 160 were receiving insulin therapy. Baseline risk factors were significantly worse in diabetic patients, who were older and had a higher rate of previous infarction and antecedent angina and a higher Killip grade at admission. Bleeding and hemorrhagic and ischemic stroke rates were similar among diabetic and nondiabetic patients. Hospital and 6-month mortality rates were highest among diabetic patients receiving insulin therapy (16.9% and 23.1%, respectively), followed by diabetic patients not receiving insulin therapy (11.8% and 17.8%), and lowest in nondiabetic patients (7.5% and 10.7%, p < 0.0001). Whereas diabetes of 5 years' duration was associated with a mortality rate similar to that of nondiabetic patients, a >5-year duration was associated with a relative mortality risk of 1.38 (95% cofidence interval [CI] 0.88 to 2.15) and a > 10-year duration with a relative mortality risk of 1.99 (95% CI 1.40 to 2.81). The independent relative risk for incremental mortality from discharge to 6 months was 1.74 (95% CI 1.21 to 2.50). Mortality rate among diabetic was patients lowest in patients who received both streptokinase and heparin (9.8% vs. 16.1% in patients who received streptokinase but no heparin, p < 0.05).Conclusions. The relative mortality of diabetis versus nondiabetic patients was similar to that observed in previous studies of patients with myocardial infarction not receiving thrombolytic therapy, indicating that mortality in diabetic patients receiving thrombolytic therapy is reduced to the same extent as in nondiabetic patients. In addition, risk of bleeding and stroke was not increased, indicating that diabetic patients can safely receive thrombolytic therapy for the same indications as nondiabetic patients.