High Treatment Costs Research Articles

Financial Impact Of Medical Waste Management In Hospital "X" Surabaya

The increase in the volume of medical waste is in line with the improvement of medical waste management performance and compliance with government regulations. Hospitals have another challenge in medical waste management with higher treatment costs that have a direct impact on financial aspects. Based on these problems, this study aims to evaluate medical waste management by comparing the level of hospital compliance with regulations and technical aspects, assessing the generation of medical waste and assessing the financial aspects of recycled medical waste management. The research method is structured observation to collect information and facts in the field so that a systematic description can be accomplished. The results of this study show that X Hospital, Surabaya has complied with the laws and regulations. The results of the study of medical waste generation obtained an average generation in the inpatient room of 88.20 Kg / day and the average waste generation per inpatient patient of 1.15 Kg / day and for outpatients of 0.05 Kg / day. The composition of recycled waste is 18.94%, infectious waste is 57.50%, pharmaceutical packaging waste (Hazardouse waste) is 10.90%, cytotoxic waste is 0,06% and sharps waste is 1.25%. The financial analysis generated from recycling activities on used hazardouse waste packaging, used syringes, used infusion bottles other than blood and/or body fluid infusions, and/or used hemodialysis fluid packaging obtained a NPV value > 0 and BCR value = 1.98 > 1, so this investment is economically feasible and the investment plan is recommended to be implemented.

Barriers and facilitators for oral health screening among tobacco users: a mixed-methods study

ObjectivesTobacco consumption adversely affects general and oral health and is considered one of the significant public health burdens globally. The present study aims to assess the barriers and facilitators for attending oral and dental health screening among tobacco users who seek cessation advice.MethodologyThe present mixed-methods study used group concept mapping (GCM) to identify the facilitators/barriers to attending oral health screening among young adults attending face-to-face and virtual Tobacco Cessation Clinic at King Saud University (Riyadh, Saudi Arabia) between September 2022 and April 2023. Study investigators included healthcare social workers, dental interns, and oral and maxillofacial medicinists. Information about demographics, general health, oral/dental health and tobacco use were collected using self-completed questionnaires. The barriers and facilitators were assessed following GCM by brainstorming, sorting, rating, and interpretation activities. Descriptive, multidimensional scaling and hierarchical cluster analysis were used to describe the study participants and produce concept maps of the generated statements.ResultsThe study included 148 participants who generated 67 statements summarised into 28 statements as facilitators or barriers. Based on a 5-point importance scale, the participants indicated the importance of facilitators under health-related cluster [e.g. when I feel pain] as the highest, followed by personal [e.g. to maintain my mouth hygiene], social [e.g. the quality of treatment] and financial clusters [e.g. the reasonable cost]. Concerning barriers, financial factors [e.g. high cost] acted as the highest-rated barrier, followed by personal [e.g. lack of dental appointments] and health-related [e.g. worry that dental problems will worsen]. The social factors were the least considerable barrier [e.g. lack of time]. Clustering these facilitators/barriers on the concept map indicated their conceptual similarity by an average stress value of 0.23.ConclusionPain was the most important facilitator to attending oral health screening by young adults seeking tobacco cessation advice. Notable barriers included the high cost of dental treatment and the lack of scheduled appointments. Thus, oral health care providers need to consider scheduling periodic and timely dental check-ups to prevent and reduce the burden of tobacco-associated and pain-causing oral diseases.

Can plethysmography have a greater place in the diagnosis, treatment and follow-up of chronic venous insufficiency?

Objectives: Chronic venous insufficiency (CVI) is one of the most common venous diseases. CVI is an important clinical picture with a high prevalence, low quality of life, and high diagnosis and treatment costs. Therefore, diagnosis, follow-up, and treatment are important for the patient's socioeconomic and life quality. In this study, we aimed to better examine a test used in the diagnosis, treatment, and follow-up of CVI. Methods: In this retrospective study, 683 patients diagnosed with CVI, who had endovenous laser ablation (EVLA) indications were evaluated between June 2013 and November 2018. EVLA procedure performed on all patients. Preoperative, postoperative 1st and 6th month Doppler USG (ultrasonography), plethysmography, and VCSS (Venous Clinical Severity Score) questionnaire was made to all patients. Results: As a result of our study, we found that there was a significant difference between the preoperative plethysmography and VCSS results of the patients and the postoperative 1st and 6th month results. With the significant difference in the VCSS questionnaire, we have shown that plethysmography gives accurate results in the diagnosis and treatment of CVI since it is an individual, quantitative, and easy test. Conclusions: EVLA is an effective and safe method in patients with venous insufficiency. Since Doppler USG is person and device dependent, we think that plethysmography, which can be used in every clinical setting and provides quantitative results independent of the person, can be used more frequently in the diagnosis and treatment of venous insufficiency. In addition, we think that plethysmography can be used as a valuable additional method in the diagnosis and follow-up of such patients, due to the venous hemodynamic data that Doppler USG cannot provide.

A survey on functional constipation and its risk factors in older people in Shahreza, Iran.

Functional constipation is prevalent among older people. It has major effects on the quality of life of them, as well as the high costs of treatment. This study investigated functional constipation and risk factors affecting older people living in Shahreza, Iran. This cross-sectional study was performed on 200 older people in Shahreza. They were selected by simple random sampling. We used the Rome III Criteria, the Elderly Physical Activity Questionnaire (PASE), and related questions from the SIB system (integrated health system). After completing the questionnaires, the data were analyzed using the mean and standard deviation, Chi-square test, independent-samples t-test, Fisher's exact test, and Mann-Whitney test. The prevalence of functional constipation was 45%. There are significant relationships between functional constipation with dental problems (P = 0.02), intake of fluid (P = 0.001), fruits (P = 0.001), and vegetables (P < 0.001), polypharmacy (P = 0.003), and antidepressants (P = 0.008), history of colon (P = 0.003) and anal (P = 0.001) diseases, stroke or mobility disabilities (P = 0.002), the level of physical activity (P = 0.002), and gender (P = 0.04) in older people living in Shahreza. According to the high prevalence of functional constipation in the studied older people, it is necessary to focus on controlling risk factors and planning to prevent the destructive effects of social restrictions on older people during the coronavirus disease 2019 (COVID-19) pandemic.

STUDY OF SENSITIVITY TO ANTIBACTERIAL DRUGS OF SIGNIFICANT PATHOGENS OF BRONCHOPULMONARY DISEASES IN CHILDREN

The spread of infectious diseases has significant economic consequences, as they lead to high treatment costs, reduced labor productivity and the need to implementmeasures to prevent and control epidemics. The problem of antibiotic resistance is largely related to the frequent and improper use of antibiotics in the treatment of children. The increased sensitivity of children's organisms to infections and, in some cases, the lack of alternative treatment methods lead to the spread of resistant strains of microorganisms. It is important to strictly control the use of antibiotics in children, to carry out rational and precisely dosed therapy, as well as to provide information to parents about the need to comply with prescribed prescriptions in order to reduce the risk of developing resistance and maintain the effectiveness of antibiotics in the treatment of childhood infections.

The reasons for seeking dental services from unqualified operators: A qualitative study

Dental services are widely available in Malaysia, but individuals are continuously reported seeking the services of non-dentist. This study was aimed at exploring the reasons for seeking dental services by individuals from unqualified operators. A qualitative study was carried out and recruited individuals who sought dental treatment from the operators. The participants were identified from the operators’ online advertisement, social media and using a snowball sampling method. Interviews were conducted face-to-face and through online meetings and recorded digitally. Structured, open-ended, and probing questions were asked using a list of topical guided questions. The recordings were transcribed, and thematic analysis was carried out using Atlas.ti Version 9. The eight participants included in this study had fitted orthodontic appliances and dental veneers, and tooth whitening services done by unqualified operators. The reasons were classified into two main themes. The dental aesthetic reasons are related to the dissatisfaction with teeth presentation including malocclusion, dental spacing and teeth whitening. The theme of non-dental related reasons is categorised into four subthemes: following the trend, cost of services, naïve and access to services. The reasons for seeking dental services from unqualified operators are multifactorial. Individuals who seek services from unqualified operators have a valid need for treatment, but their decision is strongly influenced by non-dental reasons, of which the high cost of treatment at private dental clinics and being naïve about dental services are likely the most important. More public campaigns should be done to educate and raise awareness on the issue to the public.

Direct medical cost related to the management of pemphigus: A pilot Tunisian study.

Pemphigus is a therapeutically challenging disease with high morbidity and economic burden. First-line prescription of rituximab remains limited in Tunisia due to its high cost. Systemic steroids remain the standard of care but are associated with a major risk of morbidities and higher treatment costs. To assess the direct medical costs of pemphigus in Tunisia. Retrospective estimation of direct medical costs during the 18 months following the diagnosis using the "bottom-up approach" in the Dermatology Department of Hedi Chaker Hospital, Sfax, Tunisia. Total medical costs were estimated at 38745.7 €, with an average cost of 1 210 € per patient and per year: paraclinical investigations (46%), medical treatment (30%), hospitalization (21%) and outpatient visits (3%). The average cost was the highest in the age group of 15-24 years (1553 €). Treatment costs related to corticosteroid-induced morbidity were estimated at 1208 €. The management of pemphigus in Tunisia needs to be adapted to take into account the health economic analysis in order to reduce overall disease costs and the burden of steroid-induced morbidities.

Therapeutic effects of probiotics and herbal medications on oxalate nephrolithiasis: a mini systematic review.

The majority of all kidney stone cases are oxalate urolithiasis with a high risk of recurrence. Beside its widespread occurrence, kidney stones are characterized by severe complications and high treatment costs. Probiotics and herbal medications could be forthcoming therapeutic interventions in the management of oxalate kidney stones. The PubMed/MEDLINE database was searched for keywords "Oxalobacter formigenes" AND "Oxalate" OR "oxalate degradation" AND "Lactobacillus" OR "Bifidobacterium" OR "recombinant Lactobacillus" OR "Bacillus subtilis", and "urolithiasis" AND "herbal extract". The search returned 253 results, 38 of which were included in the review. Most of the oxalate-degrading probiotics belong to the Oxalobacter formigenes, Lactobacillus, Bifidobacterium, and Bacillus genus with a minimum dosage of 107 CFU in the form of capsules, sachets, and lyophilized powder. Oxalate concentration in media was 5-50mM with an incubation time ranging from 24h to 14 days. The majority of the studies suggested that probiotic supplementation might be useful for reducing urinary excretion of oxalate and urea and alleviation of stone formation. Different herbal extracts were used on murine models of nephrolithiasis (induced by 0.5-3% ethylene glycol) with reduction of renal inflammation and urinary parameters, and calcium oxalate crystals. Several strains of probiotics and herbal extracts confer protective effects against kidney stone/nephrolithiasis, indicating their promising nature for being considered as elements of preventive / adjuvant therapeutic strategies.

Investigation of natural ventilation using a solar chimney in various solar cases

The high cost of conventional energy production, its uses, and its negative environmental impact led scientists to look for many ways to solve this problem. The main issues are environmental pollution, the high cost of air treatment, and the high cost of energy production. An essential solution is using renewable energy instead of traditional energy (petroleum, coal, natural gas, and electric power). As it is a permanent energy source, it causes no air pollution and is cheaper. In this work, an experimental study was conducted on using solar energy as an energy source in the natural ventilation of buildings and the factors affecting this ventilation. A solar chimney has been installed with and without storage materials to store energy for natural identity during sunrise and after sunset. In this work, the difference in air density with different temperatures is the main factor for energy production, which leads to a change in the airspeed (natural ventilation). The study indicates that indoor air velocity can remain higher than ambient air velocity during the day and at night for several hours. This reduces demand and dependence on conventional energy usage, which leads to cost reductions and a reduction in air and environmental pollution.

Price for waiting: the adverse outcomes of boarding critically ill elderly medical patients in the emergency department.

Boarding, the period in which a patient spends in the emergency department (ED) before admission, may be hazardous to critically ill patients, particularly the elderly. This study investigated the associations of boarding with hospital course, prognosis, and medical expenditure in older patients. From January 2019 to December 2021, the medical records of older patients (age ≥ 65) visiting the ED of a tertiary referral hospital who were admitted to the medical intensive care unit (ICU) were retrospectively reviewed. Eligible patients were categorized into two groups according to boarding time with a cutoff set at 6 h. Primary outcomes were in-hospital mortality, ICU/hospital length of stay, and total/average hospitalization cost. Subgroup analyses considered age and disease type. Among 1318 ICU admissions from the ED, 36% were subjected to boarding for over 6 h. Prolonged boarding had a longer ICU (8.9 ± 8.8 vs. 11.2 ± 12.2days, P < .001) and hospital (17.8 ± 20.1 vs. 22.8 ± 23.0days, P < .001) stay, higher treatment cost (10.4 ± 13.9 vs. 13.2 ± 16.5 thousands of USD, P = .001), and hospital mortality (19% vs. 25% P = .020). Multivariate regression analysis showed a longer ICU stay in patients aged 65-79 (8.3 ± 8.4 vs. 11.8 ± 14.2days, P < .001) and cardiology patients (6.9 ± 8.4 vs. 8.8 ± 9.7days, P = .001). Besides, the treatment cost was also higher for both groups (10.4 ± 14.6 vs. 13.7 ± 17.7 thousands of USD, P = .004 and 8.4 ± 14.0 vs. 11.7 ± 16.6 thousands of USD, P < .001, respectively). Extended ED boarding for critically ill medical patients over 65years old was associated with negative outcomes, including longer ICU/hospital stays, higher treatment costs, and hospital mortality.

Barriers to fertility preservation access in transgender and gender diverse adolescents: a narrative review.

Fertility preservation (FP) involves the cryopreservation of gametes, embryos, and/or gonadal tissue oocytes, for future use in family building. FP as part of a comprehensive approach to care of transgender and gender diverse (TGD) individuals is an understudied topic. Current evidence indicates that gender affirming therapies may increase the risk for infertility. As a result, TGD individuals, including adolescents, should receive counseling regarding FP prior to beginning gender affirming treatment. Many barriers exist to TGD adolescents receiving FP counseling and undergoing FP if desired. The objective of this narrative review is to summarize the literature regarding the desire for FP in TGD adolescents, the barriers to TGD adolescents in accessing of FP, and to discuss potential interventions for alleviation of such barriers. A literature search using the following Medical Subject Headings search terms: 'transgender persons' and 'fertility preservation' and 'adolescents' was conducted via searching PubMed. Additional articles were located via reference review. Included articles consist of qualitative and quantitative research and society guidelines. Articles from inception to 1st July 2023 were included. The results of the literature search have been summarized into the format of a narrative review. Key barriers to FP for TGD adolescents include inconsistencies in form and timing of counseling, potential worsening of gender dysphoria with FP treatment, high cost of treatment, limited research on FP outcomes, and legal barriers. Intersectionality between gender identity and other forms of minority status can compound these barriers to FP and healthcare in general. Barriers to TGD adolescents accessing FP are significant. Increased research is needed upon methods to mitigate these barriers. Solutions include increasing uniformity and timing of FP counseling by varying health care providers, advocacy efforts to mitigate legal and financial barriers, increased research efforts in FP outcomes, and increased cultural competency in clinics offering FP care to TGD adolescents.

Rutaecarpine ameliorates imiquimod-induced psoriasis-like dermatitis in mice associated with alterations in the gut microbiota.

Psoriasis is accepted as a chronic, inflammatory, immune-mediated skin disease triggered by complex environmental and genetic factors. For a long time, disease recurrence, drug rejection, and high treatment costs have remained enormous challenges and burdens to patients and clinicians. Natural products with effective immunomodulatory and anti-inflammatory activities from medicinal plants have the potential to combat psoriasis and complications. Herein, an imiquimod (IMQ)-induced psoriasis-like dermatitis model is established in mice. The model mice are treated with 1% rutaecarpine (RUT) (external use) or the oral administration of RUT at different concentrations. Furthermore, high-throughput 16S rRNA gene sequencing is applied to analyze the changes in the diversity and composition of the gut microbiota. Based on the observation of mouse dorsal skin changes, RUT can protect against inflammation to improve psoriasis-like skin damage in mice. Additionally, RUT could suppress the expression levels of proinflammatory cytokines (IL-23, IL-17A, IL-22, IL-6, and IFN-α) within skin tissue samples. Concerning gut microbiota, we find obvious variations within the composition of gut microflora between IMQ-induced psoriasis mice and RUT-treated psoriasis mice. RUT effectively mediates the recovery of gut microbiota in mice induced by IMQ application. Psoriasis is linked to the production of several inflammatory cytokines and gut microbiome alterations. This research shows that RUT might restore gut microbiota homeostasis, reduce inflammatory cytokine production, and ameliorate psoriasis symptoms. In conclusion, the gut microbiota might be a therapeutic target or biomarker for psoriasis that aids in clinical diagnosis and therapy.

Relative quantification of the recA gene for antimicrobial susceptibility testing in response to ciprofloxacin for pathogens of concern

Antimicrobial resistance (AR) is one of the greatest threats to global health and is associated with higher treatment costs, longer hospital stays, and increased mortality. Current gold standard antimicrobial susceptibility tests (AST) rely on organism growth rates that result in prolonged time-to-answer for slow growing organisms. Changes in the cellular transcriptome can be rapid in the presence of stressors such as antibiotic pressure, providing the opportunity to develop AST towards transcriptomic signatures. Here, we show that relative quantification of the recA gene is an indicator of pathogen susceptibly when select species are challenged with relevant concentrations of ciprofloxacin. We demonstrate that ciprofloxacin susceptible strains of Y. pestis and B. anthracis have significant increases in relative recA gene expression after 15 min of exposure while resistant strains show no significant differences. Building upon this data, we designed and optimized seven duplex RT-qPCR assays targeting the recA and 16S rRNA gene, response and housekeeping genes, respectively, for multiple biothreat and ESKAPE pathogens. Final evaluation of all seven duplex assays tested against 124 ciprofloxacin susceptible and resistant strains, including Tier 1 pathogens, demonstrated an overall categorical agreement compared to microbroth dilution of 97% using a defined cutoff. Testing pathogen strains commonly associated with urinary tract infections in contrived mock sample sets demonstrated an overall categorical agreement of 96%. These data indicate relative quantification of a single highly conserved gene accurately determines susceptibility for multiple bacterial species in response to ciprofloxacin.

Cost of Treatment for Brain Metastases Using Data From a National Health Insurance Provider

In the United States, brain metastases (BMs) affect 10% to 20% of patients with cancer, presenting a significant health care challenge and necessitating intricate, high-cost treatments. Few studies have explored the comprehensive care cost for BMs, and none have used real insurance claims data. Partnering with a northeastern health care insurer, we investigated the true costs of various brain-directed radiation methods, aiming to shed light on treatment expenses, modalities, and their efficacy. We analyzed medical claims from Highmark Health-insured patients in Pennsylvania, Delware, West Virginia, and New York diagnosed with BMs (ICD-10 code C79.31) and treated with radiation from January 1, 2020 to July 1, 2022. Costs for radiation techniques were grouped by specific current procedural terminology claim codes. We subdivided costs into technical and physician components and separated hospital from freestanding costs for some modalities. From January 1, 2020 to July 1, 2022, 1048 Highmark Health members underwent treatment for BMs. Females (n = 592) significantly outnumbered males (n = 456), with an average age of 64.4 years. Each member had, on average, 5.309 claims costing $2015 per claim. Total cost totaled $10,697,749. Per-treatment analysis showed that hippocampal avoidance intensity modulated radiation therapy was the costliest treatment at $47,748, followed by stereotactic radiation therapy at $37,230, linear accelerator stereotactic radiosurgery (SRS) at $30,737, Gamma Knife SRS at $30,711, and whole-brain radiation therapy at $5225. Whole-brain radiation therapy was the least costly radiation technique. Similar per-treatment prices for Gamma Knife and linear accelerator SRS support their use in treating BMs. Stereotactic radiation therapy in general was costlier on a per-use basis than SRS, prompting further scrutiny on its frequent use. Hippocampal avoidance intensity modulated radiation therapy was the costliest radiation therapy on a per-use basis by a moderate amount, prompting further discussion about its comparative cost effectiveness against other radiation modalities. This study underscores the importance of multiple considerations in treating BMs, such as tumor control, survival, side effects, and costs.

Should Emollients Be Recommended for the Prevention of Atopic Dermatitis?—New Evidence and Current State of Knowledge

Introduction: Atopic dermatitis (AD) is a chronic, pruritic skin disease with complex pathogenesis, which affects about 43 million children aged 1–4 years. One of the most known methods of alleviating symptoms of AD is emollient treatment, which varies depending on formulation and additional active ingredients. There is some evidence that emollients could be used in AD prevention in high-risk children. Materials and methods: A search of the literature from Cochrane Library, PubMed and Medline was conducted between August and September 2023 with the following keywords: “atopic dermatitis”, “emollients”, and “prevention”. Only randomised clinical trials published in the last 5 years were included into the meta-analysis. Results: Considering the inclusion criteria only 11 randomized clinical trials were taken into account, and six of them proved lack of effect of emollients in the prevention of atopic dermatitis among neonates from AD risk groups. Conclusions: Emollient treatment has a good safety profile and most of the ingredients used in formulations are nonirritant for sensitive newborn and infant skin. There is some evidence of the positive effects of emollient treatment in prevention of AD in predisposed populations. The relatively high cost of emollient treatment (vs regular infant skin-care routine) would support the necessity for further evaluation of their effectiveness in nonpredisposed populations.

Effect of the "aSSKINg" Model in Reducing Pressure Ulcer Risk: A Comparative Study Using the Braden Risk Assessment Score.

Pressure ulcer is considered a common and costly problem in the care of patients. Prevention and management of pressure ulcer are very important due to the high cost of treatment and the adverse consequences of pressure ulcer. This study aimed to evaluate the effect of implementing "aSSKINg" model in reducing pressure ulcer risk. This study used a before- and after-intervention quasi-experimental design. This study was performed on 60 patients who were not randomly selected and assigned in to control and study group. The data collection tool was a 3-part sheet (Braden scale, skin health assessment, and Pressure ulcer assessment). The incidence of pressure ulcer was 19 (60.0%) in the control group versus 9 (30.0%) in the study group with statistical significant differences. The most common site of pressure ulcer was coccyx (6 [31.6%]) in the control group and Heel (3 [33.3%]) in the study group. The application of "aSSKINg" model in the patients with pressure ulcers is effective in reducing the incidence and severity of pressure ulcers.

A comparative study of Apamarga Kshara Lepa and Jaloukavacharana in the management of Dushta Vrana

Wound healing is a challenge faced in the medical field since the time of Vedas. Though surgical debridement, chorion graft, etc. which are practiced in modern era gives effectiveness in treating non-healing ulcers, these procedures have certain limitations such as, limited centres and high cost of treatment. The present study is to compare the effect of Apamarga Kshara Lepa and Jaloukavacharana in the management of Dushta Vrana. The main aim of study is intended to evaluate the efficacy in healing the ulcer. The subjects reported at Outpatient department of Shalyatantra were allocated into two groups of 20 subjects each. The Group A patients received Apamarga Kshara Lepa as treatment and the Group B patients received Jalaukavacharana as treatment. The subjects were assessed by analysing their biochemical parameters, subjective and objective parameters. Marked improvements were noted in both groups.

Percutaneous microwave ablation versus sclerotherapy for large hepatic hemangioma: a multi-center cohort study

Objective The study aimed to compare the effectiveness and safety of ultrasound-guided microwave ablation (MWA) and percutaneous sclerotherapy (PS) for the treatment of large hepatic hemangioma (LHH). Methods This retrospective study included 96 patients who underwent MWA (n = 54) and PS (n = 42) as first-line treatment for LHH in three tertiary hospitals from January 2016 to December 2021. Primary outcomes were technique efficacy rate (volume reduction rate [VRR] > 50% at 12 months), symptom relief rate at 12 months and local tumor progression (LTP). Secondary outcomes included procedure time, major complications, treatment sessions, cost and one-, two-, three-year VRR. Results During a median follow-up of 36 months, the MWA group showed a higher technique efficacy rate (100% vs. 90.4%, p = .018) and symptom relief rate (100% vs. 80%, p = .123) than the PS group. The MWA group had fewer treatment sessions, higher one-, two- and three-year VRR, lower LTP rate (all p < .05), longer procedure time and higher treatment costs than the PS group (both p < .001). MWA shared a comparable major complications rate (1.8% vs. 2.4%, p = .432) with PS. After multivariate analysis, the lesion’s heterogeneity and maximum diameter >8.1 cm were independent risk factors for LTP (all p < .05). In the PS group, lesions with a cumulative dose of bleomycin > 0.115 mg/cm3 had a lower risk of LTP (p = .006). Conclusions Both MWA and PS treatments for large hepatic hemangioma are safe and effective, with MWA being superior in terms of efficacy.

Seroprevalence of Leptospirosis in Cattle in Smallholder Livestock Production Systems in Bungoma County, Kenya

Leptospirosis is an important re-emerging bacterial zoonosis of public health importance in Kenya. It is transmitted through contact with contaminated soil, water, or urine of infected animals. The disease is associated with high economic losses which include high cost of diagnosis and treatment, disruption of international trade in animals and animal products and loss of milk production following mastitis among others. In this study, the sero-prevalence of bovine leptospirosis in Kimilili and Mt Elgon Sub-Counties of Bungoma County in Kenya was estimated. A cross-sectional study was conducted between April to July, 2017 where blood serum samples from 200 head of cattle from five wards and one slaughter house using systematic random sampling technique. The samples were then subjected to the Enzyme Linked Immunorsorbent Assay (ELISA) test. The findings show an overall sero-prevalence for leptospirosis in cattle in the study area to be 16%. The sero-prevalence of leptospirosis in the study area by wards is as follows; 10.7% in Kibingei, 12.5% in Kimilili, 17.6 in Maeni, 16.7% in Kamukuywa and 15.6% in Kaptama. The study also reveals that the sero-prevalence was relatively higher in Kimilili Slaughterhouse which recorded 21.0%. The study therefore demonstrates that there is a high sero-prevalence of leptospirosis in cattle in Kimilili and Mt Elgon Sub-Counties, Bungoma County. This study therefore provides critical public health information which is necessary in guiding leptospirosis prevention and control in Bungoma County. It is therefore recommended that strategies for surveillance and laboratory diagnosis of leptospirosis should be initiated in Bungoma County. This will help in providing better estimates of leptospirosis burden in the county.

Evaluation of the Clinical Efficacy of Orthodontic Retention of Third Molars After Extraction of First or Second Molars

This paper explores the clinical efficacy of orthodontic retention of third molars after extraction of the first or second molars. Studies show that the use of the second molar near the movement to replace the first molar, retain the third molar although need a long treatment time and higher treatment cost, but promote the gap of tissue regeneration, preserve healthy natural teeth, restore occlusal stability, but also can avoid the late repair of the first molar or second molar. In addition, the second molar after moving near the third molar is also conducive to the eruption of the third molar, maximizing the use of the third molar, to form a healthy and complete functional tooth line. Therefore, For patients with severe removal of the first or second molars, poor prognosis, severe periapical disease, and loss of the first or second molars, the treatment method of replacing the second molar for the first molar and the third molar for the second molar can be an effective treatment option.