History Of Intake Research Articles

IJCM_300A: Clinical medicine and Public health: Is the dichotomy justified? Epidemiological investigation of a Hepatitis A case admitted at a tertiary care hospital

Background: Outbreaks of Hepatitis A Virus (HAV) infection have been associated with poor sanitation, inadequate sewage disposal and contamination of food and water. Objective: To identify the epidemiological factors associated with a patient who presented with fever and vomiting and diagnosed with Hepatitis A. Methodology: 23-year-old, female patient was admitted in the general medicine department of a tertiary care hospital with complaints of fever and vomiting. IgM ELISA tests for Hepatitis A and Hepatitis E were positive. The patient’s mother had similar symptoms. Community Medicine department was informed about the patient. A team comprising of postgraduate students, MSW, ASHA worker and Anganwadi worker visited the patient’s house. Information including clinical history, source of drinking water, history of food and water intake from outside, sanitation and waste disposal methods of the house hold were collected. Stakeholders including the counsellor and members of the self-help group of the area were informed. House to house visit of all houses in 200 meters radius from patients’ house was done to look for more cases and to assess the environment sanitation. Results: The team identified that the source of drinking water of the patient’s family was a well which was not sanitary. A nearby house was identified with an open well with open sullage less than one meter away. Seven children of that household had fever and jaundice and were treated from a local hospital, one week prior. Stakeholders were also informed and both the wells were chlorinated and the families were educated about the importance of boiling water before consumption, proper disposal of sullage and waste disposal. Conclusion: Interdepartmental communication between clinical medicine and public health played an important role in identifying and eliminating the source of infection even when one patient was diagnosed and helped to prevent HAV outbreak.

Bilateral acute retinal necrosis with choroidal detachment

A 42-year-old man with history of topiramate intake presented with sudden diminution of vision. He was diagnosed with bilateral panuveitis with retinitis and serous choroidal detachment, with ultrasound biomicroscopy revealing ciliary body effusion. Systemic investigations were negative for immunosuppression. Topiramate was stopped and the patient was started on oral valacyclovir and oral steroids 48 h after antiviral therapy. The patient responded well to the treatment leading to resolution of retinitis as well as choroidal detachment. This is a unique case of bilateral acute necrotizing retinitis and choroidal detachment, in which early recognition and prompt treatment led to a favorable outcome.

Intensive care management of organophosphate insecticide (sniper) poisoning: a Preventable death—a case series

Background Organophosphate poisoning is the commonest accidental and suicidal poisoning in developing countries like Nigeria. Respiratory distress, unconsciousness, and acute cholinergic crisis are reasons for critical care. Objective We determined the clinical presentation and outcome following sniper poisoning in critically ill patients. Methods This was a retrospective case series of 13 patients managed for sniper poisoning in a six-bed private intensive care unit in Lagos, Nigeria, from June 2016 to June 2022. The diagnosis of sniper poisoning was made based on a positive history of ingestion of sniper before presentation, and clinical signs of cholinergic hyperactivity. Results A total of 13 patients were reviewed, 3 females and 10 males with median age and APACHE II score of 23.5 years (IQR, 5.75, 27.75) and 26 (IQR, 24, 27.5), respectively. Deliberate ingestion of sniper occurred in 10 patients. Respiratory insufficiency/unconsciousness, and bradycardia/hypoxia occurred in 11 and 10 patients, respectively. The median duration of ICU admission was 6.5 days, (IQR: 4, 8). Intravenous atropine and glycopyrrolate were administered in 10 and 2 patients, respectively. The median dose of atropine on days 1, 2, and 3 were 38.9 mg, 27.6 mg and 18.5 mg, respectively. Mechanical ventilation was initiated in 10 patients, 8 of whom were discharged home. Out of 13 patients, 10 survived, while 3 died. Conclusion This case series showed that sniper poisoning is a life-threatening condition that requires immediate diagnosis and treatment. Early referral for critical care, initiation of atropine, and supportive mechanical ventilation can save lives.

Ocular Argyrosis Secondary to Long-term Ingestion of Self-Concocted Silver Colloidal Solution

Colloidal silver has traditionally been promoted as a cure-all for various ailments and has recently made a comeback as alternative medicine in the protection against and treatment of conditions including COVID-19. Long-term ingestion of colloidal silver can result in the buildup of silver in bodily tissues over months and years and lead to ocular argyrosis and other pathological changes. We describe a case of a 75-year-old Caucasian man who presented with a history of chronic ingestion of his own concoction of colloidal silver. Ocular examination revealed the initial presence of bilateral early drusenoid changes within the macula, confirmed with optical coherence tomography. This report seeks to bring more awareness to the clinical manifestations and current research of this rare condition.

An outbreak of hepatitis E virus genotype 4d caused by consuming undercooked pig liver in a nursing home in Zhejiang Province, China

Hepatitis E infection is typically caused by contaminated water or food. In July and August 2022, an outbreak of hepatitis E was reported in a nursing home in Zhejiang Province, China. Local authorities and workers took immediate actions to confirm the outbreak, investigated the sources of infection and routes of transmission, took measures to terminate the outbreak, and summarized the lessons learned. An epidemiological investigation was conducted on all individuals in the nursing home, including demographic information, clinical symptoms, history of dietary, water intake and contact. Stool and blood samples were collected from these populations for laboratory examinations. The hygiene environment of the nursing home was also investigated. A case-control study was conducted to identify the risk factors for this outbreak. Of the 722 subjects in the nursing home, 77 were diagnosed with hepatitis E, for an attack rate of 10.66 %. Among them, 18 (23.38 %, 18/77) individuals had symptoms such as jaundice, fever, and loss of appetite and were defined as the population with hepatitis E. The average age of people infected with hepatitis E virus (HEV) was 59.96 years and the attack rate of hepatitis E among women (12.02 %, 59/491) was greater than that among men (7.79 %, 18/231). The rate was the highest among caregivers (22.22 %, 32/144) and lowest among logistics personnel (6.25 %, 2/32); however, these differences were not statistically significant (P > 0.05). Laboratory sequencing results indicated that the genotype of this hepatitis E outbreak was 4d. A case-control study showed that consuming pig liver (odds ratio (OR) = 7.50; 95 % confidence interval [CI]: 3.84–16.14, P < 0.001) and consuming raw fruits and vegetables (OR = 5.92; 95 % CI: 1.74–37.13, P = 0.017) were risk factors for this outbreak of Hepatitis E. Moreover, a monitoring video showed that the canteen personnel did not separate raw and cooked foods, and pig livers were cooked for only 2 min and 10 s. Approximately 1 month after the outbreak, an emergency vaccination for HEV was administered. No new cases were reported after two long incubation periods (approximately 4 months). The outbreak of HEV genotype 4d was likely caused by consuming undercooked pig liver, resulting in an attack rate of 10.66 %. This was related to the rapid stir-frying cooking method and the hygiene habit of not separating raw and cooked foods.

COVID-19 pandemic-related impacts and addiction severity among service users in selected substance use treatment facilities in Nairobi, Kenya

ABSTRACT Background The onset of COVID-19 brought about disruption in almost every sector globally. Among the affected places in Kenya were substance use treatment facilities where service users were discharged to avoid infection. This was accompanied by closure of bars and introduction of curfews among other measures. Data on the possible impact of these disruptions on Alcohol Use Disorders is still scant. This study aimed at examining the relationship between COVID-19 pandemic experiences and severity of Alcohol Use Disorders (AUDs) symptoms. Methods Data were collected from 176 residential service users in selected substance use treatment facilities in Nairobi using Epidemic – Pandemic Impacts Inventory (EPII) and the Modified Addiction Severity Index. Results The study revealed a weak positive and significant correlation between COVID-19 impacts and addiction severity. Conclusion The findings imply the need for substance use treatment facilities to include life disruptions such as COVID pandemic in their assessment and intake history. The study recommends that treatment facilities need to enhance family programmes with patients’ families in order to address the higher addiction severity reported on this domain. This will enhance their treatment programs to address the COVID-19 challenges and future pandemics on addiction.

Predictive Ability of Hypertriglyceridemic Waist, Hypertriglyceridemic Waist-to-Height Ratio, and Waist-to-Hip Ratio for Cardiometabolic Risk Factors Clustering Screening among Chinese Children and Adolescents*

ObjectiveHypertriglyceridemic waist (HW), hypertriglyceridemic waist-to-height ratio (HWHtR), and waist-to-hip ratio (WHR) have been shown to be indicators of cardiometabolic risk factors. However, it is not clear which indicator is more suitable for children and adolescents. We aimed to investigate the relationship between HW, HWHtR, WHR, and cardiovascular risk factors clustering to determine the best screening tools for cardiometabolic risk in children and adolescents. MethodsThis was a national cross-sectional study. Anthropometric and biochemical variables were assessed in approximately 70,000 participants aged 6–18 years from seven provinces in China. Demographics, physical activity, dietary intake, and family history of chronic diseases were obtained through questionnaires. ANOVA, χ2 and logistic regression analysis was conducted. ResultsA significant sex difference was observed for HWHtR and WHR, but not for HW phenotype. The risk of cardiometabolic health risk factor clustering with HW phenotype or the HWHtR phenotype was significantly higher than that with the non-HW or non-HWHtR phenotypes among children and adolescents (HW: OR = 12.22, 95% CI: 9.54-15.67; HWHtR: OR = 9.70, 95% CI: 6.93-13.58). Compared with the HW and HWHtR phenotypes, the association between risk of cardiometabolic health risk factors (CHRF) clustering and high WHR was much weaker and not significant (WHR: OR = 1.14, 95% CI: 0.97-1.34). ConclusionCompared with HWHtR and WHR, the HW phenotype is a more convenient indicator with higher applicability to screen children and adolescents for cardiovascular risk factors.

Porphyria Cutanea Tarda (PCT) in a Patient, Treated with Hemodialysis after a Kidney Transplant Rejection Reaction: A Case Report

Porphyrias are a group of inherited metabolic disorders of haem biosynthesis, involving a deficiency in the enzyme uroporphyrinogen decarboxylase. In this case report we present a case of a patient with porphyria cutanea tarda (PCT). A 40-year-old man on hemodialysis after a kidney transplant rejection reaction, complaining of skin changes, with a history of smoking and alcohol intake. Treated with Fusidic acid Betamethasone cream, and erythropoietin. Porhyria cutanea tarda can be considered in a patient who complains of skin changes. History of alcohol intake, smoking, high ferritin levels, and increased hepatic markers can raise suspicion of disease. In patients with ESRD treatment with erythropoietin, SPF 50+ sun cream, Fusidic acid, and Betamethasone can be effective.

MyPlate: A Diet Monitoring and Recommender Application

Introduction: Diet monitoring is of great interest in practicing a healthy diet to ensure good health by keeping track of the type and amount of food consumed. The food recommender system could provide personalized suggestions about food choices that best suit user preferences, making diet monitoring a valuable tool for maintaining good health, preventing diseases, and achieving a balanced lifestyle. Methods: This article presents a diet monitoring and recommender Android mobile application utilizing a Mask Region-based Convolutional Neural Network (Mask-RCNN) and portion analysis with a content-based filtering recommender algorithm. The application, named MyPlate, will provide a daily calorie limit and nutrition guidelines based on the user profile record, such as current and ideal weight. At the same time, MyPlate can also perform food image recognition and portion analysis from the picture captured and estimate the total calories. Finally, MyPlate provides a personalized food intake recommendation based on the previous intake record. Results: The developed MyPlate application can achieve accurate food image recognition, with the mean average precision at 0.825. Besides that, the proposed MyPlate application can perform portion analysis and provide food recommendations based on intake history at 80% similarity. Conclusion: The proposed MyPlate Android application has shown the effectiveness of incorporating machine intelligence into a diet monitoring technique that can promote healthy eating habits in the community.

Prevalence and determinant factors of Chronic Energy Deficiency (CED) in pregnant women

Pregnant women with Chronic Energy Deficiency (CED) are prone to malnutrition due to prolonged imbalances in the intake of essential nutrients. This study aimed to analyze the factors associated with the risk of CED in pregnant women. This study had a quantitative, cross-sectional design and was conducted from June to August 2023 in the working area of the Parung Panjang Health Center, Bogor Regency. The sample size in this study was 140 pregnant women using purposive sampling. The respondents’ characteristics were obtained through questionnaire interviews. MUAC was collected through MUAC tape, dietary intake using a Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ) form, and hemoglobin through a rapid test. Analysis was performed using the chi-square statistical test at 95% CI. The results of this study showed that the prevalence of CED was 20,7%. There was a significant relationship between maternal age, parity, gestational age, history of infectious diseases, knowledge, energy, and protein adequacy and CED in pregnant women (p &lt;0,05). There was no significant relationship between income, anemia status, fat and carbohydrate adequacy, and the occurrence of CED (p&gt; 0,05). In conclusion, the determinants of CED include maternal age, parity, gestational age, history of infection, knowledge, energy, and protein intake.

Efficacy and predictors of immune checkpoint inhibitors in patients with gallbladder cancer.

Immune checkpoint inhibitors (ICIs) have shown promising efficacy in multiple cancers including biliary tract cancers (BTCs). However, the data focusing on the efficacy of ICIs in patients with gallbladder cancer (GBC) is still limited. In this study, we aim to assess the efficacy of ICIs in GBC and explore the clinicopathologic and molecular markers associated with ICI benefit. We retrospective analyzed 69 GBC patients who had received ICI therapy between January 2016 and December 2020. Tumor samples were obtained for genomic sequencing and immunohistochemical analysis. The median progression-free survival (PFS) and overall survival (OS) was 4.4 months and 8.5 months, respectively. Multivariate analysis indicated that alcohol intake history, carcinoma embryonic antigen (CEA) level ≥100 U/mL, and cutaneous immune-related adverse events (irAEs) were independent prognostic factors for PFS. CEA level ≥100 U/mL and cutaneous irAEs were independent prognostic factors for OS. The objective response rate and disease control rate (DCR) were 15.9% and 37.7%, respectively. Patients with cutaneous irAEs, high CD8+ T cell infiltrated or immune inflamed GBCs had higher DCR. Patients with high CD8+ T cell infiltrated or immune inflamed GBCs also had a notably improved prognosis. These results suggest that ICIs were effective in patients with GBC. High CEA level, cutaneous irAEs, high CD8+ T cell infiltration, and immune inflamed phenotype could be useful for predicting the efficacy of ICIs in GBC.

Comparative analysis of post-mortem drug concentrations in cerebrospinal fluid and blood.

This study aimed to compare the concentration of various xenobiotics in both cerebrospinal fluid (CSF) and blood. We examined 175 autopsy cases covering a wide range of ages, causes of death, and drug ingestion histories, with cerebrospinal fluid and blood samples available for toxicological testing. Analytes studied included opioids, benzodiazepines, antidepressants, antipsychotics, and illicit substances such as cannabinoids, stimulants and new psychoactive substances, including synthetic cathinones and synthetic cannabinoids. We found that concentrations in CSF were generally lower than in blood. A significant correlation was observed between drug concentrations in CSF and blood for many analytes (p < 0.05). However, the strength and direction of the correlation varied considerably depending on the physicochemical properties of the drugs, suggesting that a 'one size fits all' model may not be applicable. The results indicate that cerebrospinal fluid (CSF) can be used to detect a variety of xenobiotics, particularly amphetamines, synthetic cathinones and synthetic cannabinoids, in cases where conventional biological materials are not available. Additionally, using the results obtained in the future can lead to a better understanding of pharmacokinetic processes and the effect of post-mortem redistribution. Further research is needed to refine our understanding of these relationships.

Pulmonary Radiological Manifestations of Paraquat Poisoning: A Pictorial Essay.

Paraquat (1,1'-dimethyl-4,4'-dipyridylium) is a liquid herbicide, linked to both accidental and intentional ingestion, which can result in severe and frequently lethal poisoning. It has been known to cause injury to the lungs, kidneys, and liver. We retrospectively reviewed five cases over the last 4 years with a history of paraquat ingestion. The time duration between ingestion and high-resolution computed tomography (HRCT) was assessed. HRCT chest scan was variable, ranging from 4 to 18 days postexposure. The follow-up of the patients was also reviewed.

A prospective comparative study of the intraoperative difficulties during laparoscopic cholecystectomy in patients taking homeopathic medications for cholelithiasis versus cholelithiasis patients with no history of homeopathic medication

Background: Gallstone disease is one of the most prevalent gastrointestinal diseases with a substantial burden to health-care systems. Patients present with right upper quadrant pain, dyspepsia, nausea or vomiting. Owing to the side effects of allopathic drugs, many patients resort to homeopathic treatment for relief of pain. There are several homeopathic drugs that decrease the pain of cholecystitis as well as high cholesterol in these patients but cannot cure them off the disease. Finally, they come to general surgeon for cholecystectomy. We have noticed that performing laparoscopic cholecystectomy (LC) in these patients is difficult and time consuming. Aims and Objectives: To determine whether or not homeopathic medicine intake for treatment of cholelithiasis act as an independent factor that leads to intraoperative difficulties during LC. Materials and Methods: Study design: A prospective randomized comparative study. Study period: July 2022–December 2023 (18 months). Study groups: Group H = Patients with history of (H/O) intake of homeopathic medicines for treatment of cholelithiasis = 60 patients, Group N = Patients with no H/O homeopathic medicine intake = 60 patients. Results: Twenty-six (43.33%) patients in Group H and 11 (18.33%) patients in Group N had a difficult LC. 7 (11.67%) patients in Group H and 1 (1.67%) patient in Group N had dense adhesions around the gallbladder (GB). 13 (21.67%) patients of Group H and 3 (5%) patients of Group N had a Frozen Calot’s Triangle (fibrosis and difficult Calot’s triangle dissection). This was statistically significant. Conclusion: Our study proved that intake of homeopathic medications for the treatment of cholelithiasis leads to dense adhesions around GB as well as fibrotic adhesions leading to difficult Calot’s triangle dissection leading to a difficult LC.

Statin Use and Liver Cancer Risk: A Meta-Epidemiological Study of Retrospective Cohort Studies by the Types of Constructed Cohort.

Previous systematic reviews of retrospective cohorts (RSC) indicate that statin use decreases the risk of liver cancer. However, the summary effect size (sES) of the randomized controlled trials was not statistically significant. This study aimed to conduct a subgroup meta-analysis based on the types of constructed cohorts. RSCs were selected from previous systematic reviews. Based on the characteristics of the source database (national vs. hospital) and the selection criteria of the subjects (population vs. patients), RSCs were categorized into three types of study cohorts: a national-based population cohort (NPo), national-based patient cohort (NPa), and hospital-based patient cohort (HPa). The sES and 95% confidence intervals were calculated using a random-effects model. The 28 cohorts from 23 RSC were classified into 15 NPa, 7 NPo, and 6 HPa. The sES of 15 NPa decreased the liver cancer risk with statin intake history with statistical significance, but 7 NPo lost statistical significance. The lack of statistical significance in NPo supports the argument that the conclusions of existing systematic reviews on RSC have low validity. It is necessary to conduct a subgroup meta-analysis of the NPo, NPa, and HPa proposed in this study when conducting a systematic review of RSCs, which will evaluate various outcomes of a specific drug intake with time-varying exposure.

Association of salted tea (noon chai), Helicobacter pylori infection and gastric carcinoma

Background: Gastric cancer remains the second leading cause of cancer-related deaths worldwide. Various dietary and environmental factors have been implicated in the pathogenesis of gastric cancer. Helicobacter pylori has strong association with peptic ulcer disease and gastric cancer. Methods: This study was conducted in department of general and minimal invasive surgery SKIMS Srinagar, from May 2019 to April 2022 comprising of 50 patients. All the patients were studied prospectively using set of questionnaires about the quantity and quality of salted tea. Final inferences were drawn after analysing the data using various statistical tools. Results: The most common age group was &gt;60 years of age with male preponderance. Majority of patients had no comorbidity. About 50% of the patients were smokers. The most common histology found was intestinal type. 20% patients had proximal (cardia) tumor and 80% had distal location. Only 14% of the patients came positive for intra-operative H. pylori testing. Among the H. pylori positive patients, 14.3% were &lt;40 years of age and 85.7% were &gt;40 years of age. The most common histological grade found in H. pylori positive patients was poorly differentiated with signet ring cell type. About 88% of all the patients had a history of Noon chai intake with 14% positive and 86% negative for H. Pylori. Conclusions: There is a positive relation between Noon chai and gastric carcinoma and an inverse relation between ca stomach and presence of H. pylori intraoperatively at the time of surgical intervention.

Ulcerative Gastritis in Sarcina Ventriculi: A Case Report

Background: Sarcina Ventriculi is a Gram-positive organism, which has not been found in gastric samples from patients with gastroparesis. We report the observation of a patient with ulcerative gastritis in Sarcina Ventriculi collected in the pathological anatomy department at the Mohammed VI University Hospital in Marrakech. Case Presentation: This is a 64-year-old woman, with a history of accidental ingestion of Hydrochloric acid, who presented with chronic epigastralgia. An upper endoscopy revealed diffuse gastric erythema. The biopsies revealed a reported inflammation with the formation of an ulcerated ulcer and the presence of Sarcina organisms. Conclusions: Sarcina Ventriculi is an increasingly common Gram-positive coccus recognized in gastric biopsies, especially in patients with delayed gastric abnormalities. It occurs most often in adult females and can be easily identified by its morphological features such as basophilic staining, cuboid shape, tetrad arrangement, red blood cell-sized bundles, flattened cell walls, and nature. refractile under an optical microscope. Although the pathogenesis of the organism is debated, it has been implicated in cases of gastric perforation, emphysematous gastritis and peritonitis, as well as in the development of gastric adenocarcinoma.

An interesting case of dengue masquerading a splenic brucellosis

Mixed infections or co-infections are not uncommon in dengue fever which can occur as a result of transient suppression of host immunity by unknown mechanisms or as a part of its complication. Brucellosis co infection or post dengue complication can occur due to the indigenous practice of consumption of raw unpasteurized cattle milk. Here is a case report of a 14-year-old girl who presented with dengue fever but then continued to have persistence of fever spikes with abdominal pain requiring administration of antibiotics as well as upgradation, on evaluation was found to have splenic abscess with prior history of ingestion of raw goat’s milk with serology suggestive of Brucellosis. This case report was done to elucidate the likelihood of co infection of zoonoses like dengue and brucellosis and the importance of consideration of brucellosis as a differential in cases of unresolving pyrexia post dengue fever especially in countries with wide prevalence of this practice of consumption of unpasteurized cattle milk.

Ethmocephaly: a rare but lethal congenital anomaly

Ethmocephaly is a rare but lethal congenital anomaly. Its incidence rate is 1 in 15,000 live births and 1 in 250 in abortuses. Babies have typical dysmorphic facies in form of orbital hypotelorism, proboscis and low set malformed ears. 32 years old, daily wage labourer delivered a baby with ethmocephaly. Baby had typical facies, and no extracranial abnormality present. Baby was stillborn. She had no antenatal checkup or ultrasonogram done. However, she had history of ingestion of certain plants during early months of pregnancy. Ethmocephaly is a lethal anomaly and mostly eliminated prenatally. Although there is no diagnostic test for ethmocephaly, and confirmation of it is done only by appearance of baby after birth, important clues like recognition of risk factors like maternal diabetes, alcohol intake, ingestion of certain plants, antenatal hydrocephalus, should not be missed. Importance of routine antenatal checkup and ultrasonogram is emphasized. Recognition of risk factors and a possible co-relation with ingestion of certain other plants is also emphasized.

The global gastric cancer consortium: an update from the Stomach cancer Pooling (StoP) project.

We updated to December 2023 the main findings of the stomach cancer pooling (StoP) project including about 13 000 cases and 31 000 controls from 29 case-control and 5 nested studies. The StoP project quantified more precisely than previously available the positive associations of tobacco smoking, high alcohol consumption, meat intake, selected occupations (e.g. agricultural and miners), gastric ulcer and family history with gastric cancer and the inverse associations with socioeconomic status and selected aspects of diet (fruits, including citrus fruits, vegetables, including allium and mushrooms, and polyphenols). No consistent associations were found with coffee, yoghurt and leisure-time physical activity, metformin or proton pump inhibitors use.