History Of Past Illness Research Articles

Environmental Risk Factors Associated with Behavioral Problems among Children with Attention Deficit Hyperactivity Disorder: Maternal Perceptions

OBJECTIVE This study aims to identify environmental risk factors associated with behavioral problems in children and adolescents with attention deficit hyperactivity disorder (ADHD). METHODS A case-control study was conducted in children aged 4-15 years comprising 92 children diagnosed with ADHD and 92 controls without ADHD. Stratified sampling was used to select 184 participants residing in Chiang Mai and Lamphun provinces, Thailand. Data were collected from the mothers of the participants using a self-report questionnaire between May and August 2022. The questionnaire consisted of three parts: child characteristics (gender, age, underlying diseases, past illness history), mother’s characteristics (age, income, occupational status, history of cigarette smoking and alcohol drinking), and maternal perceptions about caring for the child and the child’s behavioral problems (exposure to chemicals/toxicants, frequent punishment, excessive use of digital media and games). Data were analyzed using descriptive statistics, chi-squared test, odds ratio (OR) and logistic regression using SPSS version 21. RESULTS Most of participants were males (86.96%) while 13.04% were females. The results showed that the ADHD cases were significantly more likely than the controls to have underlying diseases such as G6PD, allergy, and asthma (p = 0.006). There was also a statistically significant correlation with smoking history in the mothers of ADHD cases (OR = 2.64; 95% CI: 1.36-5.13 p = 0.004). In terms of maternal perceptions, the mothers of ADHD children were significantly more likely than the controls to have frequently punished the child (OR = 6.26; 95% CI: 3.24-12.07; p < 0.001), to have children who were exposed to chemicals (pesticides and fertilizer) or toxicants (passive smoking) (OR = 4.14; 95%CI: 1.76-9.73; p = 0.001), and to have allowed their child to use digital media and play video games excessively (OR = 2.82; 95% CI: 1.55-5.16; p = 0.001). After adjustment for other environmental risk factors, frequent child punishment (ORadj = 4.32; 95% CI: 2.13-8.78; p < 0.001) and exposure of the child to chemicals/toxicants (ORadj = 2.66; 95% CI: 1.00-7.02; p = 0.049) were found to be significantly related with ADHD. CONCLUSIONS Frequent child punishment was the most significant environmental risk factor related to behavioral problems among children with ADHD. This indicates the importance of healthcare providers developing strategies and/or interventions to enhance knowledge and awareness in mothers of ADHD which can improve treatment outcomes. KEYWORDS ADHD, risk factors, behavioral problems, maternal percep- tions

The impact of gender differences on the clinical characteristics of critically ill patients with venous thromboembolism: A retrospective, observational study.

The aim of this study is to describe the general information, disease and treatment of venous thromboembolism (VTE) in critically ill patients, to explore the characteristics of severe patients with deep venous VTE and provide clinical reference data for the prevention and treatment of VTE in critically ill patients. This study carried out a retrospective study on the medical records of patients who were treated in the intensive care unit of Affiliated Hospital of Jining Medical College from 2020 to 2022. The general data, general conditions, drug use, past history, VTE prevention measures, post-VTE conditions, and Padua risk score of 297 patients with VTE during the period of hospitalization in intensive care unit (ICU) were classified and statistically analyzed. A total of 297 including 171 male and 126 male patient medical records were included in the analysis, we compared multiple clinical indicators between male and female patients. Compared to women, male patients have a higher acute physiology and chronic health evaluation II score(APACHE-II score) (P = .027), a higher state of consciousness (P = .003), a higher rate of smoking and drinking history (P < .001), a lower rate of heart failure (P = .003) and chronic depression (P = .013), and a higher rate of recommended operations for male patients after VTE (P = .031). The prothrombin time (PT) (P = .041) and activated partial thromboplastin time (APTT) (P = .040) of male patients were significantly higher than those of female patients, while triglyceride (P = .009) and total cholesterol (TC) (P = .001) were significantly lower than those of female patients. The difference in D-dimer (P = .739) was not significant. This study shows that male and female patients with VTE in the ICU have significant differences in general characteristics, general clinical conditions, history of past illness, thrombosis character, and examination items, this may be the reason for the different rates of VTE between male and female patients in the ICU.

A STUDY ON PULMONARY FUNCTION TEST AMONG PETROL-PUMP WORKERS IN TIRUNELVELI TOWN

Objective: In India, automobiles plying on roads are increasing every day. This has led to an increase in petrol-pump stations and an increase in pump workers. Petrol vapors and exhaust from vehicles have ill effects on the respiratory system. Petrol is a complex combination of hydrocarbons. Continuous exposure to petroleum vapours and exhaust from vehicles causes altered respiratory physiology. Methods: This study involved 50 petrol-pump workers (PPWs) with another 50 age-matched healthy adults. Their age, history of past illness, smoking exposure, and working hours were noted. Pulmonary function test was done using a computerized Spirometer to measure various parameters. Results: Parameters of pulmonary function in PPWs have a decline in mean values such as FVC, FEV1, peak expiratory flow rate, FIVC, forced expiratory flow (FEF) (25–75%), peak inspiratory flow, VC, and ERV when compared to the control group. It reflects the development of mixed patterns of lung disease (both obstructive and restrictive). Conclusion: It is suggested that reduction or control measures against air pollution including protective equipment, the future movement toward green fuels, and identifying and protecting susceptible workers occupationally exposed to petrol and diesel fumes would be beneficial to humanity and the ecosystem.

Status Epilepticus as a Presenting Feature in Posterior Reversible Encephalopathy Syndrome: Tertiary Care Center Experience.

Though epileptic seizures are common in posterior reversible encephalopathy syndrome (PRES), status epilepticus (SE) as the presenting feature is rare. To study the clinical spectrum and outcome of patients with SE as presenting feature of PRES. This is a retrospective study. PRES was diagnosed based on the clinical features and imaging findings on brain MRI (n = 40) which became normal after 6 months follow-up imaging. Patients with SE as the initial manifestation of PRES were identified. Baseline information regarding the clinical presentation, etiology, past history of illness, treatment history, imaging findings, EEG and long-term clinical outcome. Seizure was the most common presentation seen in 31 patients (77.5%). The etiologies in PRES were preeclampsia, or eclampsia [n = 33 (82.5%)], hypertensive encephalopathy [n = 3 (7.5%)], systemic lupus erythematosus (SLE), AIP, and chronic renal failure (CRF) in one patient each [n = 01 (2.5%)]. Brain MRI showed the involvement of parieto-occipital lobes (n = 33 [82.5%]) mostly. Status epilepticus (generalized convulsive) was the presenting feature in eight cases (20%). Among them, five cases (0.5%) had a history of chronic epilepsy. In the remaining three patients, SLE and acute intermittent porphyria, CRF precipitated the SE. The study highlights the clinico-etiological spectrum of PRES and the identification of SE within its context leading to the early diagnosis and management if treated early. The role of antenatal care is important for the identification and treatment of etiologies, blood pressure, proper antiepileptic drug compliance and appropriate counseling. Prasad P. Status Epilepticus as a Presenting Feature in Posterior Reversible Encephalopathy Syndrome: Tertiary Care Center Experience. Indian J Crit Care Med 2023;27(7):488-492.

Experience of the Postoperative Intensive Care Treatment of Stanford Type A Aortic Dissection.

To summarize the experience of the postoperative intensive care treatment of Stanford type A aortic dissection (STAAD) following Sun's procedure. A total of 124 patients with STAAD who underwent Sun's procedure from January 2014 to December 2021 at the General Hospital of Ningxia Medical University were retrospectively analyzed. All patients were admitted to the cardiac surgery intensive care unit (ICU) after surgery. According to the perioperative characteristics of the patients with STAAD, intensive care treatment was given to actively prevent the occurrence of postoperative complications. In all the cases enrolled in this study, the causes of aortic dissection comprised hypertension (105 cases), trauma (six cases), Marfan's syndrome (six cases), and aorto-arteritis (seven cases). The history of past illnesses comprised hypertension (105 cases), coronary disease (25 cases), diabetes mellitus (16 cases), and chronic obstructive pulmonary disease (six cases). There were some preoperative complications, such as cardiac insufficiency, acute liver insufficiency, acute renal insufficiency, pleural effusion, pericardial effusion, pulmonary infection, lower limb ischemia, mesenteric arterial embolism, and digestive tract hemorrhage. The average cardiopulmonary bypass time was 186 ± 32.1 min, the aortic clamp time was 74 ± 12.8 min, the deep hypothermic circulatory arrest time was 21 ± 2.6 min, and the mechanical ventilation time was 34 ± 2.8 h. The average ICU and hospital residence times were 7 ± 1.6 days and 12 ± 3.6 days, respectively. Postoperative complications comprised hypoxemia (34 cases), pulmonary infections (22 cases), tracheostomy (four cases), cerebral hemorrhage (four cases), cerebral infarction (four cases), transient delirium (eight cases), secondary thoracotomies due to bleeding (two cases), alimentary tract hemorrhage (eight cases), and acute renal insufficiency (38 cases). There was no occurrence of hoarseness or chylothorax. There were 15 cases of death, and the total mortality rate was 12.1%. In four cases, the cause of death was one postoperative complication (3.2%), and in 11 cases, the cause of death was multiple postoperative complications (8.9%). The other patients were discharged from the hospital with a good prognosis for full recovery. Postoperative intensive care treatment was an important part of the successful surgical treatment of STAAD.

The Analysis and Pattern of Sudden Deaths at a Teaching Hospital, Telangana

Sudden natural death is defined as a healthy person's death within 24 hours after the onset of a terminal illness without any history of past illness. This study looks forward to assess the demographic profile, causes of sudden natural deaths, and the pattern involved in these cases. Materials and Methods: This prospective hospital-based study was conducted at an emergency department, Mamata General Hospital attached to Medical College, Khammam; Telangana, from January 2021 to December 2021. During this study period, 148 cases of sudden death victims were reported. Data of all sudden deaths 148 cases were collected, of which, 128 (86.48%) were male. Most of the th victims were in the 4-5 decade, urban and lower socioeconomic groups, and laborers. Most of the cases occurred in the winter season. No ill health before death with alcohol abuse and smoking habits. The majority of onset of terminal signs and symptoms were reported at their home, during morning hours, and the most common symptom was unconscious, the cardiovascular system was involved in 45% of cases, the Pulmonary System in 28%, the Neurological System in 20% and the Gastrointestinal system 12%. Coronary artery disease was the single largest cause of death. This study shows a pattern of male manual workers of age between 31-40 who have encountered sudden death at their residence during the daytime during winter in the months of January, February, and March mostly found unconscious. This study revealed that a significant number of sudden deaths occurred in adults, particularly in the population above 30 years. Cardiac troubles contributed the maximum number, with atherosclerosis being the main culprit causing coronary artery disease.

S2075 Mixed Adeno-Neuroendocrine Carcinoma (MANEC) of Colon: Rare Differential Diagnosis for Iron Deficiency Anemia

Introduction: Colonic Mixed adenoneuroendocrine carcinoma (MANEC) is a rare but highly aggressive tumor. In English Literature only 10 cases or less have been reported of this neoplasm, with the prognosis still unfavorable. Mixed adenoneuroendocrine carcinomas, by definition, are comprised of at least 30% of both a neuroendocrine and an adenocarcinomatous component. Cases are typically diagnosed at advanced stages, and the age of presentation is younger than the average age of colorectal adenocarcinoma (∼60 years old). Metastasis can occur anywhere but usually seen in the liver, regional lymph nodes and rarely peritoneum. The tumor neuroendocrine markers and immunophenotype are essential for the diagnosis, for example chromogranin, synaptophysin, CDX-2, and CD56. Case Description/Methods: A 53-year-old women with a history of abdominal pain was diagnosed with NET via histopathology of the cecum. The patient was referred to us by her hematologist which he ordered CT/pelvis due to her new onset of iron deficiency anemia and CT scan showed irregular bowel wall thickening of proximal ascending colon with infiltration and nodularity of surrounding fat suspicious of colon neoplasm. The patient has diabetes mellitus and hypertension other than that she had no significant history of past illness. A colonoscopy and biopsy were performed that showed poorly differentiated carcinoma with ulceration in large bowel mucosa, morphologically, high grade poorly differentiated malignant neoplasm was noted with ulceration. Histopathology and Immunohistochemical studies show the tumor cells are positive for AE1/3, CK7, synptophysin, CDX-2, while negative for CK20, chromogranin, CD56. Ki-67 shows a high labeling index (−95%). The negative stain of tumor cells for MLH-1 and PMS2 can be associated with microsatellite instability related germ line mutation. The differential diagnosis includes poorly differentiated adenocarcinoma, mixed adenoneuroendocrine carcinoma and large cell endocrine carcinoma. A definitive classification depends on the total resection specimen (Figure 1). Discussion: Mixed adenoneuroendocrine carcinoma of the colon is a neoplasm consisting of 2 components coexisting simultaneously within a tumor. It is a very rare carcinoma that presents at a younger age than colorectal adenocarcinoma. Unfortunately, it is diagnosed usually at late stages when metastasis has occurred. If detected at early stages curative surgery can be the treatment. The prognosis Is poor due to late diagnosis and dual nature of the tumor.Figure 1.: Histology and Immunohistochemical studies.

Prevalence of Chronic Energy Deficiency and Associated Factors among Non-pregnant and Non-lactating Rural Women (18-49 Ages) in Mirab-Badwacho District, Hadiya Zone, Southern Ethiopia

Background: Non-pregnant and non-lactating women are the most vulnerable and neglected segments in most society. However, the non-pregnant and non-lactating women are the best window of opportunity to implement strategies, to correct maternal and child death and improve good pregnancy outcomes especially in Ethiopia. The aim of this study was to assess the prevalence of chronic energy deficiency and associated factors among rural women (18-49 ages) in Mirab-Badwacho district, Hadiya zone, Southern Ethiopia.Methods: A community based cross sectional study was employed. Multi-stage sampling technique was used to select 634 study participants. Data were collected by structured questionnaire by trained data collectors. Descriptive statistics was done and the association between the dependent and independent variables was measured using OR at 95% confidence interval. Results: The overall prevalence of chronic energy deficiency among non-lactating and non-pregnant women was 35.2% (95% CI: 31.5%, 38.9%). Age of the respondents (AOR=1.91, 95% CI: 1.06, 3.46), family size (AOR= 1.61, 95% CI: 1.14, 2.27), meal frequency per day in the past 24 hours (AOR=3.18, 95% CI: 1.26, 8.05), drinking treated water (AOR=1.82, 95% CI: 1.11, 3.08), and past history of illness (AOR=1.60, 95% CI: 1.13, 2.26) were statistical significantly associated with women’s chronic energy deficiency.Conclusion: Chronic energy deficiency was found to be high in the study area. Therefore, sustained health and nutrition education should be recommended to the communities on health care practices, proper water treatments, feeding practices and dietary diversifications in order to improve health and nutrition outcomes of non-pregnant and non-lactating women.

English

BACKGROUND Malignant otitis externa (MOE) is a rare disorder occurring in elderly immunocompromised patients mainly in diabetics. Other immunocompromised conditions are myeloid malignancies, iatrogenic suppression secondary to treatment of malignancies, organ transplant patients, and HIV (Human Immunodeficiency Virus) patients. Most common causative organism is Pseudomonas aeruginosa. Staphylococcus aureus, Staphylococcus epidermidis also have been reported. Aspergillus species is the most common fungal pathogen causing this condition. METHODS This is a cross sectional study to find out the clinical profile of patients treated for MOE in the department of ENT of Government Medical College, Thrissur, Kerala. Sample size was 32. Patients were given a self-made questionnaire containing questions on age, gender, clinical history, and history of past illness. After getting the filled form, informed consent was taken. They then underwent general examination as well as ENT evaluation with emphasis on otological examination which included examination of ear and surrounding area. Swab from external auditory canal (EAC) was sent for culture and sensitivity. Granulations were taken from EAC to rule out malignancy. Antibiotics and antifungals depending on the pathogen were given for adequate duration. RESULTS Males were more commonly affected (78 %). Mean age of population is 60.97 ± 10.2 years. Diabetes mellitus was seen in 21 patients, of which 16 showed uncontrollable diabetes. Otalgia was present in all the patients. 14 patients showed ear discharge. Facial palsy was present in 8 patients only. Increased ESR was seen in all patients. Culture and sensitivity of all patients showed growth of Pseudomonas only. CT (Computed Tomography) revealed soft tissue in external auditory canal of all patients. At the end of the study, complete remission was seen in 18 patients. Follow up was done in 3 months and 6 months. Facial palsy was relieved in 50 % patients. CONCLUSIONS MOE predominantly affects elderly immunocompromised patients especially patients with uncontrollable diabetes. Most common organism isolated was Pseudomonas aeruginosa. Otalgia which felt more in night (nocturnal otalgia), otorrhoea, granulation in external auditory canal are the important parameters for the diagnosis of this condition. HRCT (High-Resolution Computed Tomography) temporal bone is used to see the extent of disease and also for diagnosis. ESR and CRP levels indicate the prognosis. Complete remission seen in most of the patients and facial palsy3 was relieved in 50 %. This study can be used to predict the disease progression, and to formulate a treatment plan so that morbidity and mortality associated with it can be avoided as much as possible. KEYWORDS Malignant Otitis Externa, Necrotising Otitis Externa, Pseudomonas aeruginosa, Nocturnal Otalgia, Immuno Compromised Condition

Intracranial malignant solitary fibrous tumor metastasized to the chest wall: A case report and review of literature

BACKGROUNDSolitary fibrous tumor (SFT) is a rare fibroblastic mesenchymal neoplasm that affects spindle cell soft tissues with broad-spectrum biological behavior; it is predominantly benign, and rarely metastasizes. SFT occurs mainly in the tissue structure of the serosa in the pleura and the thorax, and can be found throughout the body, though extra-thoracic localization, including the cephalic region, is un-common. We reported the first case of intracranial malignant SFT metastasized to the chest wall.CASE SUMMARYAn 81-year-old Japanese man was referred to our hospital due to progressive gait disturbance and appetite loss. His medical history included partial resection due to brain tumor, four times, and 50-Gray radiation therapy at another hospital, starting when he was 74 years old. An unenhanced head computed tomography (CT) scan revealed an 8 cm × 5.1 cm × 6.5 cm mixed-density mass at the left frontal lobe, accompanying a midline shift, and an unenhanced chest-abdomen CT scan revealed a 6 cm × 4.1 cm × 6.5 cm low-density mass in the left chest wall. A CT-guided percutaneous lung biopsy was performed, and the pathological findings were SFT corresponding to brain tumor. Finally, the correct diagnosis of his brain tumor in history of past illness revealed to be SFT, and the unremovable tumor, namely present brain lesions enlarged and metastasized to the chest wall. We established a definitive diagnosis of intracranial malignant SFT metastasized to the chest wall. We notified him and his family of the disease, and offered palliative care. He passed away on the 29th hospital day.CONCLUSIONThis case suggests the need for careful, detailed examination, and careful follow-up when encountering patients presenting with a mass.

What makes clinical documents helpful and engaging? An empirical investigation of experience sharing in an online medical community

BackgroundSocial media have emerged as a platform for experience and knowledge sharing in the medical community. The online medical community is garnering increasing research attention; however, there is a lack of understanding of what factors influence the helpfulness and engagement of experience sharing in the community. MethodsClinical documents manifest physicians’ experience and knowledge. This study fills the knowledge gap by investigating what elements of clinical documents contribute to the helpfulness of sharing clinical documents online and what influence member engagement. Clinical documents follow certain architecture to specify their structure and semantics for exchange (e.g., HL7 C-CDA). Accordingly, the structural elements of clinical documents may influence document helpfulness for the online community. Member engagement is one of the indicators of community success. We collected 6514 clinical documents from a real-world online medical community, and normalized them with the structural elements of HL7 C-CDA. We performed regression analyses to identify the structural elements that have significant impacts on document helpfulness and member engagement. ResultsThe results show that some structural elements of clinical documents such as assessment, chief complaints, medications, physical exams, procedures, results, and vital signs sections have positive effects whereas assessment and plan, general status, history and past illness of patients, instructions, problem and review of systems have negative effects on the helpfulness of clinical documents. The results also reveal that structural elements such as family history, history of past illness, medication, physical exam, review of systems, and vital signs positively; whereas assessment, assessment and plan, instruction, and result negatively; influence member engagement. ConclusionsThe findings provide guide on how to improve the effectiveness of sharing clinical experience online. The new and in-depth insights may contribute to the success of online medical communities and the quality of medical decisions.

Catheter-induced urethral injury and tubularized urethral plate urethroplasty in such iatrogenic hypospadias

BackgroundCatheter-induced urethral erosion can involve meatus, glans and any extent of penile shaft. These injuries cause a lot of psychological, social and sexual trauma to the patient. Though the use of condom drainage system can render this spinal cord injury patient effectively dry, but can lead to penile or urethral complications. Many of these patients are kept on indwelling catheter. Long duration catheterization, poor catheter care in such paraplegic patients and other morbid patients may lead to urethral erosions. We conducted a prospective study of catheter-induced urethral injury from July 2014 to February 2016 in our tertiary care centre. The demographics, past history of illness, catheter material, and duration of catheterization, securing of catheter, local examination findings and associated comorbidities were recorded. Factors leading to urethral erosion were evaluated. And patients, who were fit and were willing for surgery, underwent tubularized urethral plate urethroplasty after 4–6-week supra-pubic diversion. The objective of the study was to evaluate factors of urethral erosion, and the results tubularized urethral plate urethroplasty in iatrogenic hypospadias.ResultsWe had twelve patients of catheter associated urethral injury in the study period. Age of the patients varied from 34 to 95 years with a mean of 61.25 years. Duration of catheterization ranged from 6 to 24 months with a mean duration 10.9 months. Catheters used were silicon coated, not secured to abdomen and had comorbid condition of neurological or cardiac origin in all patients. Long duration of catheter, poor quality of catheter and poor catheter care such moribund with poor body resistance patients were the main causative factor for urethral erosion. Urethral injuries varied from erosion of distal 2 cm to entire ventral urethra till penoscrotal junction with or without penile torque. Six of these patients underwent tubularized urethral plate urethroplasty with good cosmetic and functional postoperative outcome.ConclusionPatients of spinal cord injury, patients with comorbid condition like diabetes mellitus and ischaemic heart disease, poor catheter care and long duration catheterization are likely to have severe urethral injury. Extent of injury may vary from meatal erosion to erosion of entire ventral urethra till penoscrotal junction leading to iatrogenic hypospadias. These patients either may be put on clean intermittent catheterization or supra-pubic catheterization. Results of tubularized urethral plate urethroplasty in such iatrogenic hypospadias are very good.

Patient Satisfaction with Primary Health Care Services between Insured and Non-insured patients under Community-Based Health Insurance Scheme: A Comparative Cross-Sectional Facility Based Study in North East Ethiopia

Background: Universal Health Coverage is a situation where all people can access the health services they need without incurring financial hardship. The aim of the study was to compare the overall satisfaction with primary health care among insured and non-insured outpatient service beneficiaries in five Community-Based Health Insurance (CBHI) contracted health centers in North Eastern Ethiopia. Methods: facility-based cross sectional comparative study design was conducted from March through April 2017 among 311 insured and 301 non-insured outpatients. All statistical analysis was done using Statistical Package for Social Sciences research IBM version 20.0. Multi-variable linear regression analysis was employed to control confounders in determining predictors of patient satisfaction by insurance status. Chi-Square test, unstandardized coefficient (Uβ), standardized coefficient (Sβ) Standard error, with 95% Confidence Interval (CI) and P < 0.05 was used to claim statistical significance. Results: Out of 624 outpatients, 612 respondents with a response rate of 98% were enrolled in this study. The overall, insured and non-insured patient satisfaction was 475 (77.6%), 247 (79.4%) and 228 (75.7%), respectively. The mean score with Standard Deviation of the satisfaction score was 86.14 ± 14.99 among insured and 83.85 ± 17.16 among noninsured under CBHI scheme, respectively. An independent sample t-test showed statistically significant difference where insured patients have a higher mean satisfaction score than their counterpart noninsured with t= 2.031, df=610, P=0.043. And the consultation and diagnosis service are much more performed among noninsured than insured patients on the use of a stethoscope, proper examination, taking the history of past illnesses, asked history treatment taken before arrival at the health facility and explained diagnosis to patients by health care providers with X2= 4,509 to 14.664, P-value < 0.05. Conclusions: The study finding shows that insured patients perceived with a higher level of quality of care and satisfaction score. However, non-insured patients received high proportion score on objective quality of care measurements. Therefore, to improve patient experiences at health centers and achieve financial risk protection through CBHI, program managers and health care providers should ensure quality of services to the standards at the health facility to insured and noninsured community members.

Prevalence of depressive symptoms and its associated factors among male prisoners at Dillibazar prison, Kathmandu, Nepal

Background: Depression is characterized by continuous low mood, feeling of sadness and loss of interest. To find out the prevalence of depressive symptoms and its associated factors among male prisoners in Dillibazar prison.&#x0D; Methodology: A cross-sectional analytical design was conducted among 195 male prisoners of Dillibazar by using systematic random sampling. The self-administered questionnaire technique was used for data collection along with the standard Major Depression Inventory (MDI) tool of WHO for rating the level of depression. The data were coded, tabulated using Epi-data, the analysis was done by SPSS 16 version and chi-square test was done for the associations between the variables.&#x0D; Results: The overall findings revealed that the prevalence of depressive symptoms at Dillibazar prison was (45.6%). Among the total of (45.6%) with depression, (28.2%) of them met the criteria of severe depression, (6.7%) of moderate depression while rest (10.8%), met the criteria of mild depression. It was found that the duration of stay in prison, history of alcoholism, history of smoking, frequency of disputes is not statistically significant with depression and history of past illness, history of drug abuse and depression was found a statistically significant association with p-values less than 0.05 at 5% level of significance.&#x0D; Conclusion: This will be an initial step towards drawing the attention of the authorities towards the value of mental health among prisoners in Nepal.

Prevalence of Gastroesophageal Reflux Disease and Its Risk Factors In Rural Area

Background: Prevalence of gastroesophageal reflux disease (GERD) is escalating in Asia. The present study aimed toinvestigate the prevalence of GERD symptoms as well as potential risk factors associated with GERD in residents in a rural area in Jakarta. Method: The study population consisted of subjects who aged 20 years or more and lived in rural area Kebon Bawang-Tanjung Priok, Jakarta. A self-administered questionnaire based on earlier validated questionnaire (GERDQ) was given. The questionnaire consisted of demographic characteristic, self and environment sanitary, social and past illness history, and the symptoms score for GERD. Total score for GERD’s symptoms score was 18, with a score of at least 8 was considered to have symptomatic GERD.Results: The questionnaire was completed in 90 subjects. Of the 90 subjects, 12 (13.3%) had GERDQ score ≥ 8 which was the cut-off for definingpresence of GERD. On both univariate and multivariate analysis, age 50 years old (OR = 6.33; 95% CI 1.1-35.6), handwashing habit before eating (OR = 6.93; 95% CI 1.1-43.8), and raw/tap water (OR = 10.28; 95% CI 0.8-130) were significantly associated with the presence of GERD.Conclusion: Prevalence of GERD was high (13.3%) in rural area in Jakarta. Age 50 years old, handwashing habit before eating, and raw/tap waterwere risk factors for GERD in this population.

English

Respiratory symptoms are frequently manifested among solid waste collectors. They are suffering from respiratory diseases because of frequent exposure to waste materials containing pathogenic materials and chemicals hazards for human being. Cross-sectional study was carried out to assess prevalence of respiratory symptoms and associated factors among solid waste workers &nbsp;in Yeka sub city, Addis Ababa from March to April, 2016. The sub city has a total of 13 woredas. All woredas had different number of unions organized under small scale enterprises. Thirty eight micro and small enterprise unions from all woredas were selected randomly. Study subjects were taken from selected enterprise consecutively. Observational checklist and structured questionnaire were used to collect data associated with respiratory symptoms. Binary logistic regression was performed to identify the risk factors associated with respiratory symptoms; p-values less than 0.05 were considered statistically significant. The overall prevalence of respiratory symptoms among solid waste collectors in Yeka sub city was 40.7%. Multivariate analysis revealed that respiratory symptoms prevalence was 2 times less likely among individuals use facemask on job (adjusted odd ratio [AOR] 2, 95% confidence interval [CI]: 1.1-4). The prevalence of respiratory symptom was 2.6 times more likely among individuals having sleeping disorder (AOR 2.6, 95% CI: 1.5-4.42). The prevalence of respiratory symptoms was 4.8 times more likely among study subjects who had past illness (AOR 4.8, 95% CI: 3.2-7.22). Respiratory symptoms among solid waste collectors were high. So, individuals participating in collecting solid west should use facemask, while collecting the wastes, municipal should change working hours and individuals who had history of past illness should get health information during enrollment. &nbsp; Key words: Respiratory symptoms, solid waste, solid waste collectors.

Study of health status and morbidity pattern in 5-18 years Birhor children: A primitive tribe of Chhattisgarh

Background: A 5-18 years children constitute about 31.6% of the Indian population. This age group, particularly children of underprivileged class are at higher risk to suffer from malnutrition and health-related condition and needs to be developed and cultivate for the country to progress. Objectives: To study the health status and morbidity pattern in Birhor children (5-18 years) of Dharamjaigarh Block Raigarh, Chhattisgarh. Materials and Methods: This cross-sectional study was conducted among 50 Birhor children (boys and girls of 5-18 years age). Anthropometric indices were used to determine the health status and variants, i.e., socioeconomic condition, cultural feeding practices, and family literacy were studied which could have an influence on thehealth status. Morbidity pattern was also studied by assessing the current illness by clinical examination and history of past illnesses. Results: The prevalence of underweight was 32.5%, while stunting was found in 22% and thinness in 24% children. Prevalence of common morbidities was as follows: Pallor (66%), conjunctival xerosis (38%), caries teeth (32%), skin infections (24%), and lymphadenopathy (22%). History of acute febrile illness (non-malaria) was present in 46% cases, malaria in 16%, jaundice in 16%,envenomation/intoxication/animal bites in 16%, and history of hospitalization was present in 12% cases, and trauma/accidents was there in 12% cases in the past. Conclusion: In this study, we found a high prevalence of morbidities in Birhor tribal; though, the health status of these children when compared with other tribes of different states was not critical.

Percutaneous Sacroplasty for Non-neoplastic Osteoporotic Sacral Insufficiency Fractures

Background: Osteoporosis is an important problem in those of advanced age. Osteoporosis can induce sacral insufficiency fractures (SIFs). As average life expectancy increases, the number of patients with osteoporotic SIFs also increases. Osteoporotic SIFs cause severe low back pain and immobilization. Treatment of SIFs varies from analgesia to surgery. Objectives: To describe our experience and assess the safety and effectiveness of minimally invasive percutaneous sacroplasty in patients with osteoporotic SIFs. Study Design: Retrospective evaluation. Setting: The spine and joint specialized hospital’s research center. Methods: We reviewed cases of percutaneous sacroplasty performed since 2009. We used data only from patients with osteoporotic SIFs who were followed for more than 12 months after sacroplasty. Tumor-related SIFs were excluded from our analysis. The following clinical parameters were investigated: initial diagnosis, symptoms, visual analog scale (VAS) of pain, functional mobility scale (FDC) score, past history of illness, amount of bone cement infused, and complications related to sacroplasty. Also, the following radiological parameters were analyzed: the pattern of SIFs, T-score cement leakage, and concomitant fractures in other sites. Results: Sixty-eight patients were enrolled in our study (4 men and 64 women). The mean age of the patients was 76.8 ± 6.2 years. All patients had severe osteoporosis (mean T score: -3.9 ± 0.5). Percutaneous sacroplasty was performed under fluoroscopic guidance. No major complications or procedure-related morbidity occurred. FDS and VAS scores significantly improved after sacroplasty, and the improvements lasted through the final follow-up period (P &lt; 0.05). Limitations: This study is a retrospective analysis without a control group. Conclusion: Percutaneous sacroplasty is an effective minimally invasive treatment for osteoporotic SIFs refractory to conservative management. The study patients experienced significant relief of pain and increased mobility. Key words: Sacrum, sacroplasty, insufficiency fractures, osteoporosis, minimally invasive surgery

Factors associated with blood zinc, chromium, and lead concentrations in residents of the Nam Pong River in Thailand

ABSTRACTThis cross-sectional analytical study aimed to determine the blood levels of zinc (B-Zn), chromium (B-Cr), and lead (B-Pb) and to identify the factors influencing these levels in the blood of residents of the Nam Pong River. Quantitative data collection was utilized, and systematic random sampling was conducted to obtain 420 samples for measuring serum heavy metals, including B-Zn, B-Cr, and B-Pb. Multiple regression analysis was used to identify factors influencing the accumulation of heavy metals in the population, reported mean differences, 95% confidence intervals, and p values. The average levels of heavy metals were 74.38 ± 14.00 µg/dL (95% confidence interval [CI]: 73.03–75.72) for zinc, 0.28 ± 0.23 µg/L (95% CI: 0.26–0.30) for chromium, and 2.80 ± 1.60 µg/dL (95% CI: 2.64–2.95) for lead, which all were within normal limits. Factors influencing zinc levels included occupational exposure (batteries) (mean diff = 11.56; 95% CI: 1.81–21.32, p value = 0.02) and consumption of fish from the river exceeding 300 grams/meal or three times/week (mean diff = 4.68; 95% CI: 0.09–9.45, p value = 0.05). Factors influencing chromium levels included a history of past illness (mean diff = 0.19; 95% CI: 0.05–0.34, p value = 0.01) and dust/chemical exposure from industry (mean diff = 0.05; 95% CI: 0.00–0.11, p value = 0.05). Factors influencing lead concentrations included gender (mean diff = 1.82; 95% CI: 0.26–1.98, p value = 0.001), smoking (mean diff = 1.03; 95% CI: 0.60–1.45, p value < 0.001), and occupational exposure (garage) (mean diff = 1.11; 95% CI: 0.27–1.94, p value = 0.01).

A RARE CAUSE OF ANGINA IN A MIDDLE AGED MAN

The congenital anomalies of the origin of the coronary arteries are rare entities that can be asymptomatic or can manifest with sudden death. The present case shows a 46 years old male with no history of past illnesses who consults for precordial pain. The coronary angiography showed an anomalous origin of the right coronary of the left sinus of Valsalva, this finding was confirmed by a cardiac CT scan. Patient underwent surgery for surgical reimplantation of the right coronary artery with good clinical and radiological results.