Low Socioeconomic Population Research Articles

Periodontal health of a low socioeconomic level population in Yucatan (Mexico): A cross-sectional study.

With the objective of assessing the periodontal health status, treatment needs, and oral hygiene habits of the population of Mérida, in Mexico, a descriptive cross-sectional study was performed. Four hundred forty individuals individually completed a questionnaire on oral health, oral hygiene habits, and quality of life. Additionally, a complete clinical dental examination was performed for each. For the statistical analysis, continuous variables (means and standard deviation) and categorical variables (frequencies) were studied. The associations were made using the analysis of variance test for continuous variables and the Chi-square test for categorical variables. The critical value to identify statistically significant differences was P < .05. The main concern of the population was the possible untreated caries they thought they had, with 36.21% followed by pain with 14.62%. Possible periodontal issues were the main discomfort for only 9%. The percentage of the sample that required periodontal intervention by a specialist was 21.14%. Statistically significant differences were found between age, place of residence, socioeconomic level, and schooling. There are great deficiencies in oral health in the studied group, which is accompanied by a great need for periodontal treatment. Periodontal health is closely related to oral hygiene, so the related sociocultural level should also be taken into account for the study of oral health in the most vulnerable populations. It is crucial to establish strategies to promote oral health.

Abstract 12990: Income and Outcomes in Atrial Fibrillation and Atrial Flutter: Insights From the National Inpatient Sample

Background: Socioeconomic factors are well-established, important determinants of cardiovascular health. In the United States, the association of personal income on the outcomes of patients with Atrial fibrillation (AF), and atrial flutter is unclear. Hypothesis: Lower socioeconomic status is associated with worse outcomes of patients with AF and atrial flutter. Methods: Utilizing the National Inpatient Sample (NIS), a retrospective descriptive study was conducted. We identified patients admitted for AF and atrial flutter from 2016-2020, our cohort was categorized based on patient income, which was determined using the median income for the patient's zip code. The low-income group(&lt;$50000) included patients in the first quartile of income, while the high-income(≥$50000) group included patients in the second, third, and fourth quartiles of income. We excluded patients who were younger than 18 years of age. Baseline characteristics, presence of comorbidities, and outcomes of the two groups were described. Hypothesis testing for categorical variables was performed using Chi-Square. Continuous variables were tested with a t-test. Statistical significance was defined as a two-tailed P -value of &lt;0.05. The clinical outcomes we evaluated included inpatient mortality, length of stay (LoS), total cost of hospitalization, acute kidney injury (AKI), blood transfusion, and cerebral vascular diseases. Results: In-hospital mortality was observed in 1% of the low-income group and 0.8% in the higher-income group ( P -value &lt;0.0001). LoS was 3.57+/- 0.013 in the low-income group and 3.27+/- 0.008 in the higher-income group. Total cost was $15081.22 in the low-income group and $16307.40 in the higher-income group, AKI (13.8% vs 12.6% in high-income group P -value &lt;0.0001), blood transfusions (1.4% vs 1.1% in the high-income group P -value &lt;0.0001), cerebrovascular disease (4.7% vs 4.5% in high-income group P -value &lt; 0.0006). Conclusion: Our cross-sectional study observed that patients in a lower socioeconomic population had higher mortality during hospitalizations, and increased risk of cerebrovascular disease.

Unused portions of vegetables can void malnutrition: Production, acceptability, and nutritional analysis

Nutritional deficiency is a serious public health concern in many developing nations due to the high cost of food for those in lower socioeconomic classes. 1.3 billion tons of food are reportedly lost or wasted annually, beginning in the production phase and continuing into the consumer sector. Yet, worldwide, malnutrition-related problems claim the lives of 75% of youngsters. In Asia, including India, cauliflower, turnips, radishes, and peas are frequently consumed and grown in enormous amounts. However, the leaves and pods of these vegetables are normally discarded. They include large macronutrients, vitamins, minerals, and antioxidant-rich phenolic chemicals. In this study, unwanted vegetable parts—primarily leaves and pods—typically thrown away in trash cans were repurposed to create a product that can help the low-socioeconomic population overcome nutritional deficiencies. Many product varieties were made using unused turnips, radish, peas, and cauliflower leaves. The items with the best acceptability were those that were high in calcium, iron, vitamin A, vitamin C, phenol, and antioxidants. Therefore, it can be stated that the product, which was created utilizing an abandoned vegetable portion (leaves and pods), is nutrient-dense, affordable, and capable of addressing nutritional inadequacies.

Prevalence of Polycystic Ovarian Syndrome, Its Associated Conditions And Complications: an Experience from a Low Socio-Economic Population of Sikandrabad, Karachi, Pakistan

OBJECTIVES To study the prevalence of polycystic ovary syndrome, its associated conditions and complications in the low socio-economic population of Sikandrabad, Karachi. METHODOLOGY This cross-sectional study was conducted in a primary health care centre of Ziauddin University, Sikandrabad-Karachi, Pakistan, from January-June 2021. The ethical committee of the university approved this study. All female patients with gynaecological complaints having an age between 18 to 49 years were included. Females with a history of unilateral oophorectomy, uterine abnormality and abnormal karyotype or known malignancies were excluded from the study. A sample size of 118 was calculated using open-epi software. A performed questionnaire was used to collect data from females with gynaecological complaints. PCOS was diagnosed using Rotterdam criteria. Routine examination tests were done at the Primary Health Care Clinic (PHCC) of Ziauddin Hospital, and obesity was labelled through BMI calculation. RESULTSOf 118 females in the reproductive age group screened, 55.93% reported PCOS as a major gynaecological problem, followed by endometriosis at 16.94%, uterine fibroid at 14.46% and urinary tract infections at 9.32% respectively. Patients had infertility as a major complaint, with 54.54% cases followed by menstrual abnormalities at 21.21%, obesity at 16.66% and others at 7.57%. Most patients (38%) were obese, and 34% were overweight. CONCLUSION PCOS is a prevalent complicated endocrine disorder in women in the reproductive age group, and it presents with varying gynaecological complications like infertility, menstrual disturbances, hirsutism, and acne. Obesity, hormonal imbalance and poor dietary intake affect the disease outcomes further. More multi-centred studies are needed to know the exact prevalence and causal relations.

Risk Factors for Patients Severe and Critical with Covid-19

In the fight against infectious diseases, the formation of collective immunity among the population is the main tool in the fight against diseases and the prevention of deaths. At the same time, even after vaccination, the occurrence of diseases among the population remains one of the current problems. Aim: To identify and assess risk factors for those with severe and very sever COVID-19. Materials and methods: Statistical analysis of the primary medical data of 1862 patients treated at the Republican Special Hospital for Infectious Diseases Zangiota №2, a retrospective research method was used. Results: When analyzing the patients infected with COVID-19 disease by age and gender groups, it was found that among the age groups under 20 years of age, the prevalence of the disease is almost the same among both sexes, where men are 4.88±0.2%, women are showed that 4.81±0.2%. When analyzing the patients infected with COVID-19 disease by age and gender groups, it was found that the prevalence of infection among both sexes is almost the same among the age groups under 20 years, where men are 4.88±0.2%, women are 4.81 showed that it is ±0.2%. We can explain the fact that the lifestyle and activities of these age groups in our country are almost the same, that is, they study in schools, lyceums and colleges. Among patients aged 20-49, the percentage of men is high (34.4±0.45%), while the percentage of women is slightly lower (29±0.43%). Conclusion: Factors that cause severe and very severe degree of COVID-19 include the elderly population, male sex, regular smokers, low socio economic populations, and people with chronic diseases was found to be.

Poverty and population health – The need for A Paradigm shift to capture the working poor and better inform public health planning

BackgroundCommunity-level socioeconomic disparities have a significant impact on an individual's health and overall well-being. However, current estimates for poverty threshold, which are often used to assess community-level socioeconomic status, do not account for cost-of-living differences or geography variability. The goals of this study were to compare geographic county-level overlap and gaps in access to care for households within poverty and working poor designations. MethodsData were obtained for 21 continental United States (US) states from the United Way's Asset Limited, Income Constrained, Employed (ALICE) households for 2021. Raw data contained the percentage of households at the federal poverty level, the percentage of households at the ALICE designations (working poor), and the total households at the county level. Local Moran's I tests for spatial autocorrelation were performed to identify the clustering of poverty and ALICE households. These clusters were overlaid with a 30-min drive time from critical access hospitals' physical addresses. FindingsCounty-level clusters of ALICE (working poor) households occurred in different areas than the clustering of poverty households. Of particular interest, the extent to which the 30-min drive time to critical care overlapped with clusters of ALICE or poverty changed depending on the state. Overall, clustering in ALICE and poverty overlapped with 30-min drive times to critical care between 46 and 90% of the time. However, the specific states where disparities in access to care were prominent differed between analyses focused on households in poverty versus the working poor. InterpretationsFindings highlight a disparity in equitable inclusion of individuals across the spectrum of socioeconomic status. Furthermore, they suggest that current public health programming and benefits which support low socioeconomic populations may be missing a vulnerable sub-population of working families. Future studies are needed to better understand how to address the health disparities facing individuals who are above the poverty threshold but still struggle economically to meet based needs.

Associations between the Gut Microbiota, Race, and Ethnicity of Patients with Colorectal Cancer: A Pilot and Feasibility Study.

Colorectal cancer (CRC) is more prevalent among some racial and ethnic minority and low socioeconomic status populations. Although the gut microbiota is a risk factor for CRC and varies with race and ethnicity, its role in CRC disparities remains poorly understood. We examined the feasibility of recruiting sociodemographically diverse CRC patients for a microbiome study involving a home stool collection. We also explored whether race and ethnicity were associated with gut microbiome composition. We recruited Black/African American, Hispanic/Latino, and non-Hispanic White patients who were receiving care for active CRC to complete a comprehensive dietary and lifestyle survey, self-collect a stool sample, and complete an exit interview. Gut microbial diversity and composition were analyzed using 16S rRNA gene sequencing. 30 individuals consented (of 35 who were eligible and contacted) with 5 (17%) Black/African American, 11 (37%) Hispanic/Latino, and 14 (46%) non-Hispanic White. A total of 22 (73%) completed the dietary and lifestyle survey; 18 (63%) returned a stool sample. Even after controlling for socioeconomic, dietary, or treatment-related covariates, microbiome composition was associated with race and ethnicity. Fusobacteriota (a phylum associated with the development and progression of CRC) was significantly higher in the Black/African American group compared to others, and microbial diversity was higher in samples from non-Hispanic White individuals compared to Hispanic/Latino individuals. Our study shows that it is feasible to recruit and collect stool samples from diverse individuals with CRC and found significant associations in gut microbial structure with race and ethnicity.

Outreach of the programmatic components of National Health Mission in India: An inter‐ and intra‐state analysis using nationally representative data

In 2005, India launched the National Health Mission (NHM) to achieve equity in access to primary and secondary healthcare, with special focus on maternal and child healthcare (MCH). Studies have shown that NHM has increased access to MCH services; however, the access is still low among low socioeconomic population groups. Since outreach among target population is crucial to improve access to MCH, we analyzed the level and the inter‐ and intra‐state socioeconomic inequity in the outreach in two major NHM components: conditional cash‐transfer program‐JSY, and community health workers‐ASHAs and ANMs. We used administrative records and nationally representative cross‐sectional sample surveys in the early‐ and after the targeted full‐implementation phases of NHM, and employed descriptive and multivariate methods. We found that the NHM had covered only less than one‐half of the eligible women, with considerable inter‐state variations. For instance, in the high‐focus states in 2015–16, the receipt of JSY benefits, ASHAs services, and ANMs services among eligible women was 41.5%, 40.6%, and 48.8%, respectively, whereas the respective outreach among the bottom wealth quintile was 39.8%, 45.1%, and 44.4%. However, there was attenuation in inequity overtime, favoring the poor in the outreach of JSY benefits and ASHAs services. Furthermore, underscoring the importance of program outreach, we find that district with higher level of program outreach was associated with increased uptake of MCH services among target population. Our findings imply for implementing policy measures for wider program outreach so that the NHM could serve as pathway to attain universal health‐care coverage for India.

Congenital Syphilis in the Medicaid Program: Assessing Challenges and Opportunities Through the Experiences of Seven Southern States.

Rates of congenital syphilis cases are increasing, particularly among lower socioeconomic populations within the southern United States. Medicaid covers a significant portion of these births, which provides an opportunity to improve birth outcomes. This project sought to collect information from key stakeholders to assess facilitators of and barriers to Medicaid funding of prenatal syphilis screening and to provide insight into improving screening and lowering incidence through the Medicaid program. Seven southern states (Alabama, Georgia, Kentucky, Louisiana, North Carolina, South Carolina, and Tennessee) were identified for this assessment. Researchers conducted a legal and policy analysis for each state to gather information on factors affecting congenital syphilis prevention, identify knowledge gaps, and inform the development of interview guides. Seventeen structured interviews with 29 participants were conducted to gather information on facilitators and barriers to receiving timely prenatal syphilis screening through the Medicaid program. Interview transcripts were analyzed and compared to identify key themes. Barriers to timely prenatal syphilis screening include varied laws among the states on the timing of screening, Medicaid reimbursement policies that may not adequately incentivize testing, Medicaid enrollment issues that affect both enrollment and continuity of care, and lack of clear understanding among providers on recommended testing. This work provides insight into systemic issues that may be affecting rates of prenatal syphilis screening and incidence among Medicaid enrollees and others in the U.S. South. To address rising congenital syphilis cases, policymakers should consider requiring third trimester syphilis screening, adopting policies to enhance access to prenatal care, adapting Medicaid payment and incentive models, and promoting collaboration between Medicaid and public health agencies.

Microbiological study of empyema thoracis among children in a tertiary care hospital

Background: Empyema thoracis is a condition resulting in the accumulation of purulent fluid in the pleural cavity. It is a common source of illness among young children and is the most common sequela of bacterial pneumonia. Aims and Objectives: This study was to determine the clinico-microbiological profile, causative agents, and antimicrobial susceptibility patterns of the isolates of the study population. Materials and Methods: Prospective observational study was done in the Department of Microbiology, S. C. B. M. C. H., Cuttack. The study group comprised a total of 105 cases of empyema thoracis between the age group of 0–14 years, diagnosed by aspiration of pus from the pleural space. Complete histories of cases in detail were noted. Results: A total of 41% of patients were in the age group of 5–9 years with M: F ratio of 1.1:1. Maximum cases 36 (34.3%) were seen in the spring season. Fever, cough, and breathlessness were the most common complaints. Bronchopneumonia 56 (53.3%), impetigo, and skin lesions 29 (27.6%) were the major predisposing factors. Right-side empyema 71 (67.6%) was more common than the left side 34 (32.4%). Culture revealed Staphylococcus aureus as the most common etiologic agent 26 (36.1%), of which 30.8% were methicillin-resistant S. aureus, followed by Mycobacterium tuberculosis complex 13 (18.1%). Finally, 103 (98.2%) empyema cases were recovered by antibiotics and tube thoracostomy. Conclusion: Empyema thoracis is more prevalent in the lower socioeconomic population which can be prevented by an early diagnosis of pneumonia. Effective methods to treat empyema thoracis in children include the administration of proper antibiotics and tube thoracostomy in resource-poor settings.

Digital health technologies for peripartum depression management among low-socioeconomic populations: perspectives from patients, providers, and social media channels

BackgroundPeripartum Depression (PPD) affects approximately 10–15% of perinatal women in the U.S., with those of low socioeconomic status (low-SES) more likely to develop symptoms. Multilevel treatment barriers including social stigma and not having appropriate access to mental health resources have played a major role in PPD-related disparities. Emerging advances in digital technologies and analytics provide opportunities to identify and address access barriers, knowledge gaps, and engagement issues. However, most market solutions for PPD prevention and management are produced generically without considering the specialized needs of low-SES populations. In this study, we examine and portray the information and technology needs of low-SES women by considering their unique perspectives and providers’ current experiences. We supplement our understanding of women’s needs by harvesting online social discourse in PPD-related forums, which we identify as valuable information resources among these populations.MethodsWe conducted (a) 2 focus groups (n = 9), (b) semi-structured interviews with care providers (n = 9) and low SES women (n = 10), and (c) secondary analysis of online messages (n = 1,424). Qualitative data were inductively analyzed using a grounded theory approach.ResultsA total of 134 open concepts resulted from patient interviews, 185 from provider interviews, and 106 from focus groups. These revealed six core themes for PPD management, including “Use of Technology/Features”, “Access to Care”, and “Pregnancy Education”. Our social media analysis revealed six PPD topics of importance in online messages, including “Physical and Mental Health” (n = 725 messages), and “Social Support” (n = 674).ConclusionOur data triangulation allowed us to analyze PPD information and technology needs at different levels of granularity. Differences between patients and providers included a focus from providers on needing better support from administrative staff, as well as better PPD clinical decision support. Our results can inform future research and development efforts to address PPD health disparities.

The COVID-19 Israeli tapestry: the intersectionality health equity challenge

BackgroundCOVID-19 is disproportionately affecting disadvantaged populations, with greater representation and worse outcomes in low socioeconomic and minority populations, and in persons from marginalized groups. General health care system approaches to inequity reduction (i.e., the minimization of differences in health and health care which are considered unfair or unjust), address the major social determinants of health, such as low income, ethnic affiliation or remote place of residents. Yet, to effectively reduce inequity there is a need for a multifactorial consideration of the aspects that intersect and generate significant barriers to effective care that can address the unique situations that people face due to their gender, ethnicity and socioeconomic situation.Main bodyTo address the health equity challenges of diverse population groups in Israel, we propose to adopt an intersectional approach, allowing to better identify the needs and then better tailor the infection prevention and control modalities to those who need them the most. We focus on the two main ethnic – cultural—religious minority groups, that of Arab Palestinian citizens of Israel and Jewish ultra-orthodox (Haredi) communities. Additionally, we address the unique needs of persons with severe mental illness who often experience an intersection of clinical and sociodemographic risks.ConclusionsThis perspective highlights the need for responses to COVID-19, and future pandemic or global disasters, that adopt the unique lens of intersectionality and equity. This requires that the government and health system create multiple messages, interventions and policies which ensure a person and community tailored approach to meet the needs of persons from diverse linguistic, ethnic, religious, socioeconomic and cultural backgrounds. Under-investment in intersectional responses will lead to widening of gaps and a disproportionate disease and mortality burden on societies’ most vulnerable groups.

Ecological Momentary Assessment in Research Methodology: A Literature Review

Introduction: Ecological Momentary Assessment (EMA) is a real-time data capture longitudinal methodology which is conducted through smartphones or wearable sensors. This methodology uses prompts to gather information on the current state, behavior and experience of a person in their natural environment. The purpose of this study is to explore the feasibility of using EMA as a methodology in measuring behavioural contexts around physical activity. Utility: EMA is advantageous in reducing recall errors, enhancing the validity of self-reports by actively recording a participant’s dynamic interaction with their environment, while accounting for intra- and inter-personal variation. EMA can provide researchers with more accurate information that is generalizable to real-life routines, and provides insight on processes that can undermine behavior change. Additionally, EMA is convenient due to the omnipresent accessibility of smartphones or related technologies, which are easy to use and can quickly collect data from large populations remotely. The use of EMA can answer researchers’ questions regarding participant current context, affective states, and psychological processes. This can ultimately help create innovative and feasible solutions which can be implemented into participant’s natural environments and daily lives to benefit their physical, mental and emotional well-being. Challenges: EMA requires smart technology equipment which can be expensive to supply, repair, or replace. Real-time prompts pose the challenge of subjects’ full compliance to prompts, struggling to respond in the case of competing activities, not carrying the device or device malfunctions such as battery drainage or software problems. Moreover, EMA raises concerns in its practicality with low-socioeconomic populations that cannot afford such technology, elderly populations who cannot operate these devices, or clinical populations whose psychopathology may interfere with their responses. Limitations: The use of EMA is associated with biases concerning ecological validity. For example, consistent prompts on a certain activity may cause an individual to think about the activity more or alter their behavior. In the absence of researchers, it is difficult to verify data reported by participants. It is possible to mitigate such biases by seeking confirmation through reliable sources who are in contact with the participants, to approve a subset of the data.

Levels and trends in key socioeconomic inequalities in childhood undernutrition in Ethiopia: evidence from Ethiopia demographic and health surveys 2000-2019

IntroductionThe global burden of childhood undernutrition is mainly concentrated in low-income and lower-middle-income countries. In Ethiopia, childhood undernutrition varies significantly across different population groups. The present study is aimed at examining the levels and trends in key socioeconomic inequalities in childhood undernutrition in Ethiopia.MethodsThis cross-sectional study was based on a total pooled sample of 48,782 under-five children drawn from five rounds of the Ethiopia Demographic and Health Surveys (2000–2019). We used multilevel binary logistic regression analysis to determine the key socioeconomic determinants of undernutrition among under five children. In addition, we applied concentration index and decomposition rate analysis techniques to explore the levels and trends in key socioeconomic inequalities in childhood undernutrition.ResultsPlace of residence, household wealth status (approximated by asset-based wealth index), and maternal education, among others, were the key socioeconomic variables significantly associated (p < 0.001) with childhood undernutrition in Ethiopia. The level of inequality was the highest with children from rural areas, poor households and uneducated mothers. Absolute socioeconomic inequality in childhood undernutrition prevalence rate was declined by 9.72 during the study period (2000 to 2019).ConclusionChildhood undernutrition was unequally distributed among under-five children in Ethiopia, and largely concentrated among low socioeconomic status population groups. The identified key socioeconomic drivers of inequality in childhood undernutrition can be used to inform localized interventions and communication strategies to improve nutritional status of under-five children in Ethiopia. The study underscores development of poverty reduction strategies that directly address the existing challenges of the food insecurity and childhood undernutrition for the low-income population groups in the country.

Assessment of Knowledge and Risk Factors of Osteoporosis Among the Adult and Elderly

A bone-healthy lifestyle is essential for everyone, like babies, children, teenagers, and young adults, and is particularly important for patients with osteoporosis, the most common skeletal disorder characterized by low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Low bone mass and skeletal fragility in adults may be due to low peak bone mass in early adulthood, excessive bone loss in later life, or both. Even though osteoporosis is a preventable disease, its high prevalence has resulted in massive morbidity, mortality, and decreased quality of life due to a lack of disease knowledge and awareness among the general public. Evidence based on other disorders shows that learning about the disease can help in early recognition and information about risk factors leads to prevention through lifestyle and behaviour modifications. A six-month cross-sectional study was performed with the objective of assessing the knowledge of osteoporosis, identifying the risk factors and exploring the association between sociodemographic factors and knowledge levels of osteoporosis among adults and the elderly by using the Revised Osteoporosis Knowledge Test. Participants were categorized into different socioeconomic classes by using the Kuppuswamy scale. In our study, from a total of 553 participants' responses, 217 (39.24%) were men, and 336 (60.75%) were women, with no significant variation in mean age distribution. Most participants belong to the upper-middle-class category, with a comparatively high percentage of women, followed by the lower-middle-class sort. The knowledge and understanding of osteoporosis and its contributory risk factors are poor among current study participants, which stresses the need to improve understanding among men and women through awareness programs, mainly targeting the low socioeconomic category populations.

Transforming Primary Care: Developing Health Precincts as Models for Sustainable Integrated Community-Based Healthcare

Holistic healthcare precincts are an emerging service model to address the growing health service demands of ageing consumers and an increasing prevalence of chronic diseases. In Australia and similar countries with universal publicly funded Medicare systems, the first point of access to healthcare is provided by general medical practitioners. This case report focuses on successful components of a private, integrated, patient-centred primary care model located in a low socioeconomic population in North Brisbane, Queensland. Successful components included a focus on sustainability, general practice as an anchor tenant in the health precinct, the integration of multiple services, team-based care for shared clinical services, flexible expansion options, the use of MedTech, support for small businesses and a cluster structure. The Morayfield Health Precinct (MHP) offers appropriate, safe and individualised healthcare to residents across their life continuum. Its success was built on a foundation of pre-planning, to ensure the design/build, anchor tenant and collaborative ecosystem were sustainable in the long term. MHP planning was based on an adaptation of the WHO-IPCC framework supporting true patient-centred, integrated care. Its shared vision and collaborative care are supported by its internal governance structure, tenant selection, established and emerging referral networks and partnerships. Evidence-based and informed care is further supported by internal and external research and education partnerships.

Management of Hypertension in Women. Pakistan Hypertension Clinical Practice Guidelines

Hypertension has been recognized as a global health concern. In developing countries, it is not addressed and described to the extent that the actual prevalence of the disease makes it necessary. In these countries, control of blood pressure (BP) remains suboptimal. Worldwide BP reduction is a serious issue, and the situation is more alarming situation in our country. Pakistan is one of them, more than 46% of the Pakistani population are hypertensive. In 2010, hypertension was the leading cause of death and disability worldwide, and a greater contributor to events in women. South Asia contributes 24% of world population and is undergoing a rapid epidemiological transition with significant rates of hypertension in different countries. The prevalence of hypertension in low socioeconomic population in Pakistan is 39% in women vs. 37% in men. There is no proper data regarding hypertension in women in Pakistan, except for a few populations based surveys conducted which showed the prevalence of hypertension. The pooled prevalence in Pakistani women is 24.76% vs. 24.9% for men for an age bracket of above 40 years. The occurrence is higher in urban compared to rural areas. General practitioners (GP) in Pakistan underdiagnose and undertreat high BP, especially in the elderly women. Only in 37% of patients, the treatment was initiated by a GP. 23% of this group received only sedatives alone or combination of sedatives and hypertension control medication. We lack published guidelines regarding hypertension. Hypertension still remains the major preventable cause of cardiovascular disease. Hypertension is a leading cause of mortality globally, and especially in our continent. The purpose of these guidelines is to highlight the neglected population (i.e., Women) of Pakistan, who are physically and hormonally different from men. They have more complications as a result of hypertension. Early diagnosis and proper treatment and adherence to the treatment is therefore important. The task of developing guideline on hypertension is by Go Red Chairperson and Scientific Council Pakistan in collaboration with Pakistan cardiac society. This is first clinical practice guidelines for management of hypertension which is a need of our time with the objective to control the epidemic of hypertension in women. This scientific document on hypertension in women with local recommendation which are made local studies and randomized trials and south Asian studies. These educational tool help the health care providers GP and doctors because all see the women in theirs practice and using this guideline facilitate them for treatment because specially in elderly women usually received only sedative alone or in combination with antihypertensive medicines by GPS. Our efforts will encourage GPs and medical practitioners to practice these guidelines in their clinical judgment about risk and complications, as well as in the determination and implementation of preventive, diagnostic or therapeutic medical strategies for control of hypertension. What is new in this guideline is that we focused on treatment of hypertension according to our circumstance as women have limited access to health care and are undertreated. That is the reasons why more women develop complications of hypertension as delay in diagnosis, initiation of recommended treatment and the control is only in 50% in women. These guidelines focused on risk factors and complication throughout the life cycle of women. Lifestyle management should be started in adolescent and more focus should be given to adherence to treatment. This is crucial for control of hypertension. New topics like management of hypertension in chronic kidney diseases is added. Recommendation-based treatment should be started in such cases. The initiation of widespread and intensive continuing medical education for all physicians involved in the management of women patients with hypertension will be the main benefit from this guideline.

“A STUDY OF CLINICAL, MYCOLOGICALAND TRICHOSCOPIC FEATURES OF TINEA CAPITIS IN CHILDREN”

Background: Tinea capitis (TC) is a common supercial fungal infection seen predominantly in children. The etiological factors vary from one region to the other. The clinical microbiological and trichoscopic features of the same were studied in children attending dermatology department of JJMMC Davangere. Aims: To delineate the various patterns of TC observed in central karnataka and to assess the clinical, microbiological and trichoscopic ndings in children. Methodology: Retrospective study was conducted between November 2020 - November 2021, medical records were analysed for the clinical-epidemiological, mycological and trichoscopic features of TC in children. Results: Out of 25 children, 14(56%) were male and 11(44%) were female. 13(52%) were aged between 5-10 years. Hair loss was the commonest presenting symptom in 100% followed by itching in 7(28%) of cases. Most of the children were living in crowded conditions 22(88%). Grey patch variety was the commonest 9 (36%) followed by black dot 7(28%), kerion 4(16%) and agminate folliculitis 5(20%). KOH mount was positive in 80% and culture in 40% of cases. T.violaceum was the commonest 4(40%) species isolated followed by T.mentagrophyte and T rubrum. Comma hair was the most common trichoscopic nding noted in study. Conclusion: In the present study, clinical examination microscopic and trichoscopic ndings along with epidemiological factors were considered which attributed that the most common group affected is the lower socioeconomic population. Though the causative fungi was found to vary between different regions and time, T.violaceum was the most common organisum isolated in our study. Comma hair and broken hair was most common trichoscopic ndings in our study

Climate change, the environment, and rhinologic disease.

The escalating negative impact of climate change on our environment has the potential to result in significant morbidity of rhinologic diseases. Evidence based review of examples of rhinologic diseases including allergic and nonallergic rhinitis, chronic rhinosinusitis, and allergic fungal rhinosinusitis was performed. The lower socioeconomic population, including historically oppressed groups, will be disproportionately affected. We need a systematic approach to improve healthcare database infrastructure and funding to promote diverse scientific collaboration to address these healthcare needs.

Low-quality protein modulates inflammatory markers and the response to lipopolysaccharide insult: The case of lysine.

The relationship between non-communicable diseases (NCDs) and eating behaviour has long been attributed to a surplus of food and energy. However, the increase in the prevalence of NCDs and their underlying low-grade inflammatory milieu among people of low socioeconomic status (SES) has highlighted the existence of a confounding factor. In this work, we aim to study the effect of lysine deficiency on some inflammatory markers in the absence or presence of an inflammatory insult [lipopolysaccharide (LPS)]. For this purpose, thirty-two five-week-old male Sprague Dawley rats were randomly distributed into four groups: 1) control diet, 2) control diet+LPS, 3) lysine-deficient diet, and 4) lysine-deficient diet+LPS. Groups were only allowed their experimental diets for four weeks, during which LPS (50 µg/kg) or saline injections were administered intraperitoneally three times per week. The study showed that lysine deficiency blunted growth and body compartments development, decreased albumin production and elevated liver c-reactive protein (CRP) expression, independently of interleukins 6 and 1β, the main precursors of CRP. Also, the insufficient levels of lysine in the diet increased hyperactivity and triggered an anxiety-like behaviour, exacerbated with LPS. This work presents evidence that various physiological changes are associated with the absence of a sufficient amount of lysine in the diet and can potentially increase the risk factor for diseases. Thus, the increment in NCDs among the low SES populations, who heavily rely on cereals as a main source of protein, can be, at least partially, blamed on low lysine availability in diets.