Oral Consent Research Articles

Cannabis swap: gender and tramadol use among Nigerian university students

PurposeCannabis as a recreational drug is prohibited in Nigeria. Consequently, the open use of cannabis attracts both formal and informal sanctions. As such, there is much stigma on users' faces across social spaces. This has led to innovations in drug use. Recently, non-medical use of tramadol has been rising across each of the gender categories. This study aims to understand (1) tramadol use prompts, (2) the sudden surge in gendered recreational use of tramadol and (3) the gendered challenges of recreational tramadol use among Nigerian university students.Design/methodology/approachData were collected between December 2021 and October 2022. The researcher conducted 20 semi-structured interviews, with participants chosen purposefully from acquaintances and others selected through chain referral. The selection criteria included knowledge of a particular tramadol tablet and willingness to participate. This study got ethical approval from the Anambra State Ministry of Health (Ref: MH/AWK/M/321/354) and oral consent was obtained before the interviews. The participants were assured of confidentiality. The interviews were conducted in English (the formal Nigerian language) and lasted between 30 and 65 min. The data collected were transcribed and coded manually, and themes generated.FindingsFindings suggest that peer pressures accounted for entry-level drug use. However, cannabis-related stigma is attributed to the surge in tramadol use across gender categories. Furthermore, academic pressure and sexuality are major reasons for tramadol use. The challenges associated with tramadol use include headaches and addiction.Originality/valueThis study, to the best of the author’s knowledge, presents alternative data on the surge in tramadol use among Nigerian university students.

Temperature assessment in newborn: a better method

Background: Accurate temperature assessment is essential in neonatal care as minor temperature changes can have a significant impact on the health and well-being of newborns. The purpose of this study was to compare the performance of three different types of thermometers, including non-contact infrared, digital, and mercury thermometers, for temperature assessment in newborns. Methods: This was a prospective, comparative study conducted between April 2022 and August 2022 in Cheluvamba hospital, Mysuru. A total of 400 healthy newborns were included in the study. Temperature readings were taken from the mid-forehead non-contact infrared thermometer and axilla using digital and mercury thermometers, while maintaining aseptic precautions. Parental oral consent was obtained for participation. Results: The mean temperature recorded with the digital thermometer in the axilla was statistically higher than that recorded with the mercury thermometer. The non-contact infrared thermometer showed a strong positive correlation with the mercury thermometer for the axilla region. Conclusions: The digital thermometer is a useful device for easy and valid measurement of skin temperature in newborns, especially when applied to the axilla. The findings suggest that the use of digital thermometers for axillary temperature measurement in neonates is supported by previous studies, which have reported their accuracy and reliability in comparison to mercury thermometers. The non-contact infrared thermometer may have limitations and its accuracy may vary depending on the site of measurement. The use of digital thermometers for neonatal temperature measurement may be more convenient, less hazardous, and equally reliable compared to traditional mercury thermometers.

Experiences of adolescents using sexual health services on Reunion Island: protocol for a qualitative phenomenological study

IntroductionAdolescence and early adulthood are often critical periods of sexual development. The discovery of sexual intercourse can lead to sexual risk-taking which may impact the incidence of sexually transmitted infections...

Menstruation Hygiene Practices Among Girl Students in Kathmandu Valley

The study, titled "Menstruation hygiene practices among higher-level girls students," explores the natural process of menstruation in the female reproductive system occurring monthly. Governed by hormonal changes, menstruation is a pivotal facet of the menstrual cycle, and fertility and associated with physical and emotional symptoms like cramps, mood swings, and fatigue. Proper menstrual hygiene practices are vital for women's health during this period. Inadequate water, sanitation, hygiene facilities, limited education, and deficient menstrual hygiene management make girls perceive menstruation as embarrassing and uncomfortable. In Nepal, many teenage girls lack education about menstruation, adversely affecting their health. The study aims to assess menstruation hygiene practices among higher-level female students before and during menstruation. Using quantitative and descriptive methods, the research selected 250 students through simple random sampling from 650 enrolled on two constituent campuses. These campuses were chosen via convenience sampling from 22 within the Kathmandu Valley. Ethical considerations were followed, ensuring confidentiality and obtaining oral consent from participants. The findings underline the significance of comprehensive menstrual health education and the sway of cultural beliefs on menstruation experiences. Encouraging open discussions, dispelling myths, ensuring access to accurate information, and cultivating supportive environments are essential for enhancing menstrual health and overall well-being.

A Study to Assess the Association between Malnutrition and Anemia in Underfive Children by Using two Binary Variables of Haemoglobin Crest and Low Height for Age and Low Degree of Malnutrition at Nerkundram

Background: Anemia, which is characterized by low level of hemoglobin in the blood, is one of the major public health hazards affecting people in both developed and developing countries. Anemia may occur at all stages of life, however, young children and women in the childbearing age are the most vulnerable. When anemia occurs in children, it could affect their cognitive performance and physical growth In women, anemia could adversely affect their capacity to work and may lead to poor pregnancy outcomes. Methodology: Data collection was done in selected community area of Nerkundram, for a period of 1 week. The investigator obtained written permission from the Principal, Saveetha Medical College and Hospital, Chennai and in charge of selected community area, Nerkundram. An oral consent was obtained from the samples prior to the study. The purpose of the study was explained to the subjects. The samples who fulfilled the inclusion criteria were selected. The purposive sampling technique was used to select 200 samples for the study. Everyday 25 samples were selected and collected data from them. Demographic data was collected by administering the structured tool and the biochemical variable hemoglobin was assessed clinically. The data collected were then coded and entered in Excel for further data analysis and interpretation. Results: 200 in total Participants finished this research. After 1 weeks, The present study assessed the association between malnutrition and anemia in underfive children by using two binary variables of haemoglobin crest and low height for age and low degree of malnutrition. The study concluded that most of the underfive children had moderate to mild anemia and the parents of underfive had to be educated on malnutrition and the steps to prevent anemia.

Recruiting Black and White patients to a behavioral oncology clinical trial: Lessons from the DISCO trial.

102 Background: Data show that 55% of trials are terminated due to insufficient accrual, which is especially low for patients identifying as Black. In 2021, we initiated recruitment to a clinic-based behavioral oncology trial testing the effectiveness of a health equity communication intervention designed to address patient cost concerns. This study involves patients and clinicians completing surveys before and after a video-recorded clinical interaction. We are implementing this study at an NCI-designated comprehensive cancer center in Detroit, Michigan, a city comprised of a majority of Black residents (80%). Based on the aims and literature showing that most patients agree to participate in trials if they are eligible and invited, we set a sample goal of 50% Black and 50% White patients. We use strategies based on literature and our own experience, including having a diverse staff and building trusting relationships with participants. As we begin the third and final year of recruitment with about 2/3 of our required patient sample (N=180) recruited, we consider what suggestions we can offer teams seeking to efficiently recruit a diverse patient sample to clinical trials. Methods: We based our strategies on evidence that racially concordant (same racial group) clinical dyads have greater communication quality than racially discordant (different racial group) dyads, and that medical mistrust is greater among Black than among White patients. First, we hired and trained a team that includes both Black and White members, and encouraged them to take leadership roles in the team. Second, we built trust with clinic staff, clinicians and patients. Procedures involve discussing the study with clinicians and their staff, recruiting clinicians as participants, and screening their patients for eligibility. We then recruit patients in-person in the clinic or by phone. Patients who provide oral consent are later met in person to collect written consent. Results: We have achieved a consent rate of 52% across 4 clinics; our sample includes 74 (62%) Black patients and 45 (38%) White patients. We attribute this to critical aspects of our protocol. First, recruitment of clinicians as participants helps capture the attention of and build trust with patients. Second, we have a flexible recruitment approach. Once potential participants are screened, we decide whether to approach them in person or by phone. Third, our team is comprised of Black and White individuals to reflect the patient population we hope to recruit. Last, we have the support of a diverse group of medical student team members who assist in times of increased recruitment. Conclusions: Our strategies, based on social science literature, helped achieve our goal of recruiting a sample that reflects racial diversity in our patient population. These and similar strategies can be adapted for other trials with the goal of achieving clinical trial recruitment equity. Clinical trial information: NCT04766190 .

Effectiveness of a government-led, multiarm intervention on early childhood development and caregiver mental health: a study protocol for a factorial cluster-randomised trial in rural China

IntroductionThe high incidences of both the developmental delay among young children and the mental health problems of their caregivers are major threats to public health in low-income and middle-income countries....

Information, perception, and utilization of vitamin supplementation among patients in private hospital in Bangladesh

Despite the fact that nutritional supplements are very beneficial to the human body and can help restore equilibrium when there is an imbalance, they can also have detrimental effects on the body if taken excessively, particularly if high dosages of these vitamins are taken, which can lead to a variety of health issues. The purpose of our study is to evaluate patients' knowledge, attitudes, and habits about the usage of nutritional supplements and how they affect overall health. To evaluate patient knowledge, attitudes, and practices regarding the use of nutritional supplements, an outpatient descriptive cross-sectional study was carried out in (Citylab Health Care Hospital) Kishoreganj, Bangladesh. Answers to a questionnaire created specifically for this purpose were used to gather data. Following oral consent from patients attending outpatient clinics, patients were interviewed. Data was collected for two months, starting in June 2023 and ending in July 2023. The findings of the study indicate that a majority of participants, specifically 72.5%, reported the consumption of vitamins. Furthermore, it was observed that a significant proportion of individuals, specifically 39%, were taking these vitamins under the guidance of a prescription. The results of the study indicate that vitamin C was the most widely recognized nutrient among the participants, with a prevalence rate of 62.5%. Conversely, vitamin D was found to have the lowest level of familiarity, with only 28% of respondents demonstrating awareness of this particular vitamin. The individuals obtained their knowledge regarding nutritional supplements from various sources, including internet sites, medical professionals, and books. The primary motivation for the consumption of nutritional supplements was to enhance overall health, as indicated by a majority of respondents (78%). In order to recover from the illness, they achieved a healing rate of 76%.

Contribution of Transcutaneous PCO2 in Obesity Hypoventilation Syndrome.

More and more patients have obesity-hypoventilation syndrome (OHS) because of the increasing prevalence of obesity. The accuracy of transcutaneous PCO2 (PtcCO2 ) has recently been validated. However, no study evaluated the interest of measuring systematically nocturnal PtcCO2 in the follow-up of patients with OHS and home mechanical ventilation to detect residual nocturnal hypoventilation. We aimed to evaluate the contribution of nocturnal PtcCO2 to assess nocturnal hypoventilation compared with current routine examinations, that is, daytime arterial blood gases and nocturnal pulse oximetry. A prospective monocentric pilot study was conducted from August 2018 to November 2019. Patients with stable OHS and who were treated with home noninvasive ventilation for at least 6 months were eligible to participate. After oral consent, we performed both diurnal arterial blood gases and combined home oximetry and capnography. The primary end point was the presence of residual nocturnal hypoventilation, defined as PaCO2 > 45 mm Hg or bicarbonate ≥ 27 mmol/L, SpO2 < 90% for ≥ 10% of the night, or PtcCO2 > 49 mm Hg for ≥ 10% of the night. A total of 32 subjects were included. Twenty-nine subjects with nocturnal PtcCO2 were analyzed. Eighteen of the 29 subjects showed residual nocturnal hypoventilation. The association of diurnal arterial blood gases and nocturnal pulse oximetry revealed nocturnal hypoventilation in only 9 subjects. Among the 19 subjects with both normal blood gases and normal nocturnal pulse oximetry, 11 had nocturnal hypoventilation with transcutaneous capnography. Only one subject presented with hypoventilation symptoms (asthenia). The assessment of PtcCO2 in comparison with nocturnal pulse oximetry and arterial blood gases provides important information for the diagnosis of residual nocturnal hypoventilation in the subjects with OHS who were ventilated at home.

A Cross-sectional study to evaluate maternal health care services utilization among women residing in an urban slum area, Ahmedabad

Background: Reducing the global Maternal Mortality Ratio to less than 70 per 1,00,000 live births is the first target of Sustainable Development Goal-3. Adequate utilization of Maternal and Child Health (MCH) services is essential for improved maternal and neonatal health outcomes. The utilization of MCH services is a complicated phenomenon, and several factors have an impact on it. This study aims to assess the current status of utilization of antenatal, intranatal, and postnatal maternal health services and determinants of utilization. Methods: This cross-sectional study was conducted in an urban slum during 1st January and February 2020 using a pre-tested, semi-structured questionnaire. A total of 126 women who delivered after 1st January 2018 were included as study subjects after getting informed oral consent. Data entry and analysis were done in Microsoft Excel. P-value&lt;0.05 was considered statistically significant. Result: In all, 64% of study subjects had adequate Antenatal care (ANC) services utilization. The majority (94.5%) had institutional delivery. In all, 62% of women breastfed their child within four hours after birth. The reason for inadequate utilization was mainly due to lack of unawareness of MCH services. Conclusion: Overall, MCH services are good in this area. Efforts should be made to improve the quality of services for ANC registration within first trimester, Iron and Folic Acid tablet consumption, initiation of early breastfeeding, and postnatal care services, and the major determinants that influence utilization of MCH services including mother's education and parity

Parental perspectives about information and deferred versus two-stage consent in studies of neonatal asphyxia

ObjectiveThe ALBINO Trial (NCT03162653) investigates effects of very early postnatal allopurinol on neurocognitive outcome following perinatal asphyxia where prenatal informed consent (IC) is impossible. Ethically and legally, waiver of consent...

Usage of spicy aromatic plants of the flora of Armenia in the national cuisine

Since ancient times, Armenians have used wild plants in their diet in both fresh and processed forms. Their gastronomic traditions, knowledge about useful plants, and methods of their application have been passed from generation to generation. In this review we analyse the species composition of plants that are used as spices in the national cuisine, how many there are, and what prospects there are for their use. Field surveys were conducted to collect ethnobotanical data of the use of aromatic plants in all of regions in Armenia during the years 2016–2022. 58 informants (42 women and 16 men) were interviewed after obtaining their prior informed oral consent. The informants included farmers, housewives and cooks engaged in preparing the national cuisine. All the informants participated voluntarily and shared their life experience, knowledge received from grandmothers and their professional skills. For the first time, a list of spicy plants of the flora of Armenia which were used in the preparation of national dishes is presented. Some species are no longer used, because classic spices are already available for sale, but some species of plants are still used today as a seasoning in national dishes. In the flora of Armenia there are 142 species of spicy aromatic plants belonging to 115 genera and 46 families. Studies have shown that the largest number of spicy-aromatic plants grow in Central and Southern Armenia (Armeno-Iranian floral province). On the basis of this rich plant resource, it is possible to organize the cultivation of organic spicy plants and spices in order to use them in various branches of the food industry. The recollected knowledge of our ancestors in the area of cheesemaking, winemaking, beermaking, combining centuries of experience with today's new technologies and use of spice plants can be used to develop the country's economy.

Development and Standardization of Low-Verbal Material for Assessment of Central Auditory Processing in Arabic Language

Development and Standardization of Low-Verbal Material for Assessment of Central Auditory Processing in Arabic Language

The Role of Abdominal Ultrasound in the Prediction of GDM in Early Pregnancy

Background: To detect gestational diabetes mellitus (GDM) in pregnant women as soon as possible, this study aimed to investigate the role of ultrasound in predicting GDM in early pregnancy by measuring the thickness of abdominal subcutaneous adipose tissue. Methods: This paper is a longitudinal study performed on pregnant women at 11-14 weeks of pregnancy. All the women referred during this period were screened for the thickness of abdominal subcutaneous adipose tissue, which was measured using trans-abdominal ultrasound. The patients were followed up by performing the oral glucose tolerance test (OGTT) between the weeks of 24 and 28. Finally, abdominal subcutaneous adipose tissue thickness and other variables were compared between women with and without GDM. Oral consent was obtained from patients. Results: Overall, 210 pregnant women at 11-14 weeks of gestation were enrolled in the study. The mean of abdominal subcutaneous adipose tissue thickness was measured using linear probe ultrasound as 1.72±0.33 mm. The incidence of GDM was significantly associated with maternal age and weight, parity, family history of diabetes, and histories of preeclampsia, hypertension, and recurrent abortion. There was also a statistically significant relationship between GDM and ultrasound-derived subcutaneous adipose tissue thickness at weeks 11-14 of pregnancy (P&lt;0.0001). At the cut-off point of 2.01, the sensitivity, specificity, and area under the curve (AUC) values were 91%, 92%, and 0.96, respectively. Conclusion: Measuring the thickness of the abdominal subcutaneous adipose tissue during early pregnancy may be useful in predicting GDM in the second trimester of pregnancy. Maternal higher age and weight gain, increased parity, and positive family histories of diabetes, preeclampsia, hypertension, and recurrent abortion may also increase the risk of GDM.

OA04 Impact of pre-operative and perioperative parental preparation on the success of surgery in Tunisian children with scoliosis

Abstract Background Surgical intervention in a child represents a challenging and overwhelming event for the parents. Studies have shown that parents' preoperative preparation and satisfaction with their child's preoperative care are important components of a better clinical outcome and a stronger healthcare system. Objective To investigate the preoperative and postoperative preparation of parents whose children have scoliosis and have undergone surgery, and its possible association with postoperative clinical outcomes. Methods We conducted a cross-sectional study including children and adolescents who underwent surgery for scoliosis. Disease related characteristics were reported. Successful surgery was defined as a postoperative cobb angle less than or equal to half the initial cobb angle. A questionnaire in the Tunisian dialect consisting of 10 Yes/No questions related to the preoperative and perioperative phase was established. The parents answered the questionnaire by telephone and informed oral consent was obtained. An arbitrary cutoff of 7 positive answers was set to define a well-prepared parent. Results Thirty-six children were included (sex-ratio= 0.38, mean age at surgery = 16.05 ± 2.63 [11–23]). Etiologies of scoliosis were idiopathic (n = 29), neuromuscular (n = 4) and congenital (n = 3). Twenty-two children (61.1%) had successful surgery. Regarding the questionnaire, table 1 reports the parents’ answers to the 10 questions. Question two had the most negative response with 55.5% parents reporting that during the pre-operative phase, the medical staff didn’t mention the possible complications of the surgery. Thirty-three per cent of the parents reported that the doctor didn’t explain more about the operation and the post-operative course during the peri-operative period and about 30% revealed that, on the day of surgery, the doctor didn’t explain to them the induction of anesthesia. Forty-seven per cent of the parents mentioned that the doctor didn’t inform them about the possible restrictions in occupation for their child later. Seventy-two percent of parents had ≥7 positive answers indicating that they were well prepared for the surgery, among them 52% had children in whom surgery was successful, P = 0.14. No correlation was found between a good parental preparation and age at surgery (P = 0.736). A significant association was found between success of surgery and a positive response to Q9, P = 0.032. Conclusion In our series, the lack of information about the possible complications of the surgery, during the peri-operative phase and about the induction of anesthesia was noted. Interestingly, receiving sufficient information on how to provide postoperative care at home was significantly associated with a success of surgery.

DISTANCE LEARNING OF MEDICAL PHDS IN UKRAINE UNDER COVID19 AND WAR WITH RUSSIA: A NEW REALITIES

Introduction. Distance learning during the COVID-19 outbreak in 2020-2021, and the Russian war actions whichstarted in 2022, which we refer to as "training under and after attacks," has had a significant impact on medicalundergraduate and postgraduate training in Ukraine. Despite the challenges posed by these events, the implementationof distance learning for medical PhD students proved to be beneficial for their academic performance, and regarded it asadvantageous.The aim of the research is to explore the peculiarities of distance learning for medical PhD medical students, includingits organization, main advantages, disadvantages, and challenges. The research focused on the experience of distancelearning of medical PhD students, particularly at Bogomolets National Medical University in Ukraine, and some others.Material and methods. To determine the effectiveness of distance learning for future medical PhDs, we analyzed theperformance in the course "Academic and Medical English for Medical PhD Students" of 247 medical PhD students, aged21 to 59, who were enrolled in the course at Kyiv Medical University, Bukovinian State Medical University, ZaporizhzhiaState Medical University, Kharkiv Medical Academy of Postgraduate Education, during 2021-2022, and BogomoletsNational Medical University, during 2018-2023, as well as the subjective perception of distance learning by medicalPhDs. The scope of the multi-center research was chosen to neutralize factors that may hinder objective research. Theparticipation was voluntary, upon oral consent of the respondents. The results were treated by the Statistica 19.0., and thesignificance was determined using the Wilcoxon and Student's t-tests.The study was conducted within the doctoral research framework of L. Lymar, “Developing English academic competenceof Healthcare PhD students through distance communication”, approved by the Scientific Council of Bogomolets NationalMedical University on 25.11.2021, protocol № 4.Results. The English language communicative competence characteristics of the medical PhD students were analyzed,and it was statistically determined that after distance learning, the overall level of the competence improved by 0.3-0.5points on a 5-point scale. Additionally, medical PhD students expressed positive attitude towards distance learning.The advantages of distance learning of the medical PhD students, based on a 4-year experience, include: time savingsin commuting, absence of classroom space issues, transparency in the implementation of electronic assessment, andincreased opportunities for creativity and collaboration. Under the realities of Ukraine, distance learning limited possibilityof COVID19 infection, and since 2022, mitigated military threats, with the opportunity to study in safe locations, suchas bomb shelters, in a flexible mode. Disadvantages of distance learning for Ukrainian medical PhD students includedependence on the internet connection and electricity supply, and the psychological stress factor, which is not directlyrelated to distance learning, but rather to "learning under and after fire" in Ukraine.Conclusion. Despite the stressful component of distance learning for medical PhDs, its organization using LMS andonline classes has contributed to improved performance indicators and competences, and positive attitude of PhDs todistance learning. The advantages of distance learning include time saving, the absence of classroom space issues, andbroader possibilities offered by educational systems. The disadvantages of distance learning are its dependence on internetand power supply, as well as the psychological unpreparedness of some learners and instructors for distance learning.

Effect of Yoga on Participants of Certificate Teacher Training Course (Yoga) of East Ahmedabad City, India

Yoga is recognized as a form of psychosomatic medicine that integrates a person's physical, mental and spiritual components to improve aspects of health, particularly stress-related ailments. It has been shown to contribute to chronic diseases such as heart disease, cancer and stroke. MATERIALS AND METHODS: Convenient and purposive sampling was used to collect the data because the data was gathered during the COVID-19 second wave i.e. from February 2021 to May 2021. All the participants included in the study (89) were enrolled for YOG TRAINER PROGRAM under Gujarat Yog Board and practiced yoga daily from 5am to 7am regularly for 2 months. Oral consent was taken from the participant prior to that of data collection. Paired t test was used to calculate the significant difference between the before and after BMI’s and WHR’s of the participants. RESULTS: Out of 89 participants around 70% participants were found with the visceral fat above normal range. 68 participants had BMI above normal range. 47 had waist hip ratio over normal range (&gt; 0.85). 100% participants had abnormal (above normal) Body fat. 67 participants showed body age difference of 10+ years. Though the samples suffered from higher obesity 66%, 54% and 73% didn’t showed any effects of depression, anxiety and stress respectively. CONCLUSION: Regular practice of Yoga decreased participants visceral fat &amp; body fat around 1-2 units/month. And weight around 2-4 kgs/month. Approximately 15% people normalized their body BMI and 20% normalized their WHR (waist hip ratio). 2 participants were able to overcome to regulate the thyroxine production and stop the regular thyroid medication.

#6838 SAFETY OF RAMADAN FASTING IN DIALYSIS PATIENTS: A TUNISIAN PROSPECTIVE MULTICENTER STUDY

Abstract Background and Aims Hemodialysis patients are generally exempt from Ramadan Fasting (RF) because they are more vulnerable to the risk of malnutrition as well as fluid and electrolyte imbalance. In addition, many muslim hemodialysis patients feel the spirituel need to fast during Ramadan, even when they are not compelled to do so. Moreover, there are no medical recommendations that specify who should and should not fast. The aim of our study is to explore the experiences of Muslim Hemodialysis patients fasting Ramadan in Hemodialysis centers. Method This prospective multicenter study involved patients from eight different hemodialysis centers in Monastir and Mahdia cities. Biochemical, clinical parameters and bioimpedance monitoring were performed before, during and after Ramadan with a group of Fasting Ramadan patients (RFG) and a group of Ramadan non-fasting hemodialysis patients (RNFG). Patients in RFG did so as a personal choice and they wouldn't skip fasting on dialysis days due to fear of the side effects of fasting. Oral consent was taken from all the patients included in the study. Results One hundred and four (104) patients were enrolled in this study. Among them, 44 were in the RFG, and the remaining sixty (60) patients were in the RNFG. The mean age of RFG and RNFG was 47, 13 +/- 12 years and 54, 7 +/- 15 years, respectively. 32 patients (52, 3 %) were males in RFG and 38 were males (63, 3%) in RNFG. In RFG, about 6, 8% (n = 3) and 43, 2% (n =19) had diabetes and hypertension, respectively. The mean duration on hemodialysis was 7 +/- 6, 27 years. There were no significant differences between RFG and RNFG except in diabetic and hypertension status. Comparing biological findings pre,during and post-fasting,in RFG, no significant differences were noted in serum sodium (135,9 +/- 4 ; 135,8 +/- 2,5 and 136,3 +/- 2,4 mmol/l respectively) ; and there were no drop in serum albumin during fasting (40,4 +/- 3,4 ; 40,8 +/- 3,7 and 40,6 +/- 4,34 g/l respectively). However, mean serum potassium was higher during RF (5,59 +/- 0,8 ; 5,6 +/- 1 and 5,2 +/- 0,88 mmol/l respectively) and, mean serum Phosphorus was also higher during RF (1,54 +/- 0,57; 1,73 +/- 0,52 and 1,69 +/- 0,7 mmol/l respectively). Furthermore, with bioimpedance monitoring, comparing pre, during and post Fasting, more fluid retention in patients was observed during fasting (51, 67 +/- 7; 54, 3 +/- 7, 4 and 53, 2 +/- 6 % respectively). But the mean of the inter dialytic weight gain (IDWG) remained the same (2,57 +/- 0,8 ; 2,53 +/- 0,82 and 2,61 +/- 0,7 Kg respectively), and none presented with pulmonary oedema or other emergency that might need hospitalization. However, there was positive change to body composition between pre and during fasting, shown as lower body fat mass (FM) percentage during fasting (29,4 and 28,2% respectively) and also, lower body mass index (BMI) (26,5 and 25,9 respectively). Nevertheless, when comparing findings between RFG and RNFG, there was no significant difference in any parameters. Conclusion The overall conclusions suggest that fasting is relatively well tolerated by hemodialysis patients and does not affect the morbidity and mortality rates. However, careful monitoring of fluid balance, serum electrolytes, and albumin is advisable.

Women's expectations of health care providers in the labor and delivery room in the Kurdistan Region of Iraq

Background and objective: The World Health Organization recognizes the importance of positive childbirth experience. In Iraq, patient satisfaction during maternity care visits is not routinely collected. This study was aimed to find out the women’s expectation during labor from physicians and midwives and associated factors such as socio-demographic and obstetrical characteristics. Methods: This cross-sectional study was conducted in Erbil city, located in the Kurdistan region of Iraq. A total of 1,500 women were targeted while they were accompanying another person, including children, to receive health services in Erbil and eventually 1,196 participated in the study. Data were collected through direct interviews after receiving informed oral consent. Participants were asked to describe their expectations for childbirth using an open-ended question. Responses were then grouped and categorized into 20 expectation items based on overlapping themes. Chi-square tests were used to identify associations with key socio-demographic and obstetric characteristics. Results: Level of expectation was significantly associated with education (illiterate and high education, P = 0.028),residency (suburban, P = 0.003), parity (grand multipara, P = 0.001), satisfaction with care (those satisfied, P &lt;0.001), and satisfaction with provider communication (those satisfied, P &lt;0.001). This study found that positive and calming verbal and non-verbal expressions, environmental control, encouragement of different positions and mobilization, hygiene, promotion of urinary elimination, and instruction on breathing and relaxation are highly expected by parturient women. Conclusion: Understanding women’s expectations in the delivery room is critical to health care providers in order to make appropriate care plan and support women to have a positive birth experience and to meet expectations.

Formol Gel detection of Leishmanial Antibodies: A Pilot Study for the prevalence of Visceral Leishmaniasis in Ekemkpon Community in Odukpani Local Government Area of Cross River State, Nigeria

Visceral leishmaniasis is a form of parasitic infection transmitted to human beings by the bites of female sandflies of the genus Phlebotomus in African countries, including Nigeria. This study was carried out in Ekemkpon community of Cross River State in Southern Nigeria, as a survey for the presence of leishmanial antibodies in the area. Four millilitres of blood specimens were collected, by venepuncture, from 178 consenting residents of the study community. One millilitre of cellfree serum from each blood specimen was placed in a plain test tube, to which 2 drops of concentrated formalin (40%) were added. The preparation was allowed to stand on the bench for 20 minutes. A positive Formol Gel test was indicated by the whitening and gelling of the serum like the white of an egg within 5 minutes, Chi-Square technique was used for testing the statistical significance of all parameters during analysis. Atotal of 178 residents, comprising 95 males and 83 females, were enlisted in the study after obtaining their oral consent. Positive formol gel results were detected in 24 subjects. This finding gave an overall prevalence of 13.5% (24:178) for visceral leishmaniasis in the study area. Among the residents of the study area, there were no skin manifestations suggestive of cutaneous forms of leishmaniasis. Among those who were positive for the formol gel test, there were no overt signs of classical illness. Therefore, visceral leishmaniasis exists as an asymptomatic infection in this community. It is recommended that more sensitive tests, especially molecular techniques, be carried out for a definitive diagnosis to establish the presence or absence of visceral leishmaniasis in this community.