The Complete Health Improvement Program (CHIP) and Reduction of Chronic Disease Risk Factors in the Philippines

Lifestyle modification has been demonstrated to effectively reduce the risk factors associated with chronic disease. The Complete Health Improvement Project, a 30-day diet and lifestyle modification program, has been shown to be efficacious in the US, Australasia and Canada. The present study examined the changes in selected biometric measures of 61 participants from six programs delivered in Manila, in the Philippines (May 2013 to November 2014). Overall, significant reductions were recorded in body mass (2.2%, p5.17mmol/l recorded an average reduction of 14.4%. A mean decrease of 17.0% in low-density lipoprotein levels was observed among those who entered the program with a low-density lipoprotein level \u3e3.35 mmol/l. Individuals who presented with triglycerides \u3e2.26 mmol/l recorded a mean reduction of 21.8%. Individuals with systolic blood pressure above 139 mmHg and diastolic blood pressure above 89 mmHg decreased levels by 10.3% and 7.1%, respectively. Finally, fasting plasma glucose decreased on average 24.8% among individuals entering the program with levels above 6.9 mmol/l. In conclusion, significant reductions in chronic disease risk factors can be achieved in a 30-day life style intervention delivered in the Philippines

An Epidemiological Study of the Major Factors Influencing Outcomes in Critically Ill Obstetric Patients

Introduction: An indicator of pronounced maternal morbidity is intensive care unit (ICU) admissions of obstetric patients. Few studies have been published concerning ICU admissions of obstetric patients in the developing world. Based on the fact that the risk factors defining pronounced maternal morbidity and maternal mortality in the developing world are not fully established, the present retrospective study was conducted to analyze and evaluate the obstetric admissions to the ICU in an attempt to identify the risk factors influencing maternal outcome. Methods: This retrospective analytical study involved 200 randomly selected obstetrical patients admitted to ICUs. Prior consent was obtained from local randomly selected Tertiary care hospitals to see the records of the patients from Medical Records Department. The medical records for these patients were reviewed for the collection and classification of data including the patient characteristics, the obstetric history, the preexisting medical disorders, and the causes that necessitated admission to the ICU. Results: Major obstetric and medical conditions requiring ICU admission were hemorrhage, hypertensive disorders of pregnancy (preeclampsia, eclampsia, and pregnancy-induced hypertension), severe anemia, and sepsis. The number of maternal deaths was 13% of obstetric patients admitted in ICU in our study. The most common causes of maternal mortality were hemorrhagic shock and multiorgan dysfunction syndrome. The observed mean Simplified Acute Physiology Score (SAPS II) between the surviving group of patients and the non-surviving group of patients was statistically significant. Conclusion: There is a need for high-dependency unit in tertiary care hospitals. Obstetric hemorrhage and hypertensive disorders of pregnancy are the major risk factors for ICU admission. Majority of complications occurred in women with gestational age of 37–42 weeks. There is a need to train obstetricians in obstetric medicine and critical care to do justice to these critically ill pregnant women. Focus of care for the obstetric patients who bear the major risk factors and who are admitted to the ICU should be carried out under the guidance of the ICU scoring systems such as the SAPS II and others such as APACHE-II and SOFA scores

A Study of Nosocomial Infections in Intensive Care Units of Local Tertiary Care Hospitals

Introduction: It has been reported that the incidence of nosocomial infections in the intensive care unit (ICU) is about 2–5 times higher than in the general in-patient hospital population. The objectives of the present study were to determine the incidence of nosocomial infection, to identify possible risk factors for these infections, to clarify the distribution of the causative pathogens, and to evaluate the outcome of the infected patients in terms of length of ICU and hospital stay and mortality. Methods: This was a retrospective and analytical study. For classification of the different causative pathogens associated with nosocomial infections, all the microorganisms isolated on culture from each of the patients with confirmed infection according to the Centers for Disease Control and Prevention definitions were recorded and their relative frequency of isolation was determined as percentage. Bacterial isolates were identified by Gram stain, cultures on routine media and where necessary, selective media, and specific biochemical tests following standard protocols. Results: Nosocomial infections were in 28 patients. The most frequently diagnosed nosocomial infection was nosocomial pneumonia. A total of 39 pathogens were isolated on culture and accounted for the nosocomial infections in 28 patients. Some infections were polymicrobial. Gram-negative Enterobacteriaceae were the most frequently isolated pathogens. There was no statistically significant difference between the hospital mortality rates among the patients with and without nosocomial infection. Conclusion: Gram-negative Enterobacteriaceae, as a group, were the most frequently isolated pathogens, while Pseudomonas aeruginosa was the single most frequent causative organism. The acquisition of nosocomial infections in the ICU resulted in significantly increased length of ICU and hospital stay, but did not result in statistically significant increase in ICU or hospital mortality. These findings can now be utilized toward planning a surveillance program for nosocomial infection in our ICU setting as a first step toward a better infection control strategy

Common Sleep Disorders and Risk Factors in Hemodialysis Patients

Although the function and physiology of sleep have not been fully elucidated, it is a universal need for life-forms such as human beings, and in the absence of sleep, severe physiological consequences emerge. Sleep can be defined as temporary, partial and periodic disappearance of the organism’s communication with the environment and it is reversible with various severity stimuli. Sleep disorders in hemodialysis patients are frequently seen with the contribution of various risk factors. Insomnia is the most common sleep disorder in hemodialysis patients and affects the sleep quality of patients negatively. Insomnia is a lack of adequate and restful sleep despite adequate reserved time to sleep and it refers to sleeplessness. Sleeplessness can be defined as difficulty in starting sleep, and it refers insufficiency in duration, integrity and quality of sleep despite there is adequate time and chance to sleep. Anemia, anxiety, depression and many factors cause sleep disorders in hemodialysis patients. The aim of this review is to give information about the prevalence of common sleep disorders in hemodialysis patients and the risk factors that contribute to the development of these disorders

An Analytical Study about Serum Creatine Phosphokinase as Predictor and Marker of Severity in Organophosphorus Poisoning

Introduction: Organophosphorus (OP) toxicity is an important global health problem, especially in many developing countries because of their widespread use and easy accessibility. The objectives of our study were to measure serial serum creatine phosphokinase (CPK) levels, to correlate CPK levels with severity of poisoning, and to record the total dose of atropine required. Methods: This was a retrospective and analytical study. One hundred patients of either sex, having age >14 years, presented within 12 h of ingestion or inhalation of OP. It was observed that confirmation of OP poisoning was done by seeing the packet/container with clinical presentation. Clinical severity was categorized according to Peradeniya organophosphorus poisoning (POP) scale. Results: The severity of the poisoning increased in respect to POP score, the serum CPK levels, and total dose of atropine required for treatment also increased. The difference in serial CPK levels in patients without intermediate syndrome (IMS) and with IMS, it was observed that the difference in CPK between these patients was highly significant at baseline and 48 h. There was an increase in CPK levels at admission and 48 h, but reduced by 96 h. A weak positive correlation was observed between POP score and CPK levels, as well as CPK, and atropine dose. A negative correlation was observed between butyrylcholinesterase and CPK levels. Conclusion: In our opinion, these observations suggest that there is a direct relation between serum CPK levels and IMS. Hence, it is necessary for estimating CPK levels, especially after 48 h, in moderate-to-severe poisoning patients so that IMS can be recognized at the earliest and patients can be referred to higher centers for immediate management of respiratory failure, reducing morbidity and mortality

Morbidity, Feeding Practices, and Immunization Status of Children 6 - 23 Months in Delhi

Optimal infant and young child feeding (IYCF) practices and immunization play a critical role in averting childhood illness and in achieving optimal growth and development among children. This was a cross-sectional study that assessed the morbidity and immunization status of children 6–23 months of age in three income groups in Delhi. The study also assessed feeding practices for children during illness. Results showed that the prevalence of diarrhea in the past 2 weeks preceding the survey was 8.6%, 18.3%, and 17.7% in urban slum, low-income group (LIG), and middle-income group (MIG), respectively. About 50% of children in LIG and MIG and about 45% in the urban slum had fever in the past 2 weeks preceding the survey. About 20% of mothers in urban slum and LIG reported that they were not washing their hands with soap before preparing food for their children. Although most of the children with diarrhea had received oral rehydration salts, they had not received zinc which is critical in the treatment of diarrhea. About 24% of mothers in the urban slum discontinued complementary feeding during illness. The immunization was complete for most of the children in all groups except for the 2nd dose of measles vaccine and booster dose of OPV and DPT vaccine whose coverage was found to be low in urban slums. There is an urgent need of counseling and support on IYCF during and after common childhood illnesses by the frontline health functionaries to reduce the high burden of undernutrition among children under 2 years

Organic Food Products - A Study on Perception of Women Consumers

The demand for organic food has been rapidly increasing worldwide, because of an improvement in the awareness of environmental problems and health concerns. Although the demand for organic food is increasing, the popularity of organic food is not widespread and the perception of organic food varies in the wide public. This study aimed to understand rural areas consumers’ perception of organic food and the importance of organic certification in customer’s decisions for obtaining insights into their consumption of organic food. Data were collected through a questionnaire survey. However, for the present study, the researcher selected retail shops from various stores such as small shop and department store in rural areas. The more consumers are interested in trust and are confident with the claimed benefits, the more likely will they purchase organic food. In addition, organic labels and certification turned out to be important for the consumers when shopping organic food. This research was the first study to investigate the consumers perception of organic food in a rural area. It is also observed that health, nutrition, taste, and chemical/fertilizer free nature are the attributes that have an influence on the purchase decision of organic food products by rural consumers. “Health benefits” were the first and primary reason for purchasing organic food, while “high price” was the key deterrent to purchasing organic food

A Study of Microbial Load on the Hands of Nursing Staff in Tertiary Care Hospital

Background: Infections due to hospital-acquired microbes is an evolving problem worldwide. Prevalence as high as 19%, of these infections in developing countries poses a challenge to health-care providers. A major source of horizontal transmission of the nosocomial infections are thought to be bacterial contamination of palm of hand of health care providers such as doctors and nurses. Hand hygiene is the single most cost effective preventive measure against hospital acquired infections and education is an important tool to ensure its implementation. Aim: The present study was undertaken, to demonstrate the presence of resident microbial flora on the hands of nursing staff after duty hours working at various critical areas in a tertiary care hospital with their antibiogram. Materials and Methods: This cross-sectional analytical study was carried out after ethical clearance from June to August 2020 on 100 nursing staff of either sex working in critical areas of tertiary care hospital after due informed consent from the nurses. A sterile swab moistened with sterile normal saline was used to collect the swabs from dominant (working) hands after working hours. The collected swabs were processed for isolation, identification, and antibiotic sensitivity of organisms. Results: Out of 100 swabs collected from the dominant hands of nurses working in critical areas, 83 showed the growth. All the samples cultured shows growth of more than two organisms. The major Gram-positive pathogenic organisms grown were Coagulase negative Staphylococcus spp. Forty (48.19%) followed by Staphylococcus aureus 30 (36.14%) whereas among Gram-negative Klebsiella spp. five (6.025%) and Pseudomonas aeruginosa four (4.81%) predominated. Conclusions: In the present study, the level of contamination of nursing staff was found to be high. Resident flora consisting of multi drug resistant pathogenic organisms can be greatly reduced by an increase in hand-hygiene awareness coupled with organizational interventions. We recommend to closely monitoring hand hygiene practices for effective intervention strategies

Cough-induced Diaphragmatic and Abdominal Hernia in an Asthma Patient – A Case Report

The list of complications of coughing is very long. Chronic cough as in asthma can affect every system in our body such as cardiovascular, gastrointestinal, neurological, musculoskeletal, and diaphragm. We report a case of 46-year-old male patient who was suffering from asthma for the past 15 years with occasional violent coughing. The X-ray of that patient was suggestive of pleural effusion which was misleading. A computed tomography scan of the thorax and the abdomen revealed the presence of diaphragmatic and abdominal hernia. The patient had no other history which can contribute to diaphragmatic injury except chronic cough. We found a chronic uncontrolled cough complicated with diaphragmatic and abdominal wall hernia

A Study to evaluate the Functional Outcomes after the Surgical Management of Intra Articular Fracture of Distal Humerus

Introduction: The primary goal in management of intra articular fractures of distal humerus is to achieve stable and mobile elbow. The chances of functional impairment and deformities are very high following conservative treatment of such distal intra-articular fractures of humerus. Objectives of the study were to assess the functional outcome and to compare the results after surgical management of intra articular fracture of distal humerus using Mayo elbow performance index. & to assess the range of movements, pain and union. Methods: Retrospective Evaluation study with Review and Reports of 50 cases / patients, who were diagnosed & surgically managed. Fractures were classified as per AO type A to C (except C3 comminuted) and were included in this study in whom internal fixation was done using triceps reflecting Bryan Morrey approach with some modification in few cases. Results: No patient achieved complete extension. No limitation in the pronation-supination was detected. Radiographic assessment Postoperative and follow up radiographs showed adequate fracture reduction and fracture healing in all patients. No step off more than one mm was seen. All patients had completed postoperative physical therapy at the time of the study and had achieved maximum function of elbow. Conclusion: Triceps reflecting Bryan Morrey approach is a simple and effective approach that can be used in management of the majority of the distal humeral fractures as it provides adequate visualization and reduction fracture fragments with no adverse effect on triceps muscle strengt