Incedence of Skin Disorders in Iraqi Infants and Children

See PDF PleaseSee PDF Pleas

The Accounting Education in Libyan Universities After Libyan Revolution of 2011

The aim of this paper is to explore the accounting educa- tion in Libyan universities after Libyan revolution of 201

A Study on Prevalence of Silent Myocardial Ischemia in Newly Detected Type 2 Diabetes and also in known Diabetes of various duration

INTRODUCTION: It is astonishing that Indians are aware of diabetes and its complication since 1500 BC. Charaka samhita, sushruta samhita and Astanga hrdaya are together called vridhatrayi or triad of ancients. This text deals with aetiology, symptomatology, pathology, prognosis, complications and principles of treatment and management of eight major diseases including prameha. The literary meaning of Prameha is ‘Pra’ means excess, ‘Meha’ means urine. It has been classified into 20 types under which madhumeha (Diabetes Mellitus) is one of the classification, which means Madhuhoney and meha-urine, in Charaka samhita. World wide, there is a Vast potential for Diabetes associated cardio-vascular disease, notably among the 33 million people in India (in 2003) and 23 million in China estimated to have Diabetes, predominantly type2. Many regions now have Diabetes prevalence of > 10 %. CAD is more frequent, more severe, more extensive and more diffuse in Diabetes as compared to Non-Diabetic. In the Framingham study, the incidence of IHD in Diabetes was approximately twice that of Non-Diabetic. Jacoby and Nesto4 reported that over all prevalence of CAD was as great as 55 % among adults with Diabetes as compared with 2-4 % for general population. In India the prevalence of Heart disease is escalating. We, Indians who have highest number of Diabetic population in the world is at constant threat from the CAD which is more common in Diabetic population. Thus India faces the dangerous dual epidemic of Diabetes and CAD. Since CAD is more common and fatal in Diabetics than in Non- Diabetics, the treating physician should aim at primary prevention of IHD in Diabetics and treatment of risk factors, such as Dyslipidemia, obesity, Hypertension, Smoking, Insulin resistance. Recently we have realized in terms of Plasma Cholesterol, Triglycerides as well as blood pressure value should be different in Diabetic and Non-Diabetic subjects. In addition to the treatment of risk factors should be accompanied by a systemic search for silent disease markers such as silent myocardial ischemia which is 2-3 times more frequent among Diabetics and thus CAD can be prevented before a significant clinical event. AIM OF THE STUDY: 1. To study the prevalence of Silent Myocardial Ischemia in newly detected type 2 diabetes mellitus and also already known type 2 diabetic patients of various duration using exercise stress test. 2. To study the impact of duration of diabetes in asymptomatic ischemic heart disease. 3. To study the association and influence of other risk factors causing coronary artery disease in diabetics. MATERIALS AND METHODS: Of the 205 patients enrolled for the study who attended out patient department of Government Kilpauk Medical College Hospital, 40 Patients of type 2 DM were selected for Treadmill test. Rest of the patients excluded as per exclusion criteria. 20 non diabetic patients also selected as control. Tread mill test was performed for these 60 patients using standard bruce protocol. Study Design: Case – Control Study. Place of Study: Government Kilpauk Medical College Hospital, Chennai-10. Duration of Study: July 2006 to June 2007 Inclusion Criteria: 1. Newly detected Type 2 DM – Patients detected Type-2 diabetes recently within 6 months duration. Patients diagnosed to have DM on full filling any one of the following criteria devised by ADA Recommendation. 1. Fasting plasma glucose ≥ 126mg%. 2. Post prandial plasma glucose ≥200 mg%. 3. Symptoms of diabetes with Random plasma glucose ≥200 mg %. 2. Known Type 2 Diabetic patients of various duration on treatment. 3. Age between 30 and 60 years. 4. Patients should not have any CAD symptoms. 5. Resting ECG, X-ray chest and Echocardiography should be normal. Exclusion Criteria: 1. Type 1 Diabetes Mellitus. 2. Known case of CAD. 3. Signs of left ventricular failure. 4. Patients with peripheral vascular disease as evidenced by absent peripheral pulses. 5. Patients without microvascular complication. (i) Retinopathy excluded by fundus examination. (ii) Albimunuria by dispstic method. (iii) Autonomic neuropathy. 6. Uncontrolled Systemic hypertension. 7. Age less than 30 years and more than 65 years. 8. Other absolute contraindications for exercise stress test. RESULTS: Statistical analysis was carried out for diabetic patients (Cases) and non diabetic (Controls) after categorizing each variable. Age, Duration of Diabetics, Sex, BMI, WHR, Systemic hypertension, smoking, dyslipidemia were analysed among diabetic with TMT positive and Diabetic with TMT negative and non diabetic controls. The significance of difference in means between two groups was calculated using student ‘t’ test and significance of difference in proportion using chi-square test. FISHER EXACT TEST was used when any one of the expected variable was less than 5 in chi-square test. CONCLUSION: 1. The prevalence of silent myocardial ischemia is higher in diabetic when compared to non-diabetic. Silent myocardial ischemia is present in diabetic patients even at the time of detection itself. 2. As the duration of diabetes increases, the prevalence of silent myocardial ischemia also increases. 3. Though Hypertension, smoking, dyslipidemia are independent risk factor for CAD, The association of these risk factors in diabetes further amplifies the risk of CAD in diabetic patients. 4. Detection of silent myocardial ischemia-a silent disease marker which is more prevalent in diabetic can lead to the prevention of CAD which is more common, extensive and fatal in diabetes

Healthcare spending and health outcomes: evidence from selected East African countries

Background: Over the last decade, total healthcare expenditures, comprised of both public and private healthcare expenditures, have increased in most East African countries. At the same time, health outcomes such as infant mortality rates, life expectancy at birth and other health outcome indicators have improved.Objectives: This paper examines the association between healthcare expenditures and health outcomes for eight East African countries: Burundi, Eritrea, Ethiopia, Kenya, Rwanda, Sudan, Tanzania, and Uganda. In this study, health outcomes are defined as an improvement in adult life expectancy and a reduction in the number of neonatal, infant, and under-five deaths.Methods: We implemented a panel data regression technique, analyzing both cross-sectional and time series information. This combined method has been used in healthcare studies by several authors. Data obtained from world development indicators for the years 2000-2014 was used for the panel study.Results: First, we documented that there is a strong, positive association between total healthcare expenditures and total life expectancy. While we identified a positive relationship between healthcare expenditures and female and male life expectancy, we found that healthcare had a stronger effect on improving life expectancy in females than in males. Moreover, we found a negative relationship between healthcare expenditures and the number of neonatal, infant, and under-five deaths.Conclusion: The results of this study have important policy and management implications for the eight East African countries. From a policy perspective, it is necessary to understand if a greater allocation of resources to the healthcare sector is worthwhile and to determine whether to encourage private healthcare investment. From the management perspective, investing in more private institutions, such as hospitals and clinics, is essential for health outcomes in the average country. The results of this study can be used by the World Health Organization as well as other non-governmental organizations that provide financial assistance to East African countries.Keywords: Healthcare expenditures, health outcome, life expectancy, infant deaths, under-five deaths, neonatal death

Intégration agriculture-élevage et intensification écologique dans les systèmes agrosylvopastoraux de l’Ouest du Burkina Faso, province du Tuy

International audienceEn Afrique de l'Ouest, la baisse de fertilité des sols et la diminution du disponible fourrager entrainent des problèmes de productivité et de durabilité des systèmes agropastoraux. Elles posent la question de l'intensification et de la préservation des ressources naturelles. Nous cherchons à montrer que certaines pratiques d'intégration agriculture-élevage créent des systèmes plus productifs et plus durables. Nous avons enquêté et suivi 150 exploitations de 10 villages du Mali-Sud, sur la structure de l'exploitation, les pratiques d'intégration agriculture-élevage et les performances agronomiques. La diversité des pratiques d'intégration agriculture-élevage est évaluée par des analyses multivariées et de variance. 3 types d'exploitation ont été mis en évidence chez les agriculteurs (9-14 ha et 6-19 UBT) et 3 types chez les agro-éleveurs (17-30 ha et 32-57 UBT). Les agriculteurs qui intègrent les deux activités produisent de la fumure organique et stockent du fourrage alors que les agro-éleveurs, en plus, mettent en place des cultures fourragères. L'intégration agriculture-élevage est développée par les agriculteurs les plus modestes ou les grandes exploitations d'agro-éleveurs. Les agriculteurs qui intensifient par le capital, le travail et les intrants ont de meilleures performances agronomiques alors que les agro-éleveurs qui intensifient le plus ne sont pas les plus productifs. Quelque soit le type d'exploitation, l'intégration agriculture-élevage améliore les performances agronomiques. Des études complémentaires sur les impacts de ces pratiques sur l'environnement et le domaine social seraient nécessaires pour appréhender leur contribution aux processus d'intensification écologique

A trial of intermittent preventive treatment and home-based management of malaria in a rural area of The Gambia

BACKGROUND: Individual malaria interventions provide only partial protection in most epidemiological situations. Thus, there is a need to investigate whether combining interventions provides added benefit in reducing mortality and morbidity from malaria. The potential benefits of combining IPT in children (IPTc) with home management of malaria (HMM) was investigated. METHODS: During the 2008 malaria transmission season, 1,277 children under five years of age resident in villages within the rural Farafenni demographic surveillance system (DSS) in North Bank Region, The Gambia were randomized to receive monthly IPTc with a single dose of sulphadoxine/pyrimethamine (SP) plus three doses of amodiaquine (AQ) or SP and AQ placebos given by village health workers (VHWs) on three occasions during the months of September, October and November, in a double-blind trial. Children in all study villages who developed an acute febrile illness suggestive of malaria were treated by VHWs who had been taught how to manage malaria with artemether-lumefantrine (Coartem™). The primary aims of the project were to determine whether IPTc added significant benefit to HMM and whether VHWs could effectively combine the delivery of both interventions. RESULTS: The incidence of clinical attacks of malaria was very low in both study groups. The incidence rate of malaria in children who received IPTc was 0.44 clinical attacks per 1,000 child months at risk while that for control children was 1.32 per 1,000 child months at risk, a protective efficacy of 66% (95% CI -23% to 96%; p = 0.35). The mean (standard deviation) haemoglobin concentration at the end of the malaria transmission season was similar in the two treatment groups: 10.2 (1.6) g/dL in the IPTc group compared to 10.3 (1.5) g/dL in the placebo group. Coverage with IPTc was high, with 94% of children receiving all three treatments during the study period. CONCLUSION: Due to the very low incidence of malaria, no firm conclusion can be drawn on the added benefit of IPTc in preventing clinical episodes of malaria among children who had access to HMM in The Gambia. However, the study showed that VHWs can successfully combine provision of HMM with provision of IPTc

Correlations of morphological (macroscopic and microscopic) parameters of placenta with maternal age and parity

Background: Placenta is a chief cause of maternal and perinatal mortality and significant factor in fetal growth retardation. It undergoes different variations in weight, volume, structure, shape and function continuously throughout the gestation tosupport the prenatal life. Cautious examination of placenta can give information which can be useful in the management of complications in mother and the newborn. Objective: The present work has been attempted towards determination of the morphological ( macroscopic and microscopic) parameters of human full-term placentae and their relation with different parity and age group of mothers. Patients and Methods: A whole of 40  placentae were recently collected.They were divided into four  groups (10  women each); primigravida age35 years, multigravida 35years.Neonataland placental weights,placental thickness  and  number of cotyledons were measured.Tissue for histological examination wasobtained to study the parameters of  microscopic morphometry   (number of apoptotic cells, number of terminal villi, number of syncytial knots, number of fetal capillaries and thickness of trophoblastic basement  membrane). Results: Placental and  neonatal weights were within normal range. They were augmented with maternal age and parity. Number of cotyledons was higher than those reported by other authors in other populations but it was still within normal range and it was significantly decreased in multigravida> 35.Placental thickness was within normal range and it was significantly decreased in multigravida> 35. All microscopic parameters were increased with maternal age and parity.. Conclusion: There were correlations between microscopic and macroscopic parameters. Thelength of stem villi were less in multigravida> 35 since placental thickness was decreased in this group.  All microscopic parameters were increased with maternal age and parity.These variations may have some important bearing on the placental inadequacy in higher age group and parity of mother

Healthcare spending and health outcomes: evidence from selected East African countries

Background: Over the last decade, total healthcare expenditures, comprised of both public and private healthcare expenditures, have increased in most East African countries. At the same time, health outcomes such as infant mortality rates, life expectancy at birth and other health outcome indicators have improved. Objectives: This paper examines the association between healthcare expenditures and health outcomes for eight East African countries: Burundi, Eritrea, Ethiopia, Kenya, Rwanda, Sudan, Tanzania, and Uganda. In this study, health outcomes are defined as an improvement in adult life expectancy and a reduction in the number of neonatal, infant, and under-five deaths. Methods: We implemented a panel data regression technique, analyzing both cross-sectional and time series information. This combined method has been used in healthcare studies by several authors. Data obtained from world development indicators for the years 2000-2014 was used for the panel study. Results: First, we documented that there is a strong, positive association between total healthcare expenditures and total life expectancy. While we identified a positive relationship between healthcare expenditures and female and male life expectancy, we found that healthcare had a stronger effect on improving life expectancy in females than in males. Moreover, we found a negative relationship between healthcare expenditures and the number of neonatal, infant, and under-five deaths. Conclusion: The results of this study have important policy and management implications for the eight East African countries. From a policy perspective, it is necessary to understand if a greater allocation of resources to the healthcare sector is worthwhile and to determine whether to encourage private healthcare investment. From the management perspective, investing in more private institutions, such as hospitals and clinics, is essential for health outcomes in the average country. The results of this study can be used by the World Health Organization as well as other non-governmental organizations that provide financial assistance to East African countries

Prevention of the Recurrence of Anaemia in Gambian Children Following Discharge from Hospital

BACKGROUND: In malaria endemic countries, children who have experienced an episode of severe anaemia are at increased risk of a recurrence of anaemia. There is a need to find ways of protecting these at risk children from malaria and chemoprevention offers a potential way of achieving this objective. METHODS: During the 2003 and 2004 malaria transmission seasons, 1200 Gambian children with moderate or severe anaemia (Hb concentration <7 g/dL) were randomised to receive either monthly sulfadoxine-pyrimethamine (SP) or placebo until the end of the malaria transmission season in which they were enrolled, in a double-blind trial. All study subjects were treated with oral iron for 28 days and morbidity was monitored through surveillance at health centres. The primary endpoint was the proportion of children with moderate or severe anaemia at the end of the transmission season. Secondary endpoints included the incidence of clinical episodes of malaria during the surveillance period, outpatient attendances, the prevalence of parasitaemia and splenomegaly, nutritional status at the end of the malaria transmission season and compliance with the treatment regimen. RESULTS: The proportions of children with a Hb concentration of <7 g/dL at the end of the malaria transmission season were similar in the two study groups, 14/464 (3.0%) in children who received at least one dose of SP and 16/471 (3.4%) in those who received placebo, prevalence ratio 0.89 (0.44,1.8) P = 0.742. The protective efficacy of SP against episodes of clinical malaria was 53% (95% CI 37%, 65%). Treatment with SP was safe and well tolerated; no serious adverse events related to SP administration were observed. Mortality following discharge from hospital was low among children who received SP or placebo (6 in the SP group and 9 in the placebo group respectively). CONCLUSIONS: Intermittent treatment with SP did not reduce the proportion of previously anaemic children with moderate or severe anaemia at the end of the malaria season, although it prevented malaria. The combination of appropriate antimalarial treatment plus one month of iron supplementation and good access to healthcare during follow-up proved effective in restoring haemoglobin to an acceptable level in the Gambian setting. TRIAL REGISTRATION: ClinicalTrials.gov NCT00131716