Effect of Healthy Lifestyle Interventions in Schools of Jazan City, Kingdom of Saudi Arabia: A Quasi-experimental Study

Background Unhealthy dietary habits and lifestyle among adolescents is considered as a risk factor for nutrition-related diseases in adulthood. The objective of this study was to investigate the effectiveness of a healthy lifestyle intervention—including physical activity (PA) and eating habits (EH)—among female students in Jizan City, southwest Kingdom of Saudi Arabia (KSA). Methods A representative sample of 565 school students aged 12–15 years was randomly selected from four schools in Jizan, KSA. The PA and EH were assessed using a validated self-administered questionnaire. A pre-post quasi-experimental study was implemented in three phases. Results Following the intervention, the school children in the intervention groups showed a significant improvement in their EH and PA. These improvements were documented in increased physical walking measured by the number of students walking daily, the number of days walked, and the time spent on vigorous activities (54.11 ± 54.89 to 63.24 ± 76.16). Fruits and vegetables had a similar consumption frequency in both the intervention and control groups. The snacks were frequently consumed among intervention group with a significant increase in the mean number from 1.64 ± 0.93 to 1.96 ± 1.13 (p = 0.000) and fast food were less frequently consumed among intervention group than the control group (p = 0.000). The prevalence of obesity in the intervention group was reduced from 16.3% to 12.9%, while it was significantly increased from 17.6% to 19.0% in the control group (p = 0.0148). Weight decreased by 0.37 kg in the intervention group, while it increased by 0.07 kg in the control group, but with no statistically significant increase. Conclusion: In conclusion, healthy lifestyle interventions can improve short- and long-term outcomes in school children. When examining the health benefits of healthy lifestyle, the importance of dietary and PA behaviors should be considered. Keywords:  lifestyle, dietary habits, physical activity, chronic diseases, Jazan-KSA &nbsp

May Measurement Month 2017: an analysis of blood pressure screening in Sudan-Northern Africa and Middle East

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. Sudan has the second highest prevalence of hypertension in North Africa. One in four people with a non-communicable disease has hypertension. May Measurement Month (MMM) is a global initiative, aimed at raising awareness of high BP to act as a temporary solution to the lack of screening programs worldwide. The MMM screening survey provided an opportunity to correlate between unique risk factors and BP levels among Sudanese population. Such an approach allows for directing efforts towards setting the appropriate preventive measures as opposed to disease treatment. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. The study was conducted at 100 sites distributed in four states: Khartoum, Gezira, Blue Nile, and Kassala. Overall, a total of 44 413 participants were enrolled in the survey. After imputation, 7332 out of 44 118 participants with an available mean of the second and third readings had hypertension (16.6%). A total of 6956 (15.9%) participants were found to have hypertension of the 43 742 who were not receiving treatment. Among participants who were on treatment, 155 out of 374 (41.3%) had uncontrolled BP. After adjusting for age and sex, systolic and diastolic BP's were significantly higher in those receiving antihypertensive treatment, with a previous history of stroke and with elevated body mass index. Systolic BP was significantly higher in people with diabetes and with previous myocardial infarction. Smoking was associated with increased diastolic BP and decreased systolic BP. Alcohol intake as well as BP measurement on left vs. right arm had no association with BP reading. The MMM17 was the largest BP screening campaign ever held in the country. A considerable percentage of detected hypertensives were not on treatment with a significant proportion of uncontrolled hypertension among those on treatment. These results suggest that opportunistic screening can identify significant numbers with raised BP

Knowledge and Awareness of Diabetic Retinopathy among Diabetic Sudanese Patients, Khartoum State, Sudan, 2018

Background: The level of awareness of diabetic retinopathy is considered an important factor for early diagnosis and management of diabetic retinopathy. This study aimed to assess the level of awareness of diabetic retinopathy among patients with diabetes mellitus in Khartoum, Sudan. Methods: This cross-sectional study was conducted among diabetic patients attending Zeenam and Abdullah Khalil Diabetic Centers between June and September 2018. A convenience sample of diabetic patients was used. Information on the sociodemographic characteristics of the patients, patients’ knowledge, compliance with available treatments, and routine eye examinations was collected using a semi-structured questionnaire. Patients were also asked about the barriers that may interfere with a regular eye examination. Results: A total of 200 patients were enrolled and 94 (47%) of them were female; 13% of the respondents were diagnosed with diabetic retinopathy, 31.5% were hypertensive, and 13.5% had hyperlipidemia. Additionally, 88.5% of the patients were aware that DM can affect their eyes and 87% had never been diagnosed with diabetic retinopathy. Although around 83% thought that diabetic retinopathy could lead to blindness, only 35.5% of them had undergone fundus examination by ophthalmologists. Moreover, 39% of the participants had irregular diabetes follow-up and 43% monthly follow-up. Only 31% went for regular eye check-up; however, their compliance with routine retinal assessment was poor, with a total of 72.5% of participants assuming that they have good vision and need not get their eyes checked up regularly. The chief factor that was related to increased awareness of diabetic retinopathy in the study was the level of education. Conclusion: Although a large proportion of diabetic patients in Khartoum are aware that diabetes mellitus can affect their eyes, regular retinal assessment of patients was poor, thus hindering early diagnosis and management

Non-invasive ventilation in patients with an altered level of consciousness : a clinical review and practical insights

Non-invasive ventilation has gained an increasingly pivotal role in the treatment of acute hypoxemic and/or hypercapnic respiratory failure and offers multiple advantages over invasive mechanical ventilation. Some of these advantages include the preservation of airway defense mechanisms, a reduced need for sedation, and an avoidance of complications related to endotracheal intubation. Despite its advantages, non-invasive ventilation has some contraindications that include, among them, severe encephalopathy. In this review article, the rationale, evidence, and drawbacks of the use of noninvasive ventilation in the context of hypercapnic and non-hypercapnic patients with an altered level of consciousness are analyzed

Adverse pregnancy outcomes in sickle cell trait: a prospective cohort study evaluating clinical and haematological parameters in postpartum mothers and newborns

Background: Sickle cell trait (SCT) is a congenital condition caused by the inheritance of a single allele of the abnormal haemoglobin beta gene, HbS. Carriers of SCT are generally asymptomatic, and they do not manifest the clinical and haematological abnormalities of sickle cell anaemia (SCA). However, there is evidence that they display some symptoms in stressful situations. Pregnancy is a stressful physiological event, and it is not clear if SCT adversely affects pregnancy outcomes, particularly in those from developing countries where people regularly suffer from nutritional insufficiency. Objective: This study aims to investigate pregnancy outcomes in Sudanese women with SCT. Subjects and methods: Pregnant women with (HbAS, n=34) and without (HbAA, n=60) SCT were recruited during their first trimester at El Obeid Hospital, Kordofan, Western Sudan. Following appropriate ethical approval and informed consent from the participants, detailed anthropometric, clinical, haematological, obstetric, and birth outcome data were registered. In addition, blood samples were collected at enrolment and at delivery. Results: At enrolment in the first trimester, the SCT group did not manifest SCA symptoms, and there was no difference in the haematological parameters between the SCT and control groups. However, at delivery, the women with SCT, compared with the control group, had lower levels of hemoglobin (Hb, p=0.000), packed cell volume (PCV, p=0.000), mean corpuscular haemoglobin (MCH, p=0.002) and neutrophil counts (p=0.045) and higher mean corpuscular volume (MCV, p=0.000) and platelet counts (p=0.000). Similarly, at delivery, the babies of SCT women had lower birth weight (p=0.000), lower Hb (p=0.045), PCV (p=0.000), MCH (p=0.000), and higher neutrophil (p=0.004) and platelet counts (p=0.000) than the babies of the healthy control group. Additionally, there were more miscarriages, stillbirths, and admissions to the Special Care Baby Unit (SCBU) in the SCT group. Conclusions: The study revealed that SCT is associated with adverse pregnancy outcomes, including maternal and neonatal anaemia, low birth weight, and increased risk of stillbirth, miscarriage, and admission to SCBU. Therefore, pregnant women with SCT should be given appropriate pre-conceptual advice and multidisciplinary antenatal and postnatal care

The role of non-invasive ventilation in weaning and decannulating critically ill patients with tracheostomy: A narrative review of the literature

Abstract Introduction Invasive mechanical ventilation (IMV) is associated with several complications. Placement of a long-term airway (tracheostomy) is also associated with short and long-term risks for patients. Nevertheless, tracheostomies are placed to help reduce the duration of IMV, facilitate weaning and eventually undergo successful decannulation. Methods We performed a narrative review by searching PubMed, Embase and Medline databases to identify relevant citations using the search terms (with synonyms and closely related words) "non-invasive ventilation", "tracheostomy" and "weaning". We identified 13 publications comprising retrospective or prospective studies in which non-invasive ventilation (NIV) was one of the strategies used during weaning from IMV and/or tracheostomy decannulation. Results In some studies, patients with tracheostomies represented a subgroup of patients on IMV. Most of the studies involved patients with underlying cardiopulmonary comorbidities and conditions, and primarily involved specialized weaning centres. Not all studies provided data on decannulation, although those which did, report high success rates for weaning and decannulation when using NIV as an adjunct to weaning patient off ventilatory support. However, a significant percentage of patients still needed home NIV after discharge. Conclusions The review supports a potential role for NIV in weaning patients with a tracheostomy either off the ventilator and/or with its decannulation. Additional research is needed to develop weaning protocols and better characterize the role of NIV during weaning

Non-invasive ventilation in patients with an altered level of consciousness. A clinical review and practical insights

Non-invasive ventilation has gained an increasingly pivotal role in the treatment of acute hypoxemic and/or hypercapnic respira-tory failure and offers multiple advantages over invasive mechanical ventilation. Some of these advantages include the preserva-tion of airway defense mechanisms, a reduced need for sedation, and an avoidance of complications related to endotracheal intubation.Despite its advantages, non-invasive ventilation has some contraindications that include, among them, severe encephalopathy. In this review article, the rationale, evidence, and drawbacks of the use of noninvasive ventilation in the context of hypercapnic and non-hypercapnic patients with an altered level of consciousness are analyzed

Pf7: an open dataset of Plasmodium falciparum genome variation in 20,000 worldwide samples

We describe the MalariaGEN Pf7 data resource, the seventh release of Plasmodium falciparum genome variation data from the MalariaGEN network.  It comprises over 20,000 samples from 82 partner studies in 33 countries, including several malaria endemic regions that were previously underrepresented.  For the first time we include dried blood spot samples that were sequenced after selective whole genome amplification, necessitating new methods to genotype copy number variations.  We identify a large number of newly emerging crt mutations in parts of Southeast Asia, and show examples of heterogeneities in patterns of drug resistance within Africa and within the Indian subcontinent.  We describe the profile of variations in the C-terminal of the csp gene and relate this to the sequence used in the RTS,S and R21 malaria vaccines.  Pf7 provides high-quality data on genotype calls for 6 million SNPs and short indels, analysis of large deletions that cause failure of rapid diagnostic tests, and systematic characterisation of six major drug resistance loci, all of which can be freely downloaded from the MalariaGEN website

Aerodynamic Characteristics of Nebulized Terbutaline Sulphate Using the Next Generation Impactor (NGI) and CEN Method

Characterization of the aerosolized dose emitted from a nebulized system can be determined using CEN (prEN13544-1) methodology and more recently with a Next Generation Impactor (NGI), but evaporative effects can influence the results. We have investigated these characteristics using different flows and cooling with the NGI and compared the results to the standard CEN method using two different nebulizer systems. The NGI was operated using flows of 15 and 30 L min−1 at room (ROOM) temperature and immediately after cooling at 5°C for 90 min (COLD). Two nebulizer systems, the Sidestream jet nebulizer (SIDE) and the Aeroneb Pro (AERO), were used to nebulize terbutaline sulphate respiratory solution. The CEN method was also used to provide the aerodynamic characteristics of the aerosolized dose from these two nebulizer systems. The mean (SD) mass median aerodynamic diameter (MMAD) using 15COLD, 15ROOM, 30COLD, 30ROOM, and CEN for AERO was 5.0(0.1), 4.1(0.3), 4.4(0.2), 2.0(0.3), and 3.0(1.1) μm, respectively, and 4.2(0.4), 2.6(0.4), 3.5(0.1), 1.7(0.1), and 3.2(0.3) μm for SIDE. The fine particle fraction (FPF), using the NGI, followed the expected trend associated with the corresponding MMAD values, ranging from 48.1 to 70.5% from AERO and 57.3 to 87.8% for SIDE. The mean FPF for AERO and SIDE using the CEN methodology was 72.5 and 63.6%. Overall there was a highly significant difference (p < 0.001) between the different operating conditions for the FPF and MMAD of both nebulizer systems. All methods revealed a significant difference between AERO and SIDE except CEN. Both nebulizer systems were prone to evaporation effects during in vitro testing. Cooling and using a slow flow minimizes evaporation effects with the NGI and should be adopted as the recommended compendial method. The CEN method provides different values to those of the NGI operating conditions and could not differentiate between the two nebulizer