IRRITABLE BOWEL SYNDROME MANAGEMENT: BUMPY ROAD FOR PHYSICIANS

Irritable bowel syndrome is a complex gastrointestinal disorder related to over activity of nerves supplying the gut. 1It has been matter of enormous concern for both the patients and treating physicians’ .The clinical course is diverse and takes different twist and turns. Sometimes it does present with typical symptoms like bloating, flatulence and altered bowel habits. At times there is mental illness like severe depression that comes in the way which is real challenge for the physicians to treat as mere reassurance doesn’t suffice. The longer the history of symptoms, more complicated it gets. There are multiple obstacles before making in rows in treatment.2 The most frustrating point is when the patient fails to show any improvement after months of treatment. They have symptoms in relapsing and remitting manner. Post infectious IBS is more agonizing as the patient need antibiotics in an era of increasing resistance .3Failure of one antibiotic to resolve symptoms leads to usage of multiple ones at the same time .The cramping abdominal pain and the sleepless nights leading to daytime fatigue do have an enormous and disastrous impact on the activities of daily living. After the decades of research, optimization of treatment for irritable bowel syndrome is still a daunting task even for experienced gastroenterologists.4 The emergence of alarm symptoms like bleeding per rectum,uninetentional weight loss and feeling of abdominal mass in individuals who have altered bowel for years do ring the bell for physicians to act vigilantly who were otherwise complacent. 4They were relying on traditional treatment regimens like giving laxatives,anti spasmodic and medications for depression. Some of them do consider expeditious referral to psychiatrist without getting to the bottom of the situation. Colonoscopy is advised at the end when much damaged have been caused already .It will be excellent practice to advised stool routine examination ,culture.ESR,CRP and calprotectin levels.5 They will give an idea of level of inflammation in the gut as invasive investigations are always dangerous in setting of acute flare of disease such as inflammatory bowel diseas

Spatial analysis of food poisoning cases and its environmental relations in Sabah, Malaysia

Food poisoning usually occurs with the consumption of contaminated food. Some related factors are unsafe water supply, poor sanitation, unhygienic waste disposal and unhygienic practices or poor personal hygiene by food handlers. The purpose of this study is to describe the spatial epidemiology of food poisoning cases in the four districts of Sabah. Methods: This review consists of all food poisoning cases reported from 2011 to 2014 from Kota Kinabalu, Penampang, Putatan and Papar, Sabah. The coordinates used for locations of cases are based on home addresses. Tools such as SPSS v20, ArcGIS v10 and CrimeStat IV were used for data analysis and mapping. Results: A total of 1,787 cases of food poisoning were reported during this review period. In 2011, only Kota Kinabalu and Papar illustrated significant food poisoning clusters. Meanwhile, in the year 2012 to 2014, Kota Kinabalu, Penampang and Putatan had clustering of cases. Analysis of nearest neighbour hierarchical clustering analysis showed 32 food poisoning clusters. There were 4 food poisoning points at 500 meters radius around a market place, 2 food poisoning points near a sewage plant and 1 food poisoning point near a water treatment plant. No cases were near a municipal landfill. For rivers and coastline, there were 37 points of food poisoning cases in the proximity of 500 meters. Conclusion: Food poisoning usually occurs in clusters with possible associated environmental factors

Spatial clustering of Cholera in Sabah, Malaysia

Cholera epidemics can produce devastating public health outcomes. Cholera distribution is influenced by temperature, precipitation, elevation, distance to the coastline and oceanic environmental factors such as sea surface temperature, sea surface height and ocean chlorophyll concentration. The purpose of this study is to describe the spatial epidemiology of cholera in the four districts of Sabah. Methods: This is a retrospective review of 4 years (2011 to 2014) data from the districts of Kota Kinabalu, Penampang, Putatan and Papar, Sabah. All reported cases of cholera from those areas are included. Coordinates for locations of the cases are based on home addresses. SPSS v20, ArcGIS v10 and CrimeStat IV were used for data analysis and mapping. Results: Cholera showed several clustering of cases, such as in 2011 and 2014 in Kota Kinabalu. In the year 2011 and 2013, Penampang and Papar districts had the nearest neighbour index of less than 1, but p value was not significant, meaning the pattern did not appear to be significant. Nearest neighbour hierarchical clustering analysis further revealed cholera had 7 clusters, of those 6 were first order and 1 was a second order cluster. Conclusion: Cholera shows disease clustering which could mean it is due to its common point source or localised human to human transmission. Using GIS as a tool may help in surveillance and control of cholera infections

Knowledge of Safe Swaddling Practices among Mothers of Neonates Visiting a Tertiary-Care Hospital in a Developing Country

OBJECTIVES Swaddling of new-borne and infants remains common in the developing world, but little is known about maternal knowledge of swaddling. Therefore, this study aimed to determine the level of knowledge of safe swaddling practices among mothers of neonates visiting a Tertiary-Care Hospital.METHODOLOGY This cross-sectional study was conducted in the paediatric unit of tertiary care hospital in Peshawar city, Pakistan, between July and December 2018. A total number of 370 mothers of neonates who volunteered their participation were selected using a non-probability consecutive sampling technique. The study was based on a questionnaire comprised of socio-demographic and other questions related to the knowledge of safe swaddling practices.RESULTSA total number of 370 mothers of neonates knowledge were assessed. The study participants ranged between 17 - 49 years, with a mean age of 27.14 (SD ± 5.46). Of the total, 365 (98.6%) mothers were swaddling their babies, while only 5 (1.3%) reported not practising swaddling. Most mothers (51.1%) had good knowledge, while 44.3% had adequate knowledge, and only 4.6% had insufficient knowledge regarding safe swaddling. Knowledge of safe swaddling increased with age and parity. Most mothers (90%) correctly identified that "cotton cloth or light blanket should be used to swaddle baby".CONCLUSIONIt is concluded from this study that most mothers have adequate knowledge about safe swaddling, and the level of knowledge increases with age and parity. Safe swaddling techniques and information should be given to mothers at the beginning of antenatal care to benefit from its positive outcomes and, at the same time to avoid its drawbacks

Spatial Analysis of Food and Waterborne Diseases in Sabah, Malaysia

Food and waterborne disease (FWBD) epidemic can produce devastating public health outcomes. From 1990 to 2006, the annual notifications for FWBDs in Malaysia ranged from 2,000 to about 10,000 cases. The purpose of this study was to describe the spatial epidemiology of FWBDs in four districts of Sabah from the year 2011 to 2014. This study was a retrospective review of four years (i.e. 2011 to 2014) worth of data from Kota Kinabalu, Penampang, Putatan, and Papar districts. All reported cases of cholera, dysentery, food poisoning, typhoid, and viral hepatitis A from these areas and district health offices were included. Coordinates for the locations of the cases were based on home addresses. Among a total of 1997 cases of FWBDs, food poisoning was the highest reported disease with 1787 (89.4%) cases. Kota Kinabalu had the most reported cases of FWBDs with 1368 (68.5%). In the year 2012, FWBD incidence was the highest at 16.44 per 10,000 populations. Kernel density estimation demonstrated hot spots of food poisoning and cholera in the western areas near the coast, while typhoid and viral hepatitis A cases had minimal hot spots and appeared to be dispersed. Average nearest neighbour analysis showed clusters of food poisoning and cholera cases. Further analysis with the nearest neighbour hierarchical spatial clustering presented 32 clusters of food poisoning and 7 clusters of cholera. Food poisoning and cholera usually occur in clusters. From these findings, it can be concluded that these areas, food poisoning, and cholera have significant spatial clustering and patterns. Meanwhile, other FWBDs did not occur in clusters for this study. This indicates the possibility of under-reporting or real dispersion of cases brought about by an efficient mechanism of spread from a common source

Factors of Acute Diarrhoea among Children of Under Five Years Old in Sabah, Malaysia: A Case-Control Study

Acute diarrhoea is a major public health problem and is the second leading cause of death in children. It has implications in terms of morbidity and mortality especially in the under five years old age group. The purpose of this study was to determine the factors associated with acute diarrhoea among children under 5 years old in Sabah. This was a case-control study involving 584 samples in four districts in Sabah. Analysis with multiple logistic regression discovered the associated factors of acute diarrhoea among under 5 years old were child’s age, single parents aOR5.209 (95%CI 1.09-25.01), Peribumi Sabah mother aOR1.542 (95%CI 1.01-2.34), unemployed mother aOR1.783 (95%CI 1.16-2.75), less than RM2,000 monthly household income aOR1.643 (95%CI 1.08-2.49), no garbage collection aOR1.923 (95%CI 1.24-2.98), adjacent open garbage aOR1.888 (95%CI 1.23-2.91), average rainfall of 151mm or more aOR1.768 (95%CI 1.22-2.56) and less than 1 year of breastfeeding aOR1.685 (95%CI 1.11-2.55). The study has revealed the need to improve the overall level of hygiene and sanitation in the population

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Neigbourhood Factors on Mental Health Questionnaire: Development, Validity, and Reliability among Malaysian Adolescents

Introduction: The risk factors associated with mental health among adolescents are usually described by researchers at an individual level. Neighbourhood factors and health have opened a new insight into the field of epidemiology. The aim of this study was to assess the reliability and validity of a newly developed Neighbourhood Factors on Mental Health Questionnaire among Malaysian adolescents. Methods: A cross-sectional study was conducted in four secondary schools in Kuala Lumpur, Malaysia using a newly developed questionnaire which comprised of two main domains and seven items. Exploratory factor analysis and Cronbach‟s alpha were used to measure the instrument‟s construct validity and reliability. Results: A total of 106 adolescents participated in this research. The majority of adolescents were 13 years old (40.6%), female (55.7%), Malays (68.9%), have parents who only studied until secondary school (66.0%) and lived in flats (32.1%). Bartlett‟s Test of Sphericity was significant (Chi-square = 258.361, p<0.001) and Kaiser-Meyer-Olkin (KMO) value was 0.820. The final model of the instrument contained two domains, the neighbourhood physical environment and neighbourhood social environment factors. Factor loadings for all items were satisfactory ranging from 0.591 to 0.870. The overall Cronbach‟s alpha was 0.810. Conclusions: The Neigbourhood Factors on Mental Health Questionnaire was found to be a valid and reliable instrument. It can be used to assess neighbourhood physical and social factors that can influence mental health of adolescents in Malaysia

Complacency in GERD an Imminent Disaster

Gastroesophageal reflux disease is one of the most common gastrointestinal disorders which is mainly characterized by problems with esophageal peristalsis, which is responsible for propelling food from the esophagus into the stomach or dysfunctional or weaker lower esophageal sphincter, which prevents the reflux to stomach contents.Typical symptoms involve heartburn, regurgitation of food, a sore taste in the mouth, and sometimes atypical symptoms like chest pain, signs of dental erosion and even breathlessness at night. There is also a trend of testing for helicobacter pylori in GERD patients which is absolutely not recommended at all as there is no evidence that eradication therapy will ease the symptoms.Instead, it has contributed to widespread antimicrobial resistance with physicians using them, which is otherwise a futile exercise. There is no need to try different proton pump inhibitors for a long time when there is no improvement in symptoms.The physicians in general practice should rather be generous in referring such patients on time to gastroenterology experts, as the treatment needs to be multidisciplinary and one should not be silent on sinister signs and symptoms if they are present. Endoscopy is already a safer option to screen such patients, which will suffice for the reassurance of the patients