Comparison Between Carotid Intima-Media Thickness and Coronary Artery Calcification in the Prediction of Atherosclerosis in Diabetic Patients

BACKGROUND: Cardiovascular disease is one of the atherosclerosis etiologies that can lead to death. Diabetes mellitus increases the risk of atherosclerosis. Screening tool is very beneficial for detecting atherosclerotic plaque, especially in subclinical atherosclerotic cases. Carotid intima-media thickness (CIMT) and coronary artery calcification score (CACS) are two kinds of tools that are widely used, and each of these tools has its own superiority. This study was aimed to investigate the sensitivity and specificity of both of these tools as screening tools.METHODS: The study was conducted with a cross sectional design involving 43 diabetic and 68 non-diabetic male subjects aged above 45 years old. All subjects fulfilled inclusion criteria. Carotid artery ultrasonography and CACS measurement were performed.RESULTS: Fischer exact test was used to show a significant correlation between CIMT and CACS (p<0.05). Diagnostic test was used to assess the sensitivity of CIMT toward CACS in above 75 percentile. The left common carotid artery (LCCA) showed the highest sensitivity either in diabetic (76.4%) or non-diabetic male subjects (90%).CONCLUSION: CIMT has the same sensitivity with CACS. CIMT can be used as the preferred screening tool for high risk patients and as a substitution tool to CACS for low risk patients in subclinical atherosclerosis detection

Leaving no disease behind: The roadmap to securing universal health security and what this means for the surveillance of infectious diseases in Ghana as a precedent for sub-Saharan Africa

Introduction: Ghana is the first country in sub-Saharan Africa (SSA) to aim for universal health coverage (UHC). Based on Ghana's UHC system, the accessibility and distribution of healthcare facilities were evaluated for 2020. Projecting into 2030, this study aimed at providing geographical information data for guiding future policies on siting required healthcare facilities. Ghana as a precedent for SSA was evaluated and proposed to "leave no disease behind" in the surveillance of infectious diseases (IDs). This is to reinforce the sustainable development goals (SDG) 3 agenda on health that underpins monitoring equity in "leaving no one behind." Methods: Geospatial accessibility, travel time data, and algorithms were employed to evaluate the universality and accessibility of healthcare facilities, and their future projections to meet UHC by 2030. Healthcare facilities as surveillance sites were compared to community-based surveillance to identify which would be more applicable as a surveillance system to leave no disease behind in Ghana. Findings: Ghana has 93.8%, 6.1% and 0.1% as primary, secondary and tertiary healthcare facilities respectively. It has 26.1% of healthcare facilities remaining to meet the SDG 3 health target by 2030. In terms of providing quality healthcare, 29.3% and 67.2% of the additional required healthcare facilities for optimal allocation and achieving the UHC target need to be secondary and tertiary respectively. In assessing the broad spectrum of IDs studied from 2000 to 2020, an average of 226 IDs were endemic or potentially endemic to Ghana. The majority of the studies carried out to identify these IDs were done through community-based surveillance. Conclusion: Establishing community-based surveillance sites to leave no disease behind and also providing the required healthcare facilities to reinforce leaving no one behind will enhance the universal health security of Ghana as a precedent for SSA

Validation of a 3D CT method for measurement of linear wear of acetabular cups: A hip simulator study

Background We evaluated the accuracy and repeatability of a 3D method for polyethylene acetabular cup wear measurements using computed tomography (CT). We propose that the method be used for clinical in vivo assessment of wear in acetabular cups. Material and methods Ultra-high molecular weight polyethylene cups with a titanium mesh molded on the outside were subjected to wear using a hip simulator. Before and after wear, they were (1) imaged with a CT scanner using a phantom model device, (2) measured using a coordinate measurement machine (CMM), and (3) weighed. CMM was used as the reference method for measurement of femoral head penetration into the cup and for comparison with CT, and gravimetric measurements were used as a reference for both CT and CMM. Femoral head penetration and wear vector angle were studied. The head diameters were also measured with both CMM and CT. The repeatability of the method proposed was evaluated with two repeated measurements using different positions of the phantom in the CT scanner. Results The accuracy of the 3D CT method for evaluation of linear wear was 0.51 mm and the repeatability was 0.39 mm. Repeatability for wear vector angle was 17?. Interpretation This study of metal-meshed hip-simulated acetabular cups shows that CT has the capacity for reliable measurement of linear wear of acetabular cups at a clinically relevant level of accuracy

Pregnancy-related conditions and premature coronary heart disease in adult offspring.

Objective: To investigate the association between complications during pregnancy and premature coronary heart disease in adult offspring. Methods: We conducted a population-based case-control study of 153 Indonesian patients with a first acute coronary syndrome (ACS) (age ≤55 years) and 153 age-matched and sex-matched controls. Data on complications during pregnancy (high blood pressure, preterm delivery) and maternal infections in pregnancy were obtained, together with sociodemographic data, clinical profiles, laboratory measurements and adulthood cardiovascular disease (CVD) risk factors at hospital admission or enrolment. Conditional logistic regression was performed to assess the association between overall pregnancy complications, and specific groupings of complications and premature ACS. Results: Pregnancy-related hypertension and infection were more common in mothers of cases than controls. Pregnancy complications were associated with premature offspring ACS (OR 2.9, 95% CI 1.4 to 6.0, p=0.004), and the association persisted in fully adjusted analyses (ORadjusted 4.5, 1.1 to 18.1, p=0.036). In subgroup analyses, pregnancy-related high blood pressure (ORadjusted 5.0, 1.0 to 24.7, p=0.050) and maternal infections (ORadjusted 5.2, 1.1 to 24.2, p=0.035) were associated with offspring ACS. Conclusions: Offspring of mothers with complications during pregnancy have an increased risk for premature ACS in adulthood, which may be of particular relevance in populations in transition, where the incidence of both pregnancy-related morbidity and CVD are high

Nefroprotective Effect of Gynura Procumbens Extract Against Paracetamol Toxicity in Rats

Excessive doses of paracetamol have the potential to cause acute kidney injury and even death. Gynura procumbens has been traditionally used as folk-medicine for kidney disease. This study aimed to examine the nephroprotective effect of Gynura procumbens leaf extract against paracetamol-induced nephrotoxicity in rats. Twenty-five male wistar rats (150-200 g) were divided into 5 groups. Healthy control group, placebo group, and 3 extract treatment groups that received either 100 mg/kg, 200 mg/kg or 300 mg/kg dose. The placebo (sodium carboxymethyl cellulose) or extract was given 4 consecutive days prior to paracetamol (2400 mg/kg) administration on day 5. Blood samples were withdrawn before treatment initiated (day 0), after treatment before paracetamol administration (day 5) and 24-hour after paracetamol administration (day 6). Blood samples were analyzed to obtain urea and creatinine levels. In addition, histopathological analysis was performed on the renal tissue. &nbsp;Paracetamol administration was shown to significantly increase the urea and creatinine levels, and the extract at 300 mg/kg dose was able to significantly prevent the elevation of the renal biomarkers. The histopathological analysis also revealed a significant reduction in renal histopathological injury in 300 mg/kg extract group. It can be concluded that the ethanolic extract of the Gynura procumbens at a dose of 300 mg/kg has a good protective effect on kidney function and tissue structure. Key words: Gynura procumbens, nephroprotective, paracetamo

The Climate Change Vulnerability and Risk Management Matrix for the Coastal Zone of The Gambia

Global Climate Change is one of the dire challenges facing the international community today. Coastal zones are vulnerable to its impacts. An effective approach with long-term prospects in addressing climate change impacts is it’s mainstreaming into development agenda of sectoral policies. A comprehensive risk and vulnerability assessment is a pre-requisite to ensure that the right adaptive response is taken for effective integration into developmental plans. The objective of this study is to evaluate and prioritize risks, vulnerability and adaptation issues of current and anticipated impacts of climate change on the coastal zone of The Gambia. The study will also give a methodological contribution for assessing risks, vulnerability and adaptation from the sub-national to local levels. The relevance of this study will be to create a link between the sub-national and local levels in order to facilitate the integration and mainstreaming of climate change into sectoral and local policies for more climate-resilient communities. This will aid in the promotion of strategic investment of constrained developmental resources to actualize successfully dynamic coping strategies, elude ‘maladaptation’ and less compelling responsive measures. A purposive expert sampling technique was used in selecting respondents for the study. The findings of the study reveal that by the end of the 21st century, the climatic variables likely to have the highest impact on the coastal zone of The Gambia are ‘increased flood severity’ and ‘increased temperature’. The coastal zone of The Gambia showed a high vulnerability to these climate change variables. The suggested adaptive response in addressing the impacts of increased flood intensity in the study area includes; improving regulations for restricting agriculture and livestock grazing activities to improve land cover; strengthening of early-warning systems, among others. The suggested adaptive response in addressing the increase in temperature includes: increase crop diversification and rotation to reduce total crop failure; switching to drought-tolerant crop and animal species, among others