Impact of On-Site Training of Neonatal Resuscitation Techniques in Shirati District Hospitals: Does On-Site Training Improve Knowledge, Attitude, and Practices?

Program/Project Purpose: In Tanzania, early neonatal morality remains high despite the county’s efforts towards improving health indicators. It’s estimated that birth asphyxia is involved in up to 30% of early neonatal deaths in developing countries, and is associated with high neurological morbidity for those who survive. Early interventions targeting birth asphyxia were not successful; likely due to low national priority, limited resources, and targeting limited types of providers. Helping Babies Breath (HBB) is an evidence-based neonatal resuscitation program designed for resource- limited settings. The program follows a basic intervention approach which emphasizes the importance of skilled attendants at every birth. The HBB program has been successfully implemented at eight sites within Tanzania, and has been endorsed by the Tanzanian National Government. However studies in Tanzania have been carried at referral and teaching hospitals and not at a District hospital. The purpose of this study was to examine the effectiveness of teaching HBB at the level of a District Hospital. The project took place June 2014. Structure/Method/Design: This is a prospective two-phase program evaluation to assess whether on-site training can improve knowledge, 26 Education/Training/Capacity Building attitude, and practices at a District Hospital in Shirati, Tanzania. Medical students from Touro University—California were trained as instructors for HBB curriculum. During phase 1, students designed pre- and post-surveys to measure whether the training sessions could improve knowledge and attitudes about HBB interventions. Presurveys were administered just prior to the training sessions, and post surveys were administered at the end of the training sessions. Participants included hospital labor & delivery staff. A total of 112 sets of surveys were completed during 4 training sessions. In addition, baseline data of birth outcomes were collected from delivery log books. Phase 2 of data collection will take place June 2015, and the new data will determine whether trainings effectively improved practices. Additional trainings will also be conducted at this time. Outcomes & Evaluation: Results indicate that the trainings were effective, and scores reflecting knowledge and attitudes were improved in the post-surveys. Practices will be evaluated during phase 2. Going Forward: The goal of this study was to determine if the training of District Hospital’s labor and delivery staff improves knowledge and attitudes. Results show that HBB can be implemented effectively in this setting. An ongoing challenge for this program includes language barriers. Although staff could speak English, comprehension levels varied, and some participants had difficulty understanding both the presentation and the survey questions. In future trainings, surveys should be re-written using basic sentence structure, and word choice should be considered

Prevalence and Predictors of Pap Smear Cervical Epithelial Cell Abnormality among HIV-Positive and Negative Women Attending Gynecological Examination in Cervical Cancer Screening Center at Debre Markos Referral Hospital, East Gojjam, Northwest Ethiopia

Background: Cervical cancer is the leading cause of cancer related death among women in developing countries. Cervical cancer is preceded by cervical surface epithelial cell abnormalities (ECA) which can be detected by Pap smear test. Simultaneous human papillomavirus and human immunodeficiency virus (HIV) infection increases cervical cancer. Data on the prevalence and predictors of ECA among women in Ethiopia is limited. Hence, we aimed to determine the prevalence and associated factors of ECA among women. Methods: A comparative cross-sectional study was conducted among HIV+ and HIV- women attending gynecological examination in cervical cancer screening center at the Debre Markos referral hospital. The study subjects were stratified by HIV status and systematic random sampling method was used to recruit study participants. Cervical smears were collected for Pap smear examination. Logistic regression analysis was employed to examine the possible risk factors of cervical ECA. Results: A total of 197 HIV+ and 194 HIV- women were enrolled in the study. The overall prevalence of cervical ECA was 14.1 % of which the prevalence of atypical squamous cells undetermined significance (ASCUS), low grade squamous intraepithelial lesion (SIL), high grade SIL, squamous cell carcinoma and ASC, cannot exclude high grade SIL (ASCH) were 5.1, 3.8, 4.1 and 1.0 %, 0.0 % respectively. Significantly higher prevalence of ECA (17.8 %) was observed among HIV+ women (COR 1.9, 95 % CI: 1.1 − 3.4, p = 0.036) as compared to HIV-women (10.3 %). Multiple sexual partnership (AOR 3.2, 95 % CI: 1.1 − 10.0, p = 0.04), early ages of first sexual contact (\u3c15 \u3eyears) (AOR 5.2, 95 % CI: 1.5 − 17.9, p = 0.009), parity greater than three (AOR 10.9, 95 % CI: 4.2 − 16.8, p \u3c 0.001) and long term oral contraceptive pills (OCP) use (AOR 11.9, 95 % CI: 2.1 − 16.7, p = 0.02) were significant predictors of prevalence of ECA. Conclusions: Cervical ECA is a major problem among HIV-infected women. Lower CD4+ T-cell counts of below 350 cells/μl, HIV infection, multiple sexual partnership, early age at first sexual contact, parity greater than three and long term OCP use were significant predictors of prevalence of ECA. Strengthening screening program in HIV+ women should be considered

Cytokine Storm in COVID-19 Patients, their Impact on Organs and the Potential Treatment by QTY Code-Designed Detergent-Free Chemokine Receptors

The novel coronavirus in not only causing respiratory problems, it may also damage the heart, kidneys, liver and other organs; in Wuhan 14 to 30% of COVID-19 patients have lost their kidney function and now require either dialysis or kidney transplants. The novel coronavirus gains entry into humans by targeting ACE2 receptor that found on lung cells, which destroy human lungs through cytokine storms, this leads to hyper-inflammation, forcing the immune cells to destroy healthy cells. This is why some COVID-19 patients need intensive care. The inflammatory chemicals released during COVID-19 infection cause the liver to produce proteins that defend the body from infections. However, these proteins can cause blood clotting, which can clog blood vessels in the heart and other organs; as a result, the organs are deprived from oxygen and nutrients which could ultimately lead to multi-organ failure and subsequent progression to acute lung injury, acute respiratory distress syndrome and often death. However, a novel protein modification tool called the QTY code, that are similar in their structure to antibodies, which could provide a solution to excess cytokines, these synthetic proteins can be injected into the body to blind the excess cytokines generated by the cytokine storm; this will eventually remove the excessive cytokines and inhibit the severe symptoms caused by the COVID-19 infection. In this review we will focuses on cytokine storm in COVID-19 patients, their impact on the organs and the potential treatment by QTY code-designed detergent-free chemokine receptors

Evaluation of Osteoporosis in Hemophilic Arthropathy Patients: Correlation with Disease Severity and Serum Trace Minerals

Objective. To find out the presence of osteoporosis in hemophilic arthropathy patients and its correlation with clinical severity and serum levels of magnesium, copper, and zinc. Methods. Joint score, functional assessment score, bone densitometry, and serum magnesium, copper and zinc were done in twenty male hemophilic arthropathy patients and twenty controls. Results. There was highly significant lower Z scores of lumbar spine and neck of femur in patients versus controls (P<0.011). Z score of neck of femur correlated negatively with total joint score (P=0.013) and functional assessment score (P=0.011). Serum levels of copper and zinc correlated positively with Z score of neck of femur (P=0.004, P=0.001, resp.). Conclusion. Osteoporosis represents a frequent concomitant observation in hemophiliacs. Screening of young hemophiliacs for osteoporosis is recommended with measuring serum levels of magnesium, copper, and zinc for better management of the disease

Assessment of Longitudinal Efficacy of Community Based Intervention for Schistosomiasis in Mara District, Lake Victoria Region of Tanzania

Program/Project Purpose: An estimated 200 million people are infected with schistosomiasis, making the disease one of the top neglected tropical diseases and a major global health concern. In Tanzania, with a population just over 42 million, about 33 million are in need of treatment or preventative chemotherapy. The disease is of particular concern in the Lake Victoria region, due to daily use of lake water. In conjunction with the Shirati district hospital, Touro University-CA has led control programs carried out in mobile clinics at local villages by providing screening, treatment, and education. Recently there has been a push for use of static dispensary locations for diagnosis and treatment. The aim of this study is to assess the longitudinal efficacy of community based interventions for schistosomiasis carried out from 2009-2014 and compares the utilization of static health dispensary clinics to the community based mobile clinics in reaching out to the population. Structure/Method/Design: Villagers were alerted to the screening, treatment, and education program through local leaders, announcements over the radio, and posters. Effectiveness will be measured by analyzing trends in the number of people visiting the clinics, prevalence of infection, the number treated, given positive infection status, and change in prevalence patterns with treatment. The number of people screened at dispensaries versus mobile clinics will be compared. We hypothesize that mobile clinics are effective in reducing prevalence of schistosomiasis in community based interventions and that health dispensaries provide no additional value towards increasing number of individuals screened. Outcomes & Evaluation: Univariate analysis and 2-tailed t-tests will be performed to assess if the use of services has significantly increased or not at mobile clinics from 2009-2014, and to compare utilization of health dispensaries versus mobile clinics. Prevalence of those who test positive will also be determined and analyzed to assess for a downward trend. Preliminary analysis reveals that from 2012 to 2014, prevalence of infection has decreased and that utilization of health dispensaries provides no additional value over mobile clinics. Our study supports the use of mobile clinics to carry out community-based health education, screening, and treatment programs over the use of dispensaries in rural Tanzania. Going Forward: During this study mobile clinics reported decreased prevalence and are able to capture a larger population of people interested in being screened for infection. Since use of dispensaries is favored by the Mara district, it will be important to point out the efficiency of mobile clinics or improve the efficacy of dispensaries by increasing the frequency of screenings or widening the area of promotion to other nearby villages

Relation between early stages of diabetic retinopathy and early stages of diabetic kidney disease in patients with type 2 diabetes in Egypt

Background. Diabetes mellitus is a pandemic disease. Type 2 diabetes (T2DM) is the most common type. Diabetic retinopathy (DR) and diabetic kidney disease (DKD) are disabling chronic complications. The relation between both is not yet well-established in T2DM. Egypt is considered one of the top ten countries re- garding the prevalence of diabetes that makes diabetes and its complications a major health problem. This encouraged us to conduct this research.  Materials and methods. The study included 79 patients with T2DM divided into two groups according to the presence of retinopathy. Both groups were subdivided according to urinary albumin to creatinine ratio (UACR) into normoalbuminuric and albuminuric subgroups. Retinopathy group was further subdivided according to severity of retinopathy into mild, moderate and severe non-proliferative DR (NPDR). Statistical analysis was done and relation between the severity of retinopathy and UACR was studied.  Results. Patients with retinopathy had significantly higher diabetes duration and UACR than non retinopathy group. Also in subgroups of normoalbuminuria and albuminuria, retinopathy group was significantly higher regarding the same parameters. On subdividing the retinopathy group according to severity, severe NPDR group had significantly higher UACR. The severity of DR was significantly positively correlated with UACR.  Conclusions. The present study identified a significantly positive correlation between early stages of DR and UACR in patients with T2DM in Egypt. Not all cases of DR had DKD especially in early stages and also not all cases of DKD are associated with the presence of DR in T2DM.   Background. Diabetes mellitus is a pandemic disease. Type 2 diabetes (T2DM) is the most common type. Diabetic retinopathy (DR) and diabetic kidney disease (DKD) are disabling chronic complications. The relation between both is not yet well-established in T2DM. Egypt is considered one of the top ten countries re- garding the prevalence of diabetes that makes diabetes and its complications a major health problem. This encouraged us to conduct this research.  Materials and methods. The study included 79 patients with T2DM divided into two groups according to the presence of retinopathy. Both groups were subdivided according to urinary albumin to creatinine ratio (UACR) into normoalbuminuric and albuminuric subgroups. Retinopathy group was further subdivided according to severity of retinopathy into mild, moderate and severe non-proliferative DR (NPDR). Statistical analysis was done and relation between the severity of retinopathy and UACR was studied.  Results. Patients with retinopathy had significantly higher diabetes duration and UACR than non retinopathy group. Also in subgroups of normoalbuminuria and albuminuria, retinopathy group was significantly higher regarding the same parameters. On subdividing the retinopathy group according to severity, severe NPDR group had significantly higher UACR. The severity of DR was significantly positively correlated with UACR.  Conclusions. The present study identified a significantly positive correlation between early stages of DR and UACR in patients with T2DM in Egypt. Not all cases of DR had DKD especially in early stages and also not all cases of DKD are associated with the presence of DR in T2DM. 

Relative Contribution of Angular Change of Upper and Lower Joints to the Speed and Angular Course of the Triple Throw

إن التطور في مختلف الألعاب والمسابقات الرياضية ما هو إلا نتيجة لحصيلة تفاعل العلوم المختلفة والعمل المستمر والجهد الكبير لخبراء الرياضة لتحسين مستويات الأداء والإنجاز، ومنها كرة السلة التي كان لها الحظ الكبير في التقدم والتطور سواء من الجوانب المهارية أو الخططية، فأصبحت أكثر إثارة ومتعة لكل من المشاهد واللاعب وبإدخال التصويبة الثلاثية وجد بأنها المؤشر الأساسي والمهم في حسم نتيجة المباراة. ويهدف هذا البحث إلى التعرف على التغير الي الزاوي لمفاصل الأطراف العليا والسفلى خلال حركة التصويب، وكذلك التعرف على مدى مساهمة مفاصل الأطراف العليا والسفلى في زاوية وسرعة انطلاق الكرة.وقد تم اختيار عينة البحث من منتخب الشباب القطري المشارك في بطولة آسيا عام (2000). وتم تصوير وتحليل التصويبة الثلاثية وقياس بعض المتغيرات الميكانيكية باستخدام برنامج بالتحليل الحر كي بلغة C )الزمن، المسافة، الإزاحة الزاوية ، السرعة الزاوية) لحركة مفاصل الأطراف العليا والسفلى، كما تم احتساب مدى مساهمة المفاصل في سرعة وزاوية انطلاق الكرة من خلال معادلة الانحدار التدريجي ومعادلة التنبؤ. وتبين من النتائج التي توصلت إليها الدراسة أن السرعة الزاوية لمفصل الركبة والمرفق هما المساهمان الأهم في قيم متغيرة سرعة وزاوية انطلاق الكرة، كما تبين أن مسار طيران الكرة ظهر منخفضا والده ي تسبب بصغر زاوية دخول الكرة. لذ ا كانت أهمية تقويم الأخطاء التي يصعب تحديدها بالعين المجردة لتطوير مستوى الأداء والإنجاز العام.The purpose of the study is to identify the angular change of the upper &amp; lower joints during the triple throw in basketball games. The research proposed that the angular change of the upper &amp; lower joints are major centri but ore to the value of the variables of speed &amp; angular course of the ball during triple throw. A sample of Qatar National Basketball Youth Team who participated in Asia 2000 has been chosen to analyze the Triple Throw. A number of photos were analyzed by utilizing special software that precisely measures mechanic changes of the joints of the upper and lower limbs of the body as far as tirnei distance i angular displacement and angular speed are concerned. The extent of joint contribution in the speed and the angle at which the ball is shot has also been assessed. The study came to the conclusion that the angular speed of the joints of knees and elbows are major contributors in the values of the variables of speed and angular course of the ball heading to the basket

Studying the Relationship between the Antiviral Activity and the Structure of ἰ-Carrageenan Using Ultrasonication

ἰ-carrageenan is a linear macroalgal polysaccharide that is well known for its antiviral bioactivity. Although it is considered a candidate for antiviral therapeutics, its application is highly limited due to its low solubility and high viscosity, which lower its adsorption efficiency. With the aim of deriving an active ἰ-carrageenan fragment with an improved adsorption capacity, we studied the effects of ultrasonication on structural changes in ἰ-carrageenan with respect to changes in its bioactivity against herpesviruses. An FTIR analysis revealed that ultrasonication increased the hydrophilicity of ἰ-carrageenan without changing its functional groups, and a rheological analysis demonstrated that it gradually decreased the strength of the polysaccharide gel, which completely lost its gel structure and formed small nanoparticles after 30 min of ultrasonication. Concomitantly with these physicochemical changes, a plaque assay revealed that longer ultrasonication increased the antiviral activity of ἰ-carrageenan against two herpesviruses, namely, HSV-1 and VZV. Finally, we separated the 30-min ultrasonicated ἰ-carrageenan into four fractions and found that fractions with a lower molecular weight were significantly less active against both herpesviruses than those with a higher molecular weight. Our findings show that ultrasonication induces physicochemical changes in ἰ-carrageenan that increase its antiviral bioactivity