Antibacterial Potentials of Human Urine at Acidic pH 5

To identify factors determining susceptibility of individuals to urinary tract infections (UTIs).Methods: In this descriptive study , 55 hospitalized patients' urine samples were analyzed. Presence of red blood cells , pus cells, epithelial cells, casts and crystals were observed and counted under per high power field (HPF) by microscopy. While pH, specific gravity, protein, leukocytes, nitrites, glucose, ketones, urobilinogen, blood and bilirubin, were analyzed using dipstick method. All the samples were streaked on CLED agar for isolation of bacteria; and SDA for yeast.Results: Twenty urine samples were found culture positive, of which 15 were from females and 5 from males. Cultures were isolated and identified as E. coli (11), Enterococcus (4), Klebsiella (3), Pseudomonas (1) and yeast (1). Interestingly, organisms were mainly isolated from urine samples having pH >5.5. In all the culture positive samples, pus cells were >20-40 /HPF. No patient with culture negative had urine pH 6.5 or above in the present study.Conclusion: The probability of bacteriuria (UTI) and pyuria (increase pus cells in urine) increases with rise in urine pH. Persons with urine pH5 are generally protected from UTIs. Thus mechanism/s needs to be elucidated

Prevalence of the Metabolic Syndrome in Central and South American Immigrant Residents of the Washington, DC, Area

The objective of this study was to estimate the prevalence of Metabolic Syndrome (MetS) and its risk components and then compare differences in the risk components among low-income, uninsured Central and South American recent immigrants to the USA. This cross-sectional survey sampled 1,042 adult patients from a medical clinic in metropolitan Washington, DC. The overall prevalence of the MetS was 26.9% estimated using the modified harmonized definition. The most common abnormal metabolic indicator for women was an elevated BMI ≥ 30 kg/m2 (36.1%), while, for men, it was an elevated triglyceride level (46.5%). The risk of abnormal MetS indicators increased steadily with increasing BMI. The abnormal indicator combination identifying the most subjects with the MetS included the following: high triglycerides, low HDL cholesterol, and obesity. MetS rates were highest among subjects from El Salvador and Honduras, 31.3% and 28.0%, respectively, and lowest among subjects from Bolivia (21.7%). Dyslipidemia and high BMI increased the likelihood of having the MetS, which is consistent with studies on Mexican Americans in the San Antonio Heart Study and studies within Central and South American countries. This study adds new baseline epidemiological data for largely understudied, low-income, and mostly recent immigrant groups

A strong construction of S-box using Mandelbrot set an image encryption scheme

The substitution box (S-box) plays a vital role in creating confusion during the encryption process of digital data. The quality of encryption schemes depends upon the S-box. There have been several attempts to enhance the quality of the S-box by using fractal chaotic mechanisms. However, there is still weakness in the robustness against cryptanalysis of fractal-based S-boxes. Due to their chaotic behavior, fractals are frequently employed to achieve randomness by confusion and diffusion process. A complex number-based S-box and a chaotic map diffusion are proposed to achieve high nonlinearity and low correlation. This study proposed a Mandelbrot set S-box construction based on the complex number and Chen chaotic map for resisting cryptanalytic attacks by creating diffusion in our proposed algorithm. The cryptosystem was built on the idea of substitution permutation networks (SPN). The complex nature of the proposed S-box makes it more random than other chaotic maps. The robustness of the proposed system was analyzed by different analysis properties of the S-box, such as nonlinearity, strict avalanche criterion, Bit independent criterion, and differential and linear probability. Moreover, to check the strength of the proposed S-box against differential and brute force attacks, we performed image encryption with the proposed S-box. The security analysis was performed, including statistical attack analysis and NIST analysis. The analysis results show that the proposed system achieves high-security standards than existing schemes

Operationalization of bi-directional screening for tuberculosis and diabetes in private sector healthcare clinics in Karachi, Pakistan

Background: Many countries are facing overlapping epidemics of tuberculosis (TB) and diabetes mellitus (DM). Diabetes increases the overall risk of developing Tuberculosis (TB) and contributes to adverse treatment outcomes. Active screening for both diseases can reduce TB transmission and prevent the development of complications of DM. We investigated bi-directional TB-DM screening in Karachi, Pakistan, a country that ranks fifth among high TB burden countries, and has the seventh highest country burden for DM.Methods: Between February to November 2014, community-based screeners identified presumptive TB and DM through verbal screening at private health clinics. Individuals with presumptive TB were referred for a chest X-ray and Xpert MTB/RIF. Presumptive DM cases had random blood glucose (RBS) tested. All individuals with bacteriologically positive TB were referred for diabetes testing (RBS). All pre-diabetics and diabetics were referred for a chest X-ray and Xpert MTB/RIF test. The primary outcomes of this study were uptake of TB and DM testing.Results: A total of 450,385 individuals were screened, of whom 18,109 had presumptive DM and 90,137 had presumptive TB. 14,550 of these individuals were presumptive for both DM and TB. The uptake of DM testing among those with presumptive diabetes was 26.1% while the uptake of TB testing among presumptive TB cases was 5.9%. Despite efforts to promote bi-directional screening of TB and DM, the uptake of TB testing among pre-diabetes and diabetes cases was only 4.7%, while the uptake of DM testing among MTB positive cases was 21.8%.Conclusion: While a high yield for TB was identified among pre-diabetics and diabetics along with a high yield of DM among individuals diagnosed with TB, there was a low uptake of TB testing amongst presumptive TB patients who were recorded as pre-diabetic or diabetic. Bi-directional screening for TB and DM which includes the integration of TB diagnostics, DM screening and TB-DM treatment within existing health care programs will need to address the operational challenges identified before implementing this as a strategy in public health programs

Breast cancer mortality hot spots among Black women with de novo metastatic breast cancer

Background: Black women living in southern states have the highest breast cancer mortality rate in the United States. The prognosis of de novo metastatic breast cancer is poor. Given these mortality rates, we are the first to link nationally representative data on breast cancer mortality hot spots (counties with high breast cancer mortality rates) with cancer mortality data in the United States and investigate the association of geographic breast cancer mortality hot spots with de novo metastatic breast cancer mortality among Black women. Methods: We identified 7292 Black women diagnosed with de novo metastatic breast cancer in Surveillance, Epidemiology, and End Results (SEER). The county-level characteristics were obtained from 2014 County Health Rankings and linked to SEER. We used Cox proportional hazards models to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for mortality between hot spot and non-hot spot counties. Results: Among 7292 patients, 393 (5.4%) resided in breast cancer mortality hot spots. Women residing in hot spots had similar risks of breast cancer-specific mortality (aHR = 0.99, 95% CI = 0.85 to 1.15) and all-cause mortality (aHR = 0.97, 95% CI = 0.84 to 1.11) as women in non-hot spots after adjusting for individual and tumor-level factors and treatments. Additional adjustment for county-level characteristics did not impact mortality. Conclusion: Living in a breast cancer mortality hot spot was not associated with de novo metastatic breast cancer mortality among Black women. Future research should begin to examine variation in both individual and population-level determinants, as well as in molecular and genetic determinants that underlie the aggressive nature of de novo metastatic breast cancer

The role of BMI in allostatic load and risk of cancer death

INTRODUCTION: Obesity and proinflammatory conditions are associated with increased risks of cancer. The associations of baseline allostatic load with cancer mortality and whether this association is modified by body mass index (BMI) were examined. METHODS: A retrospective analysis was performed in March-September 2022 using National Health and Nutrition Examination Survey years 1988 through 2010 linked with the National Death Index through December 31, 2019. Fine and Gray Cox proportional hazard models were stratified by BMI status to estimate subdistribution hazard ratios of cancer death between high and low allostatic load status (adjusted for age, sociodemographics, and health factors). RESULTS: In fully adjusted models, high allostatic load was associated with a 23% increased risk of cancer death (adjusted subdistribution hazard ratio=1.23; 95% CI=1.06, 1.43) among all participants, a 3% increased risk of cancer death (adjusted subdistribution hazard ratio=1.03; 95% CI=0.78, 1.34) among underweight/healthy weight adults, a 31% increased risk of cancer death (adjusted subdistribution hazard ratio=1.31; 95% CI=1.02, 1.67) among overweight adults, and a 39% increased risk of death (adjusted subdistribution hazard ratio=1.39; 95% CI=1.04, 1.88) among obese adults, when compared to those with low allostatic load. CONCLUSIONS: The risk of cancer death is highest among those with high allostatic load and obese BMI, but this effect was attenuated among those with high allostatic load and underweight/healthy or overweight BMI

The association of diabetes and obesity with prostate cancer aggressiveness among Black Americans and White Americans in a population-based study

Few studies have investigated the role of race in the association of diabetes and obesity with prostate cancer aggressiveness. Here we evaluate the independent association between diabetes and obesity with prostate cancer aggressiveness in White Americans and Black Americans

Adoption of Electronic Medical Record-Based Decision Support for Otitis Media in Children

Substantial investment in electronic health records (EHRs) has provided an unprecedented opportunity to use clinical decision support (CDS) to increase guideline adherence. To inform efforts to maximize adoption, we characterized the adoption of an otitis media (OM) CDS system, the impact of performance feedback on adoption, and the effects of adoption on guideline adherence

Prevalence and demographics of anxiety disorders: a snapshot from a community health centre in Pakistan

<p>Abstract</p> <p>Background</p> <p>The developing world is faced with a high burden of anxiety disorders. The exact prevalence of anxiety disorders in Pakistan is not known. There is a need to develop an evidence base to aid policy development on tackling anxiety and depressive disorders in the country. This is the first pilot study to address the prevalence of anxiety disorders and their association with sociodemographic factors in Pakistan.</p> <p>Methods</p> <p>A cross-sectional study was conducted among people visiting Aga Khan University Hospital (AKUH), a tertiary care facility in Karachi, Pakistan. The point prevalence of anxiety amongst the sample population, which comprised of patients and their attendants, excluding all health care personnel, was assessed using the validated Urdu version of the Hospital Anxiety and Depression Scale (HADS). The questionnaire was administered to 423 people. Descriptive statistics were performed for mean scores and proportions.</p> <p>Results</p> <p>The mean anxiety score of the population was 5.7 ± 3.86. About 28.3% had borderline or pathological anxiety. The factors found to be independently predicted with anxiety were, female sex (odds ratio (OR) = 2.14, 95% CI 1.36–3.36, p = 0.01); physical illness (OR = 1.67, 95% CI 1.06–2.64, p = 0.026); and psychiatric illness (OR = 1.176, 95% CI 1.0–3.1, p = 0.048). In the final multivariate model, female sex (adjusted odds ratio (AOR) = 2, 95% CI 1.28–3.22) and physical illness (AOR = 1.56, 95% CI 0.97–2.48) were found to be significant.</p> <p>Conclusion</p> <p>Further studies via nationally representative surveys need to be undertaken to fully grasp the scope of this emerging public health issue in Pakistan.</p