Gestational and Pregestational Diabetes in the Eastern Mediterranean Region: A Meta-analysis of Maternal and Fetal Outcomes

Pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM) are associated with adverse pregnancy outcomes including increased caesarean section rates, macrosomia, and perinatal mortality. Despite the high prevalence of GDM and PGDM in the Eastern Mediterranean Region (EMR), most of the published studies examining the association between GDM/PGDM and adverse pregnancy outcomes have small sample sizes, low statistical power, and few adverse outcomes with conflicting results. The purpose of this study was to determine the association of GDM/PGDM with adverse pregnancy outcomes among women in the EMR, by using a meta-analysis research design. Following the conceptual model of the epidemiologic triangle, the research questions for this study tested whether an association existed between GDM/PGDM and delivery by cesarean section, macrosomia, and perinatal mortality among women in the EMR. A random effects model was used for merging the weighted average of the odds ratios in the 33 primary studies. Pooling of the data showed that, in the EMR, odds of undergoing caesarean section, of having a macrosomic baby, and of perinatal death among women with GDM/PGDM were higher than those without GDM/PGDM. This study contributes to social change by providing a better picture of magnitude and severity of GDM/PGDM, in creating awareness of the seriousness of the problem, and in helping inform public health interventions in the EMR. Women with GDM/PGDM receiving proper health care can have decreased adverse outcomes which, in turn, results in healthy mothers and children forming a healthy family and leading to a healthy, productive community

Cholera – Epidemiology, Prevention and Control

Cholera is an important public health problem, causing substantial morbidity and mortality especially in the developing countries. It is an indicator of socioeconomic problems and is a global threat to public health. Worldwide, approximately 3–5 million cholera cases and 100,000–120,000 deaths due to cholera occur annually. Cholera is transmitted by drinking water or eating food, which is contaminated with the Vibrio cholerae. Approximately 5–10% of persons suffer from severe cholera and if untreated, 50% of severe cases are fatal. The frequency, severity, and duration of cholera infection vary and keep on changing in different parts of the world. Environmental factors such as climate variability, temperature, and rainfall play an important role in cholera transmission. Population density, urbanization, and overcrowding also influence cholera transmission. It is also closely associated with the social and behavioral aspects of individuals as well as communities. Each year, many cholera outbreaks are reported from different regions of the world. These outbreaks have negative impact on social and economic conditions of the affected countries. An integrated, multisectoral program, designed on evidence-based interventions, is required to prevent and control cholera

A Qualitative Review of the Supplemental Nutrition Assistance Program (SNAP) and Recommendations for Improving Nutritional Output

The Food Stamp Program (FSP) is a federal food assistance program for income-eligible individuals and households aimed at preventing hunger and improving nutrition (SNAP, 2016). Although immense growth in the program over the years has served millions of people, a growing body of research has found that program participants consume more calories, less fresh fruits and vegetables, and purchase more sugar-sweetened beverages than their non-participant counterparts (Leung, Blumenthal, Hoffnagle, Jensen, Foerster, Nestle, & Willett, 2013; Nguyen, Shuval, Njike, & Katz, 2014; Bleich, Vine, & Wolfson, 2013). Additionally, other studies have found that SNAP participants consume more high-fat dairy and processed meats and fewer nuts, seeds, and legumes than comparable non-participants (Bleich, Vine, & Wolfson, 2013). In the aggregate, the research suggests a correlation between program participation and long term diminished nutrition. In additional to nutritional deficiencies, concerns about increased program spending, welfare dependence, and fraud and abuse have also surfaced over the years (Schanzenbach, 2013). In response to growing concern and criticism, Congress passed the Food, Conservation, and Energy Act (FCEA) of 2008, which among other things, changed the name of the Food Stamps Program to the Supplemental Nutrition Assistance Program (SNAP), thereby promoting diet quality (nutrition) rather than simply promoting food (Leung, Ding, Catalano, et. al., 2012). The new law acknowledged fundamental deficiencies in SNAP and brought them to the forefront of a political agenda, paving the way for more substantive future changes. Studying SNAP’s nutritional impact and amending ineffective policies is critical because of the program’s sheer size and impact (Leung, Cluggish, Villamor, Catalano, et. al., 2014). Today, SNAP is the largest federal nutrition-assistance program in the country, with 44.6 million Americans currently enrolled (Leung, et al., 2014). This paper analyzes aspects of SNAP’s nutritional delinquencies and seeks to develop recommendations for healthy legislative reforms

Aspergilloma in a patient with no previous history of chronic lung disease

Patients with aspergilloma should undergo surgical treatment, because there is a risk of sudden life threatening hemoptysis and because there is no effective alternate medical therapy. We report a case of aspergilloma in a 47 year old man with no past history of tuberculosis presented with the complaint of hemoptysis for two weeks. It was diagnosed radiologically and treated with left upper lobectomy. Post operative course was complicated by cardiorhythmic disorder

Diagnostic Accuracy of Splenoportal Index for Detection of Esophageal Varices in Patients of Liver Cirrhosis

Background: To determine the diagnostic accuracy of splenoportal index for the prediction of esophageal varices in patients with cirrhosis Methods: In this cross sectional study patients(n= 75) having clinical and laboratory evidence of liver cirrhosis were selected. Sonographic findings of splenic index and portal vein velocity were correlated with the findings of endoscopic examination. P-value ≤ 0.05 considered as significant. Results were analyzed by creating 2 x 2 contingency tables which displayed the number of subjects who were positive on ultrasound and were also positive on endoscopy (true positives), who were ultrasound positive but were negative on endoscopy (false positives), who were ultrasound negatives but were positive on endoscopy (false negatives) and who were ultrasound negative and were also negatives on endoscopy (true negatives). Results: Majority ( 65.0%) patients were males. Patients positive on ultrasound were 70.7 % and patients positive on endoscopy were 72.0% . Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were found to be 96.3%, 95.2%, 98.1%, 90.9% and 96% respectively. Conclusion: Ultrasonography allows non-invasive and cost effective detection of esophageal varices in liver cirrhosis patients, with excellent accuracy

Giant unresectable lymphangioma of the trunk managed via intra-tumour injections of bleomycin

Surgical excision was once considered the mainstay of treatment for lymphangiomas. However, that paradigm is now changing with sclerotherapy emerging as a viable alternative. A 22-year-old girl presented with a mucopurulent and painful discharge from an extensive wound in the trunk. Chest roentogram showed a large soft tissue abnormality with multiple calcifications in the right upper abdomen and lower thorax. Magnetic resonance imaging revealed an extensive lobulated mass measuring 27 x 19 cm. Due to the extensive involvement of tissues, surgical excision did not appear to be a favourable option in this case. Local injections of bleomycin were successfully administered; resulting in complete regression of the lesion. There has been no recurrence at 2 years of follow up. Use of bleomycin sclerotherapy appears to be a safe and effective management strategy and obviates the need for primary surgery especially in extensive lymphangiomas

Inflammatory myofibroblastic tumor of the lung in an adolescent boy

Inflammatory myofibroblastic tumors of the lung are rare, here, an unusual case is described. A 14-year-old boy presented with a history of weight loss and clubbing and was found to have a solitary circumscribed mass in right lower lobe treated with lobectomy. This case indicates the need for early and complete removal of the inflammatory myofibroblastic tumor of the lung

Successful surgical embolectomy in acute massive bilateral pulmonary embolism

Acute massive pulmonary embolism is a life-threatening emergency that must be promptly diagnosed and managed. A 52-year-old man presented with progressively increasing dyspnoea for three days. He had a previous history of chronic obstructive pulmonary disease and was currently a heavy smoker. Examination revealed bilateral wheezing. Chest x-ray and electrocardiography showed non-specific changes. The patient was initially treated as a case of chronic obstructive pulmonary disease exacerbation secondary to pneumonia. However, despite optimum medical management, his oxygen saturation deteriorated. Emergent computed tomography scan of chest showed bilateral massive pulmonary emboli. As the patient\u27s haemodynamic status rapidly deteriorated, cardiothoracic surgery team was immediately consulted and the patient was taken to the operating room. Under cardiopulmonary bypass, bilateral open embolectomy was performed. Following surgical intervention, the patient made a remarkable recovery