Loneliness among women with rheumatoid arthritis:A cross-cultural study in the Netherlands and Egypt

The objective of this study was to explain loneliness as experienced by women with rheumatoid arthritis (RA) in a cross-cultural context. We studied 36 Egyptian female RA patients and 140 female Dutch RA patients.. Self-report data were collected about loneliness, physical and psychological health status, social support and social network, needs for help, attitudes and feelings of guilt. Loneliness was significantly higher among Egyptian (44.2 ± 32.3) than Dutch (12.9 ± 18.9) female RA patients (F = 54.3, p < 0.001). In Egypt, 36% of the variance of loneliness could be explained by worse affect (anxiety and depression; β = 0.51), fewer children (β = 0.31), and higher negative social support for the patients (β = 0.28) in multiple regression analysis. In the Netherlands, 35% of feeling lonely could be explained by worse affect scores (β = 0.52), less positive social support for the patients (β = 0.24), and a higher degree of disability (β = 0.21). Age of the patients and disease duration only explained 4% and 3% of the loneliness of RA patients in Egypt and the Netherlands, respectively. Female Egyptian RA patients experienced more loneliness than Dutch patients. Affect is the most important and constant variable in explaining loneliness in both countries. The role of the family in perceived loneliness is greater in Egypt than the Netherlands. Low social support received by patients is important in explaining loneliness in the Netherlands but not in Egypt

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Helicobacter pylori inversely related to clinical and functional severity of adult asthma

Background: Helicobacter pylori (H. pylori) are identified as one of the maximum inducing persistent bacterial infection; about 50% of populations were infected. Many studies detected that H. pylori have the ability for affecting extra-intestinal organs like respiratory system. Aim of the study.: is to detect the possible relationship between clinical and functional severity of bronchial asthma and H. pylori infection for better controlling of the disease. Patients and methods: A cross sectional Study carried out at the outpatient clinic of chest department, Zagazig University Hospitals, during the period from February 2015 to December 2015. One hundred and twenty asthmatic patients were selected randomly from bronchial asthma patients attended to outpatient clinic. They were agreed to do spirometry and H. pylori tests. They were (91 females) with mean age ± SD (36.96 ± 5.09) years and (29 males) with mean age ± SD (38.86 ± 4.29) years & with age range from (26–44) years. Results: The more degree of severity of bronchial asthma, the less +ve H. pylori cases, with a highly statistically significant difference between +ve and –ve H. pylori as regard severity of bronchial asthma. There was very highly statistically significant difference between mild, moderate, severe persistent asthma as regard H. plylori IgG. (P value < 0.001). Mild asthma were most +ve H. pylori (58.3%), while moderate and severe cases were (31.3%) and (10.4%) respectively. Conclusion: H. pylori infection was infrequently associated in asthmatic patients and has a prominent inverse relationship with severity of bronchial asthma and better control of the disease

Hepatitis C Viral (HCV) Infection as a novel risk factor for severe coronary artery disease: A Prospective Angiographic Study

The link between coronary artery disease (CHD) and chronic hepatitis C virus (HCV) infection has been shown in many studies. However, the effect of chronic HCV infection on the extent of coronary artery disease (CAD) has not been determined so; the aim of the present study is to determine the effect of HCV infection on the severity and the pattern of CAD in Egyptian patients. Patients and methods: This study group included two groups of patients with angiographically documented CAD; 25 HCV seropositive patients as test group and another 25 HCV seronegative patients as control group. Both groups were comparable as regard, age, sex, hypertension, and diabetes mellitus, and smoking. A detailed qualitative coronary angiographic analysis and SYNTAX score were used to assess the extent and severity of CAD. Results: The presence of total occlusion was significantly higher in the HCV seropositive group (p < 0.05) and the SYNTAX score was higher (14.86 ± 6.64 vs. 10.86 ± 7.28, p < 0.05). After adjustment, HCV seropositivity still represented an independent predictor for severity of coronary atherosclerosis demonstrated by higher SYNTAX score (p < 0.05). Conclusion: HCV infection is an independent predictor for severe coronary atherosclerosis, as demonstrated by higher syntax score. It also associated with higher incidence of totally occluded coronaries

Iodine Deficiency Disorders as a Predictor of Stunting among Primary School Children in the Aseer Region, Southwestern Saudi Arabia

Objectives: To investigate the present occurrence of stunting and explore the role of iodine deficiency disorders (IDDs) as a predictor of stunting among primary school children in the Aseer Region. Methods: In a cross-sectional investigation on school children in the Aseer region, thyroid enlargement was evaluated clinically. Urine was collected to evaluate iodine content. Results: The present study involved 3046 school-age pupils. The study disclosed a total goiter rate of 24.0% (95% CI: 22.5–25.5%). The median urinary iodine content (UIC) was 17.0 µg/L. A prevalence of stunting (height for age z score of less than −2) of 7.8% (95% CI: 6.9–8.8%) was found. In a logistic regression model, pupils having clinical goiter (aOR = 1.739; 95% CI: 1.222–2.475) and students having UIC of less than 17 µg/L (aOR = 1.934; 95% CI: 1.457–2.571) were considerably related with stunting. In the receiver operating characteristic (ROC) curve, urinary iodine content to forecast stunting was good (AUC = 0.611, 95% CI: 0.594–0.629). The curve recognized the optimum cutoff point of urinary iodine content to be ≤19.0 µg/L. The sensitivity was 59.66% (95% CI: 53.1–66.0) and the specificity was 57.62% (95% CI: 55.8–59.5). Conclusion: The present study showed that stunting among school-aged children presents a mild public health problem. On the other hand, a severe iodine deficiency situation was revealed among school children in the Aseer region. Continuous monitoring of iodine status among school children is therefore necessary. Concerted interventions that blend nutrition-sensitive with nutrition-specific approaches are expected to influence decreasing stunting significantly

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit