Physical activity and survival in chronic comorbidity among adult HIV patients in Ethiopia: a prospective cohort study

Background - Antiretroviral therapy enables people living with HIV to live long lives, and these advances have transformed HIV infection from an acute to a chronic disease. Many non-communicable diseases, including type 2 diabetes, heart disease, and stroke, are influenced by physical inactivity. Therefore, the aim of this study was to assess the level of physical activity and survival in chronic co-morbidity among adult people living with HIV in Ethiopia. Methods - An institution-based prospective cohort study of adult people living with HIV was conducted between 2019 and 2021. We included 422 people living with HIV at baseline. After the baseline visit, 364 patients without hypertension or diabetes, were followed up for two years. Nine trained nurses used a pre-tested, structured questionnaire to collect data during routine care consultations in three hospitals in southern Ethiopia. STATA version 15 was used to analyze the data. To estimate the survival probability of developing chronic comorbidities, a Kaplan-Meier survival curve was used. A Cox proportional hazards model was fitted to identify the predictors of the development of chronic comorbidities. Result - In the current study, 39% of the participants were found to have a low level of physical activity. Those who had self-management skills to maintain physical activity (p = 0.023), considered physical activity an important aspect of their HIV management (p = 0.003), and regularly attended social support groups (p = 0.002) had significantly higher levels of physical activity. The risk of chronic comorbidity increased over time, with a rate of 10.83 chronic comorbidities per 1000 persons per month. Lack of regular exercise [AHR: 2.04; 95% CI: (1.03, 5.13)], low physical activity [AHR: 2.01; 95% CI: (1.03, 7.89)], BMI greater than 25 kg/m2 [AHR: 2.74; 95% CI: (1.31, 5.12)] and low fruit and vegetable intake [AHR = 2.57; 95% CI: (1.28, 6.49)] were all associated with the development of chronic comorbidity. Conclusion - The prevalence of physical inactivity is high in the study population. A physical activity program for people living with HIV should be considered, and the promotion of self-management skills should be integrated into HIV care programs

Depression, Anxiety and Their Correlates Among Patients With HIV in South Ethiopia: An Institution-Based Cross-Sectional Study

Background: Depressive and anxious symptoms are more regularly seen in HIV-infected people than in the general population. This investigation planned to evaluate the magnitude and factors related to depressive and anxiety symptoms among HIV patients in South Ethiopia, 2018.Methods: This was an institution-based cross-sectional study directed among 363 HIV-infected individuals who had a customary visit at Hawassa University Comprehensive Specialized Hospital and Yirgalem Hospital, Ethiopia, who were incorporated into the study through systematic sampling techniques. The hospital anxiety and depression scale (HADS) was utilized to take a look at anxious and depressive symptoms.Results: The mean age of the respondents was 37.66 years (SD ±10.03). The prevalence of depression and anxiety were 32.0% and 34.4%, respectively. Patients who were living alone [AOR = 1.94, (95% CI: 1.06, 3.56)], had poor social support [AOR = 5.57, (95% CI: 1.20, 10.84)] or had HIV-related perceived stigma [AOR = 2.35, (95% CI: 1.44, 3.84)] were more likely to have depression as compared to their counterparts. Those with a previous history of mental illness [AOR = 3.36, (95% CI: 1.31, 8.61)] and poor social support [AOR = 6.67, (95% CI: 1.47, 10.33)] were more likely to have anxiety symptoms.Conclusion: The prevalence of anxiety and depression in the current study was high. Concerned health departments of the country should create guidelines to screen and treat depression and anxiety among HIV patients. Further research on hazard factors of depression and anxiety ought to be examined to strengthen and expand these findings

Photoinduced Temperature Gradients in Sub-wavelength Plasmonic Structures: The Thermoplasmonics of Nanocones

Plasmonic structures are renowned for their capability to efficiently convert light into heat at the nanoscale. However, despite the possibility to generate deep sub-wavelength electromagnetic hot spots, the formation of extremely localized thermal hot spots is an open challenge of research, simply because of the diffusive spread of heat along the whole metallic nanostructure. Here we tackle this challenge by exploiting single gold nanocones. We theoretically show how these structures can indeed realize extremely high temperature gradients within the metal, leading to deep sub-wavelength thermal hot spots, owing to their capability of concentrating light at the apex under resonant conditions even under continuous wave illumination. A three-dimensional Finite Element Method model is employed to study the electromagnetic field in the structure and subsequent thermoplasmonic behaviour, in terms of the three-dimensional temperature distribution. We show how the latter is affected by nanocone size, shape, and composition of the surrounding environment. Finally, we anticipate the use of photoinduced temperature gradients in nanocones for applications in optofluidics and thermoelectrics or for thermally induced nanofabrication

novel plasmonic nanocavities for optical trapping assisted biosensing applications

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Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: A systematic analysis for the global burden of disease study 2017

© 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Previous attempts to characterise the burden of chronic respiratory diseases have focused only on specific disease conditions, such as chronic obstructive pulmonary disease (COPD) or asthma. In this study, we aimed to characterise the burden of chronic respiratory diseases globally, providing a comprehensive and up-to-date analysis on geographical and time trends from 1990 to 2017. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we estimated the prevalence, morbidity, and mortality attributable to chronic respiratory diseases through an analysis of deaths, disability-adjusted life-years (DALYs), and years of life lost (YLL) by GBD super-region, from 1990 to 2017, stratified by age and sex. Specific diseases analysed included asthma, COPD, interstitial lung disease and pulmonary sarcoidosis, pneumoconiosis, and other chronic respiratory diseases. We also assessed the contribution of risk factors (smoking, second-hand smoke, ambient particulate matter and ozone pollution, household air pollution from solid fuels, and occupational risks) to chronic respiratory disease-attributable DALYs. Findings: In 2017, 544·9 million people (95% uncertainty interval [UI] 506·9–584·8) worldwide had a chronic respiratory disease, representing an increase of 39·8% compared with 1990. Chronic respiratory disease prevalence showed wide variability across GBD super-regions, with the highest prevalence among both males and females in high-income regions, and the lowest prevalence in sub-Saharan Africa and south Asia. The age-sex-specific prevalence of each chronic respiratory disease in 2017 was also highly variable geographically. Chronic respiratory diseases were the third leading cause of death in 2017 (7·0% [95% UI 6·8–7·2] of all deaths), behind cardiovascular diseases and neoplasms. Deaths due to chronic respiratory diseases numbered 3 914 196 (95% UI 3 790 578–4 044 819) in 2017, an increase of 18·0% since 1990, while total DALYs increased by 13·3%. However, when accounting for ageing and population growth, declines were observed in age-standardised prevalence (14·3% decrease), age-standardised death rates (42·6%), and age-standardised DALY rates (38·2%). In males and females, most chronic respiratory disease-attributable deaths and DALYs were due to COPD. In regional analyses, mortality rates from chronic respiratory diseases were greatest in south Asia and lowest in sub-Saharan Africa, also across both sexes. Notably, although absolute prevalence was lower in south Asia than in most other super-regions, YLLs due to chronic respiratory diseases across the subcontinent were the highest in the world. Death rates due to interstitial lung disease and pulmonary sarcoidosis were greater than those due to pneumoconiosis in all super-regions. Smoking was the leading risk factor for chronic respiratory disease-related disability across all regions for men. Among women, household air pollution from solid fuels was the predominant risk factor for chronic respiratory diseases in south Asia and sub-Saharan Africa, while ambient particulate matter represented the leading risk factor in southeast Asia, east Asia, and Oceania, and in the Middle East and north Africa super-region. Interpretation: Our study shows that chronic respiratory diseases remain a leading cause of death and disability worldwide, with growth in absolute numbers but sharp declines in several age-standardised estimators since 1990. Premature mortality from chronic respiratory diseases seems to be highest in regions with less-resourced health systems on a per-capita basis. Funding: Bill & Melinda Gates Foundation

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Antimicrobial resistance profile of Staphylococcus aureus isolates isolated from ear discharges of patients at University of Hawassa comprehensive specialized hospital

Abstract Background Drug-resistant microorganism are a growing global danger. Strains of S. aureus have developed resistance to many commonly used antimicrobials due to indiscriminate use of antimicrobials, and treatment becoming a challenge. Studies assessing pattern and determinants of S. aureus resistance in ear infection in Ethiopia are very scarce. This study presents overview of pattern and determinants S. aureus resistance from samples of ear discharge in Ethiopia. Method A prospective cross-sectional study was conducted on patients who visit ENT clinic of University of Hawassa comprehensive specialized hospital from February 1, 2016 to November 1, 2016. 117 specimens were collected with sterile applicator cotton swab from 117 patients with ear discharge visiting the clinic. Data was fed and then edited, cleared, entered and analyzed using SPSS version 20. Result The prevalence of S.aureus infection was 28.2%. S. aureus isolates revealed up to 97.0% level of resistance pattern to the antimicrobials tested. In the determination of the susceptibility of S. aureus on nine selected antibiotics by disk diffusion technique, 97.0% of the isolates were resistant to cloxacilin and 74.2% showed resistance to vancomycin. The overall rate of MDR was 100%, all of the isolates were found to be resistant to more than two tested antimicrobials. Conclusion S. aureus has gotten frighteningly resistant to many of common antimicrobials. Resistance rate to vancomyin is terrifyingly high. It urges us to take measures to delay resistance. Emergence of resistance highlights the value of prudent prescribing of antimicrobials and avoiding their irrational use. Further researches focusing on identifying dynamics promoting resistance, identifying high risk strains and molecular basis of resistance are required

Exclusive Breast-Feeding Practice and Associated Factors among HIV-Positive Mothers in Governmental Health Facilities, Southern Ethiopia

Introduction. Globally, over 90% of HIV infections among children are due to mother-to-child transmission and breastfeeding accounts for 5–20% of the burden. Avoidance of inappropriate feeding practices and practicing exclusive breastfeeding is recommended to reduce mother-to-child HIV transmission, but it is hardly practiced. The aim of this study was to determine the prevalence of exclusive breastfeeding practice and associated factors among HIV-positive mothers attending governmental PMTCT clinics in Southern Ethiopia. Methods. An institution-based cross-sectional study was conducted from April to May 2019. The participants of the study were 209 HIV-positive mothers at the selected PMTCT sites. The study subjects were drawn from 10 health institutions located at 6 towns in Southern Ethiopia which constituted six hospitals and four health centers. Quantitative data were collected using the pretested structured questionnaire. Logistic regression analysis was used to determine the association between the predictors and outcome variable. Results. Among the 209 participants, 81.6% (95% CI: 75.8–86.5) practiced exclusive breastfeeding and 18.4% (95% CI: 13.5–23.7) practiced mixed feeding. Mothers who had attended the recommended four antenatal visits [AOR: 3.01, 95% CI (1.1–8.28)], who had disclosed their serostatus [AOR: 3.17, 95% CI (1.12–8.99)], who had sufficient knowledge about infant feeding practice [AOR: 3.32, 95% CI (1.15–9.55)], and favorable attitude towards infant feeding practice [AOR: 5.39, 95% CI (1.65–17.6)] were more likely to practice exclusive breastfeeding. Conclusion. Exclusive breastfeeding was predominantly practiced. But mixed feeding was also being practice considerably. Improving maternal knowledge and attitude towards appropriate infant feeding practice through appropriate counseling on ANC visits could significantly improve EBF practice. It was also evident that promoting disclose of serostatus could empower the mothers to make an informed decision on how to appropriately feed their newborn

Radiologic Diagnosis and Hospitalization among Children with Severe Community Acquired Pneumonia: A Prospective Cohort Study

Objectives. This study was designed to assess the role of chest radiography for the diagnosis of pneumonia and assess the association of clinical characteristics with radiologic findings and predictors of hospitalization among children with severe community acquired pneumonia. Methods. A prospective study was conducted on 122 children between ages of 3 month and 14 years admitted to pediatric emergency unit with diagnosis of severe pneumonia from September 1st to November 30th, 2017. Eligible children were subjected to chest radiography which was read by two senior radiologists independently (R1 and R2). Disagreements between R1 and R2 were resolved by a third senior radiologist (R3). Level of agreement between radiologists was assessed using Cohen’s kappa coefficient. Clinical and laboratory parameters which could explain the variability in the duration of hospital stay were assessed using a linear regression mode. Independent predictors were assessed using multiple linear regression. Results. The median age of the cohort was 10.0 months (interquartile range (IQR): 6.75–24.0); 76 (62.3%) were male. Nearly half, 63 (51.6%) did not have radiologic evidence of pneumonia. There was low level of agreement between R1 and R2 in reporting consolidation (kappa=0.435, p-value≤0.001), haziness (kappa=0.375, p-value≤0.001), and infiltration (kappa=0.267, p-value=0.008). Children with higher recorded temperature were more likely to have radiologic abnormalities suggesting pneumonia (p-value=0.033). The median duration of hospitalization was 3 days (IQR: 1-4 days); 118 (96.7%) were discharged with improvement. Height-for-age z-score (Coef.=0.203, R2=0.041, p-value=0.027); and hemoglobin level (Coef.=-0.249, R2=0.062, p-value=0.006) explained 4.1% and 6.2% of the variability in the duration of hospital stay, respectively. Conclusion. Radiologic evidence of pneumonia was absent in half of the children with severe pneumonia. There was low agreement between senior radiologists in reporting chest radiographic findings, potentially necessitating harmonization activities to uniformly implement the WHO guidelines in reading chest radiographs