Method of Recruitment Produces a Group of Persons Who Look Different from the Groups with HIV in Most Studies: A Case-Control Study

Abstract Introduction: More than 1.1 million citizens are infected with HIV and 40,000 new cases are reported annually. Between the years 2004-2007, the Centers for Disease Control (CDC) reported a 15% increase of HIV/AIDS incidence rate in 34 states with established HIV reporting. Although the incidence of HIV infection caused by illicit drugs injection and heterosexual activities have decreased, the CDC reported 26% of new HIV cases among men who have sex with men (MSM). Objectives: The aim of this study is to reveal if the method of recruitment will produce a group of persons who look different from the groups with HIV in most studies. Also to examine the risk factors such as individual’s behavior and characteristics that lead to the increase of HIV incidence despite the existence of different treatments that was claimed to be effective and the increased awareness of HIV infection. The risk factors examined in the study were alcohol intake, drug use, education level, marital status, and the socioeconomic status among people affected with HIV. Methods: The data was obtained from the National health and Nutrition Examination Survey (NHANES) for the years 1999-2012, and it was retrieved from The Centers of Disease Control and prevention (CDC) website. A descriptive analysis was run on the sought variables to be examined, then cases and controls were matched for age +5 years, gender, and race/ethnic groups. The study is a case control study using a sample of 238 participants (N=238) in the age range of 0-80 years and residing in all 50 states. Demographic characteristics were examined for cases and controls. A conditional logistic regression was conducted to examine the risk factors associated with HIV status. Lastly, a comparison of cases and controls and the original data were conducted. Results: The results reveal that the method of recruitment of participants did have an impact on the result of the study compared to other studies. It was also found that individuals who drink more than five alcoholic drinks per day increase the odds of being infected with HIV than those who do not. Conclusion: The method of recruitment used by NHANES produced a group of persons who look different from the groups with HIV in other studies. The results of the study strongly suggests the association between risky behavior taken by individuals, such as alcohol drinking and HIV status. These findings also suggest that public health professionals have to increase the awareness of alcohol consumption among the public to reduce HIV transmission

Explanatory Factors of X-Efficiency In The Tunisian Banks: A Stochastic Frontier Approach

The Tunisian banks currently operate in a very competitive environment. Long-term viability of this sector depends on its degree of efficiency. Therefore a study relating to the determinants of X-Efficiency in Tunisian banks is of major interest. For that purpose, we made recourse to an extension of the stochastic frontier approach called " Improved SFA " which assumes a parameter of truncation specific to each bank. The empirical results reveal differences in efficiency pronounced according to the size and the structure of property of the banks. The average efficiency of the small and average sizes banks is significantly more significant than that of large banks. Moreover, the public banks are relatively more efficient than the private banks. Thereafter, we analyze the internal determinants of the level of the efficiency of the Tunisian banks. Within this framework, three results deserve to be underlined. Firstly, the improvement of the level of the efficiency of the Tunisian banks is related to the managerial capacity rather than with the size of the banks. Moreover, preponderance of the activity of credit, compared to other outputs represents a source of efficiency. Secondly, there is a negative relation between the ratio equity on total asset and the efficiency of banks, which seems to indicate that those are too committed in risk activities. Thirdly, the share of the non performants loans represents a source of inefficiency, insofar as it cost of a bank increases with these types of loans, especially for the banks of large sizes.X-Efficiency, Stochastic Frontier Approach" SFA ", Trade banks, Translog Model, internal determinants

Les Facteurs Explicatifs d'Efficience-X Dans Les Banques Tunisiennes : Une Approche De Frontière Stochastique

The Tunisian banks currently operate in a very competitive environment. Long-term viability of this sector depends on its degree of efficiency. Therefore a study relating to the determinants of X-Efficiency in Tunisian banks is of major interest. For that purpose, we made recourse to an extension of the stochastic frontier approach called " Improved SFA " which assumes a parameter of truncation specific to each bank. The empirical results reveal differences in efficiency pronounced according to the size and the structure of property of the banks. The average efficiency of the small and average sizes banks is significantly more significant than that of large banks. Moreover, the public banks are relatively more efficient than the private banks. Thereafter, we analyze the internal determinants of the level of the efficiency of the Tunisian banks. Within this framework, three results deserve to be underlined. Firstly, the improvement of the level of the efficiency of the Tunisian banks is related to the managerial capacity rather than with the size of the banks. Moreover, preponderance of the activity of credit, compared to other outputs represents a source of efficiency. Secondly, there is a negative relation between the ratio equity on total asset and the efficiency of banks, which seems to indicate that those are too committed in risk activities. Thirdly, the share of the non performants loans represents a source of inefficiency, insofar as it cost of a bank increases with these types of loans, especially for the banks of large sizes

Les Facteurs Explicatifs d'Efficience-X Dans Les Banques Tunisiennes : Une Approche De Frontière Stochastique

The Tunisian banks currently operate in a very competitive environment. Long-term viability of this sector depends on its degree of efficiency. Therefore a study relating to the determinants of X-Efficiency in Tunisian banks is of major interest. For that purpose, we made recourse to an extension of the stochastic frontier approach called " Improved SFA " which assumes a parameter of truncation specific to each bank. The empirical results reveal differences in efficiency pronounced according to the size and the structure of property of the banks. The average efficiency of the small and average sizes banks is significantly more significant than that of large banks. Moreover, the public banks are relatively more efficient than the private banks. Thereafter, we analyze the internal determinants of the level of the efficiency of the Tunisian banks. Within this framework, three results deserve to be underlined. Firstly, the improvement of the level of the efficiency of the Tunisian banks is related to the managerial capacity rather than with the size of the banks. Moreover, preponderance of the activity of credit, compared to other outputs represents a source of efficiency. Secondly, there is a negative relation between the ratio equity on total asset and the efficiency of banks, which seems to indicate that those are too committed in risk activities. Thirdly, the share of the non performants loans represents a source of inefficiency, insofar as it cost of a bank increases with these types of loans, especially for the banks of large sizes

Impact of a Designed Nursing Intervention protocol on Myocardial Infarction Patient's Outcome at a selected University Hospital in Egypt

Background: Myocardial infarction is a life threatening disease that influences the physical, psychological and social dimensions of the individual. Improper lifestyle is one of the causes of this disease.  The  designing and implementing  of  nursing  intervention protocol for MI patients could  be  one  of  the  important  and fundamental steps in improving MI patients outcomes. Aim: The aim of this study was to examine the impact of a designed nursing intervention protocol on myocardial infarction patient’s outcomes as indicated by higher post total mean knowledge scores, higher post total mean practices scores and high level of compliance to lifelong instruction. Research hypotheses: H1. Patients who will be exposed to a designed nursing intervention protocol will have a higher post total mean knowledge scores; H2. Patients who will be exposed to a designed nursing intervention protocol will have a higher post total mean practices scores; H3. Patients who will be exposed to a designed nursing intervention protocol will have a high level of compliance to lifelong instruction. Design: A quasi-experimental research design was utilized in this study Sample: A convenience sample of 40 adult male and female MI patients. Setting: The cardiac care units at a selected Cairo University Hospital were recruited to fulfill the aim of this study. Tools: Four tools were formulated& tested to collect data pertinent to the study; Socio-demographic and medical data sheet, Pre/Post knowledge questionnaire sheet, an Observational checklist and Compliance assessment sheet. Structured interview, reviewing medical records and direct observation were utilized for data collection. Results: The study results revealed that the post total mean knowledge scores of the studied subjects is increased significantly with value of t= 20.6 at p=0.000, higher post total practice scores among the studied subjects with t& p values (t=5.6 at p= 0.000 ) also, studied subjects had mild to high compliance level regarding the lifelong instructions. Conclusion: It can be concluded that, enrichment of patients' knowledge and practices in relation to their condition and utilization of the effective nursing intervention protocol as an approach of care could have a positive impact upon improvement of patients' outcome. Recommendations: The study recommended Conduction of further studies in order to assess the effectiveness of the designed protocol on patients' outcome regarding different cardiac disorders with replication of this study on a larger probability sample from different geographical locations at the Arab Republic of Egypt, in addition to establishment of cardiac rehabilitation center in the different heath care organizations. Keywards: Nursing intervention protocol, Myocardial Infarction, Outcomes, Cardiac care units

Non-Invasive Panel for Prediction of Large Esophageal Varices in Patients with HCV-Related Cirrhosis after DAAS Therapy

To study sonographic and laboratory parameters as diagnostic non-invasive Indices for prediction and screening of large varices in liver cirrhotic patients post hepatitis C virus after direct Actin antiviral drugs (DAAS). Introduction: All cirrhotic patients should be screened for esophageal varices (EV) via endoscopy, as recommended by the guidelines. However, repeated endoscopy is not well accepted by patients and is a costly procedure that places a heavy burden on the endoscopic unit. Therefore, noninvasive predictors of EVs and size discrimination for EVs are of particular importance.After dividing DAAS into three arms: arm 1 with Non-EV, arm 2grad1&2 EV (Small Vriceal arm), and arm 3 grade 3&4 EV (Large Variceal arm). medical history, physical examination, standard laboratory tests, abdominal ultrasound, and sonographic parameters such as portal vein velocity (PVV). Splenic Index (SI) Splenoportal Index (SPI), platelet count/spleen diameter ratio (PCSDR) and upper gastrointestinal endoscopy were performed for all participants.Results: The Noninvasive sonographic and laboratory parameters for prediction of the presence of EVs have demonstrated that low platelet count/spleen diameter ratio (PC/SD) at cut-off (CO) ≤ 1121.43 cu/mm, then high SPI at CO >3.98 cm /sec then high FIB4 at CO > 2.68 then high APRI at CO > 0.6 then PVV at CO ≤ 22.2 cm/sec then high SI at CO > 89.7 and lastly Child’s – Pugh’s score at CO > 6 respectively.. The Non Invasive sonographic and laboratory parameters for discrimination of the size of EVs showed that high SPI was found to be the most accurate parameter at CO less than >7.75 cm/sec Then low PC/SD at CO ≤ 514.08 cu/mm then high APRI at CO > 1.4 then high FIB4 at CO > 7,6 then high SI with AUC 0.821 at CO > 122.4 then low PVV at CO < 15 and lastly Child’s –Pugh’s score at CO> 6 respectively.Conclusions: The sonographic and laboratory indices are non- invasive parameters for the prediction of EV & discrimination of its size. And to determine when Upper Endoscopy is done for liver cirrhotic patients post-C after DAA

Spontaneous Weight Change during Chronic Hepatitis C Treatment: Association with Virologic Response Rates

Objective: We examined weight changes during chronic hepatitis C (CHC) therapy and association with virologic response. Methods: Weight changes were compared between subjects achieving rapid, early, and sustained virologic response rates (RVR, EVR, and SVR). RVR, EVR and SVR were compared among patients with or without weight loss of ≥ 0.5 body mass index (BMI) units (kg/m2) at 4, 12, 48 weeks. Results: CHC therapy was initiated in 184 cases. Median pretreatment BMI was 27.7 (18.4-51.3) with 38% overweight and 31% obese (BMI ≥25 and ≥ 30, respectively). Among patients with liver biopsies (n = 90), steatosis was present in 31.6%; fibrosis grade of 1-2/6 in 46%, 3-4 in 37.3% and 5-6 in 14.7%. Mean weight loss at 4, 12, 24 and 48 weeks of therapy were 1.2, 2.6, 3.8 and 3.3 kg, respectively. After 4 and 12 weeks of treatment, 38% and 54.3% had a BMI decrement of ≥ 0.5 kg/m2. For genotype 1, weight loss at 4 weeks was associated with significantly higher EVR (90.0% vs. 70%, p = 0.01) and a tendency towards better RVR and SVR (42.9% vs. 26.0% and 55.2% vs. 34.8%, respectively, p = 0.08). In multivariate analysis, weight loss at 4 weeks was independently associated with EVR (OR 6.3, p = 0.02) but was not significantly associated with RVR or SVR Conclusions: Spontaneous weight loss at 4 and 12 weeks of CHC therapy was associated with improved EVR. Weight loss at 4 weeks was an independent predictor of EVR but not SVR

Assessment of immunoglobulin G antibodies against oxidized low-density lipoproteins in patients with acute coronary syndrome

Background Oxidative modification of low-density lipoproteins (LDLs) induces formation of immunogenic epitopes in the LDL molecule, which leads to the formation of antibodies against oxidized low-density lipoprotein (OxLDL) that can be detected in serum. Aim of the study The objective of this study was to evaluate the association between autoantibodies against OxLDL and acute coronary syndrome (ACS). Patients and methods A total of 50 patients diagnosed as having ACS (37 male patients and 13 female patients), age ranging between 19 and 82 years and admitted to the critical care department, Cairo University, and 19 matched healthy controls were enrolled in our study. All patients were subjected to detailed medical history-taking and physical examination, serial 12-lead ECGs, serial cardiac biomarkers on admission and 24 h later, echocardiography, coronary angiography and assessement of severity using the Gensini score, and IgG anti-OxLDL antibodies measurement. Results We found significant difference in the level of antibody between patients with ACS and matched healthy controls (P < 0.001). With respect to the correlation of anti-OxLDL antibodies and the severity of ACS, we found significant correlation between the level of antibodies in patients with ACS as assessed by the Gensini score (r = 0.709) as well as between the echocardiographic findings as assessed by the wall motion score index (r = 0.589). During hospitalization, there was significant correlation of the antibody level with mechanical complications (P = 0.047) and needed immediate intervention (P < 0.001). However, the antibody level was correlated with malignant arrhythmias but P value (0.219) was insignificant because of high SD, and there was no correlation with ischemic complications (P = 0.798). Conclusion With respect to the correlation of anti-OxLDL antibodies and ACS, the patients with ACS had higher anti-OxLDL antibodies level. In addition, anti-OxLDL antibodies level was correlated with the Gensini score, wall motion score index, and major adverse cardiovascular events during hospitalization

P-wave dispersion and left atrial indices as predictors of paroxysmal atrial fibrillation in patients

Background: One-third of stroke and Transient Ischemic Attack (TIA) are cryptogenic requiring additional investigation and intervention. Occult Paroxysmal Atrial Fibrillation (PAF) has been suggested as a possible cause for these cryptogenic strokes. Objective: The aim of our study is to evaluate the role of simple ECG & bedside echocardiographic parameters for prediction of PAF in patients presenting with stroke or TIAs. Patients & methods: The study included 60 patients with non hemorrhagic stroke. During 1 week of continuous ICU monitoring, 30% of patients had PAF (group 1), the remaining 42 patients did not develop PAF (group 2). All patients were subjected to detailed history taking, thorough clinical examination including NIHSS, serial ECGs for calculation of maximum and minimum P wave duration (Pmax, and Pmin) & P wave dispersion (Pdis), and transthoracic echocardiography for calculation of left atrial volume (LAV), and left atrial volume index (LAVI). Results: It was found that Pmax & Pdis were significantly higher in group 1 in comparison to group 2 (147.7 ± 9.6 mm vs 114.3 ± 9 mm, P: <0.001) and (54.1 ± 7.5 mm vs 30.2 ± 7 mm, P: <0.001), respectively. Also LAV & LAVI were significantly higher in group 1 compared to group 2 (57.1 ± 10 mm vs 40.1 ± 12 mm, P: <0.001) & (28.9 ± 3 mm2/m2 vs 20.1 ± 8 mm2/m2, P: <0.001), respectively. On multivariate logistic regression analysis Pmax, Pdis, and LAVI were the most significant independent predictors of PAF. Conclusion: PAF is a possible etiology of patients with ischemic cerebrovascular accidents patients even in those who had normal sinus rhythm on admission. Pmax ⩾ 125 mm, Pdis ⩾ 40 mm, and LAVI ⩾ 24 are highly significant predictors of PAF with PPV of 99%, 96% and 78%, respectively, sensitivity of 98%, 94% and 89%, respectively, specificity 96%, 93% and 75%, respectively and AUC of 0.99, 0.98 and 0.87, respectively

Arrhythmias

Background: Supraventricular and ventricular arrhythmias, as well as conduction disturbances are frequently observed in COPD and two major hypotheses for arrhythmogenesis have been proposed: arrhythmias may be a consequence of hypoxaemia, hypercapnia or acid–base disturbances since they increase the electrical heterogeneity within the ventricular wall or arrhythmias may be the result of the autonomic neuropathy that characterizes COPD. Aim of the work: In this study, we attempted to non-invasively verify these hypotheses in hypoxaemic COPD patients that are not in respiratory failure by examining how PaO2, PaCO2, pH and HCO3 correlate with QTd in those patients. Subjects and methods: 25 COPD patients were subjected for Standard 12-lead ECG for arrhythmia detection and the measurement of QT intervals, chest X-ray, two dimensional echocardiography and myocardial nuclear imaging to exclude IHD. Results: We found negative significant correlation between O2 tension and the occurrence of fatal arrhythmias; the same as between O2 tension and QTd value (P values were <0.0005 in both), with QTd as the dependent variable, and age, pulmonary pressure, duration, Mg, Na, K, Hb PH, CO2 and O2 tensions as the independent variables in all subjects, it was shown that only PaO2 was the predictor of QTd with a P value of 0.02. In stable COPD patients enrolled in our study, new cutoff levels for predicting arrhythmic fatality were proposed for the QTc parameter (395 ms with a sensitivity of 92% and a specificity of 83%) and the QTd parameter (58 ms with a sensitivity of 100% and a specificity of 92%). There is a high positive significant correlation between the age of patients, duration of COPD and Hb level and the occurrence of fatal arrhythmias where P values were 0.009, <0.0005 and <0.0005 respectively; the same as with QTd value where the P values were 0.015, 0.001 and 0.039. There is a positive significant correlation between pulmonary pressure and QTc where the P value was 0.041 and pulmonary pressure with QTd where the P value was 0.028. Conclusion: Our results rule out the electropathy hypothesis and underline autonomic neuropathy as the most possible mechanism of arrhythmias in hypoxaemic, non-respiratory failure, and COPD patients