Current Overview on Disease and Health Research Vol. 3

Evidence-based management practice is an approach to decision-making and day-to day work practice that helps practitioners to critically evaluate the extent to which they can trust the evidence they have at hand. It also helps practitioners to identify, find and evaluate additional evidence relevant to their decisions. Furthermore, evidence-based management has been ignored in healthcare compared with evidence-based medicine. Unfortunately, leaders, policymakers, and managers, themselves, have no interest in applying this approach because of internal and external barriers to its use, such as the culture of decision-making based on evidence, managers’ lack of adequate knowledge about the research process, managers’ suspicions of the values of research and researchers, inadequate research dissemination, and a lack of external pressure for adopting researched practices. The objective of this chapter is to understand the rationale of evidence based practice to be implemented by Hospital Administrators.

Literature search revealed that Poland syndrome is a musculoskeletal birth defect with variable appearance. Classically, it presents as partial or full absence of pectoral muscles, breast along with upper limb anomalies. Limb anomalies may range from syndactyly to phocomelia. The Poland syndrome is found to be scattered in population but familial cases with intrafamilial occurrence have also been observed. As regards etiopathogenesis is concerned many theories have been put forth but vascular disruption theory is the most accepted one. In addition to classical presentation, the Poland syndrome may occur in concurrent with syndactyly, phocomelia, defective rib and severe thoracic wall defects causing impaired lung function. At birth and during childhood symptoms may be mild and does not require surgical intervention. Surgery should be considered only in cases where symptoms are severe as in case of massive chest anomalies impairing pulmonary functions. Aim of the chapter is to consolidate the data relating to etiopathogenesis, clinical presentations and requirement of treatment in cases of Poland syndrome.

Oral cavity manifestations and systemic disease are associated with each other. The oral cavity can be affected by various diseases such as cardiovascular disease, gastrointestinal disease, hematologic disease, diabetes mellitus, metabolic disorders, obesity, and neurologic disease. Treatment of some systemic disease also causes oral lesions. These include cancer treatment and other medications that result in salivary compromise.

Background: Osteoporosis (OP) in elderly men remains underdiagnosed and underappreciated. After a low trauma fracture, a man is less likely to have evaluation and treatment in spite of all complications.
In the present study, we aimed to determine the frequency and specificity of OP in elderly Tunisian men, and secondarily to look for the specificity of risk factors for male OP, its complications, and management.
Methods: This is a retrospective study of the records of male patients over the age of 65 who were attending our rheumatology department during a period of 14 years. All patients underwent bone mineral density (BMD) measurement with an assessment of bone mass at the femoral and vertebral sites.
Results: Fifty-nine patients were included with an average age of 71 years. Twenty-seven patients (46%) had OP and 19 (32%) had osteopenia. The average age of osteoporotic patients was 72.2 years. Fifty-four percent of our patients were smokers, of whom 88% had bone loss. Three patients (3%) with a low body mass index (<19kg /m2) were osteoporotic. OP was secondary to a known potentially OP-induced pathology in 28 patients (47%). An iatrogenic origin of OP was found in 21 patients (36%), mainly by corticosteroids. Thirty-nine bone low energy fractures were noted, including 25 (64%) vertebral fractures and 8 (20%) upper femur fractures. Twenty-one fractures (54%), including 16 vertebral fractures, were associated with OP. Only one death was lamented following a fracture of the upper end of the femur. All our osteoporotic patients and 17 patients (90%) of osteopenic patients had vitamin D and calcium supplementation. Twenty-seven (46%) patients had received bisphosphonate treatment without reporting adverse events.
Conclusion: As in all published studies, OP was mostly secondary among older men, but much more common. Low energy fractures were also common at the vertebral site.

Sudden Cardiac Death (SCD) syndrome is the second most common cause of high risk coronary anomalies in young people accounting for nearly half a million premature deaths per year. Through this case study we hope to shed light upon and draw awareness on SCD to ultimately help reduce mortality from this condition. SCD has a sudden onset and generally results in death <1 h from presentation of symptoms and can appear in persons without comorbidities that would be deemed fatal [1]. This is why it is imperative that clinicians be aware of this rapidly developing condition and methods to detect it. Our case presents a young, sedentary, symptomatic 34-year-old male who presented to his Primary Care Physician (PCP) with complaints of worsening chest pain. Upon taking the patient's history, he reported that he was a non-smoker and denied any alcohol or drug use. His family history revealed many incidences of premature coronary artery disease from both his maternal and paternal sides. Much of the research regarding SCD centers around athletes and highly active patient populations. Therefore, this case is especially poignant given the presentation of SCD within a non-athletic and sedentary profile which is an outlier to most literary presentations of SCD.

Physiotherapy is essential for the people stricken by the orthopaedic intervention. The intention of the work is to restore the patient’s moving capability by doing exercises. The system developed ensures patient to do physiotherapy exercises in the home. The requirement of the system should be cost operative and user friendly. The system is an easy to use and cost effective for the physically disabled persons. This equipment can be used for finding the range of the movement of the muscle of the patient.

The objective of this study is to investigate the modulatory effects of Apigenin (APG) on human lymphocytes after irradiation with gamma rays (3 Gy) or treatment with the antineoplastic agent, mitomycin C (MMC), in vitro. Cytogenetic biomarkers such as chromosome aberrations (CAs), sister chromatid exchanges (SCEs), and cytochalasin-B blocked micronuclei (CBMN) were investigated in blood lymphocytes treated with radiation, antineoplastic agent (MMC), and APG. Using a standard protocol, whole blood lymphocytes were grown in vitro. The frequency of CAs or micro-nuclei (MN) in human peripheral blood cells that had undergone gamma radiation (3 Gy) and subsequently been post-treated with APG did not differ significantly from one another. In comparison to controls, the frequency of SCEs per cell was higher in samples treated with APG. In comparison to MMC treatment alone, lymphocytes treated with MMC in the presence of APG showed a significant reduction (P < 0.01) in the frequency of SCEs. The data for the MN test showed that APG treatment significantly reduced (P < 0.01) the frequency of MMC-induced MN.

The aims of the study were to determine the pattern of changes in serum IgE and IgG levels and to evaluate their probable implications in the aetiopathogenesis of acute myocardial infarction (AMI). A total of 31 AMI patients were obtained from Coronary Care Unit (CCU) at seventh October Hospital, Benghazi, Libya and Jamahiriya Hospital, Benghazi, Libya during the period of September to December 1998. A total of 11 patients with Angina Pectoris (AP) were obtained as disease control and 26 healthy adult Libyans were also obtained as normal control (NC) subjects. Venous blood specimen was collected in tube with or without anticoagulant as required for routine hematological tests and biochemical investigations and special immunological assays. Serum IgE level (GM±GSD, iu/ml) was significantly elevated in AMI compared to AP and NC at the 1st day (AMI1:102.0±3.2, AP1: 39.9±1.2, NC: 36.8±1.5; ANOVA: P=0.0001) as well as at the 7th day (AMI 7: 119.8±3.7, AP 7: 37.1±1.6, NC: 36.8±1.5; ANOVA: P=0.0000). No significant differences were observed for IgE levels between AP and NC and between AMI1 and AMI7 (P>0.05). Ele- vated serum IgE level in AMI was independent of risk factors such as Hypertension (HTN), Diabetes Mellitus (DM), Smoking (Sm), history Of Previous Coronary Artery Attack (H/OP CAA), complications and streptokinase therapy (P>0.1). Serum IgG level (Mean±SD, mg/dl) was significantly declined both in AMI and AP at the 1st day as well as 7th day as compared to NC (AMI1: 1033±314, AP1: 1056±320, NC: 1258±251, ANOVA: P=0.0144; AMI7: 936±383, AP 7:1042±318, NC: 1258±251, ANOVA; P=0.0002). No significant differences were observed between IgG levels in AMI1 and AP1 (P=0.833) and in AMI7 and AP7 (P=0.307). However, the decline in IgG level at the 7th day compared with 1st day was significant in AMI (P=0.014) and insignificant in AP (P=0.859). The IgG levels at the 1st and 7th day were significantly correlated in AMI patients (r=0.764, P=0.000) and also in AP patients (r=0.658, P=0.028). AMI patients with high IgE levels may be protected from infarction consequences. Other immunological responses, such as IgG, complement, cytokines, and cellular immunity, as well as research on IgG subclasses, are needed to understand their function in the aetiopathogenesis of AMI.

SuPAR is a glycoprotein that is released during infections and inflammation. It is a serum-soluble urokinase-type plasminogen activator receptor. Polymorphonuclear neutrophils (PMN) and macrophages secrete urokinase-type plasminogen activator (uPA), which then binds to the membrane's uPAR (urokinase-type plasminogen activator receptor) . From the uPAR, the suPAR is created via cleavage. SuPAR has the potential to cause or modulate a variety of diseases in patients with cancer, infectious and inflammatory diseases (including HIV infections, tuberculosis, liver fibrosis, and inflammatory bowel disease). During cellular invasion, suPAR can convert plasminogen to plasmin, which degrades fibrin, activates matrix metalloproteases, and mediates proteolysis of extracellular matrix proteins. The activities of integrins, such as activating intracellular signalling, monocyte chemotaxis, cell adhesion, and proliferation, are modulated by suPAR. SuPAR level is a significant marker in patients with various diseases and has been linked to a worse outcome in a variety of infectious and non-infectious disorders, according to several studies. Lung disease biomarkers are necessary to aid in diagnosis, characterise clinical phenotypes, and track the effectiveness of both current and novel therapy approaches. In this review, we examine the potential of suPAR as an universal marker for lung disease diagnosis, prognosis, and therapeutic monitoring.

The purpose of this study was, therefore, to evaluate the additive effects of the elevated levels of both HBsAg and AFB1 lysine albumin adducts and determine whether the two etiological factors for liver disease are endemic in Kenya. Liver disease can be brought on by a number of factors, such as viruses, trauma, and poisons. In lower eastern Kenya, the hepatitis B virus (HBV) is a prominent cause of liver illness. AflatoxinB1-induced hepatotoxicity caused by tainted grain has already been an issue, and reports of it had been made over the years in Kitui, Makueni, and Machakos counties, among other places in the region. A study was carried out to evaluate the additive effects of hepatitis B virus (HBV) and dietary AFB1 in liver disease among the subjects. Liver disease bio markers HBSAg and AFB1 lysine albumen adducts were used in this study. The investigation was conducted as a case-control study where blood samples from appropriately selected subjects were collected and analyzed for exposure to dietary AFB1 and HBV. A non-probability purposive sampling method was used to choose and divide the study area into strata with 19 clusters. The sample size (n) for the human case-control study was determined as per the Schelsselman formula (1982), as 283 each for both cases and controls A computer software SPSS® version 18.0 was used to analyze the data statistically. For case subjects, 52.29% (n=148) of serum samples were positive for HBsAg with level range of 500 to 9800 Iu/mL and a mean of 3.204 x 103 Iu/mL {95%; CI= (2.76 to 3.65) x 103} p \(\leq\) 0.05. For controls, 24% (n=68) of serum sample was positive for HBsAg with a level range of 50 to 990 Iu/mL and a mean of 347.57 Iu/mL (95%; CI= (278.35 to 416.80), p\(\leq\) 0.05. For AFB1 lysine albumin adducts, case subjects had 55.83% (n=158) of positive serum sample with a level range of 15.5 to 135.0 pg/mg and a mean of 42.93 pg/mg (95%; CI= (39.36 to 46.51) p\(\leq\) 0.05, while the controls with 31.0% (n=88) of positive serum sample had a lower AFB1 serum albumin adducts level range of 3.5 to 60.5 pg/mg with a mean of 14.30 pg/mg (95%; CI= (12.23 to 16.36), p\(\leq\) 0.05. Case subjects had higher means for both HBsAg and AFB1 lysine albumin adducts than controls, suggesting an additive effect on liver disease among the subjects. In control subject samples, lower HBsAg suggested either a carrier state or a recent exposure and recovery from HBV. In control serum samples, lower mean AFB1 lysine albumin adducts suggested a lower level of dietary aflatoxin B1 exposure among those subjects. The case and control cohorts, the higher total number of serum samples testing positive for HBsAg, 30.83% (n=175) and AFB1 lysine albumin adducts 36.13% (n=205) out of the total sample (N=566), implied that the causal factors for the liver disease were endemic in the region. It is concluded that, even though both dietary AFB1 toxicity and HBV infection were endemic in the area, comparatively dietary AFB1 toxicity was much more prevalent in the region than hepatitis B infections and that the two factors had an additive effect to liver disease.

The aim of this study was to explore hospitals’ use of performance indicators for internal quality management activities.
The study conducted a qualitative interview among 72 health professionals and quality managers in 14 acute care hospitals in The Netherlands. The goal was to gain insight into data collection and use of performance indicators for two conditions: knee and hip replacement surgery and breast cancer surgery. Based on the data, themes were synthesized and the analyses were executed systematically by two analysts independently. Hospitals collect data for performance indicators and use it for quality management in different ways, while some do not seem to use the data for this purpose at all. Factors like ‘linking pin champions’, pro-active quality managers and engaged medical specialists seem to make a difference. A comprehensive hospital data infrastructure with electronic patient records and robust data collection software appears to be a prerequisite to produce reliable performance data for internal quality improvement.
Performance indicators are frequently used by hospitals as a tool to help internal quality control. It is advised that hospitals concentrate their human resource policies on "connecting pin champions," the employment of experts and a proactive quality manager, and to make investments in a robust data infrastructure. Furthermore, it is challenging to compare the results of performance metrics among Dutch hospitals due to variations in data collection procedures.

The purpose of this study is to assess the effectiveness and safety of intralesional vitamin D3 in warts. The study comprised 88 patients with recalcitrant warts of various sizes and duration. Vitamin D3 solution (600,000 IU, 15 mg/mL) was injected into the wart's base in amounts ranging from 0.2 to 0.5 mL. A maximum of 5 warts were injected per session at 3-week intervals until resolution or for a maximum of 4 treatments. In order to find any recurrence, patients were monitored for six months after the last injection. Topical Vitamin D has been successfully used for the treatment of warts in some cases. 88 patients completed the study. Complete response was seen in 54 of 60 (90%), partial response in 4 of 60 (6.66%), and no response in 2 of 60 (3.33%). The average number of injections required to achieve a complete resolution was 3.66. Complete resolution of distant warts was noticed in all patients. Recalcitrant warts can be treated effectively, cheaply, and safely with intralesional vitamin D3.

The purpose of this study was to report on the antibiotic susceptibility and resistance pattern of bacteria pathogens of UTIs in pregnant women in Bida, North Central, Nigeria, as well as to determine the extent of resistance of these bacteria pathogens to these drugs in the community. The research was a retrospective studies carried out between August 2012 to December 2013. For this investigation, 516 bacterial pathogens that were identified at the Medical Microbiology Department of Federal Medical Centre, Bida, Niger State, North Central, Nigeria. Out of this 516 bacteria isolates, Escherichia coli 342(66.3%) was the most predominant followed by Staphylococcus aureus 162(31.4%), Klebsiella specie 6(1.2%), Serratia marcescens 4(0.8%) and the least prevalence Proteus specie 2(0.4%). Overall susceptibility pattern of uropathogens to Nitrofurantoin was (58.5%) and Nalidixic acid (34.5%) and both were statistically significant (Nitrofurantoin p=0.000, Mean value 75.5 and Nalidixic acid p=0.000, Mean value 44.5). The most prevalent strain of Escherichia coli has susceptibility rates to Nitrofurantoin and Nalidixic Acid of 61.4 percent and 42.1 percent, respectively. Before giving a patient any medications, a routine microbiological analysis and susceptibility test should be conducted. The government should enact policies that discourage the sale and use of antimicrobials without a prescription from authorised medical personnel.

The present study was aimed to assess the efficacy of Radiofrequency as a tool for procedures for snoring - sleep apnoea. The parameters assessed were: postoperative pain-scores, intra and postoperative blood loss, reduction in subjective snoring sounds by patient and partner and reduction in AHI postoperatively. An effective treatment for snoring and obstructive sleep apnoea is radiofrequenc ablation techniques.IIt has a number of benefits, including as precise incisions, relatively bloodless field when used appropriately, reduced postoperative pain, and excellent healing with fibrosis, which helps to stiffen tissues.