Disease and Health Research: New Insights Vol. 4

Cutaneous Leishmaniasis and Quality of Life

2024-09-01T11:01:50+00:00

Introduction: Cutaneous Leishmaniasis (CL) is a neglected tropical disease caused by Leishmania parasites. It is prevalent and affecting the quality of human life in more than 100 countries globally. The impact of CL as a public health problem has often been expressed in epidemiological and clinical prevalence and incidence figures. However, considering the impact of the disease beyond morbidity, mortality and changes in patient’s appearance would help to better understand the disease.

Aim: This study determined the effect of CL on quality of life.

Methods: The sociodemographic and clinical information related to the disease was collected using an interviewer-administered questionnaire. The questions were categorised under seven domains: symptoms & feelings, daily activities, work and school, leisure, personal relationships, and treatment. Each question was scored on a three-point scale: Very much (3), A lot (2), A little (1), Undecided (0), and Not at all (0). The sum of the scores lay between 0 and 48. A higher score shows a worse quality of life. The data were entered and analysed using Statistical Package for Social Science 23. Frequencies and proportions were used to describe the data. Differences were considered statistically significant at p < 0.05.

Results: The lives of the majority (60.7%) of CL patients were significantly affected by CL. The quality of life of patients was moderately impacted by CL in 25% of the CL patients. In 32.1% of the CL patients, the effect of CL on patients’ quality of life was very large. The quality of one CL patient’s life was extremely largely affected. The disease had a small effect on 32.1% of the CL patients. Personal relationship was the most affected domain followed by symptoms, feelings and treatment. Future study with large sample sizes including rural regions is required. The domain related to personal relationships was the most affected domain followed by symptoms and feelings, treatment and leisure. Patients with CL lesions might develop a broad spectrum of psychosocial sufferings.

Conclusion: The Dermatology Life Quality Index demonstrates that CL has a small to extremely very large negative effect on the quality of life of patients. This study informs future programs and interventions aimed at mitigating the adverse consequences of this disease on individuals' quality of life.

Assessment of the Changes in the Salivary Profile and its Clinical Correlation in Leukemic Children Undergoing Chemotherapy

2024-09-01T11:06:01+00:00

The present study aimed to assess the changes in salivary profile and its clinical correlation in leukemic (ALL) children undergoing chemotherapy. Chemotherapy adversely affects the salivary glands, altering the quality and quantity of saliva. Several chemotherapeutic agents cause damage to the mucosa which affects the dividing cells of Basal epithelium and also, direct contact of these agents with connective tissues can lead to their extensive damage.

Children who have been diagnosed with Acute Lymphoblastic Leukaemia undergoing chemotherapy in Bharati Hospital, Pune were included in the study. Those children were included who fulfilled the following inclusion and exclusion criteria. Stimulated salivary samples were collected in sterile vials at 1-, 3-, and 6-month intervals and were assessed for salivary pH and buffering capacity. Caries and oral manifestations were also checked at each interval. A total of 25 children with ALL undergoing chemotherapy were included to participate in the study. The results were analysed using Statistical Package for the Social Sciences software. All the major changes were seen in the 1st month, that is, the induction phase of chemotherapy. Hence, we can say this is the most affected phase of chemotherapy. Mucositis was more common in the prepubertal age group than the younger age group in the present study. Also, it was more common in girls than boys. Given that parents and kids should be motivated to practice good dental hygiene, this study has clinical significance. To prevent difficulties later on, all preventive dental procedures should be completed as soon as feasible before starting chemotherapy.

Determination of Genotypic Factors Associated with Lower Prevalence of Type-2 Diabetes Mellitus in Raica Community of Rajasthan, India

2024-09-01T11:10:35+00:00

Objective: This study was conceptualized to assess genotypic factors associated with a lower prevalence of type-2 diabetes mellitus in the Raica community of Rajasthan, India.

Background: The prevalence of diabetes mellitus varies in different geographical regions, ethnic groups, and age groups. Lifestyle factors like sedentary life, smoking, obesity, and dietary factors.

Materials and Methods: In this study, 114 people from the Raica community and 150 people from the non-Raica community were recruited. Their demographic details age and sex, anthropometric data body mass index, and waist-to-hip ratio, and laboratory parameters like fasting blood glucose, HbA1c and physiological parameters systolic and diastolic blood pressure were taken into consideration.

Results: In the present study, there were 40 females and 74 males from the Raica community and, 52 females and 98 males from the non-Raica community. The mean age was 41.14 and 46.93 in Raica and non-Raica communities. The fasting blood glucose, HbA1c levels and physiological parameters were significantly lower in the Raica community (p< 0.05). The AG allele of the ARNT gene was more frequently seen in individuals with lower fasting blood glucose and no individual studied, had the AA allele. The distribution of ARNT G1511A genotype and allele type in subjects of Raica and Non-Raica communities with fasting blood sugar was compared. In the Raica community, 97.5% of subjects had fasting blood sugar levels below 126 mg/dl compared to non-Raica where only 38.6% of individuals had a fasting blood sugar below 126 mg/dl.

Conclusion: In individuals with or without diabetes, the genetic variant under investigation has the same frequency of distribution in both Raica and non-Raica populations. One major contributing cause to the decreased prevalence of diabetes mellitus in the Raica community is thought to be their leanness and improved glucose regulation. The socio-economic and occupational environment of the members, which need to be explored further along with the genetic factors, may better account for the leanness and better control over the glucose levels in the Raica community.

The Clinical Significance of the Impact of Vaping on Plasma Clozapine Levels

2024-09-01T11:14:09+00:00

Background: Clozapine is an antipsychotic medication essential for treating treatment-resistant schizophrenia. Heinz Baumann and his team at Wander AG, a Swiss pharmaceutical company, first synthesized Clozapine in 1958. Its plasma levels are influenced by cytochrome P450 (CYP450) enzymes, particularly CYP1A2. Vaping and traditional smoking may impact clozapine metabolism.

Objective: This study aims to explore how vaping affects the plasma levels of clozapine, focusing on the pharmacokinetic interactions between clozapine and vaping constituents, and the implications for clinical practice.

Methods: A literature review was conducted to examine the interactions between nicotine smoking, CYP450 enzymes, and clozapine metabolism. Additionally, case reports were analyzed to understand the clinical implications for patients on clozapine who switch from smoking to vaping.

Results: Unlike traditional smoking, vaping often lacks combustion products like polycyclic aromatic hydrocarbons (PAHs), leading to reduced CYP1A2 induction. Case reports showed that switching from smoking to vaping often results in elevated plasma clozapine levels due to decreased CYP1A2 activity, causing adverse effects from toxicity. However, some vape products containing combustible products like aldehydes and carbonyls can induce CYP450 enzymes, leading to subtherapeutic plasma clozapine levels.

Conclusion: Switching from smoking to vaping may affect clozapine metabolism primarily through reduced activity of the CYP1A2 enzyme. This can lead to higher serum clozapine levels, hence increased risk of toxicity and deleterious adverse effects. But vaping can also lead to the induction of CYP450 enzymes thereby causing decreased plasma clozapine levels. So, the effect of vaping on plasma clozapine levels can be dependent on its constituent ingredients. Therefore, health professionals should carefully monitor plasma clozapine levels in patients who switch from smoking to vaping and adjust dosages as needed to maintain therapeutic efficacy and minimize adverse effects.

Lack of Sleep and Its Impact on Academic Performance among Nursing Students-Najran University, Saudi Arabia

2024-09-01T11:20:45+00:00

Background: Sleep plays a very important role in a human being's health. It has been reported that sleep is an essential process for maintaining healthy physiological, psychological, and cognitive functions for human memory and learning. Nursing students might be exposed to high levels of pressure and stress due to their academic responsibilities besides other personal and societal stressors. They may not be able to sleep adequately due to many assignments, examinations and other personal activities. Thus, they are at increased risk for sleep disorders.

Aim: The main objective of the current study was to identify the association between sleeping patterns and the students' academic performance.

Methodology: This is a descriptive and facility-based study. A snowball sampling technique (SST) was utilized for this study conducted during the period from June to December 2020 at Najran University, College of Nursing. A close-ended questionnaire was utilized for collecting the data besides obtaining the academic score (GPA) from the student's records.

Results: The participants' mean age ± standard deviation (S±D) was 22.4 ± 3.1 years. The majority of students 46 (76.7%) are aged above 21 years old and half of them have a GPA range between 2.0–3.49. In this study, 85% of the studied subjects use to sleep about four to six hours per day, although 20% of them don't use to have day naps. Interestingly, 73.3% of them are currently living with their families which is correlated significantly with their GPA (P value = 0.05). Additionally, Day naps and duration of sleep hours per day were found to be statistically significant with their GPA (P value < 0.05) respectively. On the other hand, the body mass index was not statistically significant with their GPA (P value > 0.05). Nursing students frequently experienced sleepiness and insufficient sleep, which had an impact on their ability to operate during the day and their academic performance. As a result, individuals who exhibit symptoms of sleep disturbances are more likely to achieve academically poorly and receive low grades in their classes.

Conclusion: There should be suitable programs to help students identify the physical as well as psychological symptoms as early as possible and therefore, provide adequate guidance to improve their academic as well as physical performance. Additionally, any student who performs poorly in academics should be monitored and referred to the concerned professional for help.

Feasibility of Primary Care Nurse-Delivered Genetic Counselling for Mainstreaming in Ovarian Cancer Patients: A Mixed-Methods Study

2024-09-01T11:26:02+00:00

The present study was conducted to explore the feasibility of implementing mainstreaming of genetic testing for patients of ovarian cancer, by training a primary care level nurse, in a subspecialty hospital setting.

Genetic testing for Breast Cancer (BRCA) gene 1 and 2 mutations in epithelial ovarian cancers and breast cancer is recommended to guide prognosis, adjuvant treatment, and prevention of second malignancies in the patient and primary malignancy in the carrier family members or relatives. In India, the prevalence of BRCA and other cancer-causing mutations is not well understood and is not sufficiently investigated. The possible benefits of mainstreaming genetic testing include increased patient uptake and identification of at-risk carriers, who may be targeted for primordial or primary prevention of genetic malignancies with favourable results. Along with this, an exploration of factors affecting the uptake of such tests, using a structured objective survey questionnaire followed by key informant interviews to develop a qualitative questionnaire for the future phase of the study was undertaken.

The uptake of genetic testing among patients was good and among healthy relatives was negligible. The affecting factors were a lack of awareness about genetic tests and economics. The qualitative study interview explored reasons for the low uptake of tests by healthy family relatives, satisfaction with the counselling, and the impact of test results on patients. Organisation of services for ovarian cancer patients with genetic and familial pathogenic variants requires essentially establishing referral pathways at all levels including primary care, genetic clinics, and gynaecological oncology multidisciplinary subspecialty clinics. The pretest counselling by trained nurses is effective but post-test counselling necessitates a specialist oncologist. The uptake of genetic testing is affected by the level of awareness among patients and kin and the costs. Thus, information and support along with the establishment of referral pathways with clearly specified criteria for patients, family members, and referring clinicians at all levels of primary care, genetic clinics, and multidisciplinary gynaecological oncology clinics are imperative.

Pseudocyesis and Its Related Psychiatric Conditions: An In-Depth Analysis

2024-09-01T11:28:44+00:00

Background: Pseudocyesis (or pseudocyesis vera) also known as “phantom pregnancy” was previously described according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a false belief of being pregnant that is associated with objective signs and reported symptoms of pregnancy. Depression has also been strongly reported to play a major role in the development of pseudocyesis. The exact etiology and management of this rare disorder are not known but certain factors have been associated with this including the presence of certain psychiatric conditions.

Objective: This study aims to provide a better understanding of the factors associated with pseudocyesis including psychiatric disorders and available treatment modalities.

Materials and Methods: This review article was done on the available literature reporting any psychiatric disorders and psychological factors in patients with pseudocyesis, the epidemiology, etiology, and methods of treatment in humans only. Available articles published from 1970 to January 2021 were included. Using the following keywords- “pseudocyesis, false pregnancy, psychiatric disorders, schizophrenia, phantom pregnancy”, relevant articles from Google Scholar, PubMed, ScienceDirect, and Web of Science were searched and reviewed. Our initial search yielded 871 articles, out of which 14 were deemed fully eligible.

Results: According to our review, it has been found that various social and cultural factors such as strong cultural views on the need for childbearing as a prerequisite for womanhood, and loss of a child have led to the manifestation of this condition. The etiology of pseudocyesis is associated with various psychological and endocrine disturbances sometimes mediated by psychosomatic disorders. The treatment of pseudocyesis depends on the underlying associated conditions. In most case reports examined in this review, a multidimensional approach including psychotherapy; pharmacotherapy like antidepressants and antipsychotics; hormonal therapy such as replacement therapy, has been suggested as a promising therapeutic option.

Conclusion: Pseudocyesis could be associated with psychiatric conditions such as major depression, schizophrenia, bipolar disorder, hypomania, and post-traumatic stress disorder. The treatment options may vary depending on the existence of co-morbidities in each patient. Adopting a multidisciplinary strategy that includes gynecologists, psychologists, and psychiatrists is critical in providing comprehensive care to this group of patients.

The Positive Impacts of Employment-Based Contingency on the Treatment of Individuals with Substance Use Disorder: A Systematic Review

2024-09-07T13:27:26+00:00

Background and Objective: Substance use disorders (SUD) remain a major public health concern and represent a significant cause of morbidity and mortality. Given the growing need for society to address this issue of SUD, it is essential to identify effective solutions to the problems this crisis poses to people's lives, health, and socioeconomic well-being. These social welfare issues are particularly affecting minority populations, who face disproportionately high levels of marginalization and disparities in healthcare.

Aim: The goal of this study is to explore and determine the effects of employment-based contingency (EBC) on enrolling SUD individuals into treatment, the rate of treatment adherence, and the rate of post-treatment abstinence.

Methods: PubMed and Google Scholar search was conducted using the search terms ((substance use disorder) AND (unemployment)) OR (therapeutic workplace)), for randomized controlled trials (RCT) published between 2012 and 2022, reporting on participants between ages 18 and 65 years who use opioids, cocaine or alcohol.

Results: Seven RCTs met the inclusion criteria, with a total of 389 participants. Three RCTs involving 203 participants found that EBC positively impacted treatment enrollment rates, with 100%, 92%, and 100% enrollment in the respective studies. Three articles involving 172 participants found a higher rate of treatment adherence and retention to treatment among EBC participants compared to the control group. There was more naltrexone-positive urine in the EBC group compared to control (72% vs. 21%, with a p-value of .01), and 74% (EBC) vs 26% (control) participants completed treatment. Four articles with 238 participants found that EBC improved the rate of abstinence by over 50%, which is double the rate among the control group without EBC. However, in three articles with 204 participants, EBC participants and control groups exhibited an equal rate of drug abstinence during the post-intervention period, further suggesting no significant difference in the rate of abstinence between the groups.

Conclusion: EBC is effective in improving SUD treatment enrollment, treatment adherence, and post-treatment abstinence, however, the efficacy may vary depending on how much is earned as an incentive. This policy is likely to be more successful with the strong support of employers in both the private and public sectors and the provision of support such as funding for businesses willing to implement these measures in their workplace for individuals with SUD.

Prevalence of Schistosomiasis among Children Less than 18 Years in Kilosa District, Tanzania: A 3-Year Retrospective Review

2024-09-07T13:33:42+00:00

Schistosomiasis is a public health problem in Tanzania. However, in the past 15 years, mass drug administration (MDA) targeting school children has remained the mainstay for its control. Despite preventive chemotherapy for schistosomiasis in school children, the prevalence of schistosomiasis in children aged 5-17 years in Kilosa district over a 3-year period has not been reported. This study determined the prevalence of schistosomiasis among children in Kilosa district.

A retrospective study was conducted using laboratory data records from the record books of selected health facilities in four wards of Kilosa District. Samples of urine and stool submitted by young children to the laboratories of health facilities between 2014 and 2016 were recorded.

A total of 702 samples were collected from the laboratory records books involving their age, sex and schistosome species. Of the 702 individuals, 541 were examined for urinary schistosomiasis and 161 for intestinal schistosomiasis; 31 (5.7%) were infected with S. haematobium and 11 (6.8%) with S. mansoni respectively.

However, the overall prevalence of schistosomiasis in the study area was 6.27%. Among males, the prevalence of S. haematobium was 1.00% and S. mansoni was 2.35% while among females, the prevalence of S. haematobium was 3.96% and S. mansoni was 1.00%. Children aged 13-17 years were infected with both species, with S. haematobium at 5.11% and S. mansoni at 1.99%. Ruhembe Ward had the highest prevalence of both species, with S. haematobium at 8.62% and S. mansoni at 5.17%. The findings confirm that schistosomiasis is a public health problem in the district. Therefore, it is recommended that mass drug administration should be carried out in the district.

Prevalence and Assessment of Risk Factors of COVID-19: A Retrospective Study from Southern India

2024-09-10T06:18:16+00:00

Background: A research study was carried out to determine the prevalence and incidence of COVID-19 and to identify the risk factors associated with infection. The Xpert Xpress SARS-CoV-2 assay was utilized to detect COVID-19.

Methods: Out of 1001 patients tested, 119 (11.9%) tested positive for COVID-19, with 5.3% females and 6.6% males. The highest percentage of positive cases was found among symptomatic patients with influenza-like illness (ILI symptoms) in a healthcare setting and among individuals who chose to get tested.

Results: Our multivariable logistic regression analysis revealed the risk factors associated with COVID-19 transmission. The relative risk (RR) indicates the ratio of risk (probability), where RR > 1 shows that exposure increases risk, and RR < 1 indicates that exposure is protective against risk. The analysis showed that being female (RR=1.10; 95%CI: 0.79-1.55), aged between 46-60 (RR=1.19; 95%CI: 0.75-1.87), all asymptomatic high-risk individuals (RR=2.79; 95%CI: 0.35-22.20), and all symptomatic patients with ILI symptoms in a healthcare setting (RR=3.64; 95%CI: 2.05-6.44) are associated with a higher prevalence of COVID-19.

Conclusion: Despite consistent exposure at work, we observed a modest incidence of COVID-19. Community contact was strongly associated with infections, but contact at work was not unless accompanied by high-risk exposure.

How to Achieve Visualization of Obscure Drug Inhalation Stages in Inhalation Therapy?

2024-09-10T06:27:25+00:00

The drug inhalation stage in inhalation therapy is crucial but often obscure. Information on how to inhale the drug is usually conveyed to the patient using ambiguous verbal expressions, such as “strongly,” “deeply,” and “slowly.” Patients typically determine the best method of drug inhalation based on their interpretation and understanding of verbal instructions. Consequently, direct intervention to provide optimal inhalation guidance for individual patients remains challenging, which can affect disease control. This has remained largely unexplored until now.

The Tokico Inhalation Monitor^TM (TIM) was developed to address the unpredictability of the drug inhalation stage. The TIM can simultaneously measure inhalation flow rate, duration, and total volume, displaying these metrics on the screen in real time. This chapter demonstrates how TIM can visualize obscure drug inhalation stages and illustrates the effects of inhalation instructions using this device.

Morbidity in Dengue Patient with History of COVID-19 Infection: A Study from Tertiary Care Hospital in North India

2024-09-10T06:30:54+00:00

Background: The coronavirus disease (COVID-19) posed one of the deadliest pandemics since the outbreak of the Spanish flu. The already COVID-19 pandemic burdened nations, during epidemics have to cope up with dengue fever too. The continuous circulation of both viruses presented a significant problem for the healthcare system, which struggles with patient triage and prognosis. It’s suggested that dengue antibodies cross react with SARS-CoV-2. The coincident incidence of COVID-19 and dengue makes timely patient diagnosis, treatment and disease prevention difficult. However, it’s unknown whether patients with previous COVID 19 infection can develop immunity dengue virus.

Aim: To study the hematological parameters in patients with active dengue infection and its correlation with past history of COVID 19 infection. Secondary aim: To investigate the effect of previous COVID-19 infection on various hematological parameters in patients with active dengue infection. To investigate previous Covid-19 infection. Effect of 19 infections on morbidity in patients with active dengue infection, evaluation of days of hospital stay, platelet transfusions, etc.

Methods: A total of 189 patients were included in our study. The mean age was comparable between the two groups. Group A patients had a higher mean platelet count [0.68200.00 ± 0.28153.33 x106/cumm] than Group B patients [0.54181.21 ± 0.31792.06 x106/cumm]. Group A had substantially shorter hospital stays, averaging 0.380.83 days versus 3.213.24 days for Group B. In addition, Group A received a substantial reduction in platelet transfusions. Results. Patients with a previous history of COVID 19 infection had significantly lower circulating lymphocyte and monocyte counts, with lymphocytopenia previously described in patients coinfected with SARS CoV-2. However, patients with no history of previous covid-19 infection had substantially lower levels of monocytes and lymphocytes compared to those without a history.

Conclusion: Our research indicates that patients with a prior history of COVID-19 infection have reduced dengue mortality. Patients with previous COVID-19 infections had higher platelet counts, shorter hospital stays, and fewer platelet transfusions than patients with no history of COVID 19 infection.

Effectiveness of a Brief Intervention Using Genetic Polymorphism of Alcohol-Metabolizing Enzymes on Excessive Drinking among Japanese College Students and Young Adults: A Randomized Controlled Trial

2024-09-10T06:37:33+00:00

Background: This open-label, randomized controlled trial evaluated the effect of a brief intervention considering five genotype combinations of enzymes involved in alcohol metabolism (ALDH2 and ADH1B) in the students and staff of a university aged 20–30 years who were excessive drinking behavior (average amount of alcohol consumed, men: \(\ge\)4 drinks/per day and women: \(\ge\)2 drinks/per day; 1 drink = 10 g of pure alcohol equivalent).

Methods: Focusing on the primary endpoint “average daily alcohol consumption” (g pure alcohol equivalent), data were collected from a randomized self-administered questionnaire survey linked by ID number and six-month drinking records, with both the intervention and control groups surveyed at 1, 3, and 6 months after intervention and from baseline, respectively. The intervention group was genotyped for alcohol-metabolizing enzymes using saliva, and recorded the amount and contents of alcohol consumed on drinking days until the results were reported approximately one month later, and after the results were reported, the intervention was conducted in person or online for 30 minutes. The control group received traditional materials, and genetic testing was conducted at 6 months (at the end of the study) on a voluntary basis. The Wilcoxon signed rank test was used for pre- and post-intervention comparisons, and the Mann–Whitney U test was used for between group comparisons at baseline and at 1, 3, and 6 months.

Results: By the end of June 2023, 204 participants had registered and were allocated into the intervention (n=100) and control (n=96) groups using simple randomization. The mean age was 22.5 years (85 men; 111 women). Average daily alcohol consumption decreased significantly in the intervention group between “baseline to 1 month” and at 1, 3, and 6 months after the intervention (p<0.01). No significant difference was observed in the control group at all time points. Furthermore, no significant difference was found between the groups at baseline, after which the intervention group consumed significantly less average alcohol at 3 months after the intervention (p<0.01).

Conclusion: Average daily alcohol consumption significantly reduced in the intervention group at 6 months. Genetic testing for alcohol-metabolizing enzymes and health guidance on type-specific excessive drinking may be useful in reducing sustained average alcohol consumption.