Disease and Health Research: New Insights Vol. 5

The human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) is a worldwide health issue. Around 43.8 million people living with human immunodeficiency virus (PLHIV) from 2017 to 2021, 5.1 million people were not aware that they had the virus, and not all received anti-retroviral treatment (ART). The visible problems among persons living with human immunodeficiency virus (HIV) are insufficiency of HIV information about the impact it will bring into their lives and non-compliance to treatment due to fear of disclosure. The need to enhance information about HIV through extensive health teaching and exemplary education modeling may help persons living with HIV (PLHIV) live with dignity and hope as children of God. The purpose of the study is to discover what substantive theory can be used to unearth variables such as active involvement in society, life change advocacy, life promotion, dignity, one finds oneself, sensitivity to one’s knowledge needs, and accountability and commitment to be safe which led to the development of “all loving support-information, education, and counseling theory. A mixed method embedded experimental design was used in testing the theory through a double-blind approach that quantified the grounded explored experiences of the participants. The qualitative participants were 20 in focus group discussion and the quantitative participants were 30 college students living with HIV, 18-24 years old, male, Christian, and currently enrolled in a college or university in the Davao region excluding those who are sick and admitted to the hospital. Pretest findings revealed that the participants were moderately informed about facts on HIV and moderately followed the course of treatment but after a series of tests (post-test after two weeks, after one month, and after two months), reported that they were totally informed about the facts on HIV and will strictly adhere to the therapy. The pretest and post-test scores on the level of awareness and medical compliance showed significant differences after a series of tests. Thus, the application of ALS-IEC theory is effective among persons living with HIV in assessing HIV awareness and drug adherence encompassing bio-psycho-sexual-social- cultural-spiritual domains. Continued use of the personalized health assessment will also offer a learning opportunity (information) through reading (education) and nurse-delivered counseling as extended care after HIV screening counseling will address the immediate needs of clients. The study shows the general population that PLHIV needs support from the government, people, and family to nurture individual self-awareness.

The excessive and prolonged use of electronic devices with digital screens may cause some serious health problems. The ocular surface problems particularly Dry Eye Syndrome may be the most common and preventable conditions affecting the eyes. In this study, the unfavourable and potentially harmful effects of digital screens on the lacrimal system and tear functions were evaluated in 221 participants. Their ocular surface conditions were evaluated by Ocular Surface Disease Index (OSDI) scores and their lacrimal functioning was measured by Schirmer’s test. A reciprocal and statistically significant relationship was found between dry eye symptoms and OSDI scores. This relationship was more prominent, especially in long-duration use of smartphones with brighter background lights.

Background: Central nervous system (CNS) involvement is reportedly more common in AIDS-related infections. One of the leading causes of illness and death in people infected with the human immunodeficiency virus (HIV) is still infection of the central nervous system (CNS) by different opportunistic pathogens. In HIV immunocompromised patients, the clinical and radiographic pattern of CNS infection might occasionally be used to confirm the diagnosis.

Aim: The aim of this study is to describe the distribution of etiologies, clinical parameters, evaluation methods, management and complications in a group of patients treated in a hospital’s AIDS unit in a developing country.

Methodology: An observational retrospective analytical study was conducted at Eugenio Espejo Hospital, Quito-Ecuador, between April 2002 and June 2010.

Results: The prevalence of CNS infections in HIV patients was 5.9%. The main clinical manifestations were fever, headache and focal neurological deficits. The most common opportunistic infections were Toxoplasmosis 46%, Cryptococcosis 20%, Tuberculosis 19%, Encephalopathy 5%, and Progressive Multifocal Leukoencephalopathy (PML) 5%. In the first decade of the 2000s, antiretroviral therapeutic (ART) regimens were established in 84% of cases, of which 66% followed the guidelines for treatment-naïve patients (AZT/3TC/EFV). The prevalence of mortality throughout the study was 21.31%, being the most common fatal complication lactic acidosis 38%, Systemic Inflammatory Response Syndrome (SIRS) 38%, and Immune Reconstitution Inflammatory Syndrome (IRIS) 23%. The strategies for treatment adherence and reducing the risk of infections, combined with individual commitment, significantly improve both the virological response and ART resistance rates.

Conclusion: In Ecuador, until 2005, there were substantial rates of HIV-associated opportunistic CNS infections, which showed a dramatic reduction with the advent and consolidation of highly active antiretroviral therapy (HAART). Since molecular testing is only useful in specific situations and is not always available in developing countries with limited resources, many of the diagnostic methods covered here are still implemented today.

The present case report discusses giant Uterine Fibroid by Giant uterine leiomyoma. The most frequent benign gynecologic tumor of the female pelvis is uterine leiomyoma, which develops from uterine smooth muscle. Giant fibroids, on the other hand, are extremely uncommon in modern treatment and provide management difficulties.  A 28-year-old nulliparous woman presented in a private clinic in Makurdi, Benue State, Nigeria with severe pain and a slow-growing abdominal mass with pressure symptoms due to a giant uterine fibroid. Laboratory analysis showed a blood haemoglobin concentration of 8.6 g/dL. The remainder of her laboratory results were within normal limits, and pregnancy was excluded. Transabdominal ultrasonography revealed a large hypoechoic mass originating from the uterus. Intraoperatively, the mass was huge, weighed 11.6 kg, was continuous with the uterus and tightly occupied the abdominal cavity with restricted mobility. Myomectomy was done after consideration of the patient’s wishes, fertility concerns and intraoperative findings. The patient did well without complications and was discharged on day six. She got married eight months later, got pregnant six months after marriage and delivered a baby boy through caesarean section nine months later.

The recent increase in the range of inhaled medications has expanded treatment options but also complicated treatments due to the diverse inhalation devices. Patients with asthma and chronic obstructive pulmonary disease (COPD) must take the agent at the indicated dosage and use the inhaler device correctly. However, it is often difficult to achieve sufficient performance. Inhalation therapy involves two types of adherences: to the drug and to the procedures for the inhalation device. It is crucial to view inhalation guidance as a means to enhance and maintain patient adherence to inhalation therapy. This review presents eight essential points for training patients with asthma and COPD in effective inhaler techniques. These points help ensure a balance of adherence to both the medication and the inhalation device, thereby maintaining disease control in clinical settings. It is concluded that favorable patient adherence and disease control can be achieved by providing ongoing inhaler technique training in clinical settings.

Algeria's economic and social development has generated large quantities of waste, including hazardous waste. Despite the efforts made and the legislation enacted, the management and treatment of this waste continue to present significant challenges. The production of these harmful materials has become a source of problems, not only of insalubrity but also of public health. Healthcare activities help to protect health, cure patients and save lives. But they also generate waste, approximately 20% of which represents an infectious, toxic, traumatic, or radioactive risk.

The main problems concerning healthcare waste are a lack of awareness of health hazards, inadequate training in waste management, the absence of waste management and disposal systems, insufficient financial and human resources, and the low priority given to the issue. Inadequate management of healthcare waste is a serious concern in many developing countries due to the risks posed to human health and the environment. Poor management of health care wastes exposes healthcare workers, waste handlers and the community to different risks, including infections, toxic effects and injuries. Risk Management is a process for identifying hazards associated with a product, estimating and evaluating the associated risks, controlling these risks, and monitoring the effectiveness of the control. In Algeria, many efforts have been made by the government authorities in order to better manage the waste from healthcare facilities. However, most healthcare facilities do not comply with the principles stated in Algerian legislation. According to the Agence Nationale des Déchets (AND), the amount of healthcare waste generated in Algeria was around 35,000 t/year in 2018. The problem of managing this waste is acute, given the quantities generated and the lack of resources and specialized professional channels for its collection and treatment. In the hospital of Batna city, a total of about 1114 Kg of healthcare risk wastes are produced each day. The results indicated that the rate was 1.75 kg/bed/day which is higher than the national value of 0.72 kg/bed/day. However, waste management practices are not free from challenges. Thus, several injuries and infections associated with health care risk wastes were recorded in different services of the hospital of Batna. This study provides the Preliminary Hazard Analysis (PHA) for the Health Care Risk Waste (HCRW). This assessment tool is part of an overall strategy that aims at reducing the disease burden caused by poor healthcare waste management (HCWM) through the promotion of best practices of safety standards.

Background: Chronic obstructive pulmonary disease (COPD) often co-exists with other co-morbidities or diseases that have an enormous impact on its prognosis. A complex systemic disease with both pulmonary and extrapulmonary manifestations that are causally related or have shared risk factors. Cardiovascular changes on ECG and Echocardiography are one of the common comorbidities of COPD accounting for a 25% rise in major adverse cardiac events (like AMI, and stroke) and mortality. Hence acute cardiac abnormalities across all severity of COPD patients clearly contribute to the overall mortality and morbidity, so an understanding of their role noninvasively through this study holds potential for early intervention.

Objectives: This study aimed at noninvasive assessment and correlation of cardiovascular manifestation in COPD patients with its outcome.

Materials and Methods: A cross-sectional study was done in the Department of Respiratory Medicine of a rural tertiary care center on patients during the period from January 2015 to June 2016 visiting our OPD or IPD. A total of 350 study subjects were screened and those fulfilling the inclusion and exclusion criteria that were 200 consenting to participate were included in the study. COPD was diagnosed based on clinical history, clinical examination, X-ray chest, and spirometry. All patients were further subjected to electrocardiogram (ECG) and two- dimensional echocardiography (2D-ECHO) for cardiac evaluation. Data collection was done and analyzed.

Results: On ECG evaluation: arrhythmia was found in 99 (49.5%) cases, right ventricular hypertrophy (RVH) in 61(30.5%) cases, and right atrial enlargement (RAE) in 52(26%) cases. Right bundle branch blocking in 20(10%) cases poor progression of R wave in 24(12%) cases and right axis deviation was found in 30 (15%) cases.

On 2DECHO evaluation: Tricuspid regurgitation was found in 117(58.5%) cases, pulmonary hypertension in 116 (58%) cases, RAE in 79(39.5%) cases, RVH in74 (37%) cases, RV enlargement in 55(27.5%) cases, and left ventricular diastolic dysfunction in 113(56.05%) cases.

Conclusion: Cardiovascular comorbidities are highly prevalent in moderate to very severe COPD patients who need early diagnosis and treatment. Hence ECG and ECHO are simple non-invasive bedside tools for cardiac evaluation of COPD patients during acute exacerbation as well as during the follow-up of the disease.

Like the previous pandemics, COVID-19 has been succeeded by well-documented post-infectious and post-vaccination sequelae.  The circulating Spike antigen, acquired either via SARS-CoV-2 infection or mRNA therapeutics, likely drives cardiovascular and thrombotic injuries as well as cognitive and motor dysfunction. This “spike effect” has been positively correlated with angiotensin II (ANG II) upregulation, caused by the S antigen binding angiotensin-converting enzyme 2 (ACE-2), disabling this protein. ACE-2 deficiency causes an imbalance between the horizontal and vertical branches of the renin-angiotensin system (RAS) manifested by elevated ANG II levels.  In return, ANG II, a mitochondrial toxin, triggers premature cellular, including neuronal, senescence, promoting cognitive, premotor, and motor pathology.   The blood-brain barrier (BBB)-crossing, candesartan has shown beneficial effects in viral infections, neurodegeneration, and substance use disorders, suggesting that repurposing of this agent could avert the “spike effect”. In this perspective article, a look at angiotensin II receptor blockers, “sartans”, alone or in combination with angiotensin (1-7) agonists has been given, as potential treatment modalities for COVID-19 and its sequelae as well as Parkinson’s disease.

Background: Diabetes mellitus (DM) is a major public health concern, leading to increased morbidity, mortality, healthcare utilization, and costs. The prevalence of diabetes has increased significantly, so knowledge and awareness are crucial for diabetes management, and self-management education is essential for successful treatment. However, knowledge of diabetes is often poor in developing countries. Illiteracy rates are higher in these countries compared to the developed countries, which contributes to lower knowledge and awareness of diabetes among diabetic patients.

Objectives: The objective of this study is to summarize peer-reviewed publications for a selected period (13 years) about patients' knowledge and awareness of diabetes mellitus type 2.

Methodology: A total of 13 articles were selected as cross-sectional studies or systemic reviews from literature review using three databases, namely Google Sholar, PubMed, and ResearchGate, and were published in 2011-2023.

Results: Most previous cross-sectional studies reported that educational interventions led to significant increases in participants’ knowledge of type 2 diabetes and high educational qualifications were significantly related to a better understanding of diabetes.

In a multivariate analysis, greater diabetes awareness, greater medication adherence and monotherapy use were significant factors in good glycemic control.

Other previous cross-sectional studies and systemic reviews indicated that most people with diabetes understand that lifestyle changes are necessary to treat diabetes. However, many also believe that diabetes can be permanently cured and that being overly healthy can lead to diabetes. Also, Lower frequency of HbA1c monitoring is significantly associated with poor glycemic control. Moreover, the results showed that people with diabetes may have poorer control if they have had diabetes for a longer duration.

Conclusion: The source of information obtained is used as a reference for knowledge and behavior formation. Providing education can be applied to increase patient knowledge about diabetic mellitus, risk factors, and complications.

Kyrle’s disease (KD) and Flegel’s disease (FD) are rare variants of primary perforating dermatoses, characterized by transepidermal elimination of abnormal endogenous materials. In 1916, the Austrian dermatologist Josef Kyrle described multiple hyperpigmented papules and nodules 5–10 mm in size with a central keratotic plug in a 22-year-old diabetic woman. On the other hand, Flegel disease is considered a genodermatosis with autosomal dominant inheritance, manifesting in the third to fourth decade of life, although it has been reported in patients as young as 13 years of age. We describe a 6-year-old Yemeni girl with a 2-year history of generalized asymptomatic, small, reddish-brown keratotic papules with a lenticular central keratotic plug. The patient exhibited the clinical characteristics of FD; i.e., generalized small lesions mainly over the face, trunk, and extensor surfaces of the extremities, rather than the large lesions typically observed in KD. Although these features are synonymous with FD, the histology of a punch biopsy was consistent with KD. The patient was otherwise healthy, and no family members had a history of similar diseases. The patient was diagnosed with KD-FD, owing to the manifestation of features associated with both diseases. This case supports the hypothesis that KD and FD are different manifestations or at least represent different stages of the same disease.

Abstract: The present study discusses the role of microbiota in the metabolism of psychotropic drugs as well as the dysbiosis associated with the antimicrobial properties of these agents. Psychotropic drugs are endowed with antimicrobial properties and are known to alter the gut microbiome, selectively depleting the Bacteroidetes phylum, and leading to obesity.

It is well-established that obesity has reached epidemic proportions throughout the world, however, it is less known that its rates are two to three times higher in mentally ill patients compared to the general population. Both psychotropic drugs-induced dysmetabolism and high fat diet-related weight gain present with a common enteric microbial pattern, and depletion of the Bacteroidetes phylum, suggesting an overlapping pathology. Others have opined that the loss of Bacteroidetes-generated metabolites is the common denominator of weight gain induced either by an unhealthy diet or psychotropic drugs.

Since germ-free animals exposed to psychotropics have not demonstrated weight gain, altered commensal flora composition is believed to be necessary and sufficient to induce dysmetabolism. Conversely, not only do psychotropics disrupt the composition of gut microbiota but the latter alter the metabolism of the former. For example, drug metabolism starts in the gut, rather than the liver as it was construed in the past.

The potential biomarkers reflecting the status of the Bacteroidetes phylum have been discussed and a closer look at nutritional interventions, fecal microbiota transplantation, and transcranial magnetic stimulation strategies has been taken that may lower obesity rates in chronic psychiatric patients. Obesity is a modifiable risk factor of general morbidity, therefore restoring the physiological levels of Bacteroidetes phylum by various strategies may attenuate or reverse the excess weight in chronic psychiatric patients. If validated, the biological markers described here may offer the clinician additional feedback to estimate the imminence of weight-related complications.

Psychotropic drugs deplete the intestinal Bacteroidetes phylum. The absence of metabolites generated by these microbes may under-activate xenobiotic sensors aryl hydrocarbon receptor (AhR) and pregnane X receptor (PXR), disrupting the transcription of genes related to psychotropic drug metabolism, lipid, and redox homeostasis, leading to altered bioavailability of antipsychotic agents, weight gain, and lowered body iron stores.

Background: The Integrated Management of Childhood Illness (IMCI) is a strategy that was developed by the World Health Organization (WHO) and the United Nations International Children’s Fund (UNICEF) in 1992 as an integrated approach to improve child health. IMCI is needed to address infant mortality in sub-Saharan African and South Asian countries of 11 million cases, due to diarrheal diseases, pneumonia, measles, malnutrition and newborn care problems. IMCI is an approach to managing sick children carried out integrated by combining promotion, prevention, and treatment services for the five leading causes of death in infants and children in developing countries. IMCI is used as a service standard for sick infants and childhood illnesses and a guideline for health workers, especially nurses and midwives and doctors in primary healthcare facilities. IMCI contributes significantly to reducing the mortality rate of neonates, infants and children if implemented widely, properly, and correctly.

Purpose: The primary purpose of the study is to determine the key factors impacting the implementation on integrated management of childhood illnesses (IMCI).

Methods: The design of this study uses systematic review, namely literature research that assesses critically quality health journals, which have been filtered with inclusion criteria and used several Google Scholar, Science Direct and Research Gate databases as literacy in this study. This systematic review is limited to a literature search in the last 10 years (2012- 2022) by using the following keywords: IMCI, Factors, determinant, Perception, Implementation "integrated management of childhood illnesses". There were 215 results according to the keywords Impact, implementation IMCI, and perceptions.

Results: One of the factors hindering the implementation of IMCI is the national and regional strategies that do not provide space for stakeholders to review, monitor and evaluate the program. The factors that cause to implementation of IMCI are supervised by the head of community health, district authority, attitude of health workers, logistics support, experience, knowledge, and perception of health staff trained on IMCI determine in process application in each health facility.

Conclusion: Leadership, logistic support, monitoring and supervision and coordination have an impact on the IMCI implementation process.