Dr. Dharmesh Chandra Sharma
Associate Blood Transfusion Officer ( ABTO), Incharge Blood Component & Aphaeresis Unit Blood Bank, Department of Pathology, J. A. Groups of Hospital and G. R. Medical College, India.
Short Biosketch

ISBN 978-93-5547-341-7 (Print)
ISBN 978-93-5547-346-2 (eBook)
DOI: 10.9734/bpi/idhr/v8

This book covers key areas of Health Research. The contributions by the authors include genital self-mutilation, major self-mutilation, auto-castration, genital lacerations, schizophrenia, gestational carrier, commercialization, altruism, child rights, cerebrovascular accident, Arrhythmias, public health, epidemiology, infectious disease, COVID 19, body mass index, obesity, nutrition knowledge, disease surveillance, medical education,
Immediate implant, bone reconstruction, auto graft,  immediate prosthesis, fresh embalmment fluid, macrophages, chronic non-communicable diseases, dyslipidemia, chronic  kidney disease,  diabetes,  glomerular  filtration  rate, nucleotides. This book contains various materials suitable for students, researchers and academicians in the field of Health Research.


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Genital Self-mutilation in Schizophrenia-A Case Series

S. K. Praharaj, U. Bhaumik, N. Vamana, P. S. V. N. Sharma

Issues and Development in Health Research Vol. 8, 29 December 2021, Page 1-6

Background: Major self-mutilation of various parts of the body with or without suicidal intent is seen in mental illness. It needs attention due to risk of significant disability. Available literature finds majority of cases to be psychotic. These are associated with motives and various risk factors.

Case Series: In our study we describe lacerations over penis inflicted by two elderly gentlemen, both diagnoses with schizophrenia, with different motives. The aim was to try and explore the distinct reasons for such self-mutilation and whether these have any differences across socio-demographic variables, such as gender and duration of illness.

Discussion and Conclusions: Various psychodynamic factors have been ascribed to genital self-mutilation. The ability to conduct GSM without anaesthetics also points to deficiencies in pain expression in attempters. A multidisciplinary approach with antipsychotics, surgery and addressing non-compliance needs to be adopted in treatment of genital self-mutilation. Further studies are required to find out social and risk factors pertaining to genital self-mutilation.

A Novelty Concept on Surrogacy in North Macedonia

Daniela Antonovska

Issues and Development in Health Research Vol. 8, 29 December 2021, Page 7-12

Surrogacy has existed since ancient time. Depending on the way of creating an embryo, two types of surrogacy differ, traditional and gestational. When it comes to monetary compensation, two types of surrogacy exist, altruistic and commercialized. A lot of questions come to light such as: Is the altruistic surrogacy a humane gesture for all contracted parties? What if the mother changes her mind? Do the babies born of surrogacy mothers have rights? In North Macedonia, surrogacy was introduced for the first time in 2014 in the amended Law on Biomedicine and Assisted Fertilization. It was a novelty having in mind that in the Law of 2008 the surrogacy as a practice was outlawed. The amended law applies the term gestational carrier and provides a liberal stance in comparison to the Law as of 2008. The objective of the brief study is to provide an overview of surrogacy as a process in national context emphasizing legislation. Many provisions in national legislation are still unclear. Surrogacy should be seen from all perspectives and all advantages and disadvantages should be carefully considered. 

Introduction: Cerebrovascular accident contributes significantly to adult morbidity and mortality, posing serious medical, socioeconomic, and rehabilitation issues. Electrocardiographic abnormalities have been observed in the presence of neurological disease. The current study is an observational study that aims to uncover the relation between cerebrovascular accident and ECG. The goals of this study were to determine the frequency of ECG changes in cerebrovascular accidents, as well as the differences in ECG manifestations and mortality in different types of stroke.

Materials and Methods: A total of 100 patients with acute stroke were considered. Within 24 hours of admission, these patients' ECGs were recorded. Follow up of admitted patients was done to know the prognosis.

Results: T wave inversion (34.48 %) and ST segment depression (32.76 %) were the most common ECG abnormalities observed in cerebral ischemic patients, followed by QTc Prolongation (29.31 %) and the presence of U waves (27.59 %). In cases of haemorrhagic Stroke, T wave inversion (33.33%) and arrhythmias (33.33%) were followed by U waves (30.95%) and ST segment depression (23.81%). Patients with ST-T changes in the ischemic group had a higher mortality rate (66.66%), as did patients with positive U waves in the haemorrhagic group (60%). The study of ECG changes will provide insight into the prognosis and management of stroke patients, which may change their management in the future.

Conclusion: In acute stroke, ECG changes were very common. The changes are thought to be unrelated to the type of stroke. ST and T inversions were found to be common in ischemic CVA, while T inversions and arrhythmias were found to be common in haemorrhagic CVA. It was also discovered that patients with abnormal ECGs following an acute Cerebrovascular event had a higher mortality rate.

Deep Learning from the Covid-19 Pandemic

Jing Zhang

Issues and Development in Health Research Vol. 8, 29 December 2021, Page 17-22

The tremendous human sufferings and loss of life around the world caused by the Covid-19 pandemic prompt human beings to take some deep lessons from this pandemic and the pandemics/epidemics in history. Despite the fact that Covid-19 vaccines have been developed rapidly and more and more people have been vaccinated these days, the heavy death tolls and severe sufferings from the infectious Covid-19 disease all over the world have revealed our ignorance about the Covid-19 disease, the limitations of modern medicine, and the severe vulnerability of public health systems. The more we know about the coronaviruses (and other tiny invisible pathogens) and the diseases they caused in history, the better we can fight against the pathogens and save lives. To provide a historical perspective and to bridge the knowledge gap, this paper briefly reviewed the pandemics/epidemics in history and the death tolls they caused, discussed some associated factors, and identified 3 trends of the pandemics/epidemics in history. Further, this paper extended the discussion to the survival and extinction history of certain species on Earth, then took a future look of the possible climate change and environmental changes in our Solar system, and raised questions of human survival or extinction in the far future (billions of years later). The paper concluded that such deep learning from the pandemic is needed to save human lives, end the pandemic, prevent future large-scale pandemics and maybe even help prevent the possible human extinction in the far future.

Background: Good nutrition is crucial for good immune system. Precautionary measures such as self-quarantine and the temporary closure of teaching institutions to contain the spread of COVID-19 may affect normal life style pattern and nutrition practices.

Aim: The present study aim was to assess the BMI status and level of nutrition knowledge among nursing college students during covid19 lockdown

Methods: This cross sectional survey was carried out during covid19 lockdown period in Tamil Nadu among 247 nursing college students. Survey was conducted through online using valid structured questionnaire among willing participants who fulfilled the inclusion criteria. Section A included height, weight, BMI and socio-demographic variables .Section B elicited 45 Nutrition knowledge questions with 3 sub sections. Collected data were tabulated and analyzed statistically.

Results: The nutrition knowledge level results showed that majority of 54.8% had moderate knowledge, 35.7% had adequate knowledge and only 9.6% of students had inadequate knowledge. Body mass index (BMI) status revealed that 58.5% of the students were in obese II stage,36% were in obese I stage, 3.7% were overweight, 1.1% were normal and 0.7% were found to be under weight . No significant association was found between level of nutritional knowledge and body mass index at 5% level (p=0.079) High significant association was found between “programme (p = 0.000), year of study (p = 0.000) and the level of nutritional knowledge at 1% level. There was significant association between Age (p = 0.020) Family income (p = 0.021) and the level of nutritional knowledge at 5% level.

Conclusion: Students had moderate level of nutritional knowledge and majority of them were found to be Obese. No significant association and correlation was found between level of nutritional knowledge and body mass index. Transformation of nutritional knowledge into practice and creating awareness about impact of obesity, healthy life style and dietary habits would enhance their knowledge and create positive attitude towards health challenges.

Determination of Health Research Conducting Quality Perceptions of Medical Postgraduate Trainees

Shanti Chouhan, Khalida Naz Memon

Issues and Development in Health Research Vol. 8, 29 December 2021, Page 32-39

Background: Health researchers in medical universities are surrounded by existing hurdles to the health research during the process of conduction which may affect the quality of conduction of health research undertaken by the medical trainees. The bulk of the health researchers are unaware about the benefits of prevalent barriers for the good quality of conducting of health research in various public sector medical universities.  The current study is conducted to determine the effects of barriers on the quality of conduction of health research.

Objective: To assess the effects of barriers on the quality of conduction of health research.

Study Design: Descriptive cross-sectional study.

Place and Duration of Study: Research conducting postgraduate trainees in various disciplines in a public sector medical university in a developing country from 1st September 2018 to 31st December 2018.

Methodology: Two hundred & sixteen health research trainees were recruited for the study through a stratified sampling technique; the subjects included 79 males &137 females of age bracket of 24-50 years. After taking the consent, data was collected on a preformed questionnaire and analyzed in SPSS version 23.0 by computing proportions, mean ± standard deviation and using Chi- square test as statistical test of significance with the p-value of 0.05 taken as level of significance.

Results: Overall, two hundred and fifty subjects were approached to obtain the complete response of the required sample of two hundred and sixteen. The response rate was 86.4%. The 72 (33.3%) trainees in medicine and allied sciences, 66 (92%) trainees experienced various barriers in quality of conducting of health research. From 42 (19.4%) trainees in surgery and allied sciences, 22 (51.2%) perceived effects of barriers on their health research conducting (HRC) quality. Amongst 33 (15.3%) trainees in basic sciences, 15 (45%) faced various hurdles while going through their research; surprisingly all the trainees conducting research in field of pharmacology faced various barriers during research process. Out of 67 (31.0%) postgraduate trainees in dentistry, 60 (90%) reported various barriers (p= 0.03).

Conclusion: Quality conduction of health research affected by barriers is experienced by majority of medical researchers and trainees during their postgraduate training. The majority of the postgraduate trainees conducting research from clinical fields face more effects on their research conducting quality as compared to the basic sciences researchers.

Recommendation: Quality assessment protocol should be incorporated during research conducting process. Actions should be taken for reducing the barriers related to HRC quality. Collaborative health research amongst clinical and basic sciences fields can be done to improve the quality.

Aesthetic and Clinical Parameters for Immediate Implant Placement

P. Moerbeck, R. C. Cardoso, L. G. Moerbeck, Cardoso Ptlo, M. A. Barreto

Issues and Development in Health Research Vol. 8, 29 December 2021, Page 40-62

The purpose of this work is to promote a literature review parameters for the use of autograft in the immediate implant temporization in the aesthetic area, as well as to present a case report. The ranges of rehabilitation with implants have shrunk as technology, science, and industry have advanced. This technique, known as implant with immediate temporization (TIPP), is one of the topics being debated today, as the desire for aesthetic perfection grows. The fact that the anterior bone atrophy is caused by progressive bone size and nutrition in this area is quite limited endangers this aesthetic. TIPP use can be influenced by a number of factors, including implant type, bone quality and quantity, primary stability, occlusion, gingival biotype, bony walls of the gap, gap filling material, prosthetic platform used, and prosthesis type, among others. It was discovered that the patient to be evaluated unit 22 had persistent endodontic injury, bone loss in adjacent walls, and a shift pin. It was concluded that the proposed treatment produces satisfactory results in the short term. According to the literature, a recession is an impending technique. In patients with a thin biotype, a connective graft should be associated. This appears to have an impact on prosperous gingival architecture in order to achieve aesthetically pleasing rehabilitation. However, a longer study and follow-up are required to find ways to reduce buccal recession. Prosthetic platform used, the prosthesis type used, among others. It was discovered that the patient to be evaluated unit 22 had persistent endodontic injury, bone loss in adjacent walls, and a shift pin. It was concluded that, in the short term, the proposed treatment presents satisfactory results.

Health determinants on sustainable alternative medicine and primary prevention against coronavirus disease 2019, (COVID, 19), that lack cure, is determined by quality uptake of Non pharmaceutical Interventions (NPIs); regular hygiene and sanitation, keep social distance and proper uptake face masks. (Alternative medicine),100oC COVID 19 steaming cycles, in fermented green tea leaves enables active functional warmth of the anatomical lower Respiratory system and utilization of fresh arterial embalmment of COVID 19 corpses for cadaver preparations. Fermented green tea leaves contain flavonoids compounds that produce catechins to open up infected alveoli in early stages of infection. Flavonoids also contain theaflavins that kills corona viruses. Most viruses are killed at 60co to 70oC inhaled steam cycles along pharynxes, Embalmment contain 8 ingredients whose preparation is determined by case analysis to mediate hygiene. Early COVID19 clinical symptoms: fever, sore throat and coughing, may be efficiently managed by 100oC COVID 19 steam cycles boiling in fermented green tea leaves. Late clinical symptoms are dyspnea, due to aseptic shock attributed to both sudden low blood pressure and low temperatures below 37oC in the lower respiratory system to cause sudden Broncho Constrictions and deaths. Study attributed lower temperature of oxygen inhalation in lower respiratory system (not warmth to 37oC), in corona patients to more deaths witnessed in ICUs than in Home based care. Hence the study opted to ascertain Health determinants on sustainable alternative medicine and primary prevention against COVID 19, and ways to utilize infected corpse to process cadavers. Specifically, examined utilization of 100oC, COVID 19 Steam cycles in fermented green tea leaves as an alternative medicine. Uptake of NPIs, as basic hygiene measures. Lastly investigated on role embalmment of COVID 19 corpse, as distinct medical tools for education. Descriptive cross sectional, longitudinal cohort designs of mixed approaches were exploited, i.e. survey and interviews. Sampling designs were purposive prospective, retrospective. Survey used semi structured questionnaire to explore on quantitative data. KII and FGD interview guides were exploited in active interviews for qualitative data using sample size of 250 participants. Global and regional data observations on COVID 19 trends, were explored using 3Ls to determine virulence variations. Results demonstrated, 98% COVID 19 deaths are attributed to limited uptake of alternative medicine, since it had not been approved by WHO. Majority of participants ascertained that in the beginning of pandemic 100% of COVID 19 associated deaths cases, were neither embalmed nor disinfected before disposal, due to WHO restrictions. Thus a social genocides to the study region on their social customs and cultures. Hence majority affected health population, opted to plan for cool night exhumations. Which exposed them to higher health risks of OD (1.7,) RR (1, 7.7). 100oC COVID steam cycle was efficiency and accessible, as noted by discussants. But had limited MOH support. Uptake of NPIs was skewed (25%) with insignificant increase of infection among the population health. MOH failed to classify Red and Blue COVID 19 zones to enable holistic informed health behavior change. Up keep of 6 feet social distance was also insignificant during most public gatherings. Thus, need to mediate and advocate for alternative medicine awareness during emergency of the pandemics to enhance main aim of primary prevention.

Public Health Survey Fieldwork Research in Resource Limited Settings: Reflections from Uganda and Zimbabwe

Julie Abimanyi-Ochom, Miriam H. Marembo

Issues and Development in Health Research Vol. 8, 29 December 2021, Page 87-97

Globally, development of public health related policy requires routine data collection to provide evidence for public health interventions. Therefore, innumerable public health research has been conducted to monitor public health outcomes, progress, and provide evidence for health policy change in many parts of the world including Sub-Saharan Africa. Evidence on experiences of conducting public health research through data collection in Sub-Saharan Africa is limited despite the bulk of surveys conducted in this continent. There are limited studies that have documented the experiences and practicalities of conducting health survey fieldwork in such settings. This chapter gives a general overview of individual cross-sectional surveys conducted in Uganda and Zimbabwe to collect both administrative and survey data. The chapter briefly explains the survey methods, reflects on the challenges faced and lessons learnt from the fieldwork experience. The chapter concludes with practical adaptive strategies in planning and fieldwork research to minimise survey challenges, important for future public health data collection in similar resource limited setting.

Background: Dyslipidemia has consistently been associated to the development of problems such as cardiovascular disease (CVD), and it is a key component of the metabolic syndrome. Furthermore, disparities in the pattern of lipid derangements have been reported, particularly between people of African ancestry and their South Asian counterparts.

Aim: The present study aims to highlight the pattern and prevalence of dyslipidemia and other cardiovascular risk factors among the various ethnic groups in Trinidad and Tobago.

Materials and Methods: After an overnight fast of 10–12 hours, 10 mL of blood was obtained from each of the 968 patients in this investigation. Glucose, total cholesterol, triglycerides, high density cholesterol (HDL-c), very low density lipoprotein (VLDL), and low density lipoprotein (LDL) were all measured in plasma and sera (LDL). Each subject's anthropometric indices were measured, including height, weight, waist circumference, age, gender, education, occupation, ethnicity, and medical history, including medications.

Results: Our study shows that hypertriglyceridemia was prevalent in 33.88% of the patients with the highest observed prevalence of 46.69% seen in the South Asians. There were differences in body mass index (BMI), systolic blood pressure, blood glucose, triglycerides and very low-density lipoprotein cholesterol amongst the various ethnic groups (p < 0.05). However, levels of HDL-c were similar among the various ethnicities although patients of the South Asian descent tend to have a trend towards none-significantly higher levels of HDL-c compared with other ethnic groups (p > 0.05).

Conclusion: The study emphasised the well-known significant disparity in lipid profiles among people of different ethnic groups, particularly among patients with chronic noncommunicable disease (CNCD) in Trinidad and Tobago.

Background: Hyperuricaemia is an independent risk factor for kidney function decline, and its occurrence increases as the estimated glomerular filtration rate (eGFR) staging progresses.

Aims: The study aim to discuss hyperuricaemia and its correlates in patients with chronic noncommunicable diseases in a developing economy.

Methods: A total of 968 patients with diabetes, hypertension, cardiovascular disease, and chronic kidney disease were included in this retrospective study, which was conducted between January 2014 and December 2014. Each subject's blood was tested for glucose, serum uric acid, blood urea nitrogen, serum creatinine, lipid profile, liver enzymes, and albumin. Each subject provided anthropometric indices such as height, weight, waist circumference, age, gender, education, occupation, and medical history, including medications.

Results: Patients with raised serum uric acid (SUA) levels have higher mean age, systolic blood pressure (SBP), SUA, blood urea nitogen (BUN), triglycerides, albumin, and very low density lipoprotein cholesterol (VLDL) and lower mean value of estimated glomerular filtration rate (e-GFR) (P = 0.05) than patients with normal SUA levels. Correlation studies between SUA, e-GFR, BUN, serum creatinine, body mass index, (BMI), waist circumference (WC) and albumin shows strong association between SUA and these parameters (p<.0001). About 223 (23.34%) of the chronic kidney disease (CKD) patients have raised uric acid levels and 745 (76.96%) have normal uric acid levels.

Conclusion: This study emphasises the long-established link between hyperuricemia and chronic kidney disease. However, the measures already in place in lifestyle clinics must be sustained in order to prevent any trend toward an increase in serum uric acid levels in patients.