Rethinking BMI and Obesity Management: The Transformative Role of Artificial Intelligence.

The body mass index (BMI) is a longstanding, simple, and cost-effective tool for classifying individuals by weight, useful for rapidly screening populations for obesity-related health risks. However, its failure to account for muscle mass, bone density, and fat distribution can lead to misclassifications. This editorial explores the transformative potential of artificial intelligence (AI) in redefining or potentially replacing BMI as a tool for enhancing weight management strategies. Furthermore, it illustrates how AI can offer personalized health assessments, predictive analytics, and tailored interventions, overcoming BMI's shortcomings. By analyzing genetic, lifestyle, and medical data, AI enables a more nuanced approach to weight management, signifying a shift toward precision or personalized medicine. AI-driven virtual assistants enhance weight management by offering continuous support, motivation, and reminders, while AI algorithms analyze medical imaging for precise body composition assessment. AI also aids in early metabolic disorder detection and fosters community support among individuals with similar health goals. However, ethical concerns, data privacy, and algorithm biases require careful attention. Collaboration among healthcare professionals, researchers, and tech developers is vital for maximizing AI's positive impact on public health.

Age at Natural Menopause and Influencing Factors in Women Attending the Gynecological Outpatient Clinic at a Tertiary Care Hospital.

Background: Menopause is the irreversible cessation of menstruation that results from the lack of ovarian follicular function and is diagnosed after 12 consecutive months of amenorrhea without reasonable cause. This study aims to determine the average age at natural menopause and identify its associated factors among Somali women. Methods: This is a cross-sectional study conducted at the Mogadishu Somalia Türkiye Recep Tayyip Erdogan research and training hospital's Obstetrics and Gynecology outpatient clinic between June 1 and July 1, 2023. Data was collected from subjects during the data collection period using face-to-face interviews with structured questionnaires consisting of sociodemographic, lifestyle, dietary, and reproductive characteristics. A multivariate logistic regression analysis was conducted to find the association between menopause age and target variables. Results: Out of the 188 participants recruited for the study, the median age of menopause was 45.00 (95% CI = 44.50-45.62), and 48.9% had either premature or early menopause. The majority (53.7%) of the participants had a minimum of eight children. In Spearman's rank correlation analysis, we found a significantly positive correlation between menopausal age and age at first (p<0.01), last childbirth (p<0.01), number of parities (p<0.05), and age at marriage (p<0.05). In multivariate logistic regression, we found that the odds of developing premature or early menopause among unemployed women were 59% lower than those of employed women (AOR = 0.41, 95% CI = 0.18-0.93). Conclusion: In this study, we established that the age of natural menopause was lower than the findings reported by previous authors. We also found that employment status, education, history of contraceptive use, BMI, age at first and last childbirth, and parity were associated with age at natural menopause, suggesting that social, lifestyle, and reproductive factors may have an impact on menopausal age.

A successful surgical repair of a gunshot injury to the left common carotid artery without neurological deficiency: A case report.

Introduction and importance: Penetrating neck trauma is serious and has a high fatality rate, especially in individuals who suffer injuries to the common carotid artery. The mortality rates for penetrating neck trauma are estimated to be 3%-6%. Accidents that cause a lot of blood to flow, like being stabbed, shot, or hurt in a car accident, can cause a person to lose a lot of blood quickly and in a short amount of time, which can be fatal if not treated right away. Clinical presentation: we present a 26-year-old young male patient with penetrating neck trauma caused by a gunshot. The gunshot entered the right sternocleidomastoid muscle at the level of the hyoid bone and exited the left sternocleidomastoid muscle on the mid side. Clinical discussion: In a recent report on the management of major vascular injuries to the neck, carotid artery injuries accounted for about 17% of all patients presenting with penetrating neck injuries. In this case, previously published literature adds that carotid artery injury early surgical and primary repair in young patients has a good outcome. Conclusion: Considering the high morbidity and mortality associated with penetrating neck injuries, In young patients, they can be successfully managed with early surgical and primary repair with a good outcome.

Radial artery pseudoaneurisma due to unintentional arterial puncture during cephalic vein cannulation: A rare case report.

Introduction and importance: Radial artery pseudoaneurysm is considered as an extremely rare and serious complication that usually follows after cardiac catheterizations with incidence of less than 0.05%, but in lesser frequency with arterial cannulation, trauma, and inflammation or hemodialysis therapy. On the other hand, venous access is clinically important, as it allows for blood sampling, administration of medications, fluids, nutrition, and chemotherapy. But its usage is associated with complications like catheter-associated infections, injuries to peripheral nerves, along with thrombosis and phlebitis of the vessel involved as well as arterial injury. Clinical presentation: in this report, we present a 67 years old healthy nonsmoker male patient with proximal radial artery pseudoaneurysm following several attempts of cephalic vein cannulation for intravenous access. Clinical discussion: Radial artery pseudo-aneurisms are very rare with reported incidence of 0.048%, and mainly due to arterial puncture in an attempt of cardiac intervention procedures, but to the authors knowledge this is one of the first reported cases of radial artery pseudoaneurysm caused by arterial puncture in an attempt of cephalic vein cannulation. Conclusion: Radial artery pseudoaneurysm can occur after attempts of cephalic vein cannulation and patients can be successfully managed with surgical removal of the false aneurism and radial arteriorrhaphy.

The health response to the Rohingya refugee crisis post August 2017: Reflections from two years of health sector coordination in Cox's Bazar, Bangladesh.

On August 25 2017, an unprecedented influx of Rohingya refugees began from Rakhine State in Myanmar into Bangladesh's district of Cox's Bazar. The scale and acuteness of this humanitarian crisis was unprecedented and unique globally, requiring strong coordination of a multitude of actors. This paper reflects on the health sector coordination from August 2017 to October 2019, focusing on selected achievements and persisting challenges of the health sector strategic advisory group (HSSAG), and the health sector working groups including epidemiology and case management, sexual and reproductive health, community health, mental health and psychosocial support, and emergency preparedness. In the early days of the response, minimum service standards for primary health care were established, a fundamental initial step which enabled the standardization of services based on critical needs. Similarly, establishing standards for community health outreach was the backbone for capitalizing on this important health workforce. Novel approaches were adopted for infectious disease responses for acute watery diarrhoea and varicella, drawing on inter-sectoral collaborations. Sexual and reproductive health services were prioritized from the initial onset of the crisis and improvements in skilled delivery attendance, gender-based violence services, abortion care and family planning were recorded. Mental health service provision was strengthened through community-based approaches although integration of mental health programmes into primary health care has been limited by availability of specialist psychiatrists. Strong, collaborative and legitimate leadership by the health sector strategic advisory group, drawing on inter-sectoral collaborations and the technical expertise of the different technical working groups, were critical in the response and proved effective, despite the remaining challenges to be addressed. Anticipated reductions in funding as the crisis moves into protracted status threatens the achievements of the health sector in provision of health services to the Rohingya refugees.

Integrating sexual and reproductive health into health system strengthening in humanitarian settings: a planning workshop toolkit to transition from minimum to comprehensive services in the Democratic Republic of Congo, Bangladesh, and Yemen.

BACKGROUND: Planning to transition from the Minimum Initial Service Package for Sexual and Reproductive Health (SRH) toward comprehensive SRH services has been a challenge in humanitarian settings. To bridge this gap, a workshop toolkit for SRH coordinators was designed to support effective planning. This article aims to describe the toolkit design, piloting, and final product. METHODS: Anchored in the Health System Building Blocks Framework of the World Health Organization, the design entailed two complementary and participatory strategies. First, a collaborative design phase with iterative feedback loops involved global partners with extensive operational experience in the initial toolkit conception. The second phase engaged stakeholders from three major humanitarian crises to participate in pilot workshops to contextualize, evaluate, validate, and improve the toolkit using qualitative interviews and end-of-workshop evaluations. The aim of this two-phase design process was to finalize a planning toolkit that can be utilized in and adapted to diverse humanitarian contexts, and efficiently and effectively meet its objectives. Pilots occurred in the Democratic Republic of Congo for the Kasai region crisis, Bangladesh for the Rohingya humanitarian response in Cox's Bazar, and Yemen for selected Governorates. RESULTS: Results suggest that the toolkit enabled facilitators to foster a systematic, participatory, interactive, and inclusive planning process among participants over a two-day workshop. The approach was reportedly effective and time-efficient in producing a joint work plan. The main planning priorities cutting across settings included improving comprehensive SRH services in general, healthcare workforce strengthening, such as midwifery capacity development, increasing community mobilization and engagement, focusing on adolescent SRH, and enhancing maternal and newborn health services in terms of quality, coverage, and referral pathways. Recommendations for improvement included a dedicated and adequately anticipated pre-workshop preparation to gather relevant data, encouraging participants to undertake preliminary study to equalize knowledge to partake fully in the workshop, and enlisting participants from marginalized and underserved populations. CONCLUSION: Collaborative design and piloting efforts resulted in a workshop toolkit that could support a systematic and efficient identification of priority activities and services related to comprehensive SRH. Such priorities could help meet the SRH needs of communities emerging from acute humanitarian situations while strengthening the overall health system.

Uptake of health insurance among Muslims in Nairobi county, Kenya

Introduction: in Kenya and the world across, health insurance has been reckoned as an important health policy that serves to protect households from the direct financial consequences of health care and meet the Sustainable Development Goal of Universal Health Coverage and Poverty Eradication. However, health insurance uptake has remained to be a major challenge for universal health care coverage especially among Kenyan Muslims who have conflicting religious faith towards conventional health insurance. This study had two main objectives: (1) to determine level of uptake of health insurance among Muslims and (2) to examine the role of religion in health insurance uptake among Muslims.Methods: the study adopted a cross-sectional study design. Post-stratified sampling was used to select 389 respondents who participated in the survey questionnaires. Descriptive statistics, cross-tabulation and Test of independence (Chi-square) were used to analyze quantitative data using SPSS Version 20.Results: findings revealed that only 86(22%) of Muslims were enrolled in a health insurance scheme. Among the 86 Muslims who had an insurance cover, Majority were enrolled in National Health Insurance Fund (65,70.6%) while 21(29.4%) were enrolled in private health insurance schemes. Among the 303 Muslims who had no insurance cover, 285 (94.1%)preferred being enrolled in Takaful Health insurance which is Shariah Compliant. Religion played a significant role on choice and enrollment of Muslims to health insurance schemes. Religious beliefs and Shariah teachings had a statistically significant relationship with uptake of health insurance (p < 0.05).Conclusion: uptake of health insurance among Muslims is low despite the growing population of Muslims in Kenya partly due to Muslims strong religious belief and Shariah laws, which prohibits them from enrolling into conventional insurance hence limiting freedom of individual decisions on the insurance schemes to enroll in. Despite high demand for health insurance products among Muslims, there lacks health insurances products aligned to the religious beliefs and needs of Muslim hence exposing them to hefty medical bills which deepens poverty and inaccessibility to basic health care

Forewarning of poliovirus outbreaks in the Horn of Africa: an assessment of acute flaccid paralysis surveillance and routine immunization systems in Kenya.

BACKGROUND: Although the Horn of Africa region has successfully eliminated endemic poliovirus circulation, it remains at risk for reintroduction. International partners assisted Kenya in identifying gaps in the polio surveillance and routine immunization programs, and provided recommendations for improved surveillance and routine immunization during the health system decentralization process. METHODS: Structured questionnaires collected information about acute flaccid paralysis (AFP) surveillance resources, training, data monitoring, and supervision at provincial, district, and health facility levels. The routine immunization program information collected included questions about vaccine and resource availability, cold chain, logistics, health-care services and access, outreach coverage data, microplanning, and management and monitoring of AFP surveillance. RESULTS: Although AFP surveillance met national performance standards, widespread deficiencies and limited resources were observed and reported at all levels. Deficiencies were related to provider knowledge, funding, training, and supervision, and were particularly evident at the health facility level. CONCLUSIONS: Gap analysis assists in maximizing resources and capacity building in countries where surveillance and routine immunization lag behind other health priorities. Limited resources for surveillance and routine immunization systems in the region indicate a risk for additional outbreaks of wild poliovirus and other vaccine-preventable illnesses. Monitoring and evaluation of program strengthening activities are needed.

Challenges of establishing the correct diagnosis of outbreaks of acute febrile illnesses in Africa: the case of a likely Brucella outbreak among nomadic pastoralists, northeast Kenya, March-July 2005.

An outbreak of acute febrile illness was reported among Somali pastoralists in remote, arid Northeast Kenya, where drinking raw milk is common. Blood specimens from 12 patients, collected mostly in the late convalescent phase, were tested for viral, bacterial, and parasitic pathogens. All were negative for viral and typhoid serology. Nine patients had Brucella antibodies present by at least one of the tests, four of whom had evidence suggestive of acute infection by the reference serologic microscopic agglutination test. Three patients were positive for leptospiral antibody by immunoglobulin M enzyme-linked immunosorbent assay, and two were positive for malaria. Although sensitive and specific point-of-care testing methods will improve diagnosis of acute febrile illness in developing countries, challenges of interpretation still remain when the outbreaks are remote, specimens collected too late, and positive results for multiple diseases are obtained. Better diagnostics and tools that can decipher overlapping signs and symptoms in such settings are needed.

Measles control and elimination in Somalia: the good, the bad, and the ugly.

Despite enormous challenges, Somalia has been successfully implementing accelerated measles control activities since 2005. Through innovative strategies and with the support of local and international partners, the country has shown potentials of implementing measles mortality reduction activities in complex emergencies. Measles incidence has been reduced by >80% after the measles catch-up campaigns of 2005-2007, and national reported measles routine immunization coverage with first dose measles containing vaccine has reached 59% for the first time in 2009. However, the near collapse of the health care system and the ongoing insecurity continue to hamper the implementation of recommended measles control and elimination strategies in some parts of the country, making these achievements fragile. Somalia exemplifies the challenges in meeting measles elimination goals in the World Health Organization Eastern Mediterranean region. As the region is entering its 2010 measles elimination goals, it appears necessary to establish realistic and flexible interim goals for measles control in Somalia that will take into consideration the specificities of the country. Maintaining flexibility in conducting field operations, securing financial resources, multiplying opportunities for measles vaccination, and improving disease monitoring systems will remain vital to sustain and improve current achievements.