Determinants of anemia among pregnant women attending a tertiary hospital, Mogadishu, Somalia: unmatched case-control study.

OBJECTIVE: The objective of this study was to identify the factors associated with anemia among pregnant women attending a tertiary referral hospital in Mogadishu, Somalia. METHODS: An unmatched case-control study was conducted on pregnant women who visited the antenatal clinics of a tertiary referral hospital between March and July 2021. The study recruited pregnant women who had a hemoglobin level of <11 g/dL into the anemic group, while those with hemoglobin levels ≥11 g/dL were included in the non-anemic group. Demographics, clinical, obstetrics, nutrition-related, hygiene- and sanitation-related, and parasitic infection-related data were collected. RESULTS: A total of 449 pregnant women (399 anemic and 50 non-anemic) participated in the study. A total of 224 (56.7%) in the anemic group and 31 (62.0%) in the non-anemic group did not consume any dark green, leafy vegetables such as spinach, bukurey, cagaar, and koomboow (p=0.040). Notably, 255 (63.9%) in the anemic group and 21 (42.0%) in the non-anemic group had a middle-upper arm circumference <23 cm. More than half of anemic [335 (84%)] and non-anemic [46 (92.0%)] were classified under low dietary diversity score. Majority of the study participants, 288 (72.4%) of the anemic and 39 (78%) of the non-anemic groups, used pit toilets in dwellings, and 70.2% (134/191) of the anemic and 64.4% (246/382) of the non-anemic groups disposed of solid waste in open fields. CONCLUSION: This study demonstrated that women who consumed green vegetables such as spinach, bukurey, cagaar, and koomboow in their diet had middle-upper arm circumference less than 23 cm, and those with low dietary diversity significantly developed anemia during pregnancy.

Oxidative stress, DNA damage, and inflammation in COVID-19 patients.

OBJECTIVE: Severe inflammation and oxidative stress seen in COVID-19 patients cause cumulative antiviral effects, and serious inflammation increases tissue, oxidative damage, and DNA damage. Therefore, in this study, oxidative stress, DNA damage, and inflammation biomarkers were investigated in patients diagnosed with COVID-19. METHODS: In this study, blood samples were obtained from 150 Covid-19 patients diagnosed by polymerase chain reaction and 150 healthy volunteers with the same demographic characteristics. Total oxidant status (TOS), total antioxidant status (TAS), total thiol (TT), native thiol, and myeloperoxidase (MPO) activities were measured by photometric methods. The levels of tumor necrosis factor-alpha (TNF-α), interleukin 1 beta (IL-1ß), and interleukin 6 (IL-6), which are inflammation markers, were measured by the ELISA method using commercial kits. The genotoxic effect was evaluated by Comet Assay. RESULTS: The oxidative stress biomarkers; Disulfide, TOS, MPO, oxidative stress index, and IL-1ß, IL-6, and TNF-α levels of inflammation biomarkers and the DNA damage in COVID-19 patients were increased (p<0.001), and the levels of TAS, TT, and NT In COVID-19 patients were decreased (p<0.001). CONCLUSION: In COVID-19 patients, induced DNA damage, inflammation, and oxidative stress can guide the prognosis and treatment strategies of the disease.

Determinants of Disagreement with Female Genital Mutilation Among Mothers.

Aim: Female genital mutilation (FGM) is widely practiced in Somalia. Limited data are available on the attitude of the Somalia community regarding FGM. The present study aimed to explore the attitude of mothers toward the practice of FGM. Methods: A cross-sectional study was conducted from March to July 2021 among mothers attending outpatient clinics at a tertiary referral hospital in Mogadishu, Somalia. Results: A total of 247 participants were included, 65.2% of whom believed this practice should be continued. The most cited reason reported regarding FGM was a requirement for religion (90.7%). About 73.9% of mothers stated that the most cited reason reported regarding the abandonment of FGM was health complications. About 59.8% of the study participants thought that FGM could be stopped through education. The results revealed that women who graduated from primary school (OR: 2.21; 95% CI: 1.090-4.51), who had no social media account (OR: 2.305; 95% CI: 1.147-4.633), and women who were circumcised by a traditional birth attendant (OR: 4.55; 95% CI: 1.57-13.22) were more likely to think that FGM should be continued compare with their counterparts. Conclusions: We found that mothers who were less educated, had no social account and those circumcised by a traditional birth attendant had more positive attitudes toward FGM.

Five-Year Trends in Direct Costs of Chronic Obstructive Pulmonary Disease in Turkey: COPDTURKEY-3.

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is one of the major causes of mortality and morbidity worldwide. The aim of this study was to reveal the trend in direct costs related to COPD between 2012 and 2016, and to evaluate hospital costs in 2016, together with their subcomponents. MATERIAL AND METHODS: A population-based descriptive study was conducted using administrative healthcare data in Turkey. The total direct cost of COPD diagnosis-treatment for each year from 2012 to 2016, was calculated. The distribution of the hospital's COPDrelated costs for the year 2016 was also examined, together with morbidity data. RESULTS: The direct costs of the patients who were admitted to step 1, step 2, and step 3 health care centers between 2012 and 2016 increased by 41% [895 041 403TL ($496 930 501) in 2012 to 1 263 288 269TL ($417 834 197) in 2016]; the increase was 60% and 24%, for inpatient and outpatient groups respectively. In the year 2016, the direct total cost was 1003TL ($332) per patient. In 2016, mean specialist consultations per patient with mean cost per specialist consultation, and mean emergency visits per patient with mean cost per emergency visit, were 1.7, 42 TL ($14), and 0.4, 71TL ($23) respectively. For the inpatient group, the mean number of hospitalizations per patient, mean number of hospitalization days, and the mean cost per hospitalization were 0.4, 6.5, and 1926TL ($637), respectively. CONCLUSION: When the readmissions of patients with COPD were evaluated together with the costs, and compared with the statistics from other countries, it was found that the costs per patient were lower in Turkey. However, the reasons for the significant rise in inpatient costs compared to outpatient costs should be investigated. Further investigations are required regarding pulmonary rehabilitation, home health care services, preventive measures for infections, management of comorbidities, and treatment optimization, which may reduce hospitalizations.

Cost analysis of medical device spare parts.

OBJECTIVE: To establish estimation method on budget management of medical device spare parts and to evaluate the cost of medical device spare parts in affiliated hospitals of Istanbul Public Hospital Unions (PHUs). METHODS: While this evaluation was performed, the relationship between paid cost for spare parts according to technological development level of device groups and total inventory value was used. Spare part cost analysis was carried out by using the normalized weighted arithmetic average method. Cost analysis of medical equipment spare parts of Istanbul PHUs was performed by using the data retrieved from Ministry of Health Business Intelligence Decision Support System for spending of spare parts in 2015. RESULTS: The medical device spare part groups were categorized based on technological development. Among 1 to 6 PHUs, the cost ratios were acquired for high, middle, low and simple technology group as 17.31 - 40.08%, 29.14 - 43.36%, 22.62 - 27.44% and 8.16 - 11.89%, respectively. The ratio between the spare part and total inventory costs for 1-6 PHUs were calculated as 1.66%, 2.87%, 3.03%, 3.31%, 2.57% and 4.69% respectively. Expected rates based on normalized weighted method were obtained as follows; 5.76%, 4.67%, 5.31%, 4.87%, 4.34% and 4.27%. CONCLUSION: The expenditure analysis and budget planning for medical device spare parts in PHU could be predicted more accurately by taking into consideration the expected rate calculated by the normal weight method. In additon, the importance of Clinical Engineering Service Units in management of medical devices has been determined.

Obesity in adolescents and the risk factors.

OBJECTIVES: This study aims to investigate the frequency of obesity and to identify possible risk factors affecting obesity in adolescents. MATERIALS AND METHODS: This cross-sectional study included a total of 1,357 adolescents between March 2011 and May 2012 in Beyoglu district of Istanbul province of Turkey. The questionnaire including 38 questions which was developed based on the Youth Risk Behavior Survey, which is used by the Center for Disease Control and Prevention (CDC), was used for the data collection. The weight and height of the participants were measured and their body mass index (BMI) values were calculated. RESULTS: Of all participants, 54.8% were females, 5% of them were underweight, 12.6% were overweight, and 2.6% were obese. Among the male participants, the BMI values were higher (21.06±3.32 kg/m2) than females (20.26±2.88 kg/m2) (p<0.0001). The obesity ratio was higher in males (p<0.0001) and in children of highly educated parents (p<0.05). Of the participants, 23.5% were physically active. Physical activity level was higher in males, compared to females (p<0.0001). The rate of breakfast habit was higher in males than females (p=0.002). Healthy diets and losing weight in a healthy way were more commonly accepted by the students in the public schools, compared to those in private schools (p<0.0001). CONCLUSION: Obesity is an important public health problem and proper eating habits and regular physical activity should be encouraged. High-income families should also encourage their children to become more aware of the importance of physical activity. The right time for this is childhood and adolescence, in which permanent habits can be easily acquired.

Cost Evaluation of Inhaler Therapies Used in Respiratory Diseases: 1998--2015 Period in Turkey.

BACKGROUND: With the rise in life expectancy, the burden of chronic diseases, including obstructive pulmonary diseases, has increased throughout the world. OBJECTIVES: To evaluate the sales trends of inhaler pharmaceuticals. METHODS: The changes in box sales and sales amounts (in Turkish lira) of inhaler pharmaceuticals during the period 1998 to 2015 were examined and sales were projected for the next 3 years. Pharmaceuticals were classified according to form and pharmacological groups. RESULTS: The sales of inhaler pharmaceuticals have increased rapidly since 2008. The fastest increase in consumption has occurred in short-acting ß2 agonist preparations and nebulizer pharmaceuticals. Inhaled corticosteroid and long-acting ß2 agonist combination sales have been the highest since 2002, when these products entered the Turkish market. CONCLUSIONS: The inhaler pharmaceutical market has grown over the years, and this growth will continue in the future. The increased use of short-acting preparations, which should be used as symptom relievers, indicates that treatment management continues to be inadequate.

[Diagnostic efficiency of serum lipid-bound sialic acid level in malignant pleural effusions]. / Malignite kaynakli plevra sivilarinda lipide bagli sialik asit düzeyi tayininin tanisal degeri.

In this study, pleural fluid and serum lipid-bound sialic acid (LBSA) levels of 68 cases with pleural effusion hospitalised at the department of Chest Diseases in the Medical School of Selçuk University, and serum LBSA levels of 30 healthy individuals as control group were studied. Pleural effusions of 32 cases were due to malignancy of which considerably lung cancer. In the other 36 cases the causes were nonmalignant in origin. Levels of mean serum LBSA in malignant and benign groups were significantly higher than control group (p< 0.001). However, difference of the mean serum LBSA levels of malignant and benign groups was not statistically significant. We found the mean pleural fluid LBSA level of 23.34 mg/dL in malignant group and it was significantly higher than benign group (17.97 mg/dL) (p< 0.05). It was observed that there was no significant statistical difference between the pleural fluid to serum LBSA ratios of malignant and benign groups. In differential diagnosis of malignant pleural effusions, sensitivity and specificity of pleural fluid LBSA were 91%, and 51%, respectively. In conclusion, for the differentiation of malignant pleural effusions LBSA is not believed to be a reliable tumor marker since it may also increase in various chronic and inflammatory diseases. Despite of that, in cases with a suspicion of malignancy, the increased level of pleural fluid LBSA may be useful as a supportive parameter.