Association of Fluid Overload with Escalation of Respiratory Support and Endotracheal Intubation in Acute Bronchiolitis Patients.

Fluid overload has been associated with increased oxygen requirement, prolonged duration of mechanical ventilation, and longer length of hospital stay in children hospitalized with pulmonary diseases. Critically ill infants with bronchiolitis admitted to the pediatric intensive care unit (PICU) also tend to develop fluid overload and there is limited information of its role on noninvasive respiratory support. Thus, our primary objective was to study the association of fluid overload in patients with bronchiolitis admitted to the PICU with respiratory support escalation (RSE) and need for endotracheal intubation (ETI). Infants ≤24 months of age with bronchiolitis and admitted to the PICU between 9/2009 and 6/2015 were retrospectively studied. Demographic variables, clinical characteristics including type of respiratory support and need for ETI were evaluated. Fluid overload as assessed by net fluid intake and output (net fluid balance), cumulative fluid balance (CFB) (mL/kg), and percentage fluid overload (FO%), was compared between patients requiring and not requiring RSE and among patients requiring ETI and not requiring ETI at 0 (PICU admission), 12, 24, 36, 48, 72, 96, and 120 hours. One-hundred sixty four of 283 patients with bronchiolitis admitted to the PICU qualified for our study. Thirty-four of 164 (21%) patients required escalation of respiratory support within 5 days of PICU admission and of these 34 patients, 11 patients required ETI. Univariate analysis by Kruskal-Wallis test of fluid overload as assessed by net fluid balance, CFB, and FO% between 34 patients requiring and 130 patients not requiring RSE and among 11 patients requiring ETI and 153 patients not requiring ETI, at 0, 12, 24, 36, 48, 72, 96 and 120 hours did not reveal any significant difference ( p >0.05) at any time interval. Multivariable logistic regression analysis revealed higher PRISM score (odds ratio [OR]: 4.95, 95% confidence interval [95% CI]: 1.79-13.66; p = 0.002), longer hours on high flow nasal cannula (OR: 4.86, 95% CI: 1.68-14.03; p = 0.003) and longer hours on noninvasive ventilation (OR: 11.16, 95% CI: 3.36-36.98; p < 0.001) were associated with RSE. Fluid overload as assessed by net fluid balance, CFB, and FO% was not associated with RSE or need for ETI in critically ill bronchiolitis patients admitted to the PICU. Further prospective studies involving larger number of patients with bronchiolitis are needed to corroborate our findings.

Viral suppression among HIV-positive patients on antiretroviral therapy in northwestern Nigeria: an eleven-year review of tertiary care centre records, January 2009-December 2019.

BACKGROUND: Human Immuno-Deficiency Virus (HIV) remains one of the world's significant public health challenges. Viral suppression is the key indicator for treatment success in People living with HIV (PLHIV). We determined the level of viral suppression, and its associated factors among PLHIV attending Federal Medical Centre Katsina (FMC Katsina), Nigeria. METHODS: This retrospective descriptive cross-sectional study was conducted on 913 HIV positive adults enrolled in care between January 2009 and December 2019. Information on socio-demographics, clinical, immunological, Viral load (VL), and other relevant parameters were extracted from the patients' care records. The primary outcome was the proportion of patients that achieved viral suppression. We also analyzed variables that were associated with VL suppression. RESULTS: Of 913, records of 831 (91.0%) registered patients were analyzed. During the period, 751 (90.4%) achieved viral suppression, 427 (51.4%) had CD4 counts ≥ 500 and 477 (57.4%) were on HAART for ≥ 5 years. Majority, 793 (95.4%) were on first-line HAART regimen (Tenofovir-Lamivudine-Dolutegravir or Abacavir-Lamivudine-Dolutegravir), and 809 (97.4%) in the non-advanced stage (WHO stages 1 and 2). The median (interquartile range) of viral load was 20 (20-40) vs 19,989 (3311-110,340) cp/ml in virally suppressed, and unsuppressed  respectively. Factors associated with viral suppression included being unemployed (Adjusted OR [AOR] 4.9, 95% CI 2.771, 8.539), educated (AOR 4.2, 95% CI 1.098, 16.223), having a baseline CD4 count ≥ 500 cells/µl (AOR 2.7, 95% CI 1.588, 4.625), and being on first line HAART regimen [AOR 7.0, 95% CI 3.220, 15.648]. CONCLUSIONS: Our study demonstrated a good viral suppression among PLHIV on HAART. Variables associated with viral suppression included unemployment, formal education, high baseline CD4 count, and first line HAART regimen.

Estimation of the case fatality rate of COVID-19 epidemiological data in Nigeria using statistical regression analysis.

Following the emergence of COVID-19 outbreak, numbers of studies have been conducted to curtail the global spread of the virus by identifying epidemiological changes of the disease through developing statistical models, estimation of the basic reproduction number, displaying the daily reports of confirmed and deaths cases, which are closely related to the present study. Reliable and comprehensive estimation method of the epidemiological data is required to understand the actual situation of fatalities caused by the epidemic. Case fatality rate (CFR) is one of the cardinal epidemiological parameters that adequately explains epidemiology of the outbreak of a disease. In the present study, we employed two statistical regression models such as the linear and polynomial models in order to estimate the CFR, based on the early phase of COVID-19 outbreak in Nigeria (44 days since first reported COVID-19 death). The estimate of the CFR was determined based on cumulative number of confirmed cases and deaths reported from 23 March to 30 April, 2020. The results from the linear model estimated that the CFR was 3.11% (95% CI: 2.59% - 3.80%) with R 2 value of 90% and p-value of < 0.0001. The findings from the polynomial model suggest that the CFR associated with the Nigerian outbreak is 3.0% and may range from 2.23% to 3.42% with R 2 value of 93% and p-value of <0.0001. Therefore, the polynomial regression model with the higher R 2 value fits the dataset well and provides better estimate of CFR for the reported COVID-19 cases in Nigeria.

Detection of antimalarial drug resistance polymorphisms in Plasmodium falciparum chloroquine resistance transporter and Plasmodium falciparum multidrug resistance 1 genes of Plasmodium falciparum found in Kano State, Nigeria

Objectives: In 2018, malaria claimed an estimated 380,000 lives in African region, with Nigeria accounting for 24.0% (91,368) of malaria deaths from the region. Mutations in Plasmodium falciparum chloroquine resistance transporter (Pfcrt) and P. falciparum multidrug resistance 1 (Pfmdr-1) genes had reduced the effective use of artemisinin combination therapy through the development of resistance to these antimalarial agents. Our study set out to determine the antimalarial drug resistance polymorphisms in Pfcrt and Pfmdr-1 genes of P. falciparum isolates among patients in Kano State, Nigeria. Material and Methods: Malaria positive samples were collected across the three senatorial districts of Kano State. The samples were amplified using nested polymerase chain reaction to detect the Pfcrt and Pfmdr-1 genes. The amplicons were sequenced and bioinformatic analysis was done using CLC Sequence viewer 8.0 and BioEdit sequence alignment editor to detect the single-nucleotide polymorphisms. Results: In the Pfcrt gene, CVIET haplotype was seen in 26.2% of the samples while only two samples showed the 86Y mutation in the Pfmdr-1 gene. All the 86Y mutations and majority of the CVIET haplotypes were detected in the patients from rural settings where some of them noted that they consumed modern and traditional (herbs) antimalarial agents. One sample was observed to have the CVIET haplotype and N86Y mutation while the other five CVIET haplotypes were seen in five separate samples. A new mutation V62A was found in the Pfmdr-1 gene as observed in one of the sample. Conclusion: It is imperative to ensure the rational use of the right antimalarial agents and employ continuous resistance surveillance/mapping to ensure synergy in malaria containment and elimination strategies.

Awareness and knowledge about glaucoma among patients attending outpatient clinics of Jordan University Hospital.

PURPOSE: To evaluate the level of awareness and knowledge about glaucoma among Jordanians and determine the relationship between glaucoma knowledge and selected variables. METHODS: This was a descriptive and cross-sectional study conducted at a central hospital. Face-to-face interviews were performed to obtain sociodemographic data and information about glaucoma from Jordanian participants attending different outpatient clinics of Jordan University Hospital (JUH). A convenient sample of 488 participants aged 16 years and above were recruited. Consent form was signed by each participant before starting the interview. RESULTS: The mean age of the study population was 45.71 ± 15.44 years, ranging 16 to 89 years. There were 163 (33.4%) females and 325 (66.6%) males. 81.6% of participants had heard of glaucoma. Only 34.2% of participants defined glaucoma correctly. 52.4% of participants had a low level of knowledge about glaucoma. The main source of information was from family members, relatives, and friends (66.6%); however, this source inversely influenced the level of knowledge. CONCLUSIONS: The results of this study indicate a high level of awareness of glaucoma among Jordanians but low-to-average knowledge about it. Health education programs should be activated at all levels of health- and eye-care services to increase knowledge about glaucoma and prevent the irreversible loss of vision due to the second main cause of blindness worldwide.

Clinical and histopathological features of breast cancer in Jordan: Experience from a tertiary care hospital.

OBJECTIVE: To analyse breast cancer cases with respect to age, menopausal status, hormone receptors and human epidermal growth factor receptor 2 expression, in addition to nodal and distant metastases. METHODS: This retrospective study was conducted at Jordan University Hospital, Amman, Jordan, and comprised cases of breast carcinoma among females between 2006 and 2015. Clinicopathological data was collected from patient files and laboratory reports. Data was analysed using SPSS v 17. RESULTS: Of the 752 cases, 559(74.3%) were invasive ductal carcinomas of non-specific type, followed by 36(4.8%) cases of invasive lobular carcinoma. Upon investigating the clinicopathological data on the breast cancer cases, 466(61.97%) cases had sufficient information for further analysis. Of them, 414(61.97%) patients were aged above 40 years and 190(40.77%) were post-menopausal. Moreover, 221(47.42%) cases showed lymph node metastases, but only 32(6.87%) had distant metastases. The expression of oestrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 was found to be positive in 343(73.6%), 299(66.7%) and 97 (24.6%) cases, respectively. Besides, 42(9.01%) cases were triple negative, which were diagnosed only in females below 40 years age. CONCLUSIONS: These results were in concordance with international reports, except for the association of triple negative breast cancer with age where it was mainly diagnosed among females younger than 40 years age.

Seropositivity and serointensity of Toxoplasma gondii antibodies and DNA among patients with schizophrenia.

The aim of this cross sectional case control study was to examine the serofrequency and serointensity of Toxoplasma gondii (Tg) IgG, IgM, and DNA among patients with schizophrenia. A total of 101 patients with schizophrenia and 55 healthy controls from Sungai Buloh Hospital, Selangor, Malaysia and University Malaya Medical Center (UMMC) were included in this study. The diagnosis of schizophrenia was made based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The presence of Tg infection was examined using both indirect (ELISA) and direct (quantitative real-time PCR) detection methods by measuring Tg IgG and IgM and DNA, respectively. The serofrequency of Tg IgG antibodies (51.5%, 52/101) and DNA (32.67%, 33/101) among patients with schizophrenia was significantly higher than IgG (18.2%, 10/55) and DNA (3.64%, 2/55) of the controls (IgG, P=0.000, OD=4.8, CI=2.2-10.5; DNA, P=0.000, OD=12.9, CI=2.17-10.51). However, the Tg IgM antibody between patients with schizophrenia and controls was not significant (P>0.005). There was no significant difference (P>0.005) in both serointensity of Tg IgG and DNA between patients with schizophrenia and controls. These findings have further demonstrated the strong association between the active Tg infection and schizophrenia.

Discrepancies between elderly patient's self-reported and prescribed medications: a social investigation.

AIMS: To study some characteristics of the elderly people attending the family practice clinic at the Jordan University Hospital (JUH) and to evaluate their knowledge of the prescribed drugs. METHODS: A total of 400 elderly people (180 men and 220 women) aged 71 ± 5.8 years were studied regarding sociodemographic characteristics and the use of medicinal and nonmedicinal remedies. In addition, agreement between self-reported drug information and information taken from the medical records was also evaluated. FINDINGS: Almost one-third of the patients had full agreement between their knowledge of total number of drugs they take and the numbers found in the medical records, whereas 43.4% underestimated and 21.8% overestimated these numbers. Five drugs/classes were accurately estimated by the patient (methyldopa, ezetimibe, warfarin, statins and antigout drugs). Underestimation was noticed in 17 drugs/classes and overestimation in 14. The significantly underestimated drug classes were biphoshponates, proton pump inhibitors, sulfonylureas and antiepileptic drugs. CONCLUSION: Some aspects of elderly people were evaluated regarding their medication knowledge. Almost two-third of the patients did not take their drugs in the proper way. The results of the study highlight the importance of taking several actions by all healthcare workers and by the community to optimise health care provided for elderly people.

Prevalence of vitamin-mineral supplement use among Jordan University students.

OBJECTIVE: To determine the prevalence, reasons, source of information of vitamin-mineral supplement uses, and their relationship with selected demographic and lifestyle characteristics among Jordan University students. METHODS: A cross-sectional survey was carried out at Jordan University, Amman, Jordan from March to September 2005. The survey included 1,187 students aged 17-28 years. A multistage stratified sampling technique was used to recruit the participants from different majors at Jordan University. A self-administered questionnaire containing questions on use of vitamin-mineral supplement during the last year, demographic, and lifestyle characteristics was completed. RESULTS: The overall prevalence of vitamin-mineral supplement use during the last year reported by students was 27.4% (males 22%, and females 30.2%). Vitamin-mineral supplement use among university students was significantly (p<0.05) associated with age, gender, family monthly income, smoking status, physical activity, vegetarian status, and body mass index. The most frequently used supplements were multivitamins (10.4%) and multivitamins-multi minerals (10%). The most frequently given reason for supplement use was for treatment. The main frequently reported source of information was a physician (45.8%). CONCLUSION: The overall prevalence rate of vitamin-mineral supplement use is very low. Supplement users are more likely to be: females, nonsmokers, of higher income, physically active, vegetarians, and of normal body mass index. The main reason for supplement use is for treatment, and the major source of information on supplements is by physicians and pharmacists.

Factors affecting satisfaction of patients after orthognathic surgery at a University Hospital.

OBJECTIVE: To analyze factors that influence patient's satisfaction with orthognathic treatment and evaluate patient's perception of changes in physical and psychosocial aspects. METHODS: In a retrospective clinical study conducted at Jordan University Hospital, Amman, Jordan between December 2006 and December 2007, we examined 38 patients who had orthognathic surgery after an average follow-up of 20 months. Examination included evaluation of nerve function and temporomandibular function with Helkimo index. Patients filled out a questionnaire on treatment satisfaction, and perception of physical and psychosocial changes after treatment. RESULTS: Patients were generally satisfied with the result, 82% agreed they would undergo treatment again. They were divided into very satisfied n=25 and less satisfied n=13 groups according to satisfaction score, with statistically significant differences found between them concerning diagnosis, and follow-up period, with all vertical maxillary excess patients very satisfied and 75% of asymmetrical deformities patients less satisfied, and less satisfaction by patients more than one year postoperatively p=0.006. Patients perceived improvement in oral function, general health, appearance and interpersonal skills. Lower rates of joint and muscular pain, and increased mobility of lower jaw correlated with better patients' perception of health and appearance. CONCLUSION: Although patients' report high satisfaction levels, several factors such as the temporomandibular joint function could affect patients' psychosocial adjustment after treatment. Sufficient information for patients on the treatment course is required to improve satisfaction. Controlling these factors could improve patients' quality of life.

Hypertension among females in a highly disadvantaged community in Jordan.

This study was conducted with the aim of finding the prevalence rate of hypertension and the relationship between hypertension and selected socioeconomic and dietary parameters in females aged 15-49 years in a disadvantaged community in Jordan. A household survey was carried out, using a questionnaire as an instrument for interviewing subjects. About 19% of females had hypertension, ranging between 7.5% in the very young to 58% in women aged 45-49 years. Hypertension was significantly associated with almost all variables studied such as age, education, marital status, parity, obesity, and dietary patterns. Some strategies were suggested to improve the situation in the future.

Toxicity and biouptake of lead and arsenic by Daphnia pulex.

Acute and chronic toxicity studies were conducted on Daphnia pulex using synthetic lead and arsenic water samples. For acute studies, solutions with 0.25, 0.5, 1.0, 2.0, 5.0 mg/L lead and arsenic along with a control were used. The chronic studies were conducted for 21 days using 0.25, 0.5, 1.0 mg/L lead and arsenic solutions along with a control. Results indicated that the LC50 (48 hour) was 4.0 and 3.4 mg/L for lead and arsenic, respectively. Results from chronic studies suggest that the exposure to lead solutions significantly (P < 0.05) impaired the reproduction rates of Daphnia at the 1 mg/L concentration. However, the reproduction rates were enhanced at low concentrations of arsenic (up to 0.5 mg/L). A second chronic study was conducted to confirm this finding. Results from the second study indicated that lead exhibited significantly higher (P < 0.05) toxicity at 0.5 mg/L concentration, while reproduction rates in all concentrations of arsenic solutions were not significantly different from the controls. Metal analysis on exposed Daphnia, following nitric acid digestion procedures, indicated that Daphnia bio-accumulated 75.3-97.2% of the lead added to the experimental containers. This high lead biouptake coupled with the fast growth, high reproduction rates, and short life cycle all suggest that a Daphnia-based remediation (growth and partial harvest) may a viable treatment alternative that is worth considering. However, further field studies have to be conducted to verify this alternative. Biouptake or sequestration by Daphnia of arsenic at all tested concentrations was negligible, thereby, suggesting selective uptake or sequestration by daphnia under the tested pH and temperature conditions.

Quantitative morphometric study of the skeletal muscles of normal and streptozotocin-diabetic rats.

OBJECTIVES: Quantitative morphometry under light microscope was applied to analyze changes in the number and the diameters of skeletal muscle fibers and their myonuclei in the extensor digitorum longus and rectus femoris muscles of normal and streptozotocin-diabetic rats. ANIMALS: Twelve adult male albino Fischer rats each weighing 300 g were used in the study. INTERVENTIONS: Streptozotocin (STZ)-diabetes was induced by a single intravenous injection of STZ (75 mg/kg body weight) via the tail vein. Six normal and 6 STZ-diabetic rats were sacrificed; samples of the extensor digitorum longus and rectus femoris muscles were taken, fixed in modified Bouin's fluid and processed for paraffin sectioning. The muscle samples were properly oriented during paraffin embedding for cross and longitudinal sectioning. Sections from each block were cut, processed and stained with hematoxylin and eosin. Randomly selected samples from normal and STZ-diabetic rats were analyzed using a 100x objective lens of a light microscope. MAIN OUTCOME MEASURES: The diameters of the fibers and the length of the myonuclei were determined from the longitudinal sections while the diameters and number of fibers and myonuclei were measured from the cross sections. A length measuring 10x reticule fitted to the microscope eye piece was used for the direct measurement of the fibers and myonuclei profiles. Morphometric measurement from each rat was determined and the data were pooled for the control and diabetic groups of rats. All data presented are means with standard error and were statistically analyzed using the Student's t-test. RESULTS: Histological examination of the stained sections from diabetic rats revealed the presence of areas of inflammation and necrosis in the myofibers of both muscles. The estimated mean diameter of the muscle fibers in the STZ-diabetic rats was reduced by 36% and 31% respectively in the longitudinal and cross sections of the extensor digitorum longus. Similarly, the diameter of the fibers of the rectus femoris in the longitudinal and the cross sections were reduced by 44% and 31%, respectively. On the other hand, a corresponding increase in the number of fibers per unit area was recorded in both muscles of the STZ-diabetic rats which amounted to 13% and 16%, respectively as compared to those of normal rats. Analysis of the myonuclei in normal and diabetic rats revealed a slight decrease in their length and diameter which amounted to 4% and 6%, respectively for the extensor digitorum longus and to 4% and 18%, respectively for the rectus femoris. The estimated numerical density of myonuclei per unit area was 10% lower in both muscles of the diabetic rats. CONCLUSIONS: Skeletal muscular atrophy is a well-documented complication in longstanding diabetes and has been attributed to the direct effect of low serum insulin on the motor end plates and on the synthesis of contractile proteins. The present morphometric study illustrates a reduction in the diameter of the myofibers of the extensor digitorum longus and rectus femoris muscles of STZ-diabetic rats. A slight but significant decrease in the length and diameters of the myonuclei between the diabetic and the normal rats was recorded. The results also indicate more evident morphologic changes in the myofibers of the hindlimb muscle.

Estimated risk of coronary heart disease in obese adult males in Northern Jordan.

OBJECTIVE: To examine the relationship between obesity, lipid profile and blood pressure, and to quantify the risk of coronary heart disease (CHD) for the next 10 years, using the Framingham risk scoring scheme among Jordanian adult males. METHODS: We conducted this study in Al-Sarieh, Jordan during the period March to May 2001. A total of 306 apparently healthy adult males, aged 30-50 years completed all the study procedures. We selected the participants using a multi-stage cluster sampling design. Dietary history and smoking habits were obtained using a pre-tested questionnaire and interview. Blood samples were obtained and examined for lipid profiles. We measured the blood pressures, as well as the weight and height to calculate the body mass index (BMI). The sample was categorized into 3 groups using the World Health Organization classifications for BMI. The risk of CHD was calculated using a scoring scale according to Framingham scheme. Analyses of data were carried out using the Chi-square test, and the Analysis of Variance. RESULTS: The mean age of the subjects was 39 years with a mean BMI of 28.2 kg/m2. The percentage of current smokers was 44.1%. The mean of serum total cholesterol, triglycerides, low density lipoprotein cholesterol and systolic blood pressure, increased significantly with increasing BMI categories, whereas the mean of high density lipoprotein cholesterol decreased with increasing BMI categories. Prevalence of medium and high risk of CHD significantly increased as BMI categories increases. CONCLUSION: The prevalence of estimated CHD risk for the next 10 years in moderate and high CHD categories increases as the BMI categories increases among Jordanian adult men in Al-Sarieh area.