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Background: Hypertension is one of the main factors contributing to the global burden of non-communicable diseases. Previous research has revealed that stress, bad lifestyle choices and a lack of knowledge about the disease are the main causes of hypertension that can be controlled. The key cause behind the prevalence of the condition is the lack of medication adherence by patients. This study aims to evaluate medication adherence in patients with hypertension through the Morisky Medication Adherence Scale (MMAS) and to observe any adverse drug reaction leading to non-adherence of medications. Methods: A descriptive, cross-sectional study was conducted on 124 patients who attended the outpatient department of medicine. The descriptive tools were MMAS and causality scales for adverse drug reactions. Result: The mean MMAS score was 5.20±1.29. Amongst the demographic profile, age, sex, comorbidities and duration of disease were significantly associated with decreased mean MMAS scores. Forty-two patients experienced drug reactions and only four patients were adherent to their medications. Conclusion: Our study suggests that patients were poorly adherent to their medications. Effective interventions should be considered to improve adherence in patients. Monitoring for adverse drug reactions can lead to improved patient outcomes, whilst interventions to improve adherence can lead to better blood pressure control and reduced risk of cardiovascular events.

Introduction: Oral cancer presents challenging and unresolved problems for the human population, accounting for as much as 30-40% of all carcinomas in India. The current research focuses on the use of the tumour marker β2-microglobulin as a surrogate marker in patients with Oral Squamous Cell Carcinoma (OSCC) for early detection of cancer. Aim: To evaluate the level of serum β2-microglobulin in histologically diagnosed OSCC patients and compare it with age- and sex-matched healthy controls. Materials and Methods: This was a cross-sectional study conducted in the Department of Pathology at SN Medical College, Agra, over a period of one year and six months. The study included 50 histologically diagnosed OSCC cases and 40 age- and sex-matched healthy controls. Blood samples were taken from the healthy controls and OSCC patients, and the level of serum β2-microglobulin was measured using Enzyme Linked Immunosorbent Assay (ELISA). Statistical analysis was conducted using the Statistical Package for Social Sciences (SPSS) version 11. Z test and ANOVA test were used to compare various parameters. A p-value of

Abstract Background Non-communicable diseases (NCDs) constitute the leading cause of mortality globally. Low and middle-income countries (LMICs) not only experience the largest burden of humanitarian emergencies but are also disproportionately affected by NCDs, yet primary focus on the topic is lagging. We conducted a systematic review on the effect of humanitarian disasters on NCDs in LMICs assessing epidemiology, interventions, and treatment. Methods A systematic search in MEDLINE, MEDLINE (PubMed, for in-process and non-indexed citations), Social Science Citation Index, and Global Health (EBSCO) for indexed articles published before December 11, 2017 was conducted, and publications reporting on NCDs and humanitarian emergencies in LMICs were included. We extracted and synthesized results using a thematic analysis approach and present the results by disease type. The study is registered at PROSPERO (CRD42018088769). Results Of the 85 included publications, most reported on observational research studies and almost half (48.9%) reported on studies in the Eastern Mediterranean Region (EMRO), with scant studies reporting on the African and Americas regions. NCDs represented a significant burden for populations affected by humanitarian crises in our findings, despite a dearth of data from particular regions and disease categories. The majority of studies included in our review presented epidemiologic evidence for the burden of disease, while few studies addressed clinical management or intervention delivery. Commonly cited barriers to healthcare access in all phases of disaster and major disease diagnoses studied included: low levels of education, financial difficulties, displacement, illiteracy, lack of access to medications, affordability of treatment and monitoring devices, and centralized healthcare infrastructure for NCDs. Screening and prevention for NCDs in disaster-prone settings was supported. Refugee status was independently identified both as a risk factor for diagnosis with an NCD and conferring worse morbidity. Conclusions An increased focus on the effects of, and mitigating factors for, NCDs occurring in disaster-afflicted LMICs is needed. While the majority of studies included in our review presented epidemiologic evidence for the burden of disease, research is needed to address contributing factors, interventions, and means of managing disease during humanitarian emergencies in LMICs.

Background: Ever since the cluster of COVID-19 cases seen in Wuhan, China, the animal-origin virus has created havoc. These changes in clinical manifestations have been tracked in different waves, in different countries, also the virus behaving differently according to race and culture. To assess the prevalence of symptoms of COVID-19 infection during the third wave and compare it with seasonal flu and allergic rhinitis. Materials and Methods: A cross-sectional, comparative study was conducted at a tertiary hospital in Bareilly. A close-ended questionnaire was prepared to assess the otorhinolaryngological symptoms of COVID-19, seasonal flu, and allergic rhinitis. ENT findings were further confirmed by a suitable test. Results: A total of 145 tested positive for COVID-19 infection, 121 patients were diagnosed with seasonal flu, and 124 patients were diagnosed as cases of allergic rhinitis. Fever was the most common symptom in seasonal flu (100%) and COVID (93.8%) patients. Rhinorrhea (100%), lacrimation (100%), and sneezing (100%) were common symptoms in the allergic rhinitis group. A Chi-square test with Bonferroni correction showed a significant difference in the prevalence of symptoms in all three groups (P < 0.0001). Vaccination also contributed to less severity of COVID-19 disease. Conclusion: Involvement of otorhinolaryngology is considered a biomarker in all three groups with less frequent pulmonary features. It becomes necessary to correctly differentiate COVID-19 from the other two diseases for the proper treatment of patients.

Gender-based violence (GBV) is a global public health and human rights problem that is exacerbated by social and environmental stressors for a multitude of interpersonal, cultural, and economic reasons. Through sudden disruptions in the microclimate of a region, climate shocks often have a negative impact on food security, which correlates with increases in GBV. Associations between the various combinations of GBV, climate change, and food insecurity have been documented in the growing international literature, but questions remain about these associations that require further clarification. The impact of the COVID-19 pandemic caused by SARS-CoV-2 provides insight through a real time demonstration into these interactions. This review of the global literature examines the interplay between GBV, climate change, and food insecurity-including recent literature regarding the COVID-19 pandemic. This review covers original research studies employing both quantitative and qualitative methodology, those that conducted secondary analyses of existing data sources and perspective pieces derived from observed evidence. An additional analytic layer of system dynamics modeling allowed for the integration of findings from the scoping review and discovery of additional insights into the interplay between disasters, food insecurity, and GBV. Findings from this review suggest that the development and adaptation of evidence-based, focused interventions and policies to reduce the effects of climate shocks and bolster food security may ultimately decrease GBV prevalence and impact.

Twin-twin transfusion syndrome occurs in multiple gestations and involves a chronic flow of blood from one twin to another twin and is a rare entity. We present a case of 32-years-old primigravida with a twin pregnancy who presented with increasing abdominal girth inappropriate with her gestational age at 21 weeks of her pregnancy. Ultrasound findings were suggestive of twin-twin transfusion syndrome. The patient was provided with treatment options but due to polyhydramnios and short cervix, the patient went into spontaneous labour the same day with a poor pregnancy outcome. Twin-twin transfusion syndrome leads to a high rate of perinatal morbidity due to its poorly understood aetiology and difficulty in diagnosing and treatment. Early diagnosis during antenatal ultrasound is important in reducing morbidity and mortality rates.

Abstract Background Dried blood spots (DBS) are a relatively inexpensive source of nucleic acids and are easy to collect, transport, and store in large-scale field surveys, especially in resource-limited settings. However, their performance in whole-genome sequencing (WGS) relative to that of venous blood DNA has not been analyzed for various downstream applications. Methods This study compares the WGS performance of DBS paired with venous blood samples collected from 12 subjects. Results Results of standard quality checks of coverage, base quality, and mapping quality were found to be near identical between DBS and venous blood. Concordance for single-nucleotide variants, insertions and deletions, and copy number variants was high between these two sample types. Additionally, downstream analyses typical of population-based studies were performed, such as mitochondrial heteroplasmy detection, haplotype analysis, mitochondrial copy number changes, and determination of telomere lengths. The absolute mitochondrial copy number values were higher for DBS than for venous blood, though the trend in sample-to-sample variation was similar between DBS and blood. Telomere length estimates in most DBS samples were on par with those from venous blood. Conclusion DBS samples can serve as a robust and feasible alternative to venous blood for studies requiring WGS analysis.

Basal encephalocele is a rare congenital malformation. Among basal encephaloceles, the transsellar, trans-sphenoidal encephalocele is the least common subtype. We present the case of a newborn female, who presented to us with cleft lip and cleft palate. Diagnostic neuroimaging revealed the presence of transsellar trans-sphenoidal encephalocele along with agenesis of the corpus callosum. There are very few case reports of trans-sphenoidal encephalocele with corpus callosum agenesis in a patient with midline cleft lip and palate. In this report, we discuss the clinico-radiological findings of this extremely rare condition and present a brief review of the literature.

The prevalent concern in the present work environment is daycare amenities for dual career couples in developing nations like India. It plays a significant role in improvising the employee-employer relationship. This study identifies the pivotal factors like truancy and job satisfaction among dual career couples towards organizational sponsored daycare amenities. Moreover, role of organizational sponsored daycare amenities has been examined along with moderators like gender and numbers of children A descriptive research design was employed along with the usage of a self-administrated questionnaire to a sample of 197 employees from two states of Punjab i.e Amritsar and Punjab, India; to assess the moderator role of gender and number of children towards the organizationally sponsored daycare amenities. Organizational sponsored daycare amenities towards truancy rate and job satisfaction were found significant. Organizational sponsored daycare amenities are positively new to employees and even for employers in developing nations like India. Future studies may thrust on implications of organizational sponsored daycare amenities in the nourishment of organizational existence for longer eternity.

Severe ARDS in pediatrics is a life-threatening illness associated with significant morbidity and mortality, which often needs use of rescue ventilatory and non-ventilatory strategies. Despite non-encouraging results of HFOV in adults, its use still continues in pediatric population. We present three cases of primary severe ARDS, where oxygenation was refractory to conventional ventilation, prone positioning with conventional ventilation and to HFOV ventilation in supine position. In all these three cases oxygenation markedly improved with HFOV ventilation with prone positioning. Out of the three, two patients survived and one succumbed during the course of illness. We would like to hypothesize that prone positioning is feasible on HFOV and can be used as a rescue strategy for improving oxygenation and outcome when other measures fail.

Breast cancer (BC) is a heterogeneous disease. Numerous chemotherapeutic agents are available for early stage or advanced/metastatic breast cancer to provide maximum benefit with minimum side effects. However, the clinical outcome of patients with the same clinical and pathological characteristics and treated with similar treatments may show major differences and a vast majority of patients still develop treatment resistance and eventually succumb to disease. It remains an unmet need to identify specific molecular defects, new biomarkers to enable clinicians to adopt individualized treatment for every patient in terms of endocrine, chemotherapy or targeted therapy which will improve clinical outcomes in BC. Our study aimed to identify frequent hotspot mutation profile in BC by targeted deep sequencing in cancer-related genes using Illumina Truseq amplicon/Swift Accel-Amplicon panel and MiSeq technology in an IRB-approved prospective study in a CLIA compliant laboratory. All the cases had pathology review for stage, histological type, hormonal status and Ki-67. Data was processed using Strand NGS™. Mutations identified in the tumor were assessed for ‘actionability’ i.e. response to therapy and impact on prognosis.

Posterior fossa arteriovenous malformations represent 7–15% of all intracranial AVMs. They carry a higher risk of rupture than supratentorial AVMs and are associated with considerable rates of morbidity and mortality. Available treatment options include conservative management, microsurgical resection, radiosurgery, endovascular embolization, or combinations of these modalities. Recent advances in endovascular techniques have revolutionized their management with better clinical outcomes. We illustrate two cases of posterior fossa AVMs treated by endovascular techniques with good clinical outcomes. The first patient also had associated flow-related aneurysms. One of these aneurysms had already ruptured, so it was coiled first followed by AVM nidus embolization using the same microcatheter. The second patient had a diffuse type of posterior fossa AVM for which staged-embolization was planned and the first-stage partial embolization was successfully performed.

Posterior circulation strokes are potentially devastating events that carry a significant risk of morbidity and mortality. Acute basilar artery occlusion stroke is a rare posterior circulation stroke that needs emergent management. We report the case of a 67-year-old woman who developed an acute basilar artery occlusion. We achieved complete recanalization of the occluded basilar artery and its branches with endovascular mechanical thrombectomy. It is possible to achieve excellent results with mechanical thrombectomy in acute basilar artery occlusion if timely diagnosis and reperfusion can be done. We are not aware of any previous publication from Nepal describing this technique in acute basilar artery occlusion.

Imperforate hymen, though a congenital anomaly, usually presents late in puberty as lower abdominal pain, primary amenorrhea, and cyclical pain. Blood collects in vagina and uterus, proximal to imperforate hymen leading to their distention. Its presentation at infancy is a rare entity. We report such a rare case of symptomatic imperforate hymen in infancy, who presented with acute retention of urine, chills and rigor. Abdominal examination revealed an intra-abdominal mass in the lower abdomen and pelvis with the absence of vaginal opening on perineal examination. Contrast enhanced computed tomography abdomen showed large abdominopelvic cystic lesion posterior to the urinary bladder and anterior to the rectum consistent with a highly distended vagina. She was managed by the incision of the imperforate hymen and drainage of the pus. A high index of suspicion is necessary whenever a female infant presents with abdomino-pelvic mass with symptoms of fever or urinary retention.

Exposure to violence may explain sleep inadequacies reported by homeless adults, with women being potentially more susceptible to violence and sleep disturbances than men. This study examined the association between violence and sleep inadequacies among homeless adults and explored differences by sex. Adult participants were recruited from a shelter (n= 194; 71.1% men, Mage= 43.8+12.2). Participants self-reported victimization and/or witnessing violence (mugging, fight, and/or sexual assault) at the shelter, sleep duration (over an average 24 hours), insufficient sleep (days without sufficient rest/sleep), and unintentional daytime sleep (days with unintentional sleep) in the past month. Linear regressions were used to estimate associations between violence and sleep inadequacies, controlling for sex, age, race, months homeless, and depression. Moderation by sex was examined via an interaction term following mean-centering of variables. Overall, 20.6% of participants (n = 40) reported victimization since moving to the shelter. In the last month, participants reported witnessing an average of 2.9+5.1 acts of violence. Over the same timeframe, participants reported 6.9+2.0 hours of sleep nightly, 11.2+10.7 days of insufficient sleep, and 6.2+8.8 days with unintentional daytime sleep. In adjusted analyses, witnessing violence was associated with insufficient sleep (p= .001). Men and women differed only in age and race in unadjusted analyses; sex was not a significant moderator of any association between violence and sleep in adjusted analyses. Links between witnessing violence and sleep inadequacies should be considered in shelter health promotion efforts. Successful efforts to minimize violence may reduce insufficient sleep amongst both sexes.

Poor health literacy reduces the efficacy of behavior change interventions, hampers management of health conditions, and attenuates understanding of the prevention and treatment of diseases. Poor health literacy has also been linked to fair/poor self-rated health in domiciled samples; however, there is a paucity of studies on the relation amongst homeless adults, who bear a disproportionate burden of disease and disability and require a high level of care and access to health services. Here, we examined the association between health literacy and self-rated health among a convenience sample of homeless adults. Participants were recruited from six homeless-serving agencies in Oklahoma City (N = 575; 63% men, Mage = 43.6+12.3). We used logistic regression to assess the association between health literacy (confidence completing medical forms: extremely/quite a bit versus somewhat/little bit/not at all) and self-rated health (poor/fair versus good/very good/excellent), controlling for age, subjective social status, education, race, sex, income, health insurance, employment, social security recipient status, diabetes diagnosis, high blood pressure diagnosis, and high cholesterol diagnosis. In the adjusted model, health literate homeless individuals had greater odds of endorsing good/very good/excellent self-rated health compared to those somewhat/a little bit/not at all confident completing medical forms (AOR = 2.02, [CI95% = 1.35-3.02]). Interventions targeted at adjusting reading level and comprehensibility of health information are needed for homeless individuals with poor/limited health literacy, which may ultimately impact their self-rated health. Shelters and homeless-serving agencies could host classes focused on practical skills for enhancing health literacy and/or provide navigation services.

Sub-Saharan Africa (SSA) has a need for blood and blood products that exceeds current availability. This unmet demand is evidenced by persistently high mortality rates associated with potentially reversible conditions such as haemorrhage and anaemia. This study reviews current literature on blood donation in SSA to identify common local motivators and deterrents to blood donation and highlights specific interventions that have successfully increased the number of blood donors in this region. Methods: The authors searched the health literature to identify original studies conducted in SSA that addressed blood donation motivators and deterrents. Data were then extracted from each study to determine how often each study identified specific motivators and deterrents. Results: Pro-social motivation, such as altruism and the desire to have a positive effect on the community, is the most frequently noted reason for people in SSA countries to donate blood. Negative attitudes and misconceptions towards blood donation, in addition to perceived negative health effects caused by donation, are the two most frequently mentioned reasons that dissuade individuals from donating blood. Conclusion: Due to paucity of research on this topic, our understanding of blood donor behaviour in SSA is limited. Local traditions and cultures intimately shape individuals’ proclivity towards the donation process. In order to change the attitudes and behaviours of many potential donors in SSA it is important to address the deterrents to blood donation, as many represent misconceptions or culture-specific beliefs that may be the ultimate driving force dictating donor behaviour.

Health education can elevate health literacy, which is associated with health knowledge, health-seeking behaviors and overall improved health outcomes. Refugees are particularly vulnerable to the effects of low health knowledge and literacy, which can exacerbate already poor health stemming from their displacement experience. Traditional learning methods including classroom-based instruction are typically how health-related information is presented to refugees. Through a series of interactive classes focused on specific health topics relevant to the resettled refugee population, this study evaluated the effectiveness of a classroom-based health education model in enhancing the health knowledge of recently resettled refugees. We used the Wilcoxon signed-rank test to evaluate differences in pre- and post-class knowledge through test performance. We found a significant improvement in health knowledge in two refugee groups: females and those who were employed. Culturally and socially sensitive considerations including language inclusiveness, class timing, transportation and childcare provisions are important when creating an educational program for individuals with refugee backgrounds. Developing focused approaches to instruction that enhance health knowledge could lead to better health literacy and ultimately improve health-related behaviors and outcomes in the refugee population.

Background & objectives: Resistance amongst cockroaches has been reported to most of the sprayinsecticides apart from the problem of food contamination and inconvenience. Gel baits which canbe selectively applied have been found effective in control of cockroaches in laboratory studies butvery few field studies are available. This trial was planned to evaluate the efficacy of fipronil(0.01%) and imidacloprid (2.15%) gels over synthetic pyrethroid (0.02% deltamethrin + 0.13%allethrin) and propoxur (2%) aerosols in control of cockroaches in the field.Methods: Survey was done to find out pre-treatment density in catering establishments and housesby visual count and sticky trap methods. A total of 10 catering establishments and 10 houseshaving high cockroach infestation were selected by sampling (two catering establishments andhouses for each insecticidal treatment and two for control). Propoxur and synthetic pyrethroidaerosols were used for spraying the infested sites once only. Single application of fipronil andimidacloprid gels was used as crack and crevice treatment. Visual count method gave betterindications of cockroach infestation as compared to sticky trap method, hence, the same was followedfor post-treatment evaluation every week up to 12 weeks.Results: Synthetic pyrethroid could not bring about the desired reduction in cockroach infestationin the present study. Single application of fipronil gel was able to reduce cockroach infestation upto 96.8% at the end of 12 weeks whereas imidacloprid application resulted in 90.9% reduction andpropoxur resulted in 77.5%. However, propoxur was more effective in reducing the cockroachdensity by first week in comparison to imidacloprid and fipronil gels but its efficacy started decliningafter 8th week. Difference was found statistically significant by Kruskal-Wallis H-test.Conclusion: The study reports the efficacy of propoxur aerosol, imidacloprid gel and fipronil gelbaits for control of cockroaches.