The Pathophysiology and the Management of Radiocontrast-Induced Nephropathy

Contrast-induced nephropathy (CIN) is an impairment of renal function that occurs after the administration of an iodinated contrast medium (CM). Kidney dysfunction in CIN is considered transient and reversible in most cases. However, it is the third most common cause of hospital-acquired acute kidney injury and is associated with increased morbidity and mortality, especially in high-risk patients. Diagnostic and interventional procedures that require intravascular CM are being used with increasing frequency, especially among the elderly, who can be particularly susceptible to CIN due to multiple comorbidities. Therefore, identifying the exact mechanisms of CIN and its associated risk factors is crucial not only to provide optimal preventive management for at-risk patients, but also to increase the feasibility of diagnostic and interventional procedure that use CM. CM induces kidney injury by impairing renal hemodynamics and increasing the generation of reactive oxygen species, in addition to direct cytotoxicity. Periprocedural hydration is the most widely accepted preventive strategy to date. Here, we review the latest research results on the pathophysiology and management of CIN.

A combined field study of Buruli ulcer disease in southeast Benin proposing preventive strategies based on epidemiological, geographic, behavioural and environmental analyses

Buruli ulcer is a neglected tropical disease caused by M. ulcerans, an environmental mycobacterium. This cutaneous infectious disease affects populations with poor access to sanitation, safe water and healthcare living in rural areas of West and Central Africa. Stagnant open bodies of surface water and slow-running streams are the only risk factor identified in Africa, and there is no human-to-human transmission. Appropriate and effective prevention strategies are required for populations living in endemic areas. Based on a multidisciplinary approach in an area in which Buruli ulcer is endemic in South Benin, we investigated the link between all human-environment interactions relating to unprotected water and behaviors associated with Buruli ulcer risk likely to affect incidence rates. We characterised the sources of water as well as water bodies and streams used by communities, by conducting a prospective case-control study directly coupled with geographic field observations, spatial analysis, and the detection of M. ulcerans in the environment. A full list of the free surface waters used for domestic activities was generated for a set of 34 villages, and several types of human behaviour associated with a higher risk of transmission were identified: (i) prolonged walking in water to reach cultivated fields, (ii) collecting water, (iii) and swimming. Combining the results of the different analyses identified the risk factor most strongly associated with Buruli ulcer was the frequency of contact with unprotected and natural water, particularly in regularly flooded or irrigated lowlands. We confirm that the use of clean water from drilled wells confers protection against Buruli ulcer. These specific and refined results provide a broader scope for the design of an appropriate preventive strategy including certain practices or infrastructures observed during our field investigations. This strategy could be improved by the addition of knowledge about irrigation practices and agricultural work in low-lying areas.

Cognitive deterioration in association with teeth loss in elderly population: A study from Eastern India

Background: With the global increase in cognitive impairment and dementia, the need to investigate into the possible ways that can be used to prevent or delay such occurrence has been growing. Maintenance of dental care and oral hygiene has been promoted as one such aspect. Aims and Objectives: To study the association between cognitive impairment in patients without registered diagnosis of dementia with tooth loss and chewing ability. Materials and Methods: It was a cross-sectional hospital-based study where consenting elderly persons attending Dental outpatient department over 1½ years were included. Data obtained on socio-demographic details, number of tooth loss, number of remaining teeth, subjective chewing ability, cognitive assessment as per mini-mental state examination (MMSE), and Clock Drawing Test were analyzed statistically to check correlational association. Results: In this study 96 eligible elderly persons of mean age of 68.30±6.28 years showed increased cognitive impairment among females (P=0.003), increased age (P=0.009), rural background (P=0.033) and low income groups (P=0.001). Positive correlation was found between chewing capacity (P=0.348), number of remaining teeth (r=0.418) with MMSE scores. Conclusion: Our study population showed positive correlation between impaired cognition and the number of extracted tooth and chewing capacity. With further study on wider and representative population, we hope to project the role of maintaining good oral hygiene and dental care as a possible preventive strategy among many others to combat the increased burden of cognitive impairment.

Uptake of Cervical Cancer Screening and Associated Factors Among Women Attending Outpatient Services in Rwamagana Hospital, Rwanda

BackgroundCervical cancer is a global public health threat for women. Rwanda Ministry of Health recommends screening as preventive strategy. However, the screening remains low in Rwanda.ObjectiveTo determine the uptake level of cervical cancer screening and associated factors among Rwandan women.MethodsA quantitative analytical cross-sectional study design was used. We recruited 178 participants using convenience sampling from an estimated 320 women who attended outpatient department in the previous month. The sample size was calculated using the Yamane’s formula. We used chi-square test, t-test and multiple logistic regression analysis to analyse data.ResultsA total of 178 (100%) participants completed the survey. Forty-one (23%) participants had undertaken cervical cancer screening. Knowledge (OR: 1.26,95% CI:1.069-1.485, p=.006) and income were predictors of cervical cancer screening uptake. Participants earning RWF ≥ 63,751 were more likely to uptake cervical cancer screening (OR:11.141, 95% CI:3.136-39.571, p< .001) compared to those earning less than RWF 25,500 monthly.ConclusionCervical cancer screening uptake among study population was low. Participants with more knowledge and high-income were more likely to uptake cervical cancer screening. Improving women’s knowledge and socioeconomic situation would improve the uptake of cervical cancer screening.Rwanda J Med Health Sci 2021;4(3):387-397

The role of Mediterranean diet in the course of subjective cognitive decline in the elderly population of Greece: results from a prospective cohort study

Very few data are available regarding the association of adherence to the Mediterranean Diet (MeDi) with Subjective Cognitive Decline (SCD) evolution over time. A cohort of 939 cognitively normal individuals reporting self-experienced, persistent cognitive decline not attributed to neurological, psychiatric or medical disorders from the Hellenic Epidemiological Longitudinal Investigation of Aging and Diet (HELIAD study) was followed-up for a mean period of 3.10 years. We defined our SCD score as the number of reported SCD domains (memory, language, visuoperceptual and executive), ranging from 0 to 4. Dietary intake at baseline was assessed through a food frequency questionnaire; adherence to the MeDi pattern was evaluated through the Mediterranean Diet Score (MDS) that ranged from 0 to 55, with higher values indicating greater adherence to the MeDi. The mean SCD score in our cohort increased by 0.20 cognitive domains during follow-up. After adjustment for multiple potential confounders, we showed that an MDS higher by 10 points was associated with a 7% reduction in the progression of SCD within one year. In terms of food groups, every additional vegetable serving consumption per day was associated with a 2.3% reduction in SCD progression per year. Our results provide support to the notion that MeDi may have a protective role against the whole continuum of cognitive decline, starting at the first subjective complaints. This finding may strengthen the role of the MeDi as a population-wide, cost-effective preventive strategy targeting the modifiable risk factors for cognitive decline.

Wild Predators, Livestock, and Free Ranging Dogs: Patterns of Livestock Mortality and Attitudes of People Toward Predators in an Urbanizing Trans-Himalayan Landscape

Livestock depredation by large carnivores is a significant source of conflicts over predators and an important conservation and economic concern. Preventing livestock loss to wild predators is a substantial focus of human-carnivore conflict mitigation programs. A key assumption of the preventive strategy is reduction in the livestock losses leading to a positive shift in the attitudes toward predators. Therefore, it is important to quantify the true extent of livestock mortality caused by wild predators and its influence on attitudes of the affected communities. We examined seasonal and spatial patterns of livestock mortality and factors influencing people's attitudes toward wild predators i.e., snow leopards (Panthera uncia) and wolves (Canis lupus chanco) and free-ranging dogs (Canis lupus familiaris) in a Trans-Himalayan urbanizing landscape in India. We used systematic sampling to select the survey households and implemented a semi-structured questionnaire to respondents. The sampled villages (n = 16) represent a mosaic of urban and agricultural ecosystems within a radius of 40 km of Leh town. In 2016–2017, 93% of the sampled households lost livestock to predators, accounting for 0.93 animals per household per year. However, of the total events of livestock mortality, 33% were because of weather/natural events, 24% by snow leopards, 20% because of disease, 15% because of free-ranging dogs and 9% because of wolves. The annual economic loss per household because of livestock mortality was USD 371, a substantial loss given the average per capita income of USD 270 in the region. Of the total loss, weather/natural events caused highest loss of USD 131 (35%), followed by snow leopards USD 91 (25%), disease USD 87 (24%), free ranging dogs USD 48 (13%), and wolves USD 14 (4%). Despite losing a considerable proportion of livestock (33 %) to wild predators, respondents showed a positive attitude toward them but exhibited neutral attitudes toward free-ranging dogs. Gender emerged as the most important determinant of attitudes toward wild predators, with men showing higher positive attitude score toward wild predators than women. Our findings highlight the context specific variation in human-wildlife interactions and emphasize that generalizations must be avoided in the absence of site specific evidence.

Perspectives of integrated pest management in CDMX urban agriculture and impacts of SARS-CoV-2 health emergency

<p>The objective of this work was to determine the impact of COVID-19 on productive activities of farmers and extensionist, and the level of application of Integrated Pest Management (IPM) in urban agriculture in Xochimilco, Milpa Alta, Tláhuac, Tlalpan, Magdalena Contreras and Cuajimalpa at Mexico City, a metropolitan area with a high SARS-CoV-2 positive cases. In 2020, a digital survey was applied to a total of 108 farmers and extensionists during the first COVID-19 epidemic wave. The sanitary emergency reduced the continuity of the extension service. However, this was carried out with digital technologies including photographs submitted by WhatsApp for pest diagnosis purposes. During the maximum COVID-19 peak (July, 2020), only 14% of farmers declined to sowing the summer fall season 2020. The majority established corn and, to a lesser extent, vegetables in mixed topologies. However, the activity of agricultural workers was reduced to 50%. Up to 75% of farmers reported losses of 20% derived from the epidemic. The major pest control strategy was mechanical, mainly for preventive purposes (67%) followed by chemical control (52%), biological at both preventive (8%) and curative (25%) levels, and the combination of more than one strategy in less than 10%. The data indicate an intuitive understanding of the IPM benefit, although the farmer is unaware of its principles. Faced with the growing demand for fresh, quality and safe food as a COVID-19 preventive strategy, urban agriculture has great development prospects by supplying local markets without transport problems caused by regional and global contingencies such as that caused by SARS[1]CoV-2. However, public and institutional policies of great vision are required. This work recognizes the work of farmers, as well as extensionists in favor of food security.</p>