Correlation of predisposing factors and Esophageal Malignancy in high risk population of Baluchistan

Objectives: To determine frequency of esophageal malignancy in Balochistan and to evaluate its correlation with predisposing and dietary factors. Methods: This cross-sectional study was conducted from Jan 2019 to Dec 2020, at two tertiary care hospital of Quetta which caters to the entire population of province. The total number of 207 cases of esophageal biopsies were received and morphological diagnosis done by H&E staining. Results: Out of 207 (N) esophageal biopsies cases, malignancy were observed in 65%, chronic esophagitis in 19%, benign esophageal lesion in 1% and other esophageal lesions were observed in less than 4% of samples. Association with aggravating factors included tea 80.5%, use of drugs 64%, spicy food 57%, salted food 53%, quid & tobacco taken orally and through nose 44% and cigarette smoking 21.5%. The protective factors include fresh fruit 90%, fish 64% and milk 55% which were never or occasionally taken, meat chicken and beef intake was 63% & 53% and vegetable intake was 52%, but 72.5% of cases never used alcohol and mutton meat was not used by 50%. Conclusion: Esophageal cancer was associated in those groups of people which may regard as having high risk factors. These include increased intake of spicy/salted food, hot beverages, drugs, quid and smoked tobacco, coupled with low intake of fruits and vegetables, lack of awareness and low socioeconomic status. doi: https://doi.org/10.12669/pjms.38.3.4612 How to cite this:Ishaque SM, Achakzai MS, Ziauddin, Pervez S. Correlation of predisposing factors and Esophageal Malignancy in high risk population of Baluchistan. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4612 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Emergency Department Utilization, Hospital Admissions, and Office-Based Physician Visits Among Under-Resourced African American and Latino Older Adults

Objectives This study uses a theoretical model to explore (a) emergency department (ED) utilization, (b) hospital admissions, and (c) office-based physician visits among sample of under-resourced African American and Latino older adults. Methods Nine hundred five African American and Latino older adults from an under-resourced urban community of South Los Angeles participated in this study. Data was collected using face-to-face interviews. Poisson and logistic regression analysis were used to estimate the parameters specified in the Andersen behavioral model. Predictors included predisposing factors, defined as demographic and other personal characteristics that influence the likelihood of obtaining care, and enabling factors defined as personal, family, and community resources that support or encourage efforts to access health services. Results African American older adults have a greater frequency of hospital admissions, ED, and physician visits than their Latino counterparts. About 25%, 45%, and 59% of the variance of the hospital admissions, ED utilization, and physician visits could be explained by predisposing and enabling characteristics. Lower health-related quality of life was associated with a higher number of hospital admissions, ED, and physician visits. Financial strain and difficulty accessing medical care were associated with a higher number of hospital admissions. Being covered by Medicare and particularly Medi-Cal were positively associated with higher hospital admissions, ED, and physician visits. Discussion Compared to African American older adults, Latino older adults show higher utilization of (a) emergency department (ED) utilization, (b) hospital admissions, and (c) office-based physician visits. A wide range of predisposing and enabling factors such as insurance and financial difficulties correlate with some but not other types of health care use. Multi-disciplinary, culturally sensitive, clinic- and community-based interventions are needed to address enabling and predisposing factors that influence ED utilization and hospital admission among African American and Latino older adults in under-resourced communities.

Cephalic arch stenosis in the arteriovenous fistula: A retrospective analysis of predisposing factors

Background: Cephalic Arch Stenosis (CAS) is a frequently observed complication in brachiocephalic and radiocephalic arteriovenous fistulae (AVF) associated with high morbidity and healthcare expenditure. The predisposing factors and preventative strategies for CAS remain unclear. Our aim was to examine predisposing factors for CAS development in the AVF. Methods: A retrospective case-control study was performed at Gold University Coast Hospital on patients with AVFs created from 2009 to 2018 with ⩾18 months follow-up. CAS was defined as a >50% narrowing on angiographic assessment with clinically significant symptoms (dialysis dysfunction, arm swelling, prolonged bleeding after access). Results: About 187 patients with AVF were included in the analysis (36 brachiocephalic, 151 radiocephalic). CAS developed in 22 of 36 (61%) of brachiocephalic AVF and 9 of 151 (6%) of radiocephalic AVFs. Brachiocephalic AVF were ⩾12 times more likely to develop CAS than radiocephalic AVF (Hazard Ratio (HR) 12.7, 95% CI [5.6–28.3], p < 0.001). Each 1 mL/min increase in flow rate through the AVF, correlated with a 0.07% increase in the probability of development of CAS (HR 1.0007, 95% CI [1.0001–1.0012], p = 0.011). Brachiocephalic AVFs with CAS were associated with a higher number of interventional procedures per access-year compared with their non-CAS counterparts (Median [Interquartile range]: 1.76 [0.74, 3.97] vs 0.41 [0.27, 0.67], p = 0.003). Conclusion: Brachiocephalic AVF with higher access flow rates are more likely to develop CAS and earlier than radiocephalic AVF, and in a dose dependent fashion. AVF flow rate is a major factor in CAS development within brachiocephalic AVF and has potential utility in surveillance thresholds for prophylactic blood flow reduction procedures. AVFs with CAS are associated with a greater number of interventional procedures per access-year, heralding higher patient morbidity and healthcare expenditure. Further prospective studies will help define an AVF access flow rate threshold in the implementation of prophylactic strategies for CAS.

Prenatal predisposing factors associated with neonatal lupus erythematosus

Objectives To identify the prenatal predisposing factors related to neonatal lupus erythematosus (NLE). Materials and Methods A retrospective case-control study was made of 131 pregnant women with positive anti-Ro or anti-La autoantibodies and known neonatal outcomes between January 2002 and December 2019 at Siriraj Hospital, Bangkok, Thailand. There were 101 unaffected neonates and 30 NLE cases confirmed postnatally. Demographic and clinical data of the mothers and neonates with and without NLE were statistically compared. Results NLE was diagnosed in 30 out of 131 cases. A multivariate analysis identified the following significant factors for NLE: maternal anti-La antibodies (odds ratio (OR), 3.591; p = 0.030); and maternal treatment with either hydroxychloroquine (OR, 0.082; p = 0.001) or prednisolone (OR, 0.136; p = 0.017). Of the significant variables examined in the multivariate analysis models, high levels of maternal anti-La antibodies were found to be the strongest predictor of noncardiac NLE (OR, 4.558; p = 0.032), while a female baby was significantly higher in pregnancies complicated by cardiac NLE (OR, 5.374; p = 0.046). Hydroxychloroquine still provided a protective effect for both cardiac and noncardiac NLE ( p = 0.039 and 0.032, respectively). Conclusions The maternal anti-La antibodies were a beneficial predictor for NLE, especially as their high titers were influentially associated with noncardiac features. A female fetus seemed to present an increased risk for developing a congenital heart block. Nevertheless, the treatment with hydroxychloroquine during the pregnancies demonstrated a potentially protective factor against both cardiac and noncardiac manifestations.

Predisposing Factors to Drug Abuse Among In-School Adolescents in Ilorin, Kwara State, Nigeria

Drug abuse among in-school adolescents is a problem which the government of Nigeria and indeed some other countries are yet to find a lasting solution to. Drug abuse among school children can disrupt the smooth running of teaching and learning in school. One of the ways of solving the problem is by trying to find out what leads in-school adolescents into the act. The objectives of this study were to examine the predisposing factors to drug abuse among in-school adolescents in Kwara State and to examine the influence of the variables of gender, age, religion and level of study on the respondents’ response on the predisposing factors. A descriptive research design was adopted for the study. The population for the study comprised of the adolescents in secondary school and university. A sample of 403 students were selected through a multistage sampling procedure in order to participate in the study. Data was collected via a questionnaire titled ‘Predisposing Factors to Drug Abuse (PFDA)’. The questionnaire was validated by experts in test and measurement design. It has a reliability coefficient of 0.68 which adjudged the instrument to be reliable. Data was analysed with mean, rank order, t-test and analysis of variance. Hypotheses were tested at a 0.05 level of significance. Findings showed that the factors that predispose in-school adolescents to drug abuse were: peer influence, depression, lack of good parental care, low self-esteem, poor academic performance, among other factors. Findings further revealed that age, gender, religion and level of education did not make the respondents differ in their responses on the predisposing factors to drug abuse among in-school adolescents. It is recommended that counsellors, parents and stake holders in education should initiate a serious campaign regarding sensitization against drug abuse. It is also recommended that academic programs should be learner-centred.

A Cross-Sectional Study on Canine and Feline Anal Sac Disease

Limited data are available on canine and feline non-neoplastic anal sac disease. Therefore, the aim of this study was to obtain observational data on the incidence, predisposing factors, diagnosis, treatment, and recurrence rate of canine and feline anal sac disease. To this end, a questionnaire was distributed among veterinarians. The incidence of non-neoplastic anal sac disease was estimated at 15.7% in dogs and 0.4% in cats. Predisposing factors were diarrhea, skin problems, several dog breeds, and particularly small breed dogs, male cats, British shorthairs, and obesity in dogs. Diagnosis was made based on the presence of clinical signs and characteristics of the anal sac content. Manual expression and treating any potential underlying disease were the most important treatments for all three types of non-neoplastic anal sac disease. Anal sacculectomy was performed in refractory cases. The most recurrent anal sac disease condition was impaction. Diagnosis of anal sac disease should be based on clinical signs and rectal examination, as the evaluation of the anal sac content is not reliable. Surgical outcomes of anal sacculectomy can be improved when surgery is performed after medical management. Future studies should investigate these findings in prospective trials.

The Health Effects of Chunga Dumpsite on surrounding communities in Lusaka, Zambia.

ABSTRACT Background: Dumpsites in low and middle income countries (LMICs) are commonly used for solid waste disposal as opposed to landfills. However, these are naturally unsanitary hence provide ideal conditions for breeding of disease transmitting agents and become predisposing factors for spread of diseases and infections to surrounding communities. This study aimed at determining the Health Effects of Chunga Dumpsite on surrounding communities in Lusaka, Zambia. Design and Methods: This was a mixed method design and employed a cross sectional approach and case study conducted concurrently. Communities were stratified by distance into Stratum One (within 250 meters radius) and Two (above 250 to 500 meters). Quantitative data were collected from total 200 households thus 100 households from each stratum by using self-administered questionnaires. Qualitative data were collected from Two Key informants from the Local Authority and 15 participants using semi-structured interview guide. Both data were collected from December 22nd, 2018 to February 18th, 2019. Results: Results revealed that smoke and various gasses emitted from burning and decomposing waste compromised quality of air in surrounding communities. Communities were infested with flies, mosquitoes and vermin. Consequently, (73.5%) complained of persistent coughing, (65.1%) suffered from malaria, (72.6%) complained of persistent headaches and (62.2%) had frequent diarrhoea cases in stratum one. Respiratory problems were more pronounced at night possibly due to high humidity which hindered pollutants to easily escape. However, these cases reduced drastically in stratum two. Conclusions: Unsanitary dumpsites in LMICs including Zambia are commonly used as solid waste disposal facilities as opposed to sanitary landfills and become predisposing factors for spread of diseases. Short proximities to dumpsites by unplanned human settlements cause serious environmental challenges leading to public health risks to surrounding communities. Key Words: Chunga Dumpsite, Health Effects, Waste Management, Lusaka.