Open Access Review Article

Elevated Levels of Lactate Dehydrogenase Predicts Poor Outcomes for Patients with COVID-19: A Review

Dheaa Shamikh Zageer

Asian Journal of Medicine and Health, Page 139-158
DOI: 10.9734/ajmah/2020/v18i1130276

In glucose (Glc) metabolism, lactate dehydrogenase (LDH) functions by changing pyruvate into lactate. Lactate dehydrogenase (LDH) release is induced viacell death, suggesting to disease caused by virus or pulmonary deterioration, such as inflammation of the lung triggered by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). A satisfactory evidence exists by binding elevated lactate dehydrogenase (LDH) levels to the development of coronavirus disease 2019 (COVID-19) complications.

Open Access Original Research Article

Comparative Analysis of Moderate Intensity Aerobic and Progressive Resistance Exercises on Bone Mineral Density and Weight of People Living with HIV/AIDS in Alex-Ekwueme Federal University Teaching Hospital Ebonyi State

Asogwa, Eucharia Ijego, Ekine, Rupee Suoton, Asogwa, Okwudilichukwu Okwy, Chukwu, Odochi Ogbu, Orizu, Ifeoma Ada, Akamike, Ifeyinwa Chizoba, Udeoji, Dioma U.

Asian Journal of Medicine and Health, Page 9-20
DOI: 10.9734/ajmah/2020/v18i1130264

The main aim of this study was to find out the comparative effects of 6 weeks moderate intensity aerobic exercises (MIAE) and progressive resistance exercise (PRE) on bone mineral density and weight of people living with HIV/AIDS in Alex-Ekwueme Federal University Teaching Hospital Ebonyi State. The study adopted quasi experimental research design. The population of the study was 60 HIV/AIDS patients that attended HIV clinics at AE-FUTHA which formed the 58 sample size for the study after two people dropped from the control group. Simple random sampling technique was adopted for the study. Heel Densitometer (X-rite 331C) and Omron BF 400 was the instrument used for data collection of BMD and weight respectively. Mean, standard deviation and ANCOVA were used to analyze the data obtained. The instruments were not validated because they are standard. The reliability coefficient obtained from the pilot study was 0.835 and 0.994 for BMD and WEIGHT respectively. The major findings revealed that PRE had more effect than MIAE on BMD and Weight.

Open Access Original Research Article

Nutrient Analysis and Antimicrobial Activities of the Leaves and Fruit Pulp Extracts of Tetrapluera tetraptera on Clinical Bacteria Isolates

R. U. B. Ebana, U. O. Edet, I. E. Andy, C. A. Etok, V. J. Etim, K. I. Anosike

Asian Journal of Medicine and Health, Page 21-31
DOI: 10.9734/ajmah/2020/v18i1130266

Introduction: Plants are known to contain numerous phytochemicals with potential antimicrobial activity.

Aim: Nutritional, phytochemical and antimicrobial activities of the leaves and the fruit pulp extracts of Tetrapluera tetraptera was carried out.

Methodology: Collection and identification of isolates and plants parts, and preparation of extracts and nutrient (proximate, vitamins and minerals and anti-nutrients) evaluations were all done using standard protocols previously reported. Evaluations of phytochemicals were carried out using crude screening, quantification and gas chromatography coupled to mass spectrophotometer for a              robust analysis. Antimicrobial activities were evaluated using the standard disc method and chloramphenicol as control.

Results: The results revealed varying amounts of proximate nutrients (ash, fibre, moisture, carbohydrate, protein and fat) in both samples. Vitamin analysis showed the presence of vitamin A, total and soluble vitamin C, niacin, riboflavin and thiamin in both samples. Furthermore, both samples had minerals such as Na, K, CA, P, Mg, Zn, Fe, and Cu, and K, Na, Ca, Mg, P, Fe, Zn and Cu in order of decreasing abundance in the fruit pulp and leaves, respectively. Both samples showed the presence of permissible levels of anti-nutrients compared to edible vegetables. Using all three methods, several phytochemicals such as terpenes, alkaloids, flavonoids, polyphenol, organic and fatty acids, amongst other in various amounts were obtained in the samples. Antimicrobial activities against identified clinical isolates used in this study which were Escherichia coli, Staphylococcus aureus and Proteus spp with both extracts ranged from 12.78±0.03 to 17.34±0.34 mm.

Conclusion: Given the rising cases of antimicrobial resistance and absence of newer antibiotics, the antimicrobial activity of our study plant is worth further evaluations.

Open Access Original Research Article

Participants’ Feedback about and Knowledge before and after a Two-Day Medical Humanities Workshop at Mysuru, India

Pathiyil Ravi Shankar, Praveen Kulkarni

Asian Journal of Medicine and Health, Page 32-41
DOI: 10.9734/ajmah/2020/v18i1130267

Background: Medical humanities is using subjects traditionally known as the humanities for specific purposes in education in medicine. A two-day medical humanities workshop was facilitated at JSS medical college, Mysuru, India on 9th and 10th March 2020.

Objectives: The authors obtained participant knowledge before and immediately post-conclusion of the workshop and their feedback regarding the workshop.

Methods: Participants’ knowledge was measured by asking them to answer true or false a set of twenty statements. Some statements were worded negatively, and their scores reversed when calculating the total score. Total scores pre and post-workshop were compared using appropriate statistical tests (p<0.05). Participant feedback about various facets of the workshop including venue, organization, facilitators, role-plays, activities related to paintings, home assignment, debate, and elicitation sessions were obtained. Free text comments were also invited. 

Results: Thirty-four medical students (15 male and 19 female) participated. Most students were from Karnataka and the neighbouring Kerala state. The median total scores before and immediately following the workshop were 16.00 and 17.00. The increase was highly significant (p<0.001). The mean student ratings of all parameters were 3.8 and above. Role-plays and debates were the most enjoyable. A greater range of activities and more involvement of students from other institutions were suggested. A few other topics were recommended.

Conclusions: Participant feedback was positive. They wanted similar workshops in the future.              The workshop could serve as a launchpad for a medical/health humanities module at the   institution.

Open Access Original Research Article

Differences between the Incident and Prevalent Hemodialysis Patients in Egypt

Abir Farouk Megahed, Ghada El-Said, Mona Mohammed Tawfik Abdelhady, Nagy Sayed-Ahmed

Asian Journal of Medicine and Health, Page 42-54
DOI: 10.9734/ajmah/2020/v18i1130268

Background and Aim: The number of patients on hemodialysis (HD) increases continuously. The HD population is usually divided into early and late HD patients according to the duration of HD, that are known as incident and prevalent groups. Still, there is a debate about the exact definition of both the incident and prevalent groups. Furthermore, predictors of death of both of these groups are not yet identified, especially in Egyptian HD patients. We aimed to compare between the incident and prevalent HD patients as well as to define predictors of mortality among each of these groups.

Study Design and Methodology: This prospective multicenter study was started in June 2016, comprising 2123 HD patients recruited from twenty-five Egyptian HD centers. Patients were classified according to HD duration into two groups: Incident group including patients with HD duration equals to or less than 6 months, and a prevalent group including patients who had been maintained on HD for more than 6 months. All patients were observed for one and half years and their demographic data, laboratory findings and mortality events were recorded.

Results: In comparison to the prevalent group, the incident HD patients showed significantly lower hemoglobin, serum albumin, urea reduction ratio, serum phosphorus, and serum ferritin but higher average erythropoiesis stimulating agents (ESA) dose. There was significantly a higher number of patients with hypertension in the incident group, while there was no significant difference in diabetes mellitus or ischemic heart disease in both groups. There were a higher number of patients with positive hepatitis C virus antibodies and hyperparathyroidism in the prevalent group. By the end of the study, the mortality frequency was found to be significantly higher in the incident than the prevalent groups. Older age and corrected serum calcium were significant predictors of mortality in the total studied group as well as the prevalent group. However, no significant predictors of mortality could be detected among the incident group.

Conclusion: The incident HD group tends to show higher frequency of hypertension, laboratory findings suggestive of malnutrition as well as higher frequency of mortality with different pattern of mortality predictors compared to the prevalent group.

Open Access Original Research Article

The COVID-19 Pandemic and Its Effect on the Mental Health of Doctors in India

Amritha Nair, Jagadeesh Menon, Ashwin Rammohan, Abdul R. Hakeem, Sathya D. Cherukuri, Mettu S. Reddy, Mohamed Rela

Asian Journal of Medicine and Health, Page 55-70
DOI: 10.9734/ajmah/2020/v18i1130269

Background and Objectives: For doctors at the forefront of the COVID-19 pandemic, failure to acknowledge and act on the warning signs of stress can adversely affect their professional, social and personal life. We conducted a nationwide survey of a large sample of Indian doctors to measure levels of perceived stress, identify risk factors for severe stress and assess their response to current issues related to the safety and well-being of the community.

Methods: An online survey using Google forms was conducted between 1st May 2020 and 15th May 2020. The core component of the survey was the standardized Perceived Stress Scale answered on a Likert scale.

Results: Out of 520 responders, 394 (76%) were under 45 years of age 101 (19%) were between 18-30 years and 37 (7%) were above 60 years. 312(60%) were male doctors and 203 (40%) were female doctors. 90% of respondents had a post-graduate degree, 48(9%) had undergraduate degree and 168(32%) had super specialty degree. 313 (60.2%) of the respondents were practising in the private sector, 169 (33%) worked in public sector hospitals and 32(7%) in charitable hospitals. 109 (21%) had low stress, while 371 (71%) and 40 (8%) reported moderate and severe stress respectively. Multivariate analysis revealed the female gender, being financially insecure and ICU a place of work as independent risk factors for severe stress.

Conclusion: This is the first such survey done in the context of the COVID-19 pandemic from the Indian sub-continent and has identified factors that have the potential to adversely impact the mental health of doctors. These findings are applicable to many countries in Asia and Africa with similar healthcare systems and can act as a valuable guide for authorities to establish support systems at multiple levels for these “COVID Warriors”.

Open Access Original Research Article

Evaluating Patients’ Level of Satisfaction on the Quality of Health Services in Ekiti State University Teaching Hospital, Ado-Ekiti Nigeria

Esther Abosede Bamise, Alaba Tolulope Agbele, Cecilia Olajumoke Adebayo

Asian Journal of Medicine and Health, Page 79-90
DOI: 10.9734/ajmah/2020/v18i1130271

Aims: To evaluate patients’ level of satisfaction on the quality of healthcare received by focusing on waiting time due to its level of importance. Studies have shown that a good healthcare system contributes immensely to the growth of a thriving economy, because patients’ satisfaction is the major indicator of quality healthcare.

Study Design: A descriptive cross-sectional study was employed by using a structured questionnaire coupled with interview session. These was considered appropriate for data gathering in the overall outpatient department (OPD) of the health facility.

Methods: The present study evaluates patients’ satisfaction level on the QoS in Ekiti State University Teaching Hospital (EKSUTH), Nigeria; by focusing majorly on waiting time. Systematic random sampling technique was used in selecting the participants for this research, with 241 patients’ data collected. Convenience, courtesy and quality of care were used as factors to measure patients’ satisfactions.

Results: Findings from this study showed that 73.03% of the patients were satisfied with the level of services in terms of conveniences, while 80.50% of the patients were highly satisfied as regards the courtesy level, also, 77.59% of the patients were satisfied with the quality of care received at the facility. Furthermore, our result indicates that a total of 154 (63.9%) of the patients were greatly satisfied with the quality of health services received in EKSUTH, however, 87 which represents 36.1% of patients were not satisfied with the level of services rendered at the facility.

Conclusion: The respondents showed high satisfaction level in most of the services they received from EKSUTH, however, long waiting time in the health facility has shown to be an impediment to the satisfaction level as well as the quality of care (QoC) received. Therefore, improved services; especially reducing the long waiting time will motivate patients to continue to utilize EKSUTH. More so, continuous efforts should be made by the hospital’s administration to improve other areas where satisfaction level was shown to be low in the present study.

Open Access Original Research Article

Patients’ Perception of Health Care Services in Malaria Endemic Area in Mali: Villages with Health Care Services Versus villages Without Health Care Services

Mariama Kaba Combasseré- Cherif, Daniel Amoako- Sakyi, Boubacar Maiga, Samba Diop, Amagana Dolo, Issa Nébié, Marita Troye -Blomberg

Asian Journal of Medicine and Health, Page 91-99
DOI: 10.9734/ajmah/2020/v18i1130272

Aims: To assess the distribution of diseases and the reality of health service by taking the patients ‘perception in villages with health center versus those without health center.

Study Design: The assessment of distribution of diseases was done through a retrospective study from January 2010 to October 2011. The patients‘ perception of health care service was done through a prospective descriptive study conducted from September to October 2011.

Methodology: Five hundred fifty eight (558) patients from Bacoumana health district register database were included in the study for the assessment of malaria and other infectious diseases parameters using data already collected and recorded in the register. In additional, 464 adults living for at least 6 months in the rural community of Bancoumana located 60 km from Bamako (the capital of Mali) in the health district of Kati were included in the study during malaria transmission season to check their perception about health care service via the interview technique.

Results: Malaria was the most prevalent disease with 43.4% of cases. Plasmodium falciparum was the most prevalent with 97.6% of malaria cases. There was a statistical significant negative association between age and malaria (P= .007) and respiratory infections (P = .04). The village with health center rated significant interpersonal communication higher than those without health center such as compassion and support patients, reception of patients and quality of clinical examination and diagnosis.

Conclusion: Malaria remain a public health problem especially Plasmodium falciparum, the most parasite causing malaria. The study contributes for better understanding of the behaviors and the relationships between patients and health care service workers, which has a practical value for designing personalized health care services in Mali and provides a more accurate way to reflect public’s opinion in reality of health care service.

Open Access Original Research Article

Effects of Peer and Provider-Based Education Interventions on HIV/AIDS Knowledge and Behaviour-Risk among in-School Adolescents in Ebonyi State, Nigeria

A. F. Chizoba, H. N. Chineke, P. O. U. Adogu, A. E. Nwafia, C. J. Chizoba

Asian Journal of Medicine and Health, Page 100-114
DOI: 10.9734/ajmah/2020/v18i1130273

Introduction: Adolescents and youths are at high risk due to knowledge gap and behaviour risks related to HIV/AIDS thus need for intervention programs. There is paucity of data on comparative analysis on effect of the education intervention models such as peer-based and provider-based models. This study assessed the effect of peer and provider-based HIV/AIDS education on HIV knowledge and behaviour risk among adolescents and youths in Ebonyi State, Nigeria.

Methodology: This study involved 2 intervention groups (peer-based and health provider-based) and 1 control group. Multistage sampling was used to select participants. HIV education was provided by peers and health providers in the two intervention groups, but hygiene education was given to the control group. Pre-test and post-test questionnaires were deployed to assess baseline and effect of intervention on HIV/AIDS knowledge and behaviour risk. Total participants were 1831 shared among the 3 groups.

Result: Total baseline mean knowledge score was 48.8 and behaviour risk was 42.3. Within the intervention groups, significant changes were recorded in terms of knowledge gain and behaviour risk reduction post-intervention (p<0.05). No change was observed in control group. Provider-based group had higher knowledge gain and better behaviour risk reduction than peer-based group (p<0.05).

Conclusion: Baseline HIV knowledge among adolescents and youths was on unimpressive, and behaviour risk was high.  Education resulted in better knowledge and lower behaviour risk in the two groups, but health provider-based group had better outcome than peer-based group. It is recommended that the two models of HIV education intervention be adopted in secondary schools in view of their peculiarities and applicability.

Open Access Original Research Article

Patterns and Distribution of Imaging Findings on HRCT Chest in Various ILD’s: A Cross-Sectional Study

Rakib Ahmad Wani, Riyaz Ahmad Mir, Mohd Asif Naik, Aijaz Ahmad Hakeem

Asian Journal of Medicine and Health, Page 115-126
DOI: 10.9734/ajmah/2020/v18i1130274

Background: Interstitial lung diseases present with diverse clinical, radiological and histological characteristics, yet have significant overlapping features. Different ILDs have different outcomes and need correct diagnosis for appropriate management. UIP, NSIP and sarcoidosis are the most common types. Other important types being COP, RB-ILD, HSP and ILD associated with connective disorders.

Objective: To identify patterns and distributions of imaging findings on HRCT for accurate diagnosis of type of ILDs. HRCT of known cases of ILD was done and predominant imaging features of ILDs documented. We had 75 patients in our study group with male predominance (58.6%). UIP was the most common type of ILD with honeycombing, septal thickening and bronchiectasis as the predominant imaging features with sparse ground glassing. Sarcoidosis was the second most common type of ILD with mediastinal and hilar LAP, perilymphatic nodules, fibrotic bands, septal thickening and bronchiectasis as predominant imaging findings. NSIP presented with ground glassing, septal thickening, bronchiectasis, and fibrotic bands as predominant features with no or minimal honeycombing. RB-ILD presented with predominant imaging features of peribronchial thickening, centrilobular nodules, air trapping and fibrotic bands in known smokers. COP presented with predominant imaging features of peripheral consolidations and ground glassings, septal thickenings and bronchiectasis. Lung biopsy is god standard but cannot be performed in every patients owing to higher rates of complication. HRCT has assumed importance in diagnosis and management of ILDs and are relatively specific in its diagnosis.

Open Access Original Research Article

Assessing the HIV Knowledge, Awareness, and Utilization of YFS among Undergraduates in Rivers State, Nigeria

Ifeoma Chinyere Ofurum, Nneka Gabriel- Job

Asian Journal of Medicine and Health, Page 127-138
DOI: 10.9734/ajmah/2020/v18i1130275

Background: The establishment of a Youth Friendly Centre (YFC) is to ensure that the reproductive and sexual health needs of young people are adequately met. However, data have shown that a number of them are not even aware of such Centres in their vicinities or the services they offer, how much more utilize them. Therefore, this study aimed at assessing the level of HIV knowledge, awareness, and utilization of Youth Friendly Services (YFS) among undergraduates in Rivers State University, Rivers State, Nigeria.

Methods: A total of 520 students were given structured self-administered questionnaire which had been validated and pretested. Four hundred and forty-six questionnaires were returned properly filled. Information regarding knowledge of Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS), awareness, and utilization of Youth Friendly Services were obtained from the students.

Results: Two hundred and nineteen (49.1%) of the students indicated HIV had no cure, while 73(16.4%) reported that there was a cure and 154 (34.5%) specified they were uncertain. The female respondents had a better knowledge compared to their male counterparts. The respondents exhibited a high knowledge of HIV preventive measures with the majority 357 (80%) indicating that abstinence was the best means. All the students agreed that everyone was at risk of HIV if they engaged in risky behaviors. In spite of this good knowledge on HIV, only 112 (25.1%) of the students were aware of a YFCs on campus.

Conclusion: The high knowledge level of HIV exhibited by the students did not translate to the awareness and utilization of the YFS. There is still so much to be done by health workers and the university committee if the students are to be encouraged to use the services offered at the Centre.

Open Access Original Research Article

COVID-19-Related Mortality across the Gulf Cooperation Council Countries: Based on Countries’ Available Data Up to November, 2020

Amar Ahmad, Heba Mamdouh, Heba Al- Naseri, Aisha Al Hamiz, Christian Heumann, Raghib Ali

Asian Journal of Medicine and Health, Page 159-166
DOI: 10.9734/ajmah/2020/v18i1130277

Background: The world has endured a high burden of mortality and morbidity due to Covid-19 over the last year. There may be factors that account for differences in mortality rates. The Gulf Corporation Council (GCC) countries share similar cultural identities, socioeconomic conditions, population structure and display similar health-status composition of their population. There is a demand for data on the differentials of the COVID-19 pandemic across all countries. This statistical analysis primarily compared the crude mortality rates, and estimates the relative risk of COVID-19 death rates across the GCC countries using longitudinal study design.

Methods: This statistical analysis used downloaded data from Our World in Data, which was last updated on November 19, 2020. We computed COVID-19 crude mortality rates for the GCC countries individually. We estimated COVID-19 death rates for the GCC countries and compared them to the reference largest country Saudi Arabia. To adjust for most relevant confounding factors for COVID-19 deaths, a Poisson mixed effect regression model was fitted with COVID-19 new cases and the number test per case as fixed effect predictors of COVID-19 deaths. 

Results: The estimated relative risk of COVID-19 deaths rates for UAE and Qatar was 0.352 (95% CI: 0.220-0.564, p-value <0.001) and 0.467 (95% CI: 0.287-0.762, p-value = 0.002), respectively, showing 64.8% and 53.3% fewer COVID-19 death rates compared to Saudi Arabia, individually. No statistically significant difference was found between Bahrain, Kuwait and Oman as compared with Saudi Arabia.

Conclusion: The UAE has the lowest COVID-19 death rate among any other GCC countries, followed by Qatar. In addition, the number of tests per case were negatively associated with the number of Covid-19 deaths. Besides, the number of new COCID-19 infections relative to the number of patients correlates with the number of patient deaths.

Open Access Minireview Article

Dermatoglyphics of the Digits and Inter-digit Areas in Down Syndrome Patients of a Sampled Nigeria Population

Loveday Ese Oghenemavwe, Doris Ada Uche

Asian Journal of Medicine and Health, Page 1-8
DOI: 10.9734/ajmah/2020/v18i1130263

This study was carried out to determine the possible differences between the dermatoglyphic characteristics of the digit and inter-digit areas of Down Syndrome (DS) patients and healthy Nigerians. The dermatoglyphic prints of the digit and inter-digit areas were obtained by using the improvise digital method. Parameters evaluated were the digit patterns, inter-digit patterns and single flexion crease of the fifth digit. Comparison of dermal patterns in DS patients and normal ones was done using Chi-square test at a significant level of P = .05. The result of the digit patterns showed that the total mean percentage frequency for arch, radial loop, ulnar loop and whorl were 5.28%, 0.34%, 75.94% and 18.45% in DS patients and 9.55%, 1.11%, 60.11% and 29.22% in normal subjects respectively. The distribution of dermal ridge differ significantly in digits I, II and III of the right hand and digits II and III of the left hand in patients and normal subjects at P = .05 level. Down syndrome patients had more of open fields in all the inter-digit areas except in inter-digit C. The difference in patterns between DS patients and normal subjects was significant in inter-digit C and D of the left hand only. One normal subject had single flexion crease compared to four in Down syndrome patients. The findings of the study could be used as supplementary diagnostic aid for Down syndrome.

Open Access Short Communication

Addressing the Challenges of Containing Covid-19 Spread in a Rural, Poor Area in India: A Case Study

Madelon L. Finkel, Biswajit Paul, Rita Isaac, David Weller

Asian Journal of Medicine and Health, Page 167-170
DOI: 10.9734/ajmah/2020/v18i1130278

The rapid spread of COVID-19 in 2020 has illustrated how transmissible, virulent, and unpredictable this novel coronavirus is. As of mid-December 2020, over 73.6 million cases have been recorded, with 1.64 million deaths attributed to the disease. This most probably is an underestimate given that testing has been spotty and that an unknown number of asymptomatic individuals are not counted in the statistics. Also, the difference between reported confirmed cases and deaths varies by country, with Low- and Middle-Income Countries (LMICs) bearing the highest burden [1].

Open Access Short Research Article

The Prevalence of Multi-Drug Resistant Organisms and Their Outcomes in an ICU in Mauritius: An Observational Study

Dooshanveer Chowbay Nuckchady, Samiihah Hafiz Boolaky

Asian Journal of Medicine and Health, Page 71-78
DOI: 10.9734/ajmah/2020/v18i1130270

Aims: To assess the prevalence of multi-drug resistant organisms (MDRO) in an ICU of Mauritius and determine the relationship between antibiotic resistance and mortality as well as length of stay and duration of antibiotic use.

Study Design: Retrospective case control study.

Place and Duration of Study: This study examined the data of patients who were admitted from 2015 to 2016 at an ICU in Port Louis, Mauritius.

Methodology: 128 patients on whom cultures were ordered were included. Adjustment was performed using multivariate Cox regression and negative binomial regression.

Results: Out of 214 organisms that were isolated, 68% were an MDRO; 78% of Enterobacteriaceae were ESBL, 86% of Acinetobacter spp., 30% of Enterobacteriaceae and 80% of Pseudomonas spp. were carbapenem resistant while 53% of Staphylococcus aureus were MRSA. After adjustment, MDRO were linked to a non-statistically significant 13% increase in mortality (P = .056), a rise in hospital length of stay from 19 days to 29 days (P = .0013) and an escalation in duration of antibiotic use from 11 days to 24 days (P = 1.3E-10).

Conclusion: Infections with MDRO are common in Mauritius and strategies should be put into place to reduce their prevalence.