Prevalence of Helicobacter Pylori Infection Among Patients with Dyspepsia by Stool Antigen and Serology Tests

Background: Helicobacter pylori is the most common chronic bacterial infection globally and is the underlying cause of many disorders, including dyspepsia. Also, the prevalence of gastric cancer in Zanjan city is high. Therefore, this study investigates the prevalence of H. pylori infection in patients with dyspepsia by the H. pylori stool antigen (HpSA) test. Materials and Methods: This cross-sectional study was performed on patients over 18 years of age who were referred to Shafieieh Special Clinic in Zanjan with dyspepsia during 2019-2020. First, the HpSA test was examined for H. pylori infection. Since the results of two separate tests are needed to prove that H. pylori infection is negative, the serological test was used in the patients with HpSA negative results. Results: Based on the demographic information of the present study, most patients (70.1%) were under 40 years old, and most (55.1%) were women. Smoking, alcohol, drug, and non-steroidal anti-inflammatory drugs (NSAIDs) use in patients were 16.5%, 6.3%, 7.9%, and 39.4%, respectively. The highest and lowest symptoms were abdominal pain (44.9%) and burp (22%), respectively. Except for the relationship between positive serological results and age (P˂0.001), no significant relationship was found between other variables (P≥0.05). Based on the HpSA test, H. pylori infection was seen in 56.7% of patients. By the serological test, another 29 patients had H. pylori infection. Therefore, the total number of patients was 101, and the overall prevalence of H. pylori increased to 79.5%. Conclusion: The results of the present study showed that the overall prevalence of H. pylori infection was high compared to previous studies. Also, above the age of 40 years, female gender in HpSA test and male gender in serology test, higher education level, and the presence of risk factors (smoking, alcohol, and NSAIDs) have a higher positive test for H. pylori.

To the publication of the textbook "Immunology" (2021, 4th ed., Revised and enlarged) authored by academician of the Russian Academy of Sciences R.M. Khaitov

A pleasant event for specialists in immunology and specialties related to immunology took place this year. A new, 4th edition of the textbook "Immunology" has been published, prepared by the famous Russian immunologist, Academician of the Russian Academy of Sciences Rakhim Musaevich Khaitov. Compared to the previous edition, issued in 2018, this version is a substantially updated and revised version, replenished with information obtained during this relatively short period by world immunology, one of the most rapidly developing areas of scientific knowledge. With all the complexity of modern immunology, this training manual has achieved a perfect in form, consistent and at the same time accessible presentation of the material in accordance with the latest international data. Attention is drawn to the appropriate placement of perfectly done illustrations that explain the text material and create liveliness, interest and accessibility to its development. Special attention should be paid to the fact that after getting acquainted with the deeply and easily presented material about the structure and function of the immune system, the reader is fully prepared for an easier perception of special clinic-oriented information, in particular, on allergies in the chapter "Allergic diseases" presented in in accordance with the principles of evidence-based medicine, modern international and national guidelines and consensus documents. Undoubtedly, the textbook will be an irreplaceable guide for students and teachers of medical and biological educational institutions, researchers, doctors of various specialties interested in immunology and allergology.

Disease burden and adverse pregnancy outcomes due to cardiovascular conditions complicating pregnancy in Sri Lanka: a protocol

Background Cardiovascular diseases (CVD) are the commonest indirect medical cause of maternal deaths worldwide, both in high-income and low and middle-income countries. To minimize the effects of CVD in pregnancy, proper risk assessment and appropriate referral is required. In Sri Lanka, cardiovascular disease complicating pregnancy is a significant cause of maternal mortality, second only to postpartum hemorrhage. Screening for CVD in pregnancy in Sri Lanka is limited to a routine clinical assessment. Evidence-based guidelines are yet to be developed, and this deficit may have resulted in a substantial underestimation of the CVD burden. This study aims to determine the burden of CVD in early pregnancy and develop a risk prediction model to be used in field pregnancy clinics in Sri Lanka to reduce CVD effects in pregnancy. Methods A prospective cohort study was carried out in the Anuradhapura district, Sri Lanka. Following registration to the antenatal care, pregnant women fulfilling the eligibility criteria were invited to attend a special clinic at their relevant Medical Officer of Health (MOH) area. Risk assessment was done through history and a clinical examination, and suspected/probable cases were referred for an echocardiogram by a consultant cardiologist. All the recruited participants in the first trimester were prospectively followed up and screened again between 24–28 weeks of the period of amenorrhoea (POA). Antenatal ward admissions with CVD complicating pregnancy will be extracted, and a telephone interview will be carried out between 6–12 weeks after the expected delivery date to cover postpartum morbidities. Discussion This proposed study will be the largest of its kind carried out in the local setting. The study's findings will be beneficial for policymakers to develop guidelines to reduce maternal cardiovascular disease morbidities and mortalities in Sri Lanka.

Refractive Error in Juvenile Patients Presenting with Nystagmus at Tertiary Care Hospital of Karachi

Objective: To evaluate the types of refractive errors in nystagmus patients among the age (5-15 years) patients. Study Design and Setting: An observational cross-sectional study was conducted at Pediatric department of Al-Ibrahim Eye Hospital, Karachi from June 2018 to March 2019. Methodology: A total of 55 patients (110 eyes) were selected from study setting. The protocol for examination for all patients were evaluated at the special clinic of Orthoptics includes the demographic data, educational status, history of onset, type of nystagmus. The anterior segment was examined with a slit-lamp to exclude any other ocular disease. Orthoptic assessment includes cover uncover test, Hirschberg, ocular motility, prism cover test and pupillary reflex test, to observe any associated deviation. All the patients were examined after obtaining a fully informed consent. After the proper diagnosis of nystagmus patient was recruited as per inclusion and exclusion criteria with no restrictions of gender. All the observations were noted on a Proforma, Data analysis was done by using SPSS version 20. P-value <0.05 was considered as statistically significant. RESULTS: A total of 55 patients, 29 male (52.7%) and 26 female (47.3%) were selected. This study shows out of 55 patients (110 eyes), 46 (42%) eyes had myopic astigmatism, while 33 (30%) eyes were found hyperopic astigmatism, 20 (18%) eyes were observed hyperopic and 11 (10%) eyes were observed myopic. CONCLUSION: Most common type of refractive error in nystagmus was myopic astigmatism. The refractive correction should be encouraged in children with nystagmus; improvement in visual function is likely to occur

The Effects of Initial Rehabilitation Exercise on Range of Motion, Muscular Strength, and Muscle Pain after Surgery for Osteochondritis Dissecans of the Humeral Capitellum in Middle and High School Baseball Players

Background: This study evaluated the effects of a 4-week initial rehabilitation program in middle and high school baseball players who underwent removal of a loose body from osteochondritis dissecans of the capitellum humerus. Methods: Middle and high school baseball players with osteochondritis dissecans of the capitellum humerus were enrolled in this study. Each had more than 3 yr of experience and had undergone arthroscopic removal of loose bodies from the same expert at Kim's Orthop Special Clinic in Seoul. The initial exercise rehabilitation program was based on a two-stage program. Body composition, range of motion of flexion and extension in the elbow and wrist joints, grip strength, and subjective pain scale were measured before and after rehabilitation. To assess the differences between groups, we used a two-way analysis of variance. Results: The range of motion for flexion and extension of the elbow and wrist joints, grip strength, and score on the visual analog scale each were significantly improved following the 4-week program (P<0.001), had an interactive effect in time × group (P<0.001), and had significance between groups (P<0.05). Conclusion: The 4-week initial rehabilitation exercise program might improve the overall range of motion of the elbow joint and has a positive therapeutic effect on grip strength and visual analog scores. However, future welldesigned studies with more subjects and multicentric research groups are necessary for verification.

Development of a risk score to predict abnormal glycemic status among Thai dental patients

PurposeTo construct a risk score using both clinical and intra-oral variables and to determine a risk score to screen individuals according to their risk of hyperglycemia.Design/methodology/approachA cross-sectional study was carried out among 690 Thai dental patients who visited the Special Clinic, Faculty of Dentistry, Mahidol University and a mobile dental unit of His Majesty the King of Thailandss Dental Service Unit. Participants aged ≥25 years without a previous history of type 2 diabetes mellitus were included in the study. Participants diagnosed with severe anemia and polycythemia were excluded. Questionnaires were used to collect demographic data. Point-of-care HbA1c, body mass index (BMI), blood pressure and periodontal status were analyzed.FindingsA total of 690 participants were included in the study. A risk scoring system including five variables was developed. It exhibited fair discrimination (area under the curve = 0.72, 95%CI 0.68–0.71). The risk score value of 9 was used as the cut-off point for increased risk of abnormal HbA1c. Subjects that had a total risk score of 9 or more had a high probability of having abnormal HbA1c and were identified for referral to physicians for further investigation and diagnosis.Originality/valueA risk score to predict hyperglycemia using a dental parameter was developed for convenient evaluation in dental clinics.

Neurologist, 20 years’ experience, India

This chapter addresses the experience of a Neurologist who works in outreach epilepsy clinics, which cater to underserved rural patients. There was one patient, in particular, who had had epileptic seizures early in life. The description of these seizures, however, was very different from those that had happened during one of the outreach clinics conducted. The entire emphasis in the description of these seizures was on how the boy had a steady stream of spit emerging from the corner of his mouth. The Neurologist then requested to see another seizure right from the beginning. Within twenty minutes, the boy started to have one of his “seizures.” The boy was lying comfortably, hands folded, eyes shut, and there was foaming saliva at the angle of his mouth. After a few minutes, he opened his eyes and stood up and looked expectantly at the Neurologist as if gauging if the Neurologist was satisfied or not. The Neurologist then explained to the father that the current events seemed to be non-epileptic and told the boy that these “seizures” were definitely going to stop now as he had visited the special clinic. Four weeks later, the boy had not had any more “seizures.”

Risk of breast cancer in the Brazilian population

Background: Breast cancer is the second most common malignancy in female patients, thus becoming an important topic for public health. The current Gail model, already validated for other populations (e.g. White, African American, Native American, Asian), has been applied in other regions (e.g. Turkey, Qatar, Iran, Korea), however, without reflecting the ethnic diversity that the Brazilian population brings with it, through the intense miscegenation that occurred over centuries of civilization after the arrival of the Portuguese. Mobile applications are also part of the clinical practice, helping and streamlining clinical decisions, bringing benefits to healthcare professionals and patients. Objective: To translate, culturally adapt, and validate a tool for estimating the risk of developing breast cancer and to create an application for calculating the risk of developing breast cancer. Methods: Translation of the tool available on the National Cancer Institute (NCI) website from English to Portuguese (including backtranslating). Cultural adaptation through a questionnaire consultation with mastologists. Validation of the tool in a prospective observational study conducted through an interview, using the translated tool. Patients who were users of the Brazilian Unified Health System (Sistema Único de Saúde – SUS) were approached at the special clinic of Hospital Samuel Libânio, Pouso Alegre, Minas Gerais. Patients with a history of Lobular or Ductal Carcinoma in situ were interviewed, as well as those with mutations in the BRCA1 and BRCA2 suppressor genes and other hereditary syndromes associated with an increased risk of breast cancer (e.g. Cowden Syndrome , Li Fraumeni Syndrome). The risk of developing breast cancer over 5 years and throughout life has been calculated. Result: It is observed that 61.9% of the evaluating professionals were females, with a mean age of 35.9 years (SD=7.1 years), 76.2% were white, 95.2% were specialized in Mastology, and 66.7% had from 1 to 5 years of experience in the area. It is also observed that 100% attended the screening and 85.7% said they had no difficulty in identifying the risk factor. The mean age of the patients submitted to the interview was 49.9 years (SD=13.4 years), with a minimum age of 35 years and a maximum of 79 years. 62.5% of women were white, 50% had their menarche between 12 and 13 years old, 31.3% had their first term pregnancy before the age of 20 and 56.3% did not report first-degree relatives with breast cancer. The risk calculated using the tool for eligible patients was 1.3% over the next five years (Standard Deviation±0.86) and 12.41% over life (Standard Deviation±8.72), with no significant difference compared to the general population. Conclusion: The tool has been translated, culturally adapted, and validated according to international protocols for successful tool validation. The application for Android platform was developed.

Clinical profile of patients with steroid sensitive nephrotic syndrome at tertiary care centre in Gujarat, India

Background: Nephrotic syndrome is a significant cause of chronic renal disease in children. The objective of the study was to analyze demographic profile, response to steroids and associated complications, in children with Nephrotic syndrome.Methods: A retrospective study of all patients referred to Renal diseases clinic at GMERS Medical College Gotri Vadodara was done. Period of study was from year 2014 to June 2017. Variables assessed were sex distribution, age at presentation for first attack, occurrence of complications, steroid responsiveness and use of steroid sparing agents. Study was done from special clinic cards used for documentation of visits of patients in Nephrotic disease special clinic.Results: 59 patients were studied. Mean age at presentation of was 4.08 years. Sex distribution ratio was 1.18:1. 88% of cases were infrequent relapsers. Steroid dependence was observed in 8.4% of cases. Complications were noted in 38% children. UTI was the commonest complication 13.5%. Associated renal conditions were present in 5% of children.Conclusions: In the present study clinical profile of children with Nephrotic syndrome was concordant with typical nephrotic syndrome in children. Pattern of nephrotic syndrome and response to treatment did not differ significantly from other studies.