European Journal of Medical and Health Sciences European Journal of Medical and Health Sciences en-US (Editor-in-Chief) (Support) Fri, 06 Mar 2020 16:33:41 -0500 OJS 60 Obstructive Neoplastic Anuria Overview at Ibn Rochd University Hospital–A Retrospective Study <p>I<u>ntroduction</u> : Obstructive anuria due to pelvic cancers is the most common obstructive anuria in our context, its diagnosis is easy, but it causes a lot of morbidity with often heavy and long management.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</p> <p><u>Materials and methods</u> : This is a retrospective study containing 40 cases of confirmed neoplastic anuria treated in the urology department at the Ibn Rochd University Hospital in Casablanca Morocco between January 2016 and October 2018.</p> <p><u>Purpose</u> : The aim of our study was to establish the epidemiological, clinical, therapeutic and natural historyin patients with neoplastic obstructive anuria.</p> <p><u>Results</u> : The mean age was 56 years old with a notable female predominance. The male to female ratio was 0.6. Sixty percent (60%) of our patients were consulted within24 hours after the onset of anuria, the main symptoms preceding or accompanying anuria were lower back pain (75%) and hematuria (37.5%).</p> <p>Criteria for a positive diagnosis included urinary retention with complete absence of diuresis, the anuria was confirmed by probing or ultrasound, dilation of the urinary excretory system on ultrasound and acute impairment of renal function.</p> <p>To prevent patient from going into metabolic disorders, hemodialysis was performed in 27 patients (67.5%). Internal diversion of urine by mounting a JJ catheter was initially attempted in 40% of the cases. In case of attempt failure, or in case of locally advanced pelvic tumors, percutaneous nephrostomy was performed with a success rate of 100%.</p> <p>Upon follow up for 30 months, mortality rate was 5% (n=2), 95% of the patients benefited from a specialized follow-up for their etiological neoplasm.</p> <p>&nbsp;<u>Conclusion</u> : The management of neoplastic obstructive anuria must be rapid, the type of urinary diversion is chosen according to the clinical presentation and the technical platform available.</p> Moussaab Rachid, Youness Chakir, Mahdi Graiouid, Mahmoud Alafifi, Mohammed Dakir, Adil Debbagh, Rachid Aboutaieb Copyright (c) 2020 Moussaab Rachid, Youness Chakir, Mahdi Graiouid, Mahmoud Alafifi, Mohammed Dakir, Adil Debbagh, Rachid Aboutaieb Fri, 06 Mar 2020 16:33:10 -0500 Characteristics of Cataract Patients in Wangaya Hospital Bali Year 2019: A Descriptive Study <p>Cataract is one of the most common cause of visual disturbance with increasing incidence and prevalence in the world. It is characterized by a clouding of the normally clear lens and is associated with age but can also occurs congenitally or be caused by eye trauma. In Wangaya Hospital, blurred vision due to cataract is one of the eye cases that is often found in eye clinics with varying types of cataract, maturity, age, and sex. Therefore, researcher wanted to find out the characteristics of cataract patients in the eye clinic of Wangaya Hospital. The study was conducted at the eye clinic of Wangaya Hospital using secondary data obtained from the eye clinic register in January 2019 to December 2019. This research was a quantitative descriptive study with cross-sectional research design, sampling was done by a total sampling. Univariate analysis was performed for the collected data. We have collected 178 samples with prevalence of cataract in men was 52%, and that for woman was 48%. Most cataract was found at age of &gt;65 years old (41%), and with senile type cataract accounting for 84%. Immature cataract was the commonest type (76%), with the same percentage between men and women which was 38%. More immature cataract occurred at age &gt;65 years by 44% while more mature cataract were found at age 56-65 years (42%). Most common characteristics of cataract patients in Wangaya Hospital during 2019 were men, immature and senile cataract, and with age at &gt;65 years old. The percentage of men and women in immature type cataract were similar.</p> Anak Agung Ayu Putri Khrisnawati, Ketut Pramana Adiputra, I.A. Putri Kartiningsih, Ni Made Dwipayani, Harumi Purwa Prahesthy Copyright (c) 2020 Anak Agung Ayu Putri Khrisnawati, Ketut Pramana Adiputra, I.A. Putri Kartiningsih, Ni Made Dwipayani, Harumi Purwa Prahesthy Tue, 10 Mar 2020 17:23:05 -0400 Breast Self-Examination Practice Among Female Secondary School Students In Osogbo, Western Nigeria <p><strong>Background: </strong>Breast cancer is the most common invasive cancer affecting women worldwide. It comprises 22.9% of invasive cancers in women and 16% of all female cancers.&nbsp;&nbsp; It affects about 12% of the women population worldwide. In Nigeria, about one breast cancer death is reported in every 25 cases identified and the practice of breast self-examination has been reported to range from 19% to 43.2%. This cross sectional study assessed the knowledge, attitude and practice of breast self-examination (BSE) among female secondary school students in Osogbo Metropolis.</p> <p><strong>Methods: </strong>A total of 400 respondents were selected using multistage sampling technique. Data were collected using pre-tested self-administered semi structured questionnaire, analyzed using Statistical Package for Social Sciences and presented using appropriate tables and charts. Level of significance set at &lt; 0.05.</p> <p><strong>Results: </strong>The mean age ± SD is 14.77 ± 1.46 years. &nbsp;390 (97.5%) respondents reported that they have heard of breast cancer while 235 (58.8%) respondents stated that they have heard of breast self-examination (BSE). 15 (3.8%) respondents said the procedures is time wasting while 82 (20.5%) respondents said the procedures were strenuous. 199 (49.8%)&nbsp; strongly disagree that performing breast self-examination may expose them to breast cancer. Individuals with poor knowledge are one time less likely to do breast self-examination (OR = 1.245, CI = 0.647 - 2.394) while in terms of attitude, those with unfavorable attitude are one time less likely to do breast self-examination (OR = 1.025 CI = 0.949 -1.107).</p> <p><strong>Conclusion: </strong>This study revealed a larger proportion of respondents have heard about breast cancer and breast self-examination but with inadequate knowledge of the correct procedures of breast self-examination (BSE) thereby resulting into poor attitude &amp; practice of breast self-examination (BSE). This challenge therefore indicates an urgent need for continuous awareness and sensitization programs in the communities.</p> I. N. Usman, S. O. Olanrewaju, Saheed Opeyemi Usman Copyright (c) 2020 I. N. Usman, S. O. Olanrewaju, Saheed Opeyemi Usman Sat, 14 Mar 2020 04:56:06 -0400 Once The Eldery, Now The Youth : Epidemiological Study Of Non-Communicable Diseases Among Children Under 15 Years Of Age In Yaoundé-Cameroon <p>Background: In sub-Saharan Africa, communicable diseases have long been among the most prominent contributors to disease burden. However, like most low-income and middle-income countries across the globe, countries in sub-Saharan Africa are experiencing a shift from disease-burden profiles dominated by communicable diseases and childhood illnesses to profiles featuring an increasing predominance of chronic, non-communicable diseases (NCDs). Objective : The main objective of this study is to investigate the magnitude of non-communicable chronic diseases at the Chantal Biya Foundation in Yaoundé. Design and participants: This is an institution-based and cross-sectional study conducted from january to december 2018. Participants were in and out patients who visited the institution and whose a medical condition was clearly diagnosed. Results : Of the 643 medical records, leading causes of visit were infectious diseases (51.1%), followed by NCDs (48.9%). Diagnosed NCDs range from sickle cell disease (5.7%), injuries (9.8%), cardiovascular diseases (12.0%), to cancers (25.0%). Conclusion There is a significant burden of NCDs among adolescents in Yaoundé. Then, interventions for primordial prevention (ie, actions to inhibit the emergence of NCD risk factors) and primary prevention (ie, actions on existing NCD risk factors), as well as educational programmes on leading modifiable behavioural risk factors and metabolic risk factors are crucial.</p> Blaise Nguendo Yongsi Copyright (c) 2020 Blaise Nguendo Yongsi Sat, 14 Mar 2020 13:16:42 -0400 Oral Submucous Fibrosis and Its Relation with Stromal Vascularity: A Systematic Review <p>Oral submucous fibrosis (OSMF) is a chronic progressive, scarring disease affecting oral, oropharyngeal, and sometimes the esophageal mucosa. It is characterized by the progressive fibrosis of the submucosal tissue. The pathogenesis of OSMF has been directly related to the habit of chewing areca nut and its commercial preparation, which is widespread in Indian subcontinent and Southeast Asia. Malignant transformation has been reported in 7%–12% cases of OSMF. Histopathological spectrum of OSMF includes the apparent alterations observed in the epithelium and connective tissue. Vascularity in OSMF has always been a matter of debate. The prevailing concept is that epithelial atrophy occurs due to lack of perfusion. The present systemic review was done to evaluate oral submucous fibrosis and its relation with stromal vascularity.</p> Sayed Nishat Abdul Copyright (c) 2020 Sayed Nishat Abdul Sat, 14 Mar 2020 13:26:52 -0400 Treatment Options and Follow-Up among Iraqi Patients with Breast Carcinoma <p>Breast cancer ranks the first among the Iraqi population and the leading cause of cancer related female mortality. In addition to the barriers that impede early detection of that cancer other major challenges include the capacity for effective multimodality treatment.</p> <p><em>Aim</em>: To review and follow up a sample of Iraqi female patients diagnosed with breast cancer in a main referral center; recording their clinico-pathological characteristics, the offered treatment options and the rate of recurrence.</p> <p><em>Material and Methods</em>: This retrospective study analyzed the clinical and pathological characteristics of 230 Iraqi female patients histologically diagnosed with breast carcinoma who had reliable valid data related to their demographic, clinical and tumor pathological status. The studied parameters included the age of the patient, marital status, parity, age at first delivery, occupation, history of lactation and hormonal intake, family history of breast and any other cancer, histological type, tumor grade and clinical stage. Hormone receptors (Estrogen and Progesterone) and HER2 over expression contents of the primary tumors were evaluated immunohistochemically. The offered treatment options included surgery, chemotherapy, radiotherapy, hormonal and biological targeted therapy. The rate of recurrence was evaluated after a follow-up period of three years.</p> <p><em>Results</em>: Only 3.5% of the patients were under the age of 30 years while 39.1% were aged 50 years and over. About 84% were married, 11.3% were nulliparous, 24.9% had their first delivery before the age of 20 years and 56.9% were housewives. History of lactation was reported in 60.4%, whereas history of breast cancer was registered in 17.4%. The most common histological type of breast carcinoma was the infiltrative ductal (86.5%), well differentiated carcinomas were diagnosed in only 5.2%. The rates of positive ER, PR and HER2 tumor contents were 68.3%, 65.7% and 29.6% respectively. Overall 8.3%, 4.3%, 39.6% and 7.8% of the patients were diagnosed at stages I, II, III and IV respectively.&nbsp; Surgery was the primary treatment modality prescribed to the vast majority (96.1%) of the patients; 88.2% of those underwent modified radical mastectomy and only 3.6% had breast conservative surgery. Whereas 91.7% received chemotherapy, radiotherapy, hormonal and biological therapy were applied on 65.7%, 63.5% and 27.4% respectively. Recurrence of breast carcinoma three years following treatment was displayed among 9.7%; displaying significant direct association with the clinical stages of the disease (p&lt;.05).</p> <p><em>Conclusions</em>: Breast cancer is still diagnosed at relatively advanced stages at the time of first presentation in Iraq; requesting radical mastectomy. Early detection represents the principal approach to control breast cancer in the near future. Regular long-term follow up through multidisciplinary tumor boards is mandatory to monitor response to therapy and recurrence.</p> Nada Alwan, Mena M. Shawkat Copyright (c) 2020 Nada Alwan, Mena M. Shawkat Tue, 24 Mar 2020 07:26:58 -0400 Clinical Characterization of COVID-19 <p>The world is on the brink of a pandemic due to the Novel coronavirus-19. The World Health Organization (WHO) urged countries all over the world to take necessary measures to control then new coronavirus disease (COVID-19) and further limit the overwhelmingly number of people infected and falling ill to the disease. It is widely known that COVID-19 affects the lung causing pneumonia with characteristic ground-glass opacity. Few research studies outlines the effect of the Novel coronavirus on other parts of the body such as stomach, liver, and kidneys. Interestingly, COVID-19 causes a cytokine storm that overwhelms the body leading to inhibition of body’s cellular immune responses by the virus through lowering the white blood cells count specifically lymphocytes, and platelets count. This paper summarizes the effect of COVID-19 on various body organs.</p> Hassan S. Naji Copyright (c) 2020 Hassan S. Naji Tue, 24 Mar 2020 07:43:31 -0400 A Curse of Knowledge in Diagnosis of Thalassemia <p>How socioeconomic development affect the diagnosis of thalassemia? Here, we report a couple (husband and wife) from United Arab Emirates (UAE) with microcytic anemia. The parents belong to Arabian tribes with a high prevalence of a- and b-thalassemia. They wanted to have another (sixth) child and their blood counts were investigated before <em>in vitro</em> fertilization. The parents and five children had standard blood tests (complete blood and reticulocyte cell counts, serum ferritin, and hemoglobin analysis) followed by genetic investigations of hemoglobin-a locus 1 and 2.&nbsp; In addition, the parents had a genetic investigation of hemoglobin-b locus for 22 common variants.&nbsp; The parents were found to have no abnormality in hemoglobin-b locus.&nbsp; They had two pathogenic a-globin gene variants: one rare variant in the 3’ prime untranslated region of <em>HBA2</em> (c.*92A&gt;G; rs63750067) and one common deletion in <em>HBA2</em> (-a<sup>3.7</sup>). There were four distinct genotypes: -a<sup>3.7</sup> homozygote (mother), c.*92A&gt;G heterozygote (father), double heterozygotes (four children), and -a <sup>3.7</sup> heterozygote (one child).&nbsp; The couple was cleared for the <em>in vitro</em> fertilization.&nbsp; In contrast to ‘standard’ approach, the genetic test for thalassemia is controversial. The findings in this family are discussed in the context of recent epidemiologic and genetic studies in the local population. It was concluded that the rapid development in the UAE was accompanied by acquisition of new information about thalassemia which, paradoxically, increased diagnostic uncertainties in the setting of premarital guidance.</p> Fatma Aljasmi, Srdjan Denic, Abdul-Kader Souid Copyright (c) 2020 Fatma Aljasmi, Srdjan Denic, Abdul-Kader Souid Wed, 25 Mar 2020 15:10:38 -0400 Adult Intussusception: Three Cases Reports and Review of the Literature. <p>&nbsp;Adult intussusception occurs infrequently and differs from childhood intussusception in its presentation, etiology, and treatment. Diagnosis can be delayed because of its longstanding, intermittent, and non-specific symptoms and most cases are diagnosed at emergency laparotomy. Treatment entails simple bowel resection in most cases. Reduction of the intussusception before resection is controversial, but there is a shift against this, especially in colonic cases. This paper presents the diagnosis and management of three cases of adult intussusception, in our hospital.</p> Amal Hajri, Karim Yaqine, Saad Rifki El Jai, Rachid Boufettal, Driss Errguibi, Farid Chehab Copyright (c) 2020 Amal Hajri, Karim Yaqine, Saad Rifki El Jai, Rachid Boufettal, Driss Errguibi, Farid Chehab Wed, 25 Mar 2020 16:20:58 -0400 The Correlation Between Asthma Severity and Neutrophil to Lymphocyte Ratio <p><em>Background—</em>The prognosis is essential in management and follows up of asthmatic patients. Neutrophil to lymphocyte ratio is considered as the common prognostic marker for many diseases especially the asthma.</p> <p><em>Aim of study—</em>To assess the relationship between asthma severity and neutrophil to lymphocyte ratio in comparison to healthy controls.</p> <p><em>Patients and methods—</em>This study is a cross sectional study conducted in Respiratory Consultancy Clinic in Baghdad Teaching Hospital in Medical City during the period from 1st of October, 2018 to 31st of March, 2019 on sample of 50 asthmatic patients and 50 healthy controls. The diagnosis of asthma was confirmed by the supervisor through clinical symptoms, signs, spirometery with reversibility test (according to GINA guideline.).</p> <p><em>Results—</em>A highly significant difference was observed between asthmatic cases and controls regarding age (p&lt;0.001). A significant association was observed between obesity and asthmatic cases (p=0.001). There was a highly significant association between high neutrophil/lymphocyte ratio and asthmatic cases (p&lt;0.001). The neutrophil/lymphocyte ratio was significantly increased with advanced age, females, severe and uncontrolled asthma.</p> <p><em>Conclusions—</em>The neutrophil to lymphocyte ratio is useful biomarker in assessment of asthma severity.</p> Meena Abdul-Sattar Darwesh, Ibtihal Shukri Abd Alhaleem, Muhammed Waheeb Salman Al-Obaidy Copyright (c) 2020 Meena Abdul-Sattar Darwesh, Ibtihal Shukri Abd Alhaleem, Muhammed Waheeb Salman Al-Obaidy Thu, 26 Mar 2020 07:46:11 -0400 The Altemeier Procedure for Strangulated Rectal Prolapse: A Case Report <p class="Abstract"><span lang="EN-US">Rectal prolapse is the complete protrusion of the rectum through the anal canal. It is most common in elderly people, but can rarely occur at any age, the strangulated rectal prolapse is a rare complication. We report the case of a 78-year old men who underwent emergency surgery for strangulated rectal prolapse. Emergency perineal rectosigmoidectomy (Altemeier repair) was performed with simple outcome.</span></p> <p class="Abstract"><span lang="EN-US">This case highlights the importance of Altemeier’s procedure in the face of a strangulated rectal prolapse in an emergency situation<em>.</em></span></p> Amal Hajri, Karim Yaqine, Saad Rifki El Jai, Rachid Boufettal, Driss Errguibi, Farid Chehab Copyright (c) 2020 Amal Hajri, Karim Yaqine, Saad Rifki El Jai, Rachid Boufettal, Driss Errguibi, Farid Chehab Fri, 27 Mar 2020 04:04:18 -0400 Association of Lower Lumbar Facet Joint Osteoarthritis With Demographic Factors And Intervertebral Disc Degeneration In Patients With Low Back Pain <p><em>Background</em>: Facet joint osteoarthritis (FJO) is an important element of lumbosacral degenerative disease. However, its association with other possible risk factors is still controversial. This study was conducted to investigate the association of FJO with risk factors and with presence of lumbar intervertebral disc degeneration (IVDD).</p> <p><em>Patient and method</em>: Lumbosacral magnetic resonance imaging (MRI) examinations of 100 patients (36 male and 64 female) with low back pain (LBP) were reviewed in this cross-sectional retrospective study for the presence of FJO. The overall prevalence of FJO as well as the number of levels affected was correlated with the age, gender, body weight, height, BMI, female parity. FJO was also correlated with presence of corresponding IVDD.</p> <p><em>Results:</em> Overall prevalence of FJO was 23%. The prevalence of FJO was significantly associated with advancing age (p=0.018). Females were more affected than males but without statistical significance (p value = 0.79). Similarly, FJO were more frequent in women with advanced multiparity but the association was statistically not significant (p value 0.1) there was statistically significant association between BMI and number of levels affected by FJO (p value 0.037).&nbsp; IVDD was significantly associated with higher prevalence of FJO especially at L3/4 and L4/5 levels (p values P&lt;0.0001 and 0.04 respectively).</p> <p><em>Conclusion</em>: Age was the single most important factor significantly associated with both overall higher prevalence of FJO and higher number of involved levels. BMI was statistically associated with increasing number of level affected. IVDD was significantly associated with presence of FJO at L3/4 &amp; L4/5 levels.</p> Haider Al-Tameemi, Farah Hikmet Majid Copyright (c) 2020 Haider Al-Tameemi, Farah Hikmet Majid Wed, 01 Apr 2020 15:47:02 -0400 Visual Outcomes Following Small Incision Cataract Surgery (SICS) in Wangaya Hospital, Bali, Indonesia <p>Cataract is considered as one of the causes of visual impairment and blindness globally and specifically in Indonesia. Manual small incision cataract surgery (SICS) is a surgical technique that is commonly performed to improve the visual outcomes among cataract patients. This study is aimed to determine the visual outcomes of cataract patients who had done the SICS and to evaluate its effectiveness. An observational study was carried out among cataract patients in Wangaya Hospital, Bali, Indonesia. Patient who underwent SICS procedures were followed-up to obtain their postoperative visual acuity and complications. A total number of 23 patients with 34 operated eyes were included in the study. Cataract was found as an important cause of visual impairment and blindness among the study group, with the number of preoperative blindness and visual impairment was 52.2% and 43.5%, respectively. On the other hand, the SICS procedure showed the results of good visual outcomes in 41.2% of operated eyes and reduced the number of blindness to 0.0% among the study group. There was only 1 (2.9%) complication found postoperatively, which was IOL decentration. In conclusion, the result from SICS surgery in Wangaya Hospital, Bali, Indonesia showed better improvement in visual outcomes and reducing the rate of blindness among cataract patients. The SICS also showed a low postoperative complication rate. Hence, SICS should be continually sustained as the surgical technique to be performed among cataract surgery patients.</p> Krisnhaliani Wetarini, Putu Anindya Agrasidi, Ida Ayu Putri Kartiningsih, Ni Made Dwipayani, Harumi Purwa Prahesthy Copyright (c) 2020 Krisnhaliani Wetarini, Putu Anindya Agrasidi, Ida Ayu Putri Kartiningsih, Ni Made Dwipayani, Harumi Purwa Prahesthy Wed, 01 Apr 2020 15:54:17 -0400 Anatomopathological Correlation Between The Clinical Tumor Stage And The Cystectomy Piece <p class="Abstract"><em><span lang="EN-US">Objectives</span></em><span lang="EN-US">: For a better staging of bladder tumors, we studied the characteristics and the clinical tumor stage in a series of patients and we compared them with the anatomopathological results of cystectomy.</span></p> <p class="Abstract"><em><span lang="EN-US">Materials and methods:</span></em><span lang="EN-US"> The clinical data of 126 patients who had had radical cystectomy with ilio-obturator dissection for bladder cancer in our department were analyzed retrospectively.</span></p> <p class="Abstract"><em><span lang="EN-US">Results</span></em><span lang="EN-US">: Of the 126 cases studied, 86% were men (109 cases) and 14% women , the average age in our series is 60 years. There was a correlation in 48.4% of the cases. The differences between clinical and pathological stages were statistically significant, the agreement was moderate with a percentage of 1.5% of pT0 at the cystectomy site (P &lt;0.005). We found the following results: 100% of the 2 T0 tumors were T2. 80% of the 31 T1 tumors were T1, while 7 were T2; 28.3% of T2 tumors were T2, 11.6% were superficial tumors; 77.7% of T3 tumors were T3; 100% of T4 tumors were T4. Pathological lymph node involvement was diagnosed in 77 patients (61.1%) while only 19.8% was diagnosed with an abdominopelvic CT scan (P &lt;0.005).</span></p> <p class="Abstract"><em><span lang="EN-US">Conclusion</span></em><span lang="EN-US">: This study demonstrated the high risk of the presence of an increase or decrease in the local stage of the primary tumor and of lymph node involvement.</span></p> El Mahdi Graiouid; Messian Gallouo; Abderrahmane Doumer, Mohammed Dakir, Adil Debbagh, Rachid Aboutaieb Copyright (c) 2020 El Mahdi Graiouid; Messian Gallouo; Abderrahmane Doumer, Mohammed Dakir, Adil Debbagh, Rachid Aboutaieb Wed, 01 Apr 2020 16:24:07 -0400 Impact of Accompanied Referral and Effective Counseling on Enrolment And Linkage to ART of Newly Identified HIV Positive Clients Toward Achieving Epidemic Control in South-Western Nigeria <p><em><u>Background</u></em><u>:</u> Very high rates of late or no ART initiation remains a persistent challenge to the achievement of PEPFAR 95-95-95 targets despites new NAIIS report stating prevalence of HIV in Nigeria as 1.5%. This study assessed the impact of accompanied referral (AR) and effective counseling (EC) on enrolment and ART treatment commencement of newly diagnosed HIV positive patients.&nbsp;&nbsp;&nbsp;</p> <p><em><u>Methods</u></em>: This study is a Quasi- experimental and analyzed routine program data on linkage from October 2017 – October 2019 for 45 health facilities in two States in South-West Nigeria. The first 6 months (Q1 and Q2 FY18) had no intervention while accompanied referral (AR) was implemented in Q3 and Q4 FY18. EC was implemented with AR in Q1&amp;Q2 FY19 and was followed up till Q3 and Q4 FY19. Data analysis was done using SPSS and significance fixed at P &lt; 0.05</p> <p><em><u>Results</u></em><u>:</u> A total of 6114 newly identified HIV-positive clients were identified; mean age was 35.7 ± 13.9 and 31.5% were in the 30-39 years age bracket. Index Testing contributed 28.7% of the HIV positive Clients identified. Percentage Enrolment in Q1 and Q2FY18 increased from 65.8% and 65.6% respectively to 89.9% and 83.8% in Q3 and Q4 FY18. This increased to 99.6% in Q1FY19, 100% in Q2, 99.7% in Q3 and 99.9% in Q4FY19. Percentage linkage to ART in Q1 and Q2FY18 increased from 61.9% and 65.6% respectively to 85.4% and 75.7% in Q3 and Q4 FY18. This increased to 98.8% in Q1FY19, 99.5% in Q2, 99.7% in Q3 and 99.2% in Q4FY19.</p> <p><em><u>Conclusion</u></em>: AR coupled with EC had the best impact on enrolment, initiation on ART, time to enrolment and initiation.</p> A. M. Adebanjo, S. O. Usman, A. Emeh, E. Ogboghodo, F. Elusoji, L. Akpan, I. Oguejiofor, J. Ale, C. Udechukwu, F. E. Owolagba, B. Amoo, T. Jolayemi, P. Okonkwo Copyright (c) 2020 Saheed Opeyemi Usman, S. O. Usman, A. Emeh, E. Ogboghodo, F. Elusoji, L. Akpan, I. Oguejiofor, J. Ale, C. Udechukwu, F. E. Owolagba, B. Amoo, T. Jolayemi, P. Okonkwo Wed, 01 Apr 2020 16:58:23 -0400 The Risk Factors Associated With Early Age At First Birth Amongst Angolan Women: Evidence From The 2015-2016 Angola Demographic And Health Survey <p>Reducing adolescent childbearing has been a global priority since the 1994 International Conference on Population and Development. Age of a woman at first birth is significant in her life because motherhood involves a substantial commitment of time and resources, and it tends to set the stage within which other roles are assumed. There are consequences related to early age at first birth for both the mothers and the children. Data and Methods: The data used for analysis came from the 2015-2016 MIHS of Angola which was its first DHS. The 2015-2016 Angolan MIHS collected information from 14&nbsp;379 women aged 15-49 years from 16&nbsp;109 households. Women were asked questions around ages at which they gave births to their children. The Tarone-Ware test was used to test the equality of the survival functions. The Cox PH model was used to determine the factors that were associated with early age at first birth. Results and Conclusion: Results revealed that women who had their sexual intercourse at a young age (HR = 4.66; p &lt; 0.001), women who never had a termination of pregnancy (HR = 1.22; p &lt; 0.001), women who were never married (HR = 1.19; p &lt; 0.001), women with no education (HR = 3.22; p &lt; 0.001), women with primary education (HR = 5.08; p &lt; 0.001), women with secondary education (HR = 5.06, p &lt; 0.001), women of Christian religion (HR = 1.10; p = 0.035) and women who resided in informal houses (HR = 1.30; p &lt; 0.001) were significantly associated with the risk of early age at first birth.</p> Tshaudi Motsima Copyright (c) 2020 Tshaudi Motsima Wed, 01 Apr 2020 17:11:19 -0400 Evaluation of the Status of Entrepreneurship in Mashhad University of Medical Sciences <p><em>Background:</em> Nowadays, universities are not only the place for producing knowledge, but also they must take steps to adopt global standards in order to play their role in meeting social needs. This research was conducted with the aim of investigating the impact of university education globalization on entrepreneurship and Knowledge-Based companies and presenting the model.</p> <p><em>Materials and Methods:</em> The present study is a descriptive-analytical type with two qualitative and quantitative phases. In the qualitative phase of the research, six experts and professionals related to the research topic selected by snowball sampling method were interviewed and the data obtained from these interviews was analyzed by using Strauss and Corbin's three-step coding method, and the related questionnaire was designed. In the quantitative phase, a researcher-made questionnaire was provided for 384&nbsp;&nbsp; University professors&nbsp;&nbsp; of the universities of Medical Sciences of Ferdowsi, and Azad university of Mashhad, selected by stratified random sampling. Descriptive and inferential statistics and SPSS-19 and Smart PLS-3 software were used to analyze the data.</p> <p><em>Results:</em> According to the research findings, 293 participants were men and almost half of them had a bachelor's degree. Also, the significance level for the relationship between the university educations globalization and entrepreneurship, the relationship between the university education globalization on the development of Knowledge-Based companies and, finally the relationship between entrepreneurship and the development of Knowledge-Based companies were reported less than 0.05, as a result of which it can be said that there is a significant relationship between these variables.</p> <p><em>Conclusion:</em> Regarding the role of Knowledge-Based companies in the economic and scientific development of countries and the impact of universities on supporting these companies, it is suggested that universities, by approximating themselves to the global criteria, play their role in advancing this route.</p> V. Fallah, S. Saffarian, Majid Hassanzade Copyright (c) 2020 V. Fallah, S. Saffarian, Majid Hassanzade Wed, 01 Apr 2020 17:23:05 -0400 Isolation, Identification And Prevalence Of Pseudomonas Aeruginosa Isolates From Clinical And Environmental Sources In Onitsha Metropolis, Anambra State <p>This study was aimed to isolate and identify Pseudomonas aeruginosa and to determine the prevalence rate of isolated P. aeruginosa in Hospitals in Onitsha. Isolates of P. aeruginosa were recovered from both clinical and environmental sources using Cetrimide agar, Blood agar, Mueller-Hinton agar and MacConkey agar.&nbsp; All the inoculated plates were incubated at 37°C for 24-48 hours and growth was evaluated on these media. Isolates were identified on the basis of standard bacteriological methods like morphology, colonial characteristics, smell in culture, haemolysis, as well as pigment production on these media. All suspected isolates were further characterized and identified by many biochemical reactions. Results revealed that only 22 (18.3%) isolates were P. aeruginosa, while other 98 (81.7%) represented other bacterial genera. The 22 isolates included 19 (86.4%) environmental isolates and 3 (13.6%) clinical isolates. Pseudomonas aeruginosa was most commonly isolated from sink (13.6%), then mops and cleaning buckets (9.1%) and least from theatre bed, nasal swab, floor, disinfectant, ear and wound swab (4.5%). The pigment varied from bluish-green to yellowish-green with a grape-like odor. All isolates were Gram negative, produced β-hemolysis on blood agar and were motile. The biochemical tests showed all the isolates to be strongly positive for catalase, oxidase, citrate, and casein hydrolysis. The prevalence rate of P. aeruginosa is relatively high and its isolation from sources like sinks and theatre bed could be suggestive of the role of this pathogen in nosocomial infections.</p> C. O. Ezeador, P. C. Ejikeugwu, S. N. Ushie, N. R. Agbakoba Copyright (c) 2020 C. O. Ezeador, P. C. Ejikeugwu, S. N. Ushie, N. R. Agbakoba Thu, 02 Apr 2020 16:36:41 -0400 Liver Abscess Caused by Citrobacter Freundii Secondary to Cholecysto-antral Fistula: A Case Report <p class="Abstract"><span lang="EN-US">Liver abscesses secondary to bilio-enteric fistulas are rare and therefore unknown to the attending physician. In this report, we present a bilio-enteric communication, between the gallbladder; which was macro lithiasic; and the stomach revealed by an upper digestive hemorrhage in a septic context in a 34 year old man. A pyogenic bacterial liver abscess developed because of the fistula without biliary obstruction. The patient was treated surgically with disconnection of the fistula and drainage of the abscess. The liver abscess is probably due to the contamination of the bile by the cholecysto-gastric fistula. The germ isolated was a citrobacter freundii which is rarely involved in liver abscesses.</span></p> Amal Hajri, Oussama Lafkih, Driss Erguibi, Saad Rifki El Jai, Rachid Boufettal, Farid Chehab Copyright (c) 2020 Amal Hajri, Oussama Lafkih, Driss Erguibi, Saad Rifki El Jai, Rachid Boufettal, Farid Chehab Sun, 05 Apr 2020 09:44:50 -0400 Acute Appendicitis Secondary to Enterobius Vermicularis Infestation: A Case Report <p>The association of Enterobius vermicularis and appendicitis were recognized in the late XIXe century, when an incidence of 19% of appendicular infestation in children with appendicitis was reported. Other studies showed that the relationship between this parasitosis and appendicitis varied from 0.2 to 41.8 worldwid. In this paper we present an adult patient with acute appendicitis caused by Enterobius Vermicularis discovered in per-surgical procedure, and we’re going to discuss on the bases of the literature the epidemiological, clinical, and therapeutic characteristics of the appendicular localization of oxyurosis.</p> Abdelillah El Bakouri, Amal Hajri, Abdelhak Ettaoussi, Mounir Bouali, Fatimazahra Bensardi, Khalid El Hattabi, Abdelaziz Fadil Copyright (c) 2020 Abdelillah El Bakouri, Amal Hajri, Abdelhak Ettaoussi, Mounir Bouali, Fatimazahra Bensardi, Khalid El Hattabi, Abdelaziz Fadil Sun, 05 Apr 2020 11:30:30 -0400