Epidemiological factors affecting health service utilization in diabetic patients in Ethiopia

 

Diabetes-related deaths reached 2 million in 2019. The highest percentage of undiagnosed diabetes (59.7%) was observed in Africa, where accessibility to health services is pivotal to improving the outcome of diabetic patients. The study aims to assess the association between diabetic patients’ epidemiological factors and accessibility to healthcare services in a low-income country. The retrospective cohort study included diabetes-related outpatient department (OPD) visits and hospitalizations from 01/01/2018 to 31/08/2021 at St Luke Hospital (Ethiopia). Potential predictors were sociodemographic factors, COVID-19 cases, mean monthly temperature, and precipitations. The ARIMA method was applied to OPD visits and hospitalizations time series. OPD visits increased over time (p < 0.001) while hospitalizations were stable. The time series model was ARIMA(0,1,1) for OPD visits and ARIMA(0,0,0) for hospitalizations. Diabetes OPD patients were 1,685 (F = 732, 43%). Females had an average of 16% fewer OPD accesses per month (p = 0.002). Patients missing follow-up were 801 (48%). The time between follow-ups was longer as age increased (p < 0.001). There were 57 fewer forecast OPD visits per month on average using COVID-19 cases as ARIMA regressor. OPD visits decreased differently by geographic area as COVID-19 cases increased (p < 0.001). Hospitalized patients for diabetes were 408, 85 (20.8%) newly diagnosed. The odds ratio (OR) of diagnosis at admission was lower as age increased (OR 0.98, p = 0.009). Compared to type 1 diabetes, hospitalized females with type 2 (117-39.7%) were fewer than males (p = 0.019). Readmissions were 52, 10 (19.2%) within 30 days, without OR difference by sex, age, or diabetes type. Despite an increase in OPD visits for diabetic patients over the study period, the number of losses at follow-up and diagnoses at hospitalization remains high. Gender and age influenced service utilization. Females’ access to care is still problematic (concept of “missing women”).

Key messages

• Primary health care should be implemented to improve access to health services and diabetes management.

• Ensuring equity in healthcare accessibility should be a priority in low-income countries.

Diabetic ketoacidosis among patients admitted to a general hospital in Ethiopia: a spatial analysis

 

Non-Communicable diseases are rapidly increasing in low- and middle-income countries. The number of patients with diabetes is estimated to reach 4.7 million in Ethiopia by 2045. Ensuring access to care is critical to improving the management and clinical outcome of diabetic patients. The study describes the characteristics of patients with diabetic ketoacidosis (DKA) and evaluates the relationship between the severity of clinical presentation and the travel time to the hospital. A retrospective cohort study was conducted on the charts of patients admitted for DKA at St. Luke Catholic Hospital (SLCH), Wolisso, Oromia Region (Ethiopia), between 01/01/2021 and 31/08/2021. Demographic and clinical data were collected. Negative binomial regression was used to explore the relationship between the incidence of admissions for DKA and travel time to the hospital. Logistic regression was used to estimate the odds of insulin treatment. Results were presented with 95% confidence intervals. During the study period, 651 patients were admitted, including 77 (11.8%) for DKA (33 females (42.9%) and 44 males (57.1%)), with no differences based on diabetes type (p = 0.258). The mean age was 35 years (IQR 19.0-52.0). Mean BMI was 18.4 kg/m2 (IQR 15.6-19.5), with no differences based on diabetes type (p = 0.639). Cumulative incidence of hospitalizations was significantly correlated to travel time to the hospital (p = 0.039) with an Incident Rate Ratio of 1.01%[1.00-1.02]. The cumulative incidence ranged from 7.0%[4.5-10.3] in Wolisso to 30.8%[14.3-51.8] in Ameya, the most distant district. The relative probability of insulin treatment was higher with increasing time to SLCH (OR 1.11[1.02-1.21] p = 0.027). The hospitalization rate for DKA was significantly correlated with the travel time to the hospital. Access to care is therefore a key factor for health that should be taken into account by improvement programs and the spatial analysis of travel time could help focus on priority areas.

Key messages

• Spatial analysis can be a robust tool to tailor population healthcare needs on its own topography.

• Health policies must consider that accessibility can influence the severity of clinical presentation.

Correlation Between Cyclo-oxygenase-2 and Vascular Endothelial Growth Factor Expression in Canine and Feline Squamous Cell Carcinomas

Overexpression of cyclo-oxygenase (COX)-2 is involved in tumour growth and spread by modulating the production of angiogenic factors such as vascular endothelial growth factor (VEGF). Expression of COX-2 and VEGF was investigated immunohistochemically in 51 canine and feline cutaneous and non-cutaneous squamous cell carcinomas (SCCs) and the correlation between expression of these molecules and clinicopathological variables was evaluated. COX-2 and VEGF expression was not observed in normal skin keratinocytes. COX-2 overexpression occurred in 53% and 61% of the canine and feline SCCs, respectively. The expression of both markers was higher in cutaneous compared with non-cutaneous SCCs. In both species COX-2 and VEGF expression was correlated with the progression of the disease, but not with the presence of lymphatic invasion, tumour grading or tumour classification in the cutaneous tumours. Further study will be required to understand the role of the COX-2 pathway in angiogenesis in SCC.

Total plasma magnesium in healthy and critically ill foals

Abnormalities in total Mg (tMg) concentration in plasma and/or serum are common in critically ill humans, and the association with increased mortality has been documented in several clinical studies in adults and newborns with hypoxic-ischemic encephalopathy. Abnormalities in tMg were studied in hospitalized dogs, cats, and adult horses. Newborn foals were scarcely studied with regard to Mg concentration. The aims of the present study were: (1) to compare two analytical methods for the determination of tMg in plasma: the automated colorimetric method and the atomic absorption spectrometry; (2) to measure plasma tMg in healthy foals during the first 72 hours after birth and in sick foals during the first 72 hours of hospitalization; (3) to compare total plasma Mg concentration among healthy foals, foals affected by perinatal asphyxia syndrome (PAS), prematurity and/or dismaturity, and sepsis; (4) to evaluate tMg plasma concentration in surviving and non-surviving foals. One hundred seventeen foals were included in the study: 20 healthy and 97 sick foals. The automated method used in clinical practice probably overestimates plasma tMg. Due to its higher sensitivity and specificity, the atomic absorption spectrometry should be considered the method of choice from an analytical point of view, but requires an instrumentation not easily available in any laboratory and specific technical skills and competencies. Plasma tMg in healthy foals were included in the range 0.52 to 1.01 mmol/L and did not show any time-dependent change during the first 72 hours of life. In sick foals, tMg evaluated at T0 was statistically higher than tMg measured at subsequent times. Foals affected by PAS had a tMg at T0 significantly higher (P < 0.01) than healthy, septic, and premature and/or dysmature foals. The t test found significantly higher (P < 0.01) plasma tMg measured at T0 in non-surviving than in surviving foals. Plasma tMg could be a useful parameter for the diagnosis of PAS and the formulation of the prognosis in critically ill foals.

Cadmium accumulation and antioxidant responses in Sparus aurata exposed to waterborne cadmium

Cadmium (Cd), a nonessential trace element, is rapidly accumulated by most living organisms and subsequently exerts its toxicity at different molecular levels. This study exposed gilthead sea bream (Sparus aurata) to waterborne 0.1 mg/l Cd for 11 days and investigated the Cd accumulation pattern, lipid oxidation, and response of antioxidant defences. At the end of the experiment, mean Cd concentrations in gills and liver, the organs most prone to metal accumulation, were 209.4 and 371.7 ng/g ww, respectively. Muscle did not show any Cd retention during the 11 days of exposure. In liver, the cytosolic fraction of the metal was chelated into the nontoxic form by metallothionein (MT), a specific Cd-inducible protein. Zn and Cu concentrations were not influenced by Cd exposure. Glutathione (GSH) concentrations and the antioxidant enzyme activities of GSH reductase and GSH peroxidase showed an overall decreasing trend. In addition, lipid and aqueous hydroperoxide levels did not show any significant variation. Oxidative stress indirectly generated by Cd seems to be compensated for by the different biochemical systems tailored to decrease cellular damage. In particular, the negative effects of Cd accumulation in tissues were probably counteracted by the induction of MT.

Comparative reactivity of serum samples from Argentinean HIV-infected patients with V3 peptides from subtype B or BF recombinants

To analyze humoral cross-reactivity to V3 peptides from subtype B and BF recombinant forms, plasma samples from 50 HIV-1-infected patients were characterized by sequencing fragments of the env and pol genes. An in-house EIA was performed using peptides corresponding to the 15 central amino acids of the V3 loop of gp120 from subtypes B (MN, SF2) and F1 and a consensus peptide from Argentinean BF recombinants. No differences were found with respect to the infecting subtype, but significant differences were found among the peptides. Reactivity was higher against the MN and BF peptides in both groups infected with subtype B (n = 28) and BF (n = 22) recombinants than against subtype F1 and SF2 peptides.

Cadmium accumulation and biochemical responses in Sparus aurata following sub-lethal Cd exposure

Cadmium (Cd), a heavy metal with limited biological function, is widely distributed in the aquatic environment as a result of natural and anthropogenic activities. The effect of 4 and 11 days exposure of gilthead sea bream Sparus aurata to sub-lethal concentrations of Cd was evaluated as levels of Cd content and Cd-metallothionein (MT) presence in different organs. The possible genotoxic effect was also evaluated in erythrocytes by using the "comet assay", a promising tool for estimating DNA damage at the single-cell level. The results obtained show that in the controls, Cd content was significantly higher in gills compared to in liver, but the treatment of fish with 0.1mg/l Cd induced a stronger accumulation of metal in liver depending on the length of the exposure period. Cd traces were found in plasma, muscle and kidney. Cd forms complexes in the cytosol with MT only in the liver but Cd-MT content significantly increased after 11 days of exposure to the metal, while after 4 days of treatment the protein level was similar to the control. The "comet assay" performed on S. aurata eryhtrocytes isolated from fish treated for 4 and 11 days with 0.1mg/l Cd, showed that there was no DNA damage at both exposure periods.

[Prevalence of human immunodeficiency virus (HIV)-Trypanosoma cruzi co-infection and injectable-drugs abuse in a Buenos Aires health center]

The aim of this study was to evaluate the prevalence of human immunodeficiency virus (HIV)-Trypanosoma cruzi co-infection in a Buenos Aires health center. A retrospective analysis of the clinical charts of 602 HIV-infected patients was performed. Only 51.3% of the patients were evaluated against T. cruzi. The global co-infection prevalence was 4.2%, being more frequent among injectable drug users (IDU) (8.9% vs. 2.6%, < 0.05). The indication of T. cruzi testing should be stressed for HIV-infected patients, especially in those centers where IDU are assisted.

Trace metals in arcid clam Scapharca inaequivalvis: effects of molluscan extracts on bioluminescent bacteria

The relationship between a supposed effect of molluscan extracts on bioluminescent bacteria and metal concentrations in the extracts was investigated. For this purpose a biotoxicological assay based on bioluminescent bacteria (BLB) and extracts from metal exposed molluscs, Scapharca inaequivalvis, was optimized to monitor Cd and Cu marine pollution. Cu and Cd concentrations increased in tissues of experimentally exposed molluscs. Molluscan extracts inhibited the bacterial luminescence, the inhibition decreasing as the time of mollusc exposure to metals increased, suggesting a reduction of the "bioactive" metals. In regard to the use of BLB test in environmental monitoring, the analysis of Cu, Cd, and metallothionein (MT) was first performed in tissues from molluscs collected in three different areas of Northern Adriatic Sea. Metal concentrations reached maximum values in the gills, while Cd was mostly bound to MT in the kidney. Significant differences in metals and MT concentrations were found depending on the sampling sites. The biotoxicological assay resulted slightly correlated with the biochemical parameters.

Viral reactivation and pseudotype production in an in vitro superinfection system with two different strains of HIV-1

Viral production and variability of HIV-1 is normally high in vivo causing the necessary conditions for cellular superinfection. In order to evaluate the superinfection dynamics in vitro, H9HTLVIIIB cell line was superinfected with HIVMN. Superinfected cells showed nearly 50% cell mortality at day 1 post-superinfection (ps), which increased significantly up to day 4 ps. Superinfecting genome was detectable until day 10 ps. The superinfecting strain was found in the supernatant only on day 1 ps, but was recovered up to day 4 ps by coculture with non-infected cells. The existing strain (HIVHXB2) was recovered throughout the studied period. Pseudotype formation by the HIVHXB2 genome and envelope proteins of the superinfecting strain (HIVMN) was observed from day 1 to 6 ps. Viral production was increased by 1.7 LOG in superinfected cells from day 1 ps. Both viral production increase and pseudotype formation could be relevant for HIV pathogenesis in vivo.

Molecular characterization of chromosome 22 deletions by short tandem repeat polymorphism (STRP) in patients with conotruncal heart defects

The haploinsufficiency of chromosome 22q11.2 can cause both DiGeorge and velocardiofacial syndromes, both of which are characterized by conotruncal heart defects as well as a wide range of other extracardiac anomalies. Several studies have demonstrated that approximately 10-20% of patients with conotruncal heart defects have a 22q11.2 deletion. In clinical laboratories, the deletion is usually detected by fluorescent in situ hybridization (FISH). We set up a polymerase chain reaction-based non-radioactive method for molecular analysis of the 22q11.2 region in conotruncal cardiac patients with conotruncal defects. Sixty-four children with conotruncal defects and their parents were genotyped by polymerase chain reaction, using fifteen polymorphic markers. We identified nine deletions (confirmed by FISH): eight were "de novo" and one familial, maternally inherited. Six deletions were of paternal and three of maternal origin. There were seven deletions of 3 Mb and the other two were of 1.5 Mb. This method is a cost-effective means of characterizing the 22q11.2 region and it can be applied for a rapid screening of 22q11.2 deletion in patients at risk. In agreement with previously published data, we found no correlation between the sizes and the parental origin of deletions and cardiac or extra-cardiac phenotypes.

Metallothioneins (MTs) in marine molluscs

The presence of MTs in marine molluscs was firstly hypothesized in oyster and in mussel during the seventies, however mussel's and oysters' MTs were completely purified and sequenced rather later. Already from the first studies it was evident that the purification of molluscan MTs was more difficult than in mammals. Mussel's MTs are characterized by the presence of a monomeric and a dimeric form. Several physiological and biochemical parameters can influence the concentration and the isolation of MT from molluscan tissues. Remarkable variations in MT isolation and quantification might depend on the purification and storage protocol. Because of possible artefacts due to the isolation procedure the establishment of a standard protocol for MT quantification in marine mollusc is still an important goal. In a few species the presence of very low molecular weight metal binding ligands has also been reported, in these cases it cannot be excluded that the native MT has been cleaved by the action of proteases. This review aims to report: 1) importance of a standard method for MT purification and quantification in molluscs; 2) distribution of MT among molluscan species; 3) data concerning oyster's and mussel's MTs which are the two more deeply investigated marine molluscs; 4) biotic and abiotic factors influencing MT concentration, and 5) biological role of MT and use of MT as a biochemical marker of heavy metal pollution.

Combined treatment with growth hormone and gonadotropin-releasing hormone analogues in children with isolated growth hormone deficiency

In subjects with an isolated GH deficiency the inhibition of puberty by GnRH-analogue administration may be attempted to delay the onset, or to prolong the duration, of pubertal maturation in order to improve final height. We report our experience on the matter in 10 subjects (6M, 4F) suffering from isolated GH deficiency with a chronological age ranging from 6.5 to 10.6 years at diagnosis. After a period of 1-5.1 years of GH treatment, GnRH-analogues (long-acting D-Trp-6-GnRH) were added to GH for 12 months, when six subjects were still prepubertal and four in early puberty. During combined therapy, a regression in pubertal development was shown in three out of four children in early puberty, while serum testosterone or estradiol decreased. Height velocity decreased (from 5.23 +/- 1.49 (mean +/- SD) to 4.12 +/- 0.67 cm/year; p < 0.02), whereas height SD scores for bone age increased (from -0.75 +/- 0.42 to -0.47 +/- 0.55; p < 0.02). During the year of combined therapy, bone age increased only 0.57 +/- 0.27 years. The values for predicted height (TW2 and Bayley-Pinneau method) after combined treatment were also higher than those after treatment with GH alone (p < 0.02 and p < 0.001, respectively). Our preliminary data showed that the addition of GnRH-analogues to GH in subjects with isolated GH deficiency reduces the effect of GH on height velocity, but determines an improvement in statural prognosis, although a proper answer will not be obtained until final height has been achieved.

[Human hydatidosis: field echography for the determination of groups at high risk in the evaluation of a control program]

The development of small ultrasonographic equipment has permitted to incorporate this technique to the methods of early detection of Human Hydatidosis. 689 echographies were carried out in this experience, and 5.51% of compatible images in the whole population, and 12.24% in groups of risk (those living together with the operated ones) were found. It was observed a significant decrease in the infection percentages in man in the whole population of areas under Control Program, using the echographic screening. In conclusion, echography might be incorporated to the epidemiologic surveillance system of human Hydatidosis.

Apparent free cortisol concentrations in patients with anorexia nervosa at different stages of the disease

We have measured the total cortisol concentration (TC) and the apparent free cortisol concentration (AFCC) in plasma samples of 17 patients with anorexia nervosa (AN) at different stages of the disease, in basal conditions and after suppression test. We measured free cortisol values directly by a RIA method in dialyzed plasma samples after an equilibrium dialysis system. We have found significantly elevated TC and AFCC values in basal conditions and after suppression test only in the group of patients in the severe stage of the disease. In addition, a significant (p less than 0.05) correlation existed between percent loss of ideal body weight TC and AFCC values after suppression test. Our results suggest that the hypothalamus-pituitary-adrenal axis may be grossly impaired only in the severe stage of AN.