Statistical characterization of managerial risk factors: a case of state-run hospitals in India

Public healthcare institutions are the crucial component in the social and economic development of a nation, particularly India. However, public hospitals in India confront multiple operational risk factors that compromise patient satisfaction. Although all the risk factors are essentially critical, the impact potential of any risk factor is ultimately determined by its ability to induce other risk factors. The current research derives motivation from these scenarios and investigates the characteristics of crucial operational risk factors experienced in the public healthcare sector in a South Indian state. Extensive questionnaire-based surveys were conducted among civilians and healthcare professionals in two phases, i.e., prior to the COVID-19 crisis and during the COVID-19 crisis, for identifying significant risk factors. The collected data is analysed using statistical techniques like exploratory factor analysis (EFA) and partial least squares based structural equation modelling (PLS-SEM) to characterise the inter-relationships between risk factors. The research discloses the translational effect of administrative/infrastructure constraints in public hospitals in compromising the operational performance indirectly through human-related issues rather than having a direct influence. More precisely, the presented model indicates that risk factors like the physical infrastructure limitations and shortage of staff will overburden the existing employees, resulting in human-related issues, including attitudinal issues of employees and community mistrusts and misbelieves. The results reveal seemingly resolvable budget allocation issues, but at the same time alarms the authorities to execute immediate countermeasures. Ultimately, this research seeks to empower public hospital administrators with interesting insights and managerial implications drawn from the statistical models.

Analysis of the operational risk factors in public hospitals in an Indian state

PURPOSE

Risk management in the healthcare sector is a highly relevant sub-domain and a crucial research area from the humanitarian perspective. The purpose of this paper is to focus on the managerial/supply chain risk factors experienced by the government hospitals in an Indian state. The present paper analyzes the inter-relationships among the significant risk factors and ranks those risk factors based on their criticality.

DESIGN/METHODOLOGY/APPROACH

The current research focuses on 125 public hospitals in an Indian state. Questionnaire-based survey and personal interviews were conducted in the healthcare sector among the inpatients and hospital staff to identify the significant risk factors. An integrated DEMATEL-ISM-PROMETHEE method is adopted to analyze the impact potential and dependence behavior of the risk factors.

FINDINGS

The analysis asserts the absence of critical risk factors that have a direct impact on patient safety in the present healthcare system under investigation. However, the results illustrate the remarkable impact potential attributed to the risk factor, namely, staff shortage in inducing other risk factors such as employee attitudinal issues, employee health issues and absenteeism altogether resulting in community mistrust/misbeliefs. Maintenance mismanagement, monsoon time epidemics, physical infrastructure limitations are also found to be significant risk factors that compromise patient satisfaction levels.

PRACTICAL IMPLICATIONS

Multiple options are illustrated to mitigate significant risk factors and operational constraints experienced by public hospitals in the state. The study warrants urgent attention from government officials to fill staff vacancies and to improve the infrastructural facilities to match with the increasing demand from the society. Furthermore, this research recommends the hospital authorities to start conducting induction and training programs for the hospital employees to instill the fundamental code of conduct while working in hectic, challenging and even in conditions with limited resources.

ORIGINALITY/VALUE

Only limited papers are visible that address the identification and mitigation of risk factors associated with hospitals. The present paper proposes a novel DEMATEL-ISM-PROMETHEE integrated approach to map the inter-relationships among the significant risk factors and to rank those risk factors based on their criticality. Furthermore, the present study discloses the unique setting of the public healthcare system in a developing nation.

FRI0073 SEROLOGICAL PREDICTORS OF THE SEVERITY OF RHEUMATOID ARTHRITIS RELATED INTERSTITIAL LUNG DISEASE

Background:

The most common extra-articular manifestation of rheumatoid arthritis(RA) is interstitial lung disease (ILD). Although pulmonary manifestations in RA encompass the main airway, parenchyma, vasculature and pleura, ILD in particular, is associated with reduced survival. Up to 10% of RA patients suffer from clinically significant ILD while a substantial proportion have abnormal CT chest findings despite being asymptomatic.There are various biochemical and serological markers to predict the severity of the joints in RA. However, the clinical and laboratory determinants of RA related ILD (RA-ILD) are not well defined owing to the paucity of research data in this regard.

Objectives:

The main objective of this study is to determine the correlation between the rheumatoid factor (RF) serotypes and the severity of RA-ILD based on computer tomography (CT) findings.

Methods:

We recruited a total of 100 RA patients who were tested for IgA RF, IgG RF and IgM RF and had high resolution CT chest performed. Participants were aged above 18 years, met the 2010 ACR/EULAR RA criteria, had RA for more than 6 months, were non-smokers, not pregnant and had no known chronic lung disease or lung malignancy based on their medical records. Seventy-two patients had ILD changes on HRCT of the chest and were included in this study. The CT images were scored based on a scoring system proposed by Kazerooni et al. Ground glass opacities represented the alveolar findings whereas honeycombing and septal thickening were the interstitial findings. The ground glass and fibrosis scores were on a scale of 0-5, with higher scores for greater involvement of the lobes. For each subject, the maximum ground glass and fibrosis scores were 25, respectively.

Results:

The frequency of RF positivity was comparable across the 3 serotypes (83.33-84.72%). The correlation between the clinical variables and the CT scores are listed in Table 1.We found that the the CT scores for ground glass showed significant positive correlation with disease duration (p=0.047)and IgA RF levels (p<0.050)whereas the fibrosis scores had significant relationship with multiple clinical covariates i.e age (p=0.004), disease duration (p=0.042), IgA RF levels (p<0.050), IgG RF levels (p=0.041) and anti-CCP levels (p=0.006). On multivariate analysis, only IgA RF levels remained significantly (p<0.05, standardized beta coefficient =0.604) associated with the ground glass scores. As for the fibrosis scores, IgA RF levels and age were independent predictors based on multivariate analysis after adjusting for confounders, with p scores of <0.05 and 0.02, respectively.

Table 1.

Correlation of CT scores with clinical covariates and antibodies

ParametersGround glassFibrosisrp valuerp valueAge0.2290.0530.3340.004Disease duration0.2350.0470.2400.042Total MSS0.0580.6280.2240.145Cumulative Methotrexate dose0.0390.7480.0980.413Ig A0.608<0.050.576<0.05Ig M0.0530.6600.0190.873Ig G0.1830.1240.2410.041Anti CCP0.1170.3280.3190.006

Conclusion:

The IgA RF was the only serotype which was independently associated with the severity of RA-ILD.

References:

[1]Bongartz, T., Nannini, C., Medina-Velasquez, Y. F., Achenbach, S. J., Crowson, C. S., Ryu,et al. (2010). Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study. Arthritis and rheumatism, 62(6), 1583-1591.

[2]Dawson, J. K., Fewins, H. E., Desmond, J., Lynch, M. P., & Graham, D. R. (2001). Fibrosing alveolitis in patients with rheumatoid arthritis as assessed by high resolution computed tomography, chest radiography, and pulmonary function tests. Thorax, 56(8), 622-627.

[3]Kazerooni, E. A., Martinez, F. J., Flint, A., Jamadar, D. A., Gross, B. H.,et al. (1997). Thin-section CT obtained at 10-mm increments versus limited three-level thin-section CT for idiopathic pulmonary fibrosis: correlation with pathologic scoring. AJR Am J Roentgenol, 169(4), 977-983.

[4]van der Helm-van Mil, A. H., & Huizinga, T. W. (2012). The 2010 ACR/EULAR criteria for rheumatoid arthritis: do they affect the classification or diagnosis of rheumatoid arthritis? Annals of the rheumatic diseases, 71(10), 1596-1598.

Disclosure of Interests:

Sakthiswary Rajalingham Speakers bureau: Pfizer (500USD), Syahrul Sazliyana Shaharir: None declared, Radhika Sridharan: None declared

Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study

OBJECTIVE

Posterior circulation ischemic stroke (PCiS) constitutes 20-30% of ischemic stroke cases. Detailed information about differences between PCiS and anterior circulation ischemic stroke (ACiS) remains scarce. Such information might guide clinical decision making and prevention strategies. We studied risk factors and ischemic stroke subtypes in PCiS vs. ACiS and lesion location on magnetic resonance imaging (MRI) in PCiS.

METHODS

Out of 3,301 MRIs from 12 sites in the National Institute of Neurological Disorders and Stroke (NINDS) Stroke Genetics Network (SiGN), we included 2,381 cases with acute DWI lesions. The definition of ACiS or PCiS was based on lesion location. We compared the groups using Chi-squared and logistic regression.

RESULTS

PCiS occurred in 718 (30%) patients and ACiS in 1663 (70%). Diabetes and male sex were more common in PCiS vs. ACiS (diabetes 27% vs. 23%, p < 0.05; male sex 68% vs. 58%, p < 0.001). Both were independently associated with PCiS (diabetes, OR = 1.29; 95% CI 1.04-1.61; male sex, OR = 1.46; 95% CI 1.21-1.78). ACiS more commonly had large artery atherosclerosis (25% vs. 20%, p < 0.01) and cardioembolic mechanisms (17% vs. 11%, p < 0.001) compared to PCiS. Small artery occlusion was more common in PCiS vs. ACiS (20% vs. 14%, p < 0.001). Small artery occlusion accounted for 47% of solitary brainstem infarctions.

CONCLUSION

Ischemic stroke subtypes differ between the two phenotypes. Diabetes and male sex have a stronger association with PCiS than ACiS. Definitive MRI-based PCiS diagnosis aids etiological investigation and contributes additional insights into specific risk factors and mechanisms of injury in PCiS.

Strategic capabilities for managing risks in supply chains: current state and research futurities

Purpose

The purpose of this paper is to investigate the distinction and relationships between the significant strategic capabilities for managing risks in supply chains. This intersectional review exposes a substantial conceptual contradiction between the perspectives reported by various researchers. Further, the current paper classifies the literature into four categories according to the broad objectives investigated by the research papers.

Design/methodology/approach

Initially, a bibliometric analysis aligned with the concepts of a systematic literature review is conducted followed by a descriptive review focusing on models and methods. The software called BibExcel is utilized to extract and analyze the bibliographic information in a textual form from the research articles associated with strategic capabilities of the logistics sector. The results are exported to the software known as Gephi to visualize keyword co-occurrence analysis as networks. A well-structured descriptive review is also conducted to identify avenues for future research.

Findings

Despite conventional supply chain capabilities like efficiency and effectiveness, eight significant strategic capabilities of supply chains for managing risks are identified from the literature. These capabilities with positive connotations include flexibility, reliability, resilience, robustness, agility, adaptability, alignment and responsiveness. Considering the vast literature on flexibility/reliability along with its numerous dimensions and scope, the authors found that resilience, robustness, agility, adaptability, alignment and effectiveness are achievable through flexibility/reliability. Accordingly, it is appropriate to state reliability and flexibility as supply chain capabilities to achieve the other six supply chain competencies. Furthermore, the entire literature in this domain can be classified into four genres according to the addressed objectives, namely, concept development/validation, capability assessment, network design and performance evaluation.

Research limitations/implications

The information revealed from the keyword co-occurrence analysis along with the research implications provided in the penultimate section will assist budding researchers in framing novel and promising research objectives. Supply chain administrators and policymakers can utilize the literature classification and the notable references provided in this review for locating potential methods for assessing supply chain strategic capabilities, designing the supply chain and evaluating the performance of the supply chain.

Originality/value

An integrated bibliometric and descriptive literature review procedure is utilized in this paper. Furthermore, this critical review is the first work on comprehensively mapping the research relationships among various strategic capabilities required for mitigating supply chain risks.

Green supply chain management practice adoption in Ugandan SME manufacturing firms

Purpose

– The purpose of this paper is to advance enviropreneurial orientation (EO) as a new internal driver for green supply chain practice adoption. Because manufacturing supply chains are major contributors to environmental pollution, green practice adoption is a means of reducing environmental pollution. However, why owner/managers adopt green practices remains uncertain. The concept of EO is a potential and important motivation for adoption of green supply chain practices that has yet to be explored. The study investigates the relationship between EO and green supply chain practice adoption.

Design/methodology/approach

– Cross-sectional survey design was employed to collect data from owners/managers of SME manufacturing firms in Uganda. The structural equation modelling was used to analyse results on the influence of each of nine EO on green supply chain practice adoption and the influence of EO dimensions on green supply chain practice adoption.

Findings

– Findings show that EO positively influences green supply chain practice adoption. All but two of nine dimensions of EO were significant predictors of green supply chain practice adoption. Competitive aggressiveness and perceived pressure from environmental regulations were not significant predictors for green supply chain practice adoption.

Research limitations/implications

– The study was cross-sectional. A longitudinal survey was more appropriate because of the presence of a behavioural variable green supply chain practice adoption. Further a comparative study is required because of the existence of differences in classifications of SMEs in both the developing and developed countries.

Originality/value

– The research contributes to further scholarly understanding of green practice adoption in SMEs through offering a new construct, EO, and its role in influencing green supply chain practice adoption. The authors develop EO as a construct, a concept that has not been developed for more than two decades.

Comparison on the use of semi-automated and automated core biopsy needle in ultrasound guided breast biopsy

OBJECTIVE

The aim of this study was to compare the use of semi-automated (Medax Velox 2; Poggio Rusco, Italy) and automated (Bard Magnum Biopsy Instrument; Covington, GA, USA) core biopsy needles, for ultrasound guided breast biopsy.

MATERIALS AND METHODS

A 14G semi-automatic spring loaded core biopsy needle with a 22-mm-throw (Medax Velox 2; Poggio Rusco, Italy) and 14-gauge automated needle device with a 22-mm-throw biopsy gun (Bard-Magnum Biopsy Instrument, Covington, GA, USA) were used for breast biopsies under ultrasound guidance on alternate months during the study period between July 2009 and May 2011. One hundred and sixty lesions were biopsied and specimens were sent for histological evaluation.

RESULTS

The automated needle obtained a higher number of histology reports at 84% (67/80) as compared with the semiautomated needle at 60% (48/80) (Fisher exact test, p value=0.023). Inadequate samples with the automated needle were much less at 9% (7/60) than with the semiautomated needle at 23% (18/60) (Fisher exact test, p value=0.028). The semi-automated needle showed slightly less fragmented samples. However, the number of fragmented samples with definitive diagnosis was slightly higher with the automated compared with the semiautomated needle, at 16% (13/80) and 13% (10/80) respectively. Compared with histology of 29 lesions that were excised, the semi-automated needle had higher sensitivity (100%) but lower specificity (75%) and accuracy (90%) compared with the automated needle (88% sensitivity, 100% specificity, 95% accuracy).

CONCLUSION

Definitive diagnosis from the study samples slightly favours the use of automated core biopsy needle as compared to semi-automated core biopsy needle.

An Empirical Investigation of Mobile Banking Adoption in Developing Countries

Mobile phone has become an integral part of our lives. The penetration rate of mobile phones in the developing countries has increased abruptly and this is a good sign for the banking sector. Mobile banking is the most recently launched innovative feat in the banking sector. The unique ability of mobile banking to perform banking transactions irrespective of place and time has given a competitive edge over traditional banking. Even though, all circumstances are in favour of mobile banking, it has failed to take off in most of the developing countries. Hence, the main objective of the study is to find out the constructs which affect the adoption of mobile banking in India. A model has been proposed with the factors namely perceived usefulness, perceived ease of use, self-efficacy, perceived risk, perceived enjoyment, relative advantage, compatibility, trust, social influence and personal innovativeness. The proposed model has been tested using various statistical analyses and the findings of this study reveal that relative advantage has the strongest relationship with the intention to use mobile banking.

Comparative effects of different triazole compounds on antioxidant metabolism of Solenostemon rotundifolius

The effect of different triazole compounds, viz., triadimefon (TDM) and hexaconazole (HEX) treatments on the antioxidant metabolism of Solenostemon rotundifolius Poir., Morton plants was investigated in the present study under pot culture. Plants were treated with TDM at 15 mg l(-1) and HEX at 10 mg l(-1) separately by soil drenching on 80, 110 and 140 days after planting (DAP). The plants were harvested randomly on 90, 120 and 150 DAP for determining the effect of both the triazoles on non-enzymatic antioxidant contents like ascorbic acid (AA), reduced glutathione (GSH) and alpha-tocopherol (alpha-toc), activities of antioxidant enzymes like superoxide dismutase (SOD) and ascorbate peroxidase (APX). All the analyses were made in leaf, stem and tubers of both control and treated plants. It was found that both these triazole compounds have profound effects on the antioxidant metabolism and caused an enhancement in both non-enzymatic and enzymatic antioxidant potentials under treatments. These results suggest that, the application of triazoles may be a useful tool to increase the antioxidant production in S. rotundifolius and thereby make it an economical food crop.

Antioxidant potential and indole alkaloid profile variations with water deficits along different parts of two varieties of Catharanthus roseus

The variations in antioxidant potentials and indole alkaloid content were studied in the present investigation, in two varieties (rosea and alba) of Catharanthus roseus, an important herb used in traditional as well as modern medicine, exposed to water deficit stress. The antioxidant and alkaloid profiles were estimated from root, stem, leaf, flowers and pods. The antioxidant potentials were examined in terms of non-enzymatic antioxidant molecules and activities of antioxidant enzymes. The non-enzymatic antioxidant molecules studied were ascorbic acid (AA), alpha-tocopherol (alpha-toc) and reduced glutathione (GSH). The estimated antioxidant enzymes were superoxide dismutase (SOD), ascorbate peroxidase (APX), catalase (CAT), peroxidase (POX) and polyphenol oxidase (PPO). The antioxidant concentrations and activities of antioxidant enzymes were high under water deficit stress in all parts of the plants. Indole alkaloid content was high in the roots of rosea variety in response to stress when compared to alba variety.

Comparative effects of different triazole compounds on growth, photosynthetic pigments and carbohydrate metabolism of Solenostemon rotundifolius

The effects of two triazole compounds, triadimefon and hexaconazole, on the growth and carbohydrate metabolism were studied in Solenostemon rotundifolius Poir., Morton plants under pot culture. Plants were treated with triadimefon at 15mg l(-1) and hexaconazole at 10mg l(-1) separately by soil drenching on 80, 110 and 140 days after planting (DAP). The plants were harvested randomly and growth parameters were studied on 90, 120 and 150 DAP for determining the effect of both the triazole on growth and chlorophyll pigments. These triazole compounds increased the chlorophyll pigments. However, both the treatments decreased the fresh and dry weights of shoot and leaf area. Both these triazole resulted in a marginal increase in starch content and decreased the sugar contents. The carbohydrate metabolizing enzymes alpha- and beta-amylase activities were reduced and invertase activity increased in S. rotundifolius under triadimefon and hexaconazole treatments.

Carbohydrate metabolism in Dioscorea esculenta (Lour.) Burk. tubers and Curcuma longa L. rhizomes during two phases of dormancy

We have examined the changes in carbohydrate metabolism in food yam (Dioscorea esculenta (Lour.) Burk.) tubers and in an economically important spice cum medicinal plant turmeric (Curcuma longa L.) rhizomes under storage. Both specimens showed varied levels of dormancy and sprouting appeared at the end of dormant period. Harvested, fully matured tubers of yam and rhizomes of turmeric were stored in wooden boxes under the conditions of 28+/-2 degrees C temperature and 65-75% relative humidity (RH) in dark. The starch, sugars, enzymes of starch degradation, respiration, glycolysis, tricarboxylic acid (TCA) cycle and oxidative pentose phosphate pathway (PPP) were studied during 1-70 days after harvest (DAH). This investigation revealed that, the starch degradation and the enzymes involved, viz. alpha-amylases and starch phosphorylase showed a lower level of activity during early period of dormancy, while sugar content and enzymes of carbohydrate metabolism increased rapidly during sprouting. The isoenzymic profiles of alpha-amylases showed marked variations in these two phases. The key enzymes of glycolysis, TCA cycle and PPP, viz. aldolase, succinic dehydrogenase, malic dehydrogenase, glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase were increased even before the visible appearance of sprouting and their activities were at their maximum during sprouting. Based of the observations the dormancy period may be distinctly divided into peak period of rest and presprouting period.

Changes in antioxidant metabolism of Vigna unguiculata (L.) Walp. by propiconazole under water deficit stress

In the present study, a pot culture experiment was conducted to estimate the ameliorating effect of propiconazole (PCZ) on drought stress in cowpea (Vigna unguiculata (L.) Walp.) plants. From 30 days after sowing (DAS), the plants were subjected to 3, 6 and 9 days interval drought (DID) stress and drought stress with PCZ at 15 and 15 mg l(-1) PCZ alone and 1 day interval irrigation was kept as control. The plant samples were collected on 34 DAS (3 DID), 37 DAS (6 DID) and 40 DAS (9 DID). The plants were separated into root, stem and leaf for estimating the antioxidant contents and activities of antioxidant enzymes. Individual and combined drought stress and PCZ treatments increased ascorbic acid (AA), alpha-tocopherol (alpha-toc) contents, superoxide dismutase (SOD), ascorbate peroxidase (APX), catalase (CAT) and polyphenol oxidase (PPO) activities when compared to control. The PCZ treatment mitigated the adverse effects of drought stress by increasing the antioxidant potentials and thereby paved the way for overcoming drought stress in V. unguiculata plants.

Prevalence and pattern of epilepsy in India

PURPOSE

To estimate the prevalence of epilepsy in India by meta-analysis of previously published and unpublished studies and to determine patterns of epilepsy by using community-based studies.

METHODS

We attempted to identify as many previously published and unpublished studies as possible on the prevalence of epilepsy in India. The studies were assessed with regard to methods and definitions. The prevalence rates for rural and urban populations and for men and women were calculated with a 95% confidence interval (CI). The studies that provided details on age structure, age-specific rates, and patterns of epilepsy were chosen for meta-analysis. Both crude values and age-standardized prevalence rates were calculated after accounting for heterogeneity.

RESULTS

Twenty studies were found involving a sample population of 598,910, among whom 3,207 had epilepsy. This resulted in a crude prevalence of 5.35/1,000. After a correction for heterogeneity due to interstudy variation, the overall prevalence per 1,000 (and its 95% CI) was 5.33 (4.25-6.41); with urban areas at 5.11 (3.49-6.73); rural areas, 5.47 (4.04-6.9); men, 5.88 (3.89-7.87); and women 5.51 (3.49-7.53). After correction for the variability in estimates of heterogeneity, age-standardized rates (from five studies) revealed that the prevalence rates per 1,000 (and the 95% CI), were as follows: overall, 5.59 (4.15-7.03); men, 6.05 (3.79-8.31); women, 5.18 (3.04-7.32); urban, 6.34 (3.43-9.25); rural, 4.94 (3.12-6.76). Urban men and women had a higher prevalence of epilepsy compared with rural ones, however the difference was not statistically significant. Age-specific prevalence rates were higher in the younger age group, with the onset of epilepsy reported mostly in the first three decades of the sample population's lives. The treatment gap (i.e., the percentage of those with epilepsy who were receiving no or inadequate treatment) was more than 70% in the rural areas.

CONCLUSIONS

Based on the total projected population of India in the year 2001, the estimated number of people with epilepsy would be 5.5 million. Based on a single study on the incidence of epilepsy, the number of new cases of epilepsy each year would be close to half a million. Because rural population constitutes 74% of the Indian population, the number of people with epilepsy in rural areas will be approximately 4.1 million, three fourths of whom will not be getting any specific treatment as per the present standard.

Novel mask design for multiwavelength dayglow photometry

We present and discuss a novel mask design that provides multiwavelength measurement capability for the dayglow photometer.

Conformational analysis of A and B rings in 2-, 4-, and 6-bromosubstituted steroidal 4-en-3-ones by nuclear magnetic resonance

The conformational preference of A and B rings in four differently functionalized bromosubstituted 4-en-3-one steroids is studied by concerted application of high-resolution one- and two-dimensional nuclear magnetic resonance (NMR) techniques, such as homonuclear and heteronuclear correlated spectroscopy, transient and steady-state nOe spectroscopy, temperature-dependent chemical chemical shift variation, and application of a modified Karplus equation. The steroids studied include 6 beta-bromocholest-4-en-3-one (3), 4,6 beta-dibromocholest-1,4-dien-3-one (2), 2 alpha,4,6 beta-tribromocholest-4-en-3-one (1), and (25R)-2 alpha,6 beta-dibromospirost-4-en-3-one (4). Steroids 1-4 were prepared by either acid-catalyzed or free-radical bromination from appropriate 4-en-3-one steroid. The study has yielded an insight into the factors responsible for conformational preferences of the A and B rings of these bromosubstituted steroids. Bromosubstitution at the 2 alpha position is responsible for the inversion of the A ring to inverted 1 beta,2 alpha-halfchair conformation. The electronic interaction between 4-bromine and carbonyl oxygen distorts the A-ring conformation further. Inversion of the A ring has a concomitant effect of distortion in the chair form of the B ring. Conformational preferences of A and B rings are not found to be influenced by transmission effect of a side chain or oxygenated ring system. Temperature-dependent NMR studies indicate the reduced conformational flexibility of the A ring for 2 alpha-bromosubstituted steroids. Complete assignment of the 13C and 1H resonances of two of the steroids studied (3 and 4) is presented.

Risk factors for ischemic stroke: a case control analysis

Case control analysis of 204 patients with acute ischemic stroke revealed the matched pair odds ratio (and 95% confidence limits) for hypertension, ECG abnormality, heart disease of any type, diabetes, smoking and alcohol intake to be 3.95 (2.5, 6.2), 2.1 (1.4, 3.1), 2.1 (1.4, 3.2), 1.7 (1.1, 2.6), 1.8 (1.1, 2.8) and 1.5 (0.86, 2.6), respectively. Except alcohol intake, the other factors were statistically significant. Hemoglobin, packed cell volume (hematocrit), serum cholesterol, triglycerides and low-density lipoprotein cholesterol levels were not found to be significant. High-density lipoprotein (HDL) cholesterol and uric acid were significantly lower and the ratio of total cholesterol to HDL cholesterol (TC/HDL) was higher among stroke patients. The risk was considerably higher when there was any combination of hypertension, heart disease and HDL cholesterol level lower than 45 mg/dl. Logistic regression revealed hypertension, heart disease of any type, lower HDL cholesterol and uric acid and higher ratio of TC/HDL to be significant factors.

Dayglow photometry: a new approach

A unique photometer capable of measuring line intensities of <0.1% of the bright background continuum (5 x 10(6)/A) has been developed and successfully commissioned for the measurement of daytime OI 630.0-nm emission from the thermosphere. The photometer employs a low resolution (10(4)) Fabry-Perot etalon, temperature tuned narrowband (3-A) interference filter, radial chopper, and up/down counting system. The optimum choice of the photometer parameters and a unique method of eliminating the background enabled us to overcome the limitations of the earlier attempts to make measurements on such phenomena as dayglow and has opened up a wide range of uses. However, at present, it is being discussed only in the context of dayglow measurements.

Clinical and epidemiological study of Bell's palsy in Benghazi, Libya

An intensive search for 2 years for patients with Bell's palsy, conducted through the polyclinics, university hospitals and physiotherapy centres in Benghazi, revealed a total of 242 cases. The average annual incidence per 100,000 population was 23.35 and the age-adjusted incidence 35.72. The incidence increased with age up to the sixth decade. Seasonal clustering was noted in the months of December and January. Hypertension and diabetes mellitus were associated in 4.1% and 7% of patients, respectively. Only four patients presented during pregnancy. Recurrent facial paralysis was encountered in 5.4% of patients and was characterized by male preponderance and a tendency to recur more frequently on the same side as the initial paralysis. Familial incidence and bilateral involvement were rare features. Twelve per cent of patients who were followed up had moderate to severe residual weakness.

Incidence and pattern of cerebrovascular diseases in Benghazi, Libya

During a 12 month study period, a total of 329 incident cases of stroke occurred in Benghazi, Libya. This provided an unadjusted annual incidence rate for stroke of 63 per 100,000 population; the corresponding rates for the male and female were 69 and 58 per 100,000 respectively. The sex dependent difference in the incidence was not statistically significant. Cerebral infarction was the commonest type of stroke accounting for 80.9%. The incidence rates increased with age in all categories of stroke. Hypertension and ischaemic heart disease were common risk factors among the male patients, while diabetes and hypercholesterolaemia were more frequent in the female patients.

Stroke in the young: incidence and pattern in Benghazi, Libya

Out of 329 cases of stroke registered in Benghazi between November 1, 1983 and October 30, 1984, 63 patients comprising 32 males and 31 females belonged to the 15-40-year age group (stroke in the young). The annual age-specific crude incidence of stroke in the young was 39.3 and 40.3 per 100,000 for men and women, respectively. The age-adjusted incidence rate for both sexes for the age-specific (15-40 years) population was 47 per 100,000. The sex-dependent difference in the incidence was not statistically significant. These results emphasize that the high incidence of stroke in the young in Benghazi is not a reflection of the age distribution of the population. Hypertension, diabetes mellitus, heart disease and hypercholesterolemia were important components of high stroke profile in the young. One or more risk factors were identified in 78% of total young stroke victims and in all the patients under the age of 30. Eight young stroke subjects died during the study period.

Descriptive epidemiology of motor neuron disease in Benghazi, Libya

A total of 23 patients with motor neuron disease (MND), encompassing 17 cases of amyotrophic lateral sclerosis, 4 of progressive muscular atrophy and 2 of progressive bulbar palsy, was diagnosed in Benghazi, north-eastern Libya, between 1980 and 1985. The male to female ratio was 2.3:1. The average incidence of MND was 0.89/100,000 population/year (0.87 when age and sex-adjusted to the Libyan population). Eighteen patients were alive on the prevalence day, September 15, 1985, which provided a prevalence rate of 3.47/100,000 population (3.42 if adjusted). Age-specific incidence rates were highest in the 50- to 59-year-old age group, 8.14/100,000/year for men and 6.10/100,000/year for women. The median age at the time of diagnosis was 51 years, and the median duration for the 5 dead MND patients after the onset of the disease was 30 months. The median survival time for all MND cases combined was 42 months.

Pseudotumour cerebri: incidence and pattern in North-Eastern Libya

The present documentation of 23 female patients with pseudotumour cerebri seen in Benghazi, North-Eastern Libya, over a period of 2 years constituted 21 cases with idiopathic pseudotumour and 2 patients with associated endocrine diseases. The clinical, laboratory and CT scan findings indicated idiopathic hypoparathyroidism in 1 case. The association of pseudotumour and hypothyroidism in a 40-year-old woman is suggested to be more than coincidental. The patient group was significantly more obese. Moderate to severe visual loss occurred in 9 patients. The incidence and extent of visual impairment did not correlate with the duration of symptoms, degree of obesity, use of contraceptive pills, steroid treatment, the presence of systemic hypertension, menstrual irregularity or empty sella. The incidence of 1.7 per 100,000 for the total and 3.6 per 100,000 for the female population in Benghazi observed in the present study is believed to be more than the frequency (as assessed by the hospital incidence) reported from other regions. A high prevalence of obesity may partly explain the increased occurrence of pseudotumour cerebri in North-Eastern Libya.

Epidemiological and clinical study of epilepsy in Benghazi, Libya

An epidemiologic study of adult patients (aged greater than 15 years) with epilepsy was made over a 2-year period, through the policlinics, EEG laboratory, and university hospitals in Benghazi, northeastern Libya. Based on a total of 568 patients (310 male and 258 female), the prevalence rate on 31 December 1984 was 2.3/1,000 in the population above the age of 15 years (1.9, if age standardized). The age-specific prevalence per 1,000 population decreased from 3.6 in the 15-24 year age group to 1 in the greater than 60-year age group. For 70.8% of the patients the onset of epilepsy occurred in the first 2 decades of life, and for 7.6% it commenced after the age of 40. The duration of epilepsy when first seen in the study period was less than 1 year in 14.6%, and greater than 10 years in 25.7%. The percentages of primary generalized, partial seizures secondarily generalized, simple partial, and partial complex seizures were 55.6, 18.8, 10.4, and 14.6%, respectively. Antecedents that could be considered potential causes of epilepsy were found in 17.5% of cases. Fifty-five patients had status epilepticus, 24 of whom had symptomatic epilepsy and eight recurrent status. EEG revealed generalized epileptic activity in 199 cases and focal seizure activity in 118. Computerized tomography (CT) scan, done in 219 patients, disclosed abnormal results in 50. Among those with abnormal CT scans, 84% had partial seizures. Monotherapy with carbamazepine or phenytoin was used in the majority of cases. The influence of social, cultural, and religious factors in the diagnosis and management of epilepsy as seen in Benghazi are discussed.