Extracellular vesicles and angiotensin-converting enzyme 2 in COVID-19 disease

Extracellular vesicles(EVs)are membranous vesicular structures released from almost all eukaryotic cell types under different physiological or pathological conditions.Growing evidence demonstrates that EVs can serve as mediators of intercellular communication between donor and recipient cells or microorganism-infected and noninfected cells.Coronavirus disease 2019(COVID-19)disease is caused by infection of the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)of host cells in the respiratory system and various extra-pulmonary tissue/organs,resulting in complications of multiple organ systems.As the cell surface receptor,angiotensin-converting enzyme 2(ACE2)mediates cellular entry of SARS-CoV-2 into the host cells in patients with COVID-19.Recent studies have found that ACE2 can be released with EVs,which have been shown to interfere with the entry of the virus into host cells and thus may be involved in COVID-19 pathophysiology.In addition,ACE2,neprilysin(NEP),and thimet oligopeptidase(TOP)are the key enzymes that regulate angiotensin metabolism by converting angiotensin II or angiotensin I to angiotensin 1-7,the latter of which has protective effects in counterbalancing the harmful effects of angiotensin II in COVID-19 disease.This review summarizes the recent research progress regarding EV-associated ACE2,NEP,and TOP and the perspectives of their potential involvement in the pathophysiology of COVID-19 disease.

Tendency to Avoid Physical Activity and Sport:Associations with Weight Stigma,and Psychological Distress in a Two-Wave Longitudinal Study

Background:Physical inactivity is a major public health problem worldwide that results in physical and mental health problems.One major issue for physical inactivity is weight stigma(WS),especially perceived WS,which could lead to a tendency to avoid physical activity(PA).To better understand the association between perceived WS and PA,knowledge of the likely mediators in this association such as weight bias internalization(WBI)and psychological distress were investigated in the present study.Methods:Using a two-wave longitudinal study and convenient sampling,388 Taiwan residents participants(55%females;mean age=29.7 years[SD±6.3])completed two surveys six months apart.Body mass index(BMI),Perceived Weight Stigma Scale(PWSS),Weight Bias Internalization Scale(WBIS),Depression,Anxiety,Stress Scale(DASS-21),and Tendency to Avoid Physical Activity and Sport Scale(TAPAS)were assessed.Results:A mediation model controlling for age,gender,and BMI with 5000 bootstrapping resamples was performed.Perceived WS exerted significant direct effects on WBI(β=0.25;p<0.001),psychological distress(β=0.15;p=0.003),and tendency to avoid PA(β=0.10;p=0.027);WBI exerted a significant direct effect on tendency to avoid PA(β=0.47;p<0.001).Standardized indirect effects of WBI and psychological distress on the association between perceived WS and tendency to avoid PA were 0.12 and 0.01,respectively.Conclusion:Given the direct association of perceived WS on the tendency to avoid PA and the mediating role of WBI in this association,interventions addressing perceived WS and WBI may contribute to promoting PA.Therefore,health interventionists(both when planning and executing PA programs)need to consider weight stigmawhen encouraging physical activity.

Evidence-Based Medicine of Screening of Diabetic Retinopathy among Type 2 Diabetes: A Clinical Overview

Diabetic retinopathy (DR) is a well-characterized chronic ocular disorder that developed in nearly all diabetic patients in the long run. The knowledge of DR is crucial to manage this disorder when planning screening and preventive programs and identifying the appropriated therapeutic strategies among. Expectant management may represent a valid therapeutic approach depending upon the clinical manifestations of the disease and, in particular, on the changes over time. If early treatment of DR reduces the probability of severe stage or slows the progression of blindness, it might sufficiently reduce treatment costs in later years to offset the costs of screening and early treatment. In addition, whether screening for DR is worthwhile is contingent on whether subjects are willing to pay the eye screening program that would decrease the risk of photocoagulation. In this review we discuss epidemiology, management, and economic evaluation of screening of DR among type 2 diabetes.

Prevalence, Knowledge, Attitude and Practices of Diabetes Mellitus among Jazan Population, Kingdom of Saudi Arabia (KSA)

Background: Diabetes mellitus (DM) prevalence is increasing in Arabian Gulf countries and Saudi Arabia is ranked as the 7th country world widely estimated to have the highest numbers of people with diabetes in 2000 and 2030. Objectives: This study intended to estimate the prevalence, risk factors of diabetes among adult population of Jazan region, Saudi Arabia. Methods: Observational cross sectional survey conducted among adult Saudi population aged 15 years of age and over who attended eight Primary Health Care Centers (PHCCs) in Jazan region. Standardized questionnaire as well as diabetic registry was utilized for this research. The questionnaire involved risk factors of DM and sociodemographic variables. Statistical analysis involved: chi-square test (or Fisher exact test where applicable) was used to evaluate the prevalence of DM among different sub-groups. The crude odds ratios (OR) were estimated by univariate analysis to observe the association of each variable with DM. Results: The overall prevalence of DM among study participants was found to be 12.3% (95% CI: 10.9 - 13.8). The prevalence of DM according to gender showed that women are of significantly higher prevalence 19.0% with confidence interval (95% C.I. 15.9 - 22.6), compared with only 9.8% for male (95% CI. 8.4 - 11.4). Participant’s body mass index, age, family history of diabetes and daily exercise and work involved physical activities that showed a significant association with DM. Conclusion: Increased prevalence of diabetes calls for urgent steps towards prevention and health promotion, programs designed to reduce its burden.

Advanced glycation end product signaling and metabolic complications:Dietary approach

Advanced glycation end products(AGEs)are a heterogeneous collection of compounds formed during industrial processing and home cooking through a sequence of nonenzymatic glycation reactions.The modern western diet is full of heat-treated foods that contribute to AGE intake.Foods high in AGEs in the contemporary diet include processed cereal products.Due to industrialization and marketing strategies,restaurant meals are modified rather than being traditionally or conventionally cooked.Fried,grilled,baked,and boiled foods have the greatest AGE levels.Higher AGE-content foods include dry nuts,roasted walnuts,sunflower seeds,fried chicken,bacon,and beef.Animal proteins and processed plant foods contain furosine,acrylamide,heterocyclic amines,and 5-hydroxymethylfurfural.Furosine(2-furoil-methyl-lysine)is an amino acid found in cooked meat products and other processed foods.High concentrations of carboxymethyl-lysine,carboxyethyl-lysine,and methylglyoxal-O are found in heat-treated nonvegetarian foods,peanut butter,and cereal items.Increased plasma levels of AGEs,which are harmful chemicals that lead to age-related diseases and physiological aging,diabetes,and autoimmune/inflammatory rheumatic diseases such as systemic lupus erythematosus and rheumatoid arthritis.AGEs in the pathophysiology of metabolic diseases have been linked to individuals with diabetes mellitus who have peripheral nerves with high amounts of AGEs and diabetes has been linked to increased myelin glycation.Insulin resistance and hyperglycemia can impact numerous human tissues and organs,leading to long-term difficulties in a number of systems and organs,including the cardiovascular system.Plasma AGE levels are linked to all-cause mortality in individuals with diabetes who have fatal or nonfatal coronary artery disease,such as ventricular dysfunction.High levels of tissue AGEs are independently associated with cardiac systolic dysfunction in diabetic patients with heart failure compared with diabetic patients without heart failure.It is widely recognized that AGEs and oxidative stress play a key role in the cardiovascular complications of diabetes because they both influence and are impacted by oxidative stress.All chronic illnesses involve protein,lipid,or nucleic acid modifications including crosslinked and nondegradable aggregates known as AGEs.Endogenous AGE formation or dietary AGE uptake can result in additional protein modifications and stimulation of several inflammatory signaling pathways.Many of these systems,however,require additional explanation because they are not entirely obvious.This review summarizes the current evidence regarding dietary sources of AGEs and metabolism-related complications associated with AGEs.

The use of outcome feedback by emergency medicine physicians: Results of a physician survey

BACKGROUND: Feedback on patient outcomes is invaluable to the practice of emergency medicine but examples of effective forms of feedback have not been well characterized in the literature. We describe one system of emergency department(ED) outcome feedback called the return visit report(RVR) and present the results of a survey assessing physicians' perceptions of this novel form of feedback. METHODS: An Opinio web-based survey was conducted in 81 emergency physicians(EPs) at three EDs.RESULTS: Of the 81 physicians surveyed, 40(49%) responded. Most participants indicated that they frequently review their RVRs(83%), that RVRs are valuable to their practice of medicine(80%), and that RVRs alter their practice in future encounters(57%). Respondents reported seeking other forms of outcome feedback including speaking with other EPs(83%) and reviewing discharge summaries of admitted patients(87%). There was no correlation between demographic data and use of RVRs.CONCLUSION: EPs value RVRs as a form of feedback. RVRs could be improved by reducing the observational interval and optimizing report relevance and differential weighting.

Latent Tuberculosis Infection among Household Contacts of Pulmonary Tuberculosis Cases in Central State, Sudan: Prevalence and Associated Factors

Introduction: Tuberculosis is a major health problem in developing countries including Sudan. Screening for TB cases through Household contacts (HHCs) investigation is an appropriate strategy to interrupt transmission of TB. Objectives: To determine the prevalence tuberculosis infection and risk factors for tuberculosis infection among household contacts in Wadimadani locality, Central State, Sudan, between November 2015 and April 2016. Methods: An analytical cross-sectional study conducted. During study period, to confirm TB diagnosis, all suspect contacts were tested through sputum samples, tuberculin skin test or chest X-ray. Structured questionnaire was used to collect socio-demographic and environmental factors. Results: One hundred forty six patients of smear-positive pulmonary tuberculosis were included in the study, 657 household contacts were identified and screened. Forty three new TB cases were detected from household contacts, yielding a prevalence of 6.5% (95% confidence interval = 0.05, 0.09) of latent tuberculosis infection (LTBI). Two factors were significantly associated with LTBI among HHCs: duration of contact with a TB patient ≤ 4 months (P = 0.03) and the educational status (P = 0.02). Conclusion: Screening of HHCs of index case of TB will contribute in early detection and treatment of new cases, and considered as a forward step towards eliminating TB.

Prevalence and Risk Factors of Hepatitis B Virus in Jazan Region, Saudi Arabia: Cross-Sectional Health Facility Based Study

Objectives: The objectives of this study were to estimate the prevalence of the HBV infection in Jazan, Kingdom of Saudi Arabia (KSA) and to correlate serologic findings with epidemiological data and known risk factors. Methods: Cross-sectional study conducted in 10 health facilities Jazan province. Study participants (2041) were interviewed using a structured questionnaire. HBsAg was tested in the blood samples collected from the study participants using commercially available kits. Results: The overall prevalence of hepatitis B among study participants was 8.3% (95% CI: 7.2 - 9.6). The prevalence of HBsAg was found to be the highest (22.4%) among those who were over 60 years old (95% CI: 13.2 - 35.0). For participants under 20 years old, the prevalence was the lowest, at only 2.5%. For males the HBV prevalence was 11.2% (95% CI: 9.3 - 13.3), compared to 7.0% (95 CI: 5.5% - 8.8%) for females. Subjects with a family history of HBV (p = 0. 002) and dental procedures (p = 0.008) were found to be associated with higher risk for HBV infection. Conclusion: The prevalence of HBsAg in adults in Jazan remains highly relative to KSA national level. Results showed a marked reduction in HBV among participants under 20 years old. This could be mainly attributed to the successful implementation of the children’s HB immunization programs in the region. Additional efforts to control HBV and vaccination for adults are highly recommended.

Feasibility, effectiveness, and perceptions of an Internet-and incentive-based behavioral weight loss intervention for overweight and obese college freshmen: A mixed methods approach

Challenges inherent with the transition to college are often accompanied by weight gain among college freshmen. Weight gain and duration of obesity increase metabolic syndrome and cardiovascular disease risk in young adulthood, which supports the need for weight loss interventions tailored to college students. The purpose of this investigation was to conduct a mixed methods pilot trial to determine the efficacy and acceptability of a semester long Internet-and incentive-based weight loss intervention for overweight/obese college freshmen. Participants (n = 27, aged >18 yrs, BMI >25) were randomly assigned to a 12-week social cognitive theory (SCT)-based intervention (Fit Freshmen [FF]) or a health information control group. The FF intervention also included modest financial incentives for weight loss. Primary outcomes included body weight/composition, dietary and physical activity (PA) behaviors, and psychosocial measures (i.e. self-efficacy, self-regulation) associated with diet, PA, and weight loss. Students in the FF intervention participated in focus groups to provide qualitative feedback on program structure and design. FF participants demonstrated significant reductions (all group differences

The Prevalence of Adrenal, Parathyroid and Cardiac Dysfunction in Patients with Beta Thalassemia Major

Background: Adrenal and parathyroid insufficiency are uncommon in patients with transfusion dependent Beta Thalassemia (β-TM). Further, myocardial echocardiographic abnormalities are recognized but with a variable outcomes Aim: The aim is to determine the prevalence of adrenal and parathyroid insufficiency in patient with transfusion dependent β-TM. And to assess left ventricle systolic and diastolic function using Pulsed Doppler (PD) and Tissue Doppler (DT) echocardiogram. Methods:The study was conducted on patients with β-TM (n = 99, age 15.92 ± 8.92 years) and compared with an age-matched controls (n = 98 age 15.79 ± 8.94 years). In all participants echocardiographic indices of M mode and PD and TD were performed. Blood samples were withdrawn for measuring the serum cortisol, parathyroid and Ferritin. Correlation between the level of cortisol and ferritin level was evaluated. Results: Patients with β-TM compared with controls, had significantly thicker LV septal wall index of 0.65 ± 0.26 vs 0.44 ± 0.2190, p 0.001 and LV posterior wall of 0.65 ± 0.235 vs 0.43 ± 0.214, p ± 5.5 vs 5.0 ± 5.6, p = 0.23. Furthermore patients with β-TM had higher E/A ratio (1.54 ± 0.18 vs 1.23 ± 0.17, p 0.01) and shorter deceleration time (DT) (170.53 ± 13.3 vs 210.50 ± 19.20 m sec, p 0.01). The ratio of transmitral E wave velocity to the tissue Doppler E wave at the basal septal mitral annulus (E/Em) was significantly higher in β-TM group (19.68 ± 2.81 vs 13.86 ± 1.41, p 0.05). The tissue Doppler systolic wave (Sm) velocity and the early diastolic wave (Em) were significantly lower in β-TM group compared with controls with Sm, of 4.82 ± 1.2 vs 6.22 ± 2.1 cm/sec, p 0.05 and (Em) of 3.51 ± 2.7 vs 4.12 ± 2.5 cm/sec p 0.05, respectively). The tricuspid valve velocity was significantly higher in β-TM patients compared with controls (2.85 ± 0.56 vs 1.743 ± 0.47 m/sec, respectively, p 0.01). The prevalence of adrenal insufficiency in patients with β-TM was 16%, hypoparathyroidism of 4.5% weak negative correlation between serum level of cortisol and the serum Ferritin. Conclusion: Patients with β-thalassemia major had a high prevalence of subclinical adrenal insufficiency of 16%, hypoparathyroidism of 4.5% with weak negative correlation between the low level of cortisol ≤160 nmol/L and high serum ferritin. Echocardiographic Pulsed Doppler showed a restrictive LV diastolic pattern suggestive of advanced diastolic dysfunction but preserved left ventricle systolic function.

A Comparison between Patients’ and Residents’ Perceptions of Patient Centeredness and Communication Skills among Physicians Working at Jordan University Hospital

Aim: This research aims to evaluate patient-centeredness and communication skills from the patients’ point of view and that of the physicians’ point of view and compares the two outcomes. Methods: This was a cross-sectional study with a convenient sample of 418 patients and 94 residents. Instrument of the study was a structured questionnaire that aimed to evaluate patient centeredness and communication skills of the residents. Results: Residents gave themselves a significantly higher score than the score given to them by patients in most studied aspects such as the extent to which the doctor discussed the patient’s problem, the extent to which the doctor explained the problem, the doctor introduced himself, the doctor greeted the patient properly and others. The only aspect for which patients gave residents higher score than that residents gave themselves was the extent to which the doctor asked the patient about what is expected to be done (ECG, CT scan, giving antibiotics, …). Conclusion: A transformation from doctor centered approach to patient centered approach is needed.

Comparative study of breast cancer in Mexican and Mexican-American women

Breast cancer is the number one cause of can- cer deaths among Hispanic women in the United States, and in Mexico, it recently became the primary cause of cancer deaths. This malign- nancy represents a poorly understood and un- derstudied disease in Hispanic women. The ELLA Binational Breast Cancer Study was es- tablished in 2006 as a multi-center study to as- sess patterns of breast tumor markers, clinical characteristics, and their risk factors in women of Mexican descent. We describe the design and implementation of the ELLA Study and provide a risk factor comparison between women in the U.S. and those in Mexico based on a sample of 765 patients (364 in the U.S. and 401 in Mexico). Compared to women in Mexico, U.S. women had significantly (p < 0.05) lower parity (3.2 vs. 3.9 mean live births) and breastfeeding rates (57.5% vs. 80.5%), higher use of oral contraceptives (60.7% vs. 50.1%) and hormone replacement therapy (23.3% vs. 7.6%), and higher family history of breast cancer (15.7% vs. 9.0%). Re- sults show that differences in breast cancer risk factor patterns exist between Mexico and U.S. women. We provide lessons learned from the conduct of our study. Binational studies are an important step in understanding disease pat- terns and etiology for women in both countries.

Depression among medical students in Tunisia:Prevalence and associated factors

BACKGROUND Medical school is known for its lengthy process,which is both physically and emotionally draining.Students’mental balance would shrink as they progress in their medical training.A systematic review and meta-analysis reported that the prevalence of depressive symptoms among medical students remained relatively constant at 27.2%.AIM To assess the prevalence of depressive symptoms among Tunisian medical students and evaluate its associated factors.METHODS This is a descriptive cross-sectional study that was carried out in the second semester of the academic year 2017/2018,between April 2018 and July 2018 among 1138 medical students.Data were collected using a socio-demographic questionnaire and the Beck Depression Inventory-II(BDI-II).RESULTS Sixty-four percent(n=728)of the participants had depressive symptoms,of which 266(23.4%)met the criteria for mild,271(23.8%)for moderate,and 191(16.8%)for severe depressive symptoms.Female gender,low socio-economic level,smoking habits and history of mental disorder,performing leisure and physical activities,satisfaction toward a career choice,and happiness perception were the main prognostic factors for depression among medical students.Although academic grades may not be considered a prognostic factor,final-year students appeared to be less depressive than their colleagues.CONCLUSION These findings give insight into mental health issues and comorbidities among Tunisian medical students.It is a hopeful request for decision-makers and academic authorities to set serious measures and draw effective interventions to minimize the currency of psychological distress among this subpopulation.

Gynecological Side Effects of Tamoxifen among Sudanese Women, Khartoum, Sudan, 2020

Background: In Sudan, the common endocrine therapy tamoxifen is prescribed to HR-positive patients, which is associated with a variety of complications such as hot flashes, vaginal discharge, and vaginal dryness. Objective: This study aimed to determine the gynecological side effects of tamoxifen among Sudanese women who have been diagnosed with breast cancer in Khartoum, Sudan. Methods: A retrospective cross-sectional study was conducted at Alzara Hospital in Al Amal Toure Revere, Sudan. A convenience sample of individuals previously diagnosed with breast cancer attended refer clinic. From October 2020 to September 2021, all patients attending were checked for eligibility. Results: A total of 100 patients were enrolled in the study;60% of patients reported increased vaginal secretions after taking the drug, 28% reported normal vaginal secretions with no change, and 11% reported decreased secretions after taking the medication, while 22% developed vaginal bleeding, and 22% of the ultrasound results revealed endometrial masses among the study patients. Also, 54 percent of female patients experienced hot flashes after taking the medication, and 12% of women missed some doses of treatment. Conclusion: Tamoxifen results in several gynecological side effects in women with breast cancer. A high percentage of women in the study developed hot flashes, vaginal bleeding, and discharge, in addition to having ultrasound results showing endometrial masses among them.

Impact of chronic disease self-management programs on type 2 diabetes management in primary care

AIM: To assess the effectiveness of the Chronic Disease Self-Management Program(CDSMP) on glycated hemoglobin A1c(HbA1c) and selected self-reported measures.METHODS: We compared patients who received a diabetes self-care behavioral intervention, the CDSMP developed at the Stanford University, with controls whoreceived usual care on their HbA1c and selected self-reported measures, including diabetes self-care activities, health-related quality of life(HRQOL), pain and fatigue. The subjects were a subset of participants enrolled in a randomized controlled trial that took place at seven regional clinics of a university-affiliated integrated healthcare system of a multi-specialty group practice between January 2009 and June 2011. The primary outcome was change in HbA1c from randomization to 12 mo. Data were analyzed using multilevel statistical models and linear mixed models to provide unbiased estimates of intervention effects.RESULTS: Demographic and baseline clinical characteristics were generally comparable between the two groups. The average baseline HbA1c values in the CDSMP and control groups were 9.4% and 9.2%, respectively. Significant reductions in HbA1c were seen at 12 mo for the two groups, with adjusted changes around 0.6%(P < 0.0001), but the reductions did not differ significantly between the two groups(P = 0.885). Few significant differences were observed in participants' diabetes self-care activities. No significant differences were observed in the participants' HRQOL, pain, or fatigue measures.CONCLUSION: The CDSMP intervention may not lower HbA1c any better than good routine care in an integrated healthcare system. More research is needed to understand the benefits of self-management programs in primary care in different settings and populations.

The correlation between keratoconus and eye rubbing: a review

Keratoconus is a non-inflammatory disorder which is gradual in development;corneal thinning and ectatic protrusion characterizes it. Keratoconus prevalence varies between different regions depending on several factors that affecting its prevalence. There are risk factors for developing keratoconus such as demographic and environmental factors. It was suggested that eye rubbing was associated with the development of keratoconus. The main aim of this review was to summarize the literature data about keratoconus and to identify the role of eyerubbing in the aetiology of the disease. A number of 24 articles was reviewed through the Pub Med, Google Scholar and Research Gates. There are many keywords used such as keratoconus, aetiology of keratoconus, eye rubbing, keratoconus prevalence, keratoconus and eye rubbing correlation. We concluded that eye rubbing causes the thinning of keratocyte, and the degree of effect of eye rubbing depends on the period and force of performing eye rubbing. It is recommended to avoid eye rubbing to prevent keratoconus, this can be achieved by avoiding itching and treating dryness of the eye and avoiding wearing eye lenses.

Awareness and knowledge about glaucoma among patients visiting the screening clinic in Jeddah Eye Hospital,Saudi Arabia

AIM:To explore levels and determinants of awareness and knowledge about glaucoma among patients.METHODS:This was a cross-sectional study that included adult patients from October to the end of December 2018.A semi-structured questionnaire was designed by the researchers to measure the levels of awareness and knowledge about 18 basic information about glaucoma.The sheet was divided into 4 domains:types of glaucoma,risk factors,clinical features,and management.A knowledge score(KS,range=0-18)was calculated,with higher scores indicating higher levels.RESULTS:A total of 383 patients responded to the questionnaire,61.9%males,mean±SD age was 38.5±12.94 years old,and 61.6%had a university degree or higher.Of them,6.3%and 23.2%reported personal and family history of glaucoma,respectively.The most frequently reported source of information about glaucoma was another person with glaucoma(28.2%),followed by physicians(24.8%)and TV(19.6%).Knowledge by item ranged from 3.1%to 82.5%correctness rate,while KS showed mean=5.91 and median=5;and reliability testing of the knowledge scale showed Cronbach’s alpha=0.782.Higher KS were found among respondents with higher educational level(P=0.036),diabetes history(P=0.025),and personal(P<0.001)and family(P<0.001)history of glaucoma.CONCLUSION:This study reveals low awareness and knowledge levels about glaucoma among the attendees of a local eye care hospital,where several misconceptions about disease risk factors,clinical features,and management are identified.

Diabetes mortality and environmental heavy metals in North Carolina counties: An ecological study

Introduction: Arsenic, beryllium, cadmium and nickel have been associated with the prevalence of diabetes mellitus in populations exposed to these elements. However, diabetes mortality has not been evaluated. This ecological study correlated airborne concentrations of these metals with diabetes mortality in North Carolina counties. Methods: County level data were extracted from the 2000 US Census, the 1999 US Environmental Protection Agency National Air Toxins Assessment, and 2001-2005 diabetes mortality rates by county from the North Carolina State Center for Health Statistics. Multivariable linear regression correlated airborne concentrations of each element with diabetes mellitus mortality rates in all 100 North Carolina counties controlling for county-level characteristics. Airborne concentrations were logarithmically transformed to normalize their distribution. Results: The lowest air concentrations detected were beryllium and cadmium, with nickel showing the highest concentration. Logarithmic concentrations spanned from 3.74 to 4.02 orders of magnitude. County-level diabetes mortality rates were negatively associated with median county income, but positively associated with county-level air concentrations of arsenic, beryllium, cadmium and nickel. Conclusions: These results support diabetes mortality effects of air pollution, and agree with other studies correlating arsenic, beryllium, cadmium and nickel with diabetes prevalence. Policy implications include regulating point source air pollution.

Lipid-lowering effect of Oroxylum indicum(L.)Kurz extract in hyperlipidemic mice

Objective:To investigate the effect of Oroxylum indicum fruit extract on high-fat diet-induced hyperlipidemic mice.Methods:The phytochemical composition of Oroxylum indicum fruit extract was determined by liquid chromatographymass spectrometry/mass spectrometry(LC-MS/MS)and gas chromatography-mass spectrometry.Forty-two male mice were used.The mice were divided into six groups:normal control,high-fat diet control,simvastatin treatment(20 mg/kg BW/day),and Oroxylum indicum fruit extract(100,200,300 mg/kg BW/day)treatment groups.Food intake,body weight,serum parameters,lipid profile,and histopathological lesions of the kidney,liver,and epididymal fat were observed.Results:LC-MS/MS results revealed four major components of Oroxylum indicum fruit extract:luteolin,apigenin,baicalein,and oroxylin A.Twenty-seven volatile oils were identified from Oroxylum indicum fruit extract.Daily oral administration of Oroxylum indicum fruit extract at 100 to 300 mg/kg BW/day significantly reduced the body weight,total cholesterol,triglyceride,and low-density lipoprotein cholesterol level(P<0.05),whereas high-density lipoprotein cholesterol was higher than the high-fat diet control group.Treatment with 300 mg/kg BW/day Oroxylum indicum fruit extract reduced the pathological lesion and prevented fat accumulation in the kidney and liver.Conclusions:Oroxylum indicum fruit extract has hypolipidemic effect in hyperlipidemic mice,and the active ingredients of Oroxylum indicum fruit extract,both flavonoids and volatile oils,should be further explored as an antihyperlipidemic agent.

HIV and AIDS related knowledge, beliefs and attitudes among rural communities hard to reach in Sudan

Background and Objective: There is a rising concern about Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) related knowledge in rural communities of Sudan. This study focuses on determining the extend of knowledge, beliefs, and attitudes about HIV/ AIDS among rural communities difficult to access in the six States of Sudan. Subjects and Methods: Six thousand and one hundred twenty five respondents were interviewed through the method of house-to-house visits. A structured questionnaire was administered by research assistants recruited from the Faculty of Medicine, Khartoum University during a rural residency campaign in six states of Central, Eastern and Northern Sudan during 2008/2009. Results: Of the total interviewees, 48% were aware of the HIV/AIDS risk;46% reported to have good health seeking behaviors for HIV/AIDS. 54.4% of women reported to have better knowledge about the disease than men (45.6%). 38% (2005) had not heard of safety use of condom whereas 16% (320) had used it. Logistic regression revealed that 5.3% of knowledge about the disease was explained by gender, education and religion adjusted over age of the respondents. Conclusions: Mass media were the most common source of information about the existent risk of HIV/AIDS in rural communities. These findings could assist Sudanese National Aids Programme (SNAP), healthcare providers and policymakers to develop informative materials and health education programs to educate rural community is about the risk of HIV/AIDS.