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Amr Molla,1 Hassan Alrizqi,2 Emtinan Alharbi,2 Arwa Alsubhi,3 Saad Alrizqi,4 Omar Shahada4 1Department of Medicine, Taibah University, Medina, Saudi Arabia; 2Medina Specialist Hospital, Medina, Saudi Arabia; 3Department of Dermatology, King Saud Medical City, Riyadh, Saudi Arabia; 4College of Medicine, Taibah University, Medina, Saudi ArabiaCorrespondence: Amr MollaDepartment of Medicine, College of Medicine, Taibah University, 344 Universities Road, Medina, 42353, Saudi ArabiaTel +966504342992Email amolla@taibahu.edu.saPurpose: Acne vulgaris is a common dermatological disease in adolescents that show high prevalence rates of anxiety and depression that may lead to consequences that affect quality of life. This study aimed to assess and compare anxiety and depression in patients with acne and a control group and to determine their correlation with other demographic data.Patients and Methods: This was a case-control study conducted in 2019 for 3 months at the derma-tology department of Ohud Hospital and two other private clinics in the Medina region of Saudi Arabia. For this study, 296 consecutive patients in the age group of 12 to 60 years who were diagnosed as having acne vulgaris were enrolled and matched with a control group. Data were collected through a self-administered questionnaire, including sociodemographic data and Hospital Anxiety and Depression Scale scores.Results: We found no significant differences between the two groups regarding sex, age group, nationality, and educational level, but found a significant difference in marital status (p < 0.001). Most (62.5%) of the acne cases were moderate in severity. The overall anxiety score in the acne group was 7.68 ± 4.90, with a significant difference with the control group (p = 0.031), whereas the anxiety level and depression score showed no significant difference (p = 0.082 and p = 0.656, respectively). Moreover, a strong correlation was found between anxiety and depression in the acne group (r = 0.732, p < 0.001).Conclusion: A positive correlation was found between the anxiety and depression scores in the patients with acne, which was not related to age group or educational level. However, the anxiety scores of the patients with acne showed a significant relationship with sex.Keywords: GAGS, HADS questionnaire, anxiety, depression, acne vulgaris, case control

BACKGROUND Tuberculosis (TB) is a curable and preventable disease. Emergence of multi drug resistance TB (MDR TB) threatens to undo the progress made towards control of TB. While treatment is available for MDR TB, it is of a long duration and is also more expensive and toxic. Understanding the various factors that are associated with MDR TB may help to formulate and implement effective preventive practices for control of MDR TB. We wanted to assess the various epidemiological factors among MDR TB cases registered under Revised National Tuberculosis Control Programme (RNTCP) in East Sikkim and study the current & past TB treatment including adverse drug reactions. METHODS A community-based case control study was conducted over 4 months in the eastern district of Sikkim. MDR TB cases registered under Revised National Tuberculosis Control Programme (RNTCP) in the first two quarters of 2019 were compared with matched healthy controls. Data was collected by a door to door survey using a pre-designed and pre-tested questionnaire and analysed on Statistical Package for the Social Sciences (SPSS) 20. RESULTS A total of 62 cases (14 non-respondents) of MDR TB were identified and were matched with 63 controls. 30.5 % cases were young adults in the age group 15 to 25 years, 66 % of the cases reported being currently unemployed, 16 % were homemakers, 11 % of cases fell below poverty line. A higher proportion of cases as compared to controls reported a habit of skipping a meal, poor housing conditions and comorbidities than controls. A known history of contact with a case of tuberculosis was given by 11.3 % cases; 18 % cases gave a previous history of TB; about 51 % cases reported a delay in diagnosis which delayed treatment initiation. CONCLUSIONS Previous history of TB with history of relapse / failure, contact of MDR TB emerged as the most significant risk factors and presence of comorbid conditions like diabetes & hypertension can be used to indicate higher risks of drug resistance. KEYWORDS Multi Drug Resistant Tuberculosis, MDR TB, Case control, Revised National Tuberculosis Control Programme, Sikkim

Objective The aim of this study was to characterize Covid-19 cases and explore risk factors associated with mortality among hypertensive patients with COVID-19 country-wide. Methods We used a retrospective case control study design to provide a detailed account of cases and explore risk factors associated with mortality among hypertensive patients with COVID-19 country-wide. A total of 441 patients were included in the study in the ratio of one case to two controls (1:2), matched by age. Results Deaths due to Covid-19 varied with hypertensive condition with more deaths registered in hypertensive patients. Clinical signs and symptoms in Covid-19 patients varied greatly between hypertensive and non-hypertensive patients, with a leaning favouring the latter. The risk of death due to Covid-19 among hypertensive patients increased with age and meaningfully associated with underlining comorbidities such as HIV, TB, cardiovascular, and liver disease. Conclusion Our study reveals predictive factors for mortality in COVID-19 hypertensive patients that can be used by policy makers and health care practioners to identify those at a higher risk and determine proper treatment approach to achieve best possible clinical outcomes.

Background: The association between maternal serum copper levels and premature rupture of membranes (PROM) is debated. Aims: This study aims to study the relationship between maternal serum copper levels and the incidence of PROM and to determine risk factors of PROM in Aleppo University Hospital of Obstetrics and Gynecology. Settings and Design: Sixty pregnant women were subjected for this study. Materials and Methods: Pregnant women were subjected for analyzing serum copper concentrations. Maternal serum copper levels were measured by atomic absorption spectroscope. Statistical Analysis: By SPSS (version 22.0). Results: A significant correlation was found between maternal serum copper levels and the incidence of PROM. The relationship presents when copper level is considered as a categorical variable, as mothers with copper deficiency were significantly more vulnerable for PROM (Odds ratios = 0.15, confidence intervals: 0.04–0.61, P = 0.002). Furthermore, the relationship presents when copper level is considered as a numerical variable, as mothers with lower serum copper levels were at significantly higher risk to develop PROM. Difference in means between the two groups was 40.87 μg/dL with CI (14.98–66.75) μg/dL (P = 0.003). Conclusion: Within its limitations, this study suggests a significant relationship between maternal serum copper levels and PROM.

Background Each year, the current level of modern contraceptive use averts 188 million unintended pregnancies, which in turn results in 112 million fewer abortions. Of the 867 million women in the developing world who are sexually active and want to avoid becoming pregnant, approximately 222 million of them have an unmet need for modern contraception. In spite of several advantages and potential effectiveness of Intra Uterine Contraceptive Device, its utilization still too low in Sub Saharan African countries including Ethiopia. Objectives To identify the determinant factors for utilization of intra uterine contraceptive device among women visiting primary health care facilities in Mekelle city. Method Facility based unmatched case-control study design was conducted among 234 women (78 cases and 156 controls). Data was collected by structured questionnaire. Data entry and cleaning was done using EPI- Info version 5.3.1 and analysis done using SPSS version 20.0 statistical software. During analysis the variables were defined, categorized and the difference in variables was determined. Odds ratio used to show degree of association between independent variables with Intra Uterine Contraceptive Device. Result Marital status ([AOR (95%CI) =8.59(2.60–28.43)], number of pregnancies (AOR (95%) CI = 5.69(1.020–31.802), number of alive children [AOR (95%CI) =3.5 (1.03–11.9) are variables continued to have statistically significant association with use of Intra Uterine Contraceptive Device. Other determinants found to have significant association includes awareness about Intra Uterine Contraceptive Device, visual exposure to Intra Uterine Contraceptive Device, and participants told about availability of health care provider able to insert Intra Uterine Contraceptive Device. Conclusion This study has identified marital status, Gravidity, number of alive children and awareness to Intra Uterine Contraceptive Device as major determinants for use of Intra Uterine Contraceptive Device. Thus, it is vital at addressing the aforementioned determinants will be vital to improve utilization of Intra Uterine Contraceptive Device. Plain English summary Among long acting reversible modern contraceptive methods, Intra Uterine Contraceptive Devices (IUCDs) are the most reliable and effective as well as with fewer side effects. Despite these advantages and cost effective potential of Intra Uterine Contraceptive Device its utilization is still too low in Sub Saharan countries like Ethiopia. Thus, this study intended to identify the factors that limit the utilization of Intra Uterine Contraceptive Device among women of Ethiopia in Mekele City. The study identify that the utilization of Intra Uterine Contraceptive Device was determined by the marital status of the women, the number of previous pregnancy and recent alive children and the level of awareness about Intra Uterine Contraceptive Device of the women. Therefore, providers training that focus on promoting Intra Uterine Contraceptive Device, centering on increasing awareness and practice about Intra Uterine Contraceptive Device is very important.

The objective of this study was to assess the association between dietary patterns and risk of hepatocellular carcinoma (HCC) among US adults in a hospital-based case-control study. We analyzed data from 641 cases and 1002 controls recruited at The University of Texas MD Anderson Cancer Center during 2001–2018. Cases were patients with a pathologically or radiologically confirmed new diagnosis of HCC, controls were cancer-free spouses of patients with cancers other than gastrointestinal, lung, liver, or head and neck cancer. Cases and controls were frequency-matched by age and sex. Dietary patterns were identified by principal component analysis. Odds ratios (ORs) and corresponding confidence intervals (CIs) were computed using unconditional logistic regression with adjustment for major HCC risk factors, including hepatitis B virus and hepatitis C virus infection. A vegetable-based dietary pattern was inversely associated with HCC risk (highest compared with lowest tertile: OR 0.66, 95% CI 0.46–0.94). A Western diet pattern was directly associated with HCC risk (highest compared with lowest tertile: OR 1.79, 95% CI 1.19–2.69). These findings emphasize the potential role of dietary intake in HCC prevention and clinical management.

Background Congenital hypothyroidism (CH) is the most important cause of mental and physical retardation in newborns. The prevalence of CH has been reported high in East Azerbaijan province of Iran. However, the risk factors for CH are poorly understood. This study aimed to determine and compare risk factors for permanent and transient CH in East Azerbaijan, Iran. Methods A case-control study was conducted in the Iranian national screening program for CH. This study included 680 neonates: 340 neonates with confirmed CH and 340 matched healthy controls born at the same period and from the same residential area as the cases. Multiple logistic regression analyses were used to estimate the crude and adjusted odds ratios and 95% confidence intervals for the association between different risk factors and transient and permanent CH. Results Out of the 680 participants, 364 (53.53%) were male. Family history of CH (OR = 5.09, 95% CI: 1.66–15.63), neonatal jaundice (OR = 3.89, 95% CI: 2.36–6.43) and parental consanguineous relation (OR = 2.19, 95% CI: 1.51–3.17) were associated with an increased risk of permanent CH. Likewise, the use of Betadine in pregnancy (OR = 4.87, 95% CI: 1.45–16.28), family history of CH (OR = 5.98, 95% CI: 2.04–17.48), neonatal jaundice (OR = 2.81, 95% CI: 1.75–4.52), parental consanguineous relation (OR = 3.86, 95% CI: 1.92–5.74), and gestational age at birth (OR = 3.2, 95% CI: 1.90–5.41) were identified as risk factors for transient CH. Conclusion Family history, neonatal jaundice, gestational age at birth, and Betadine usage in pregnancy are associated with CH.

Background: American cutaneous leishmaniasis (CL) is a neglected tropical disease typically associated with men working in remote, sylvatic environments. We sought to identify CL risk factors in a highly deforested region where anecdotal reports suggested an atypical proportion of women and children were infected with CL raising concern among authorities that transmission was shifting towards domestic spaces and population centers. Methods: We describe the characteristics of CL patients from four participating clinics after digitizing up to 10 years of patient data from each clinic’s CL registries. We assessed risk factors of CL associated with intradomestic, peridomestic, or non-domestic transmission through a matched case-control study with 63 patients who had visited these same clinics for CL (cases) or other medical reasons (controls) between January 2014 and August 2016. The study consisted of an in-home interview of participants by a trained field worker using a standard questionnaire. Risk factors were identified using bivariable and multivariable conditional logistic regression. Results: Between 2007 and 2016, a total of 529 confirmed CL positives were recorded in the available CL registries. Children and working aged women made up 58.6% of the cases. Our final model suggests that the odds of sleeping in or very near an agricultural field were five times greater in cases than controls (p = 0.025). Survey data indicate that women, children, and men have similar propensities to both visit and sleep in or near agricultural fields. Conclusions: Women and children may be underappreciated as CL risk groups in agriculturally dependent regions. Despite the age-sex breakdown of clinical CL patients and high rates of deforestation occurring in the study area, transmission is mostly occurring outside of the largest population centers. Curbing transmission in non-domestic spaces may be limited to decreasing exposure to sandflies during the evening, nighttime, and early morning hours. Our paper serves as a cautionary tale for those relying solely on the demographic information obtained from clinic-based data to understand basic epidemiological trends of vector-borne infections. Antecedentes: la leishmaniasis cutánea americana (LC) es una enfermedad tropical desatendida que se asocia típicamente con hombres que trabajan en entornos selváticos remotos. Buscamos identificar los factores de riesgo de CL en una región altamente deforestada donde los informes anecdóticos sugirieron que una proporción atípica de mujeres y niños estaban infectados con CL, lo que generó preocupación entre las autoridades de que la transmisión se estaba desplazando hacia los espacios domésticos y los centros de población. Métodos: Describimos las características de los pacientes con CL de cuatro clínicas participantes después de digitalizar hasta 10 años de datos de pacientes de los registros de CL de cada clínica. Evaluamos los factores de riesgo de CL asociados con intradoméstico, peridoméstico, o transmisión no doméstica a través de un estudio de casos y controles emparejados con 63 pacientes que habían visitado estas mismas clínicas por CL (casos) u otras razones médicas (controles) entre enero de 2014 y agosto de 2016. El estudio consistió en una entrevista en el hogar de participantes por un trabajador de campo capacitado utilizando un cuestionario estándar. Los factores de riesgo se identificaron mediante regresión logística condicional bivariable y multivariable. Resultados: Entre 2007 y 2016 se registraron un total de 529 CL positivos confirmados en los registros de CL disponibles. Los niños y las mujeres en edad laboral constituían el 58,6% de los casos. Nuestro modelo final sugiere que las probabilidades de dormir en o muy cerca de un campo agrícola eran cinco veces mayores en los casos que en los controles (p = 0,025). Los datos de las encuestas indican que las mujeres, los niños, y los hombres tienen propensiones similares tanto a visitar como a dormir en o cerca de campos agrícolas. Conclusiones: Las mujeres y los niños pueden ser subestimados como grupos de riesgo de CL en las regiones dependientes de la agricultura. A pesar del desglose por edad y sexo de los pacientes clínicos con LC y las altas tasas de deforestación que ocurren en el área de estudio, la transmisión ocurre principalmente fuera de los centros de población más grandes. Frenar la transmisión en espacios no domésticos puede limitarse a disminuir la exposición a los flebótomos durante la tarde, la noche y las primeras horas de la mañana. Nuestro artículo sirve como una advertencia para quienes confían únicamente en la información demográfica obtenida de los datos clínicos para comprender las tendencias epidemiológicas básicas de las infecciones transmitidas por vectores.

We aimed to assess if subjects with diabetes exhibit higher prevalence of chronic back pain than age-sex-province of residence-matched non-diabetic controls. We also aimed to identify predictors for chronic neck pain (CNP) or chronic low back pain (CLBP) among subjects with diabetes. A case control study was conducted using data obtained from the Spanish National Health Survey 2017. Multivariable conditional and unconditional logistic regression models were constructed. A total of 2095 diabetes sufferers and 2095 non-diabetic matched controls were analyzed. The prevalence of CNP and CLBP was 27.3% and 34.8%, respectively, in diabetes sufferers and 22.1% and 29.0% in non-diabetes controls (both, p &lt, 0.001). After multivariable analysis, the ORs showed significantly higher adjusted risk of CNP (OR 1.34, 95% CI 1.19&ndash, 1.51) and CLBP (OR 1.19, 95% CI 1.09&ndash, 1.31) in diabetes cases. Diabetes sufferers with CNP or CLBP showed higher use of pain medication and higher prevalence of migraine/frequent headache than controls. Female sex, worse self-rated health and use of pain medication were predictors for CNP and CLBP in subjects with diabetes. CNP and CLBP are significantly more prevalent in diabetes sufferers than in controls. Current results can help to design better preventive and educational strategies for these highly prevalent and burdensome pains among diabetic patients.

Background: Preeclampsia has been a major problem for obstetric care in Indonesia due to risks of preterm birth and lower Apgar score. Objective: This study is to examine relationships of preeclampsia, preterm births, and Apgar Score. Methods: This used an analytic study with retrospective case-control design in Dr. Soetomo Academic Hospital. A case group was taken by total sampling from medical records of all patients who had preterm delivery in 2017, and a control group of term deliveries was taken by random sampling. Then the data were analysed by using Chi-square test and Fisher’s Exact Test. Results: There were 80 samples for each group. 63.75% of patients by age of 20-35 years were who delivered preterm birth, 40.00% had normal BMI, 40.00% were nulliparous, 92.50% did not have history of preterm labour, 50.00% had preeclampsia with severe features, and 46.25% had spontaneous vaginal delivery. Around 47.14% neonates from preeclamptic women were born at 32

Background The incidence of premature rupture of membranes ranges from about 5% to 10% of all deliveries. A woman with premature rupture of membranes is at risk of intra-amniotic infection, postpartum infection, endometritis, and death. A neonate born from premature rupture of membranes mother is at high risk of respiratory distress syndrome, sepsis, intraventricular hemorrhage and death. Little is known regarding the risk factors in Ethiopia. Therefore, this study was conducted to identify risk factors of premature rupture of membranes among pregnant women admitted to public hospitals in Mekelle city, Tigray, Ethiopia. Methods Hospital based unmatched case control study design was implemented on 240 samples (160 controls and 80 cases) from pregnant mothers admitted to public hospitals in Mekelle city from February – April/2016. Data was collected by interviewer administered Structured questionnaire and checklist. Binary logistic regression model was used to see the association between dependent and independent variables and multivariable logistic regression was used to identify the independent predictors of premature rupture of membranes. Results A total of 160 controls and 80 cases were enrolled in the study. Multivariable logistic regression showed that history of abortion [AOR 3.06 (CI: 1.39, 6.71)], history of PROM [AOR 4.45 (CI: 1.87, 10.6)], history of caesarean section [AOR 3.15(CI: 1.05, 9.46)] and abnormal vaginal discharge in the index pregnancy [AOR 3.31(CI: 1.67, 6.56)] were positively associated with premature rupture of membranes. Conclusions Past obstetric history and risks in the index pregnancy have an association with premature rupture of membranes. The finding of the study suggests early identification and treatment of genitourinary infection.

Background The aim of this study was to evaluate the prediction factors for perforated peptic ulcer (PPU). Methods At St. Luke’s International Hospital in Tokyo, Japan, a case control study was performed between August 2004 and March 2016. All patients diagnosed with PPU were included. As control subjects, patients with age, sex and date of CT scan corresponding to those of the PPU subjects were included in the study at a proportion of 2 controls for every PPU subject. All data such as past medical histories, physical findings, and laboratory data were collected through chart reviews. Univariate analyses and multivariate analyses with logistic regression were conducted, and receiver operating characteristic curves (ROCs) were calculated to show validity. Sensitivity analyses were performed to confirm results using a stepwise method and conditional logistic regression. Results A total of 408 patients were included in this study; 136 were a group of patients with PPU, and 272 were a control group. Univariate analysis showed statistical significance in many categories. Four different models of multivariate analyses were conducted, and significant differences were found for muscular defense and a history of peptic ulcer disease (PUD) in all models. The conditional forced-entry analysis of muscular defense showed an odds ratio (OR) of 23.8 (95% confidence interval [CI]: 5.70–100.0), and the analysis of PUD history showed an OR of 6.40 (95% CI: 1.13–36.2). The sensitivity analysis showed consistent results, with an OR of 23.8–366.2 for muscular defense and an OR of 3.67–7.81 for PUD history. The area under the curve (AUC) of all models was high enough to confirm the results. However, anticoagulants, known risk factors for PUD, did not increase the risk for PPU in our study. The conditional forced-entry analysis of anticoagulant use showed an OR of 0.85 (95% CI: 0.03–22.3). Conclusions The evaluation of prediction factors and development of a prediction rule for PPU may help our decision making in performing a CT scan for patients with acute abdominal pain.

Introduction Various researches have stated the correlation between serum uric acid (sUA) and cardiovascular disease (CVD); however, no local studies are available. In this study, we will determine the prevalence of hyperuricemia in patients with acute myocardial infarction and compare with the control group. Methods This case-control study was conducted from March to November 2019 in the tertiary care hospital in Pakistan. In all, 119 patients with acute myocardial infarction were enrolled in this study, and 119 controls were identified from the outpatient department. Their sUA levels were measured within 24 hours of acute myocardial infarction. Results The mean sUA levels were significantly higher in patients with acute myocardial infarction (AMI) in comparison to the control group (6.17 ± 2.12 vs. 5.51 ± 1.89, p-value; 0.01). Overall, there were more patients with hyperuricemia in the case group compared to the control group (47.89% vs. 33.6%, p-value = 0.04) Conclusion In this study, after adjustment of other known factors, hyperuricemia is associated with AMI. Efforts should be made to include screening for hyperuricemia in patients with a high risk of myocardial infarction.

Objective To our knowledge, the independent association between central obesity, defined by waist circumference (WC) or waist-to-hip ratio (WHR), and diabetic retinopathy (DR) remains unknown in Chinese individuals. Method The study was conducted in two stages. First, the relationship between WC or WHR and DR was estimated in a case-control set (DR vs. non-DR) for the whole population before and after propensity score matching. Subsequently, a systematic review and meta-analysis was performed on evidence from the literature to validate the relationship. Results Of 511 eligible patients, DR (N = 156) and non-DR (N = 156) patients with similar propensity scores were included in the propensity score matching analyses. Central obesity (defined by WC) was associated with risk of DR (odds ratio [OR] 1.07, 95% confidence interval [95% CI] (1.03–1.10). The meta-analysis showed that central obesity significantly increased the risk of DR by 12% (OR 1.12, 95% CI 1.02–1.22). Analysis of data from 18 studies showed a significant association between continuous body mass index and risk of proliferative DR (OR 0.95, 95% CI 0.93–0.98; I2 = 50%). Conclusion Central obesity, particularly as defined by WC, is associated with the risk of DR in the Chinese population.

Background It is unclear whether benzodiazepines increase the risk of suicide. The aim of this study was to test the hypothesis that benzodiazepines are associated with an increased risk of suicide, by comparing psychopharmacological interventions between psychiatric patients who committed suicide and a group of matched controls. Methods The case group comprised 154 psychiatric patients (101 men, 53 women; age range: 13–96 years) who had committed suicide in Örebro County, Sweden. Control psychiatric patients matched by age, sex, and main psychiatric diagnosis were selected for each case. Binary logistic regression was used to calculate odds ratios in unadjusted and adjusted models. Results Benzodiazepine prescriptions were more common among cases than controls (65/154 [42.2%] versus 43/154 [27.9%], p = 0.009, odds ratio: 1.89 [95% CI: 1.17–3.03]). This association remained significant in a model adjusted for previous suicide attempts and somatic hospitalizations (odds ratio: 1.83 [95% CI: 1.06–3.14]). No statistically significant differences were seen between the groups in the use of any other subtype of psychopharmaceutical agent. Conclusions These data indicate that benzodiazepine use may increase the risk of suicide. However, this study is limited by the potential for indication bias.

Introduction:on April 17/2017 Janamora district, Amhara regional state health officials reported an increasing number of people with a cough. The objectives of this study was to investigate the outbreak, describe risk factors and implement control measures. Methods:we conducted a community based unmatched 1:1 case-control study April 22-May 10, 2017. We used a probable case definition (≥2 weeks cough with vomiting, apnea, or inspiratory whoop) to identify suspected pertussis cases. Neighbors of cases were considered as controls. We conducted a door-to-door active case search and reviewed medical records, assessed vaccination status by parental interview or vaccination card. We implemented multivariable logistic regression to identify independent factors associated with the outbreak. Results:we investigated 60 cases and 60 controls. Most (68.3%) of the cases were under the age of 15. The majority (86.6%) of pertussis suspected cases, and 83.4% controls had not received any pertussis vaccine. The overall attack rate was 0.13% and the case fatality rate was 3.3%. The age-specific attack rate for under-five children was 0.33%. Females were more likely to have pertussis (AOR: 2.91; 95% CI: 1.17-7.22), contact with pertussis suspected person (AOR: 6.29; 95% CI: 2.53-15.62) and living in a relatively poorly ventilated house (AOR: 3.01; 95% CI: 1.17-7.70) were also significant risk factors of pertussis. Conclusion:weak supplementary immunization activities might have contributed to the outbreak. Treating household contacts and integration of diagnostic laboratory test of pertussis into the local health system is of paramount importance to detect outbreaks early on.

Objective The aim of this study was to assess the occurrence of malaria outbreak and investigate contracting factors of malaria in Simada District, Northwest Ethiopia. A single observation original research. Results Among the total 54 cases, 44 (81.5%) of them were confirmed malaria cases. The average attack rate was 20 per 100 and slide positivity rate was 81.5%. People in the age group of 5–14 years were most affected with an attack rate of 37%. Presence of water bodies for mosquito breeding inside less than 1 km radius (AOR = 3.32, 95% CI 1.18–9.34), no knowledge on transmission, prevention and control mechanisms of malaria (AOR = 4.36, 95% CI 1.64, 12.23), not using Insecticide Treated Bed Net (AOR = 5.85, 95% CI 1.94, 17.54) and absence of environmental control (AOR = 10.01, 95% CI 2.94, 33.33) were factors associated with malaria outbreak. Electronic supplementary material The online version of this article (10.1186/s13104-019-4315-z) contains supplementary material, which is available to authorized users.

Background Globally in 2015 about 214 million malaria cases and 438,000 deaths were reported with 75% were from Sub-Saharan Africa. Malaria transmission in Ethiopia is unstable, and outbreaks are considered public health emergencies. Understanding the trigger for outbreaks in low-transmission areas can help facilitate malaria elimination. On July 8th malaria outbreak was reported from Laelay Adyabo district. The objective was to investigate the magnitude and associated factors with malaria outbreak. Methods We defined a case as confirmed malaria using microscopy or a rapid diagnostic test for Plasmodium parasites in a resident of Laelay-Adyabo District from July 9–28, 2017. We identified cases by reviewing health facility records and conducted a case-control study using randomly-selected cases from a line list, and two neighborhood controls per case. A pretested semi-structured questionnaire adapted from WHO malaria guidelines was used to collect data from case-patients and controls. We calculated crude (COR) and adjusted (AOR) odds ratios to identify factors associated with malaria. Result A total of 145 confirmed malaria cases (57.9% males) were identified with village attack rate (AR) of 12.1/1000. The AR was higher among males than females (14.1 verses 10.1/1000), children aged 5–14 years (12.9/1000), and in Zelazle Kebelle (13.6/1000 population). Wearing protective clothing (AOR = 0.27, 95% CI 0.11–0.66), having good knowledge of malaria transmission (AOR = 0.25, 95% CI 0.08–0.75), having waste collection material at home (AOR = 0.25 95% CI 0.11–0.61), availability of mosquito breeding sites around home (AOR = 9.08, 95% CI 3.6–22.93), and staying outdoor overnight (AOR = 3.7, 95% CI 1.44–9.56) were independently associated with malaria. Conclusion The overall attack rate for malaria during this outbreak was high affecting > 1% of the population. Wearing protective clothing at night, knowing about malaria transmission, having mosquito breeding sites around the home, staying outdoors overnight, and having waste collection material in their house were predictors of the infection. Laelay Adyabo district health office should provide health education on malaria transmission and prevention measures and how to clear mosquito breeding sites. Electronic supplementary material The online version of this article (10.1186/s12889-019-6798-x) contains supplementary material, which is available to authorized users.

Iron deficiency anemia (IDA) is the most common type of anemia. Impaired iron absorption can be caused by a decrease in trace elements as zinc, which is found in the structure of enzymes that coordinate or catalyst iron metabolism. The aim of this study is to detect if zinc deficiency is associated with IDA and to determine the effect of associated zinc deficiency on symptoms of IDA in adult IDA patients. This case-control study included 30 IDA patients with matched healthy control group (n = 30) for age and sex. For each subject, the parameters were evaluated: hemoglobin (Hb); mean corpuscular volume (MCV), total iron binding capacity (TIBC), serum iron, serum ferritin (SF). Serum zinc levels were measured by atomic absorption method with the PerkinElmer Analyst. Symptoms attributed to iron deficiency or depletion, defined as fatigue, cardiopulmonary symptoms, mental manifestations, epithelial manifestations, and neuromuscular symptoms were recorded. Serum zinc levels were lower in IDA patients (43.4 ± 7.9 mg/dL) than in the control subjects (94.7 ± 16.75 mg/dL; p < 0.0001). Zinc deficiency was associated with worse cardiovascular symptoms (p = 0.04), epithelial symptoms (p = 0.027), and restless leg syndrome (p < 0.001) in patients with IDA. Measurement of zinc levels should be considered for IDA patients. With the help of our study, iron and zinc supplementation instead of only iron replacement may be considered in cases of iron deficiency particularly, in patients with severe epithelial dysfunctions. Further studies are still needed to evaluate the benefit of zinc and iron supplementation in IDA patients.

Background: Maternal mortality is one of health indicators of a country. Based on demographic and health survey in Indonesia in 2012, the data presented the fact that there was a significant increase on maternal mortality which was 359 maternal mortality in every 100,000 live births. Maternal mortality rate indicated a decrease to 305 maternal mortality in every 100,000 live births which was stated as a finding in Intercensal Population Survey in 2015. District of Brebes was one of the districts in the province of Central Java which had the highest maternal mortality in 2016 which was 54 maternal mortality. This research aims to reveal the risk factors that influence maternal mortality. Those are proximate determinants, intermediate determinants and contextual determinants. Subjects and Method: This research was observational analitical study design using a case control. This research was conducted in district of Brebes, Central Java from February to March 2017. Subjects of the research were 162 which were chosen using a table of Sample Size for a Hypothesis Test of the Odds Ratio (1:2), and acquiring 54 cases and 108 controls. The dependent variables were maternal mortality, and the independent variables were maternal education, maternal job, numbers of visits to Antenatal Clinic (ANC), birth attendant, place of delivering babies, high-risk pregnancy, obstetric complications. The data was univariately, bivariately and multivariately analised using a double logistic regression, and then stata 13 path analysis. Results: The results of this research indicated that the risk factors which directly influenced maternal mortality were the amount of visits to ANC

Polymorphisms in the proprotein convertase subtilisin/kexin type 9 (PCSK9) gene are associated with severe hypercholesterolemia and stroke. Here, we investigated the relationship between single nucleotide polymorphisms in PCSK9 and stroke in 237 patients with lacunar infarction in the Uygur and Han populations in Xinjiang Uygur Autonomous Region of China. Using the SNaPshot single-base terminal extension method, four PCSK9 gene polymorphisms were analyzed. We found a significantly strong relationship between the PCSK9 rs17111503 (G > A) polymorphism and increased susceptibility to lacunar infarction by variant homozygote comparison, and using the dominant and recessive models in the Han population but not in the Uygur population. Low triglyceride levels were found in AA carriers (rs17111503, G > A) in the Han population but not in the Uygur population. Association analysis revealed that the rs17111503 (G > A) polymorphism was not significantly associated with smoking, alcohol drinking, history of hypertension or diabetes in the Han or Uygur lacunar infarction patients. rs11583680, rs483462 and rs505151 were not associated with risk of lacunar infarction in the Han or Uygur populations. Our findings suggest that the PCSK9 rs17111503 (G > A) polymorphism is associated with susceptibility to lacunar infarction in the Han population but not in the Uygur population.

Background: Recent evidence suggests an interconnection between chronic periodontal disease and systemic diseases. Aim: The aim of this study is to evaluate the possible association between nonalcoholic fatty liver disease (NAFLD) and inflammatory periodontal disease among north Indian population. Settings and Design: Tertiary health care center, cross-sectional case-control observational study. Materials and Methods: A total of 40 cases, i.e., patients with NAFLD and 40 healthy volunteers were included over a period of 8 months and their periodontal status was compared. The status of their hepatic health was ascertained by anthropometric, imaging, and biochemical evaluation including ultrasound examination of abdomen and transient elastography. Statistical Data Analysis: Paired t-test, multivariate logistic regression analysis using IBM SPSS STATISTICS (version 22.0, Armonk, NY: IBM Corp). Results: The study revealed that only 11.9% and 20% of participants had periodontitis, in healthy controls and hepatic disease patients, respectively. A statistically significant difference was observed in clinical parameters of periodontal status, except for malocclusion. Comparative analysis of tumor necrosis factor-α (TNF-α), interleukin-6, C-reactive protein, and cytokeratin-18 revealed differences in mean scores, though statistically nonsignificant. Only aspartate transaminase, number of missing teeth, and bleeding on probing (BOP) were observed with higher odds ratios for hepatic disease patients. Spearman correlation analysis revealed significant positive correlations between TNF-α and BOP, for cases. Conclusion: Patients with hepatic disease showed a higher prevalence of periodontal disease, worse oral hygiene and periodontal health status compared to healthy individuals.

Background Benshangul Gumuze region is one of the regional states in Ethiopia, with highest rate of neonatal mortality rate. The trend increased at alarming rate from 42/1000 live birth in 2005 to 62/ 1000 live birth in 2011. Hence, identifying predictors of neonatal death and implement evidence based interventions at community level is crucial to reduce the mortality. Therefore, the purpose of this study was to identify predictors of neonatal mortality in Assosa zone, Western Ethiopia. Methods A community based matched case control study was conducted from February 1, until December 30, 2013. The study included 114 cases who died during the first 28 completed days after birth from September 1, 2010 till September 1, 2013. For each case, one alive control matched approximately by the same date of birth (−/+ 2 days) was identified from the preliminary data collected. Finally, multivariate conditional logistic regression analysis was performed; and goodness of fit of the final model was tested using likely hood ratio test. All analysis was done using EPI Info version 7 and SPSS version 16 statistical softwares. Results Model households in health extension packages [AmOR = 0.32; 95%CI:0.12–0.86], age at first pregnancy

Background Per- and poly- fluoroalkyl substances (PFASs) are a large family of synthetic chemicals, some of which are mammary toxicants and endocrine disruptors. Their potential as breast carcinogens is unclear. Our objective was to evaluate the risk of breast cancer associated with serum PFAS concentrations in a nested case-control study within the California Teachers Study. Methods Participants were 902 women with invasive breast cancer (cases) and 858 with no such diagnosis (controls) who provided 10 mL of blood and were interviewed during 2011–2015, an average of 35 months after case diagnosis. PFASs were measured using automated online SPE-HPLC-MS/MS methods. Statistical analyses were restricted to six PFASs with detection frequencies ≥ 95%: PFOA (Perfluorooctanoic acid), PFNA (Perfluorononanoic acid), PFUnDA (Perfluoroundecanoic acid), PFHxS (Perfluorohexane sulfonic acid), PFOS (Perfluorooctane sulfonic acid), and MeFOSAA (2-(N-Methyl-perfluorooctane sulfonamido) acetic acid. Unconditional logistic regression was used to calculate adjusted odds ratios (ORs), estimating the breast cancer risk associated with each PFAS. Results For all cases of invasive breast cancer, none of the adjusted ORs were statistically significant but marginally significant ORs

Background The incidence of premature rupture of membranes ranges from about 5% to 10% of all deliveries. A woman with premature rupture of membranes is at risk of intra-amniotic infection, postpartum infection, endometritis, and death. A neonate born from premature rupture of membranes mother is at high risk of respiratory distress syndrome, sepsis, intraventricular hemorrhage and death. Little is known regarding the risk factors in Ethiopia. Therefore, this study was conducted to identify risk factors of premature rupture of membranes among pregnant women admitted to public hospitals in Mekelle city, Tigray, Ethiopia. Methods Hospital based unmatched case control study design was implemented on 240 samples (160 controls and 80 cases) from pregnant mothers admitted to public hospitals in Mekelle city from February – April/2016. Data was collected by interviewer administered Structured questionnaire and checklist. Binary logistic regression model was used to see the association between dependent and independent variables and multivariable logistic regression was used to identify the independent predictors of premature rupture of membranes. Results A total of 160 controls and 80 cases were enrolled in the study. Multivariable logistic regression showed that history of abortion [AOR 3.06 (CI: 1.39, 6.71)], history of PROM [AOR 4.45 (CI: 1.87, 10.6)], history of caesarean section [AOR 3.15(CI: 1.05, 9.46)] and abnormal vaginal discharge in the index pregnancy [AOR 3.31(CI: 1.67, 6.56)] were positively associated with premature rupture of membranes. Conclusions Past obstetric history and risks in the index pregnancy have an association with premature rupture of membranes. The finding of the study suggests early identification and treatment of genitourinary infection.

Background Zimbabwe is on track towards achieving viral suppression among adults (87%). However, adolescents have only achieved 44% by 2016. In Harare city, 57% of adolescents had attained viral suppression after 12 months on ART compared to 88% among adults. We determined factors associated with virological failure among adolescents (age 10–19 years) on antiretroviral therapy (ART) in Harare city. Methods We conducted a one to one unmatched case control study among 102 randomly recruited case: control pairs at the two main infectious disease hospitals in Harare. A case was any adolescent who presented with VL > 1000c/ml after at least 12 months on ART. A control was any adolescent who presented with VL

Objective Although cervical cancer is a preventable disease, it remains a leading cause of death among women in developing countries. In this unmatched case control design, 55 cases and 109 controls were included. The main objective of this study was to assess the risk factors of precancerous cervical lesion in Adama town. Results A total of 164 participants were recruited in this study. Of the 109 controls, 64 (61%) and 41 (39%) of cases were using oral contraception. Women who were using oral contraception were two times at risk for developing precancerous cervical lesion than who were not using (COR = 2.059 95% CI 1.006, 4.216; AOR = 2.342). Out of 55 cases, 21 (38.2%) cases had a history STI and out of 109 controls, 24 (22.2%) controls had a history of STI. It was revealed that STI has a significant association for developing of precancerous lesion. Women who had a history of STI were two times at risk of developing precancerous cervical lesion than who had no (COR = 2.187; AOR = 2.485). It was found that initiation of sexual intercourse before the age of 15 years has 5.6 risks to develop precancerous cervical lesion (COR = 5.625 AOR = 6.703). Electronic supplementary material The online version of this article (10.1186/s13104-018-3244-6) contains supplementary material, which is available to authorized users.

Background Purpose of this study was to investigate differences between primiparous term pregnancies, one leading to vaginal delivery (VD) and the other to acute cesarean section (CS) due to labor dystocia in the first stage of labor. We particularly wanted to assess the influence of body mass index (BMI) on CS risk. Methods A retrospective case-control study in a tertiary delivery unit with 5200 deliveries annually. Cases were 296 term primiparous women whose intended vaginal labor ended in acute CS because of dystocia. Controls were primiparas with successful vaginal delivery VD (n = 302). The data were retrieved from medical records. Multiple logistic regression analyses were used to assess the associations between BMI and covariates on labor dystocia. Results In the cases ending with acute CS, women were older (OR 1.06 [1.03–1.10]), shorter (OR 0.94 [0.91–0.96]) and more often had a chronic disease (OR 1.60 [1.1–2.29]). In this group fetal malposition (OR 42.0 [19.2–91.9]) and chorioamnionitis (OR 10.9 [5.01–23.6]) were more common, labor was less often in an active phase (OR 3.37 [2.38–4.76]) and the cervix was not as well ripened (1.5 vs. 2.5 cm, OR 0.57 [0.48–0.67] on arrival at the birth unit. BMI was higher in the dystocia group (24.1 vs. 22.6 kg/m2, p < 0.001), and rising maternal pre-pregnancy BMI had a strong association with dystocia risk. If BMI increased by 1 kg/m2, the risk of CS was 10% elevated. Among obese primiparas, premature rupture of membranes, chorioamnionitis and induction of labor were more common. Their labors were less often in an active phase at hospital admission. Severely obese primiparas (BMI ≥ 35 kg/m2) had 4 hours longer labor than normal-weight parturients. Conclusions Labor dystocia is a multifactorial phenomenon in which the possibility to ameliorate the condition via medical treatment is limited. Hospital admission at an advanced stage of labor is recommended. Pre-pregnancy weight control in the population at reproductive age is essential, as a high BMI is strongly associated with labor dystocia.

Background: Despite considerable loss of life by deliberate self-burning in low and middle-income countries, few scholars have examined psychiatric factors such as adverse life events that may be related to self-immolation. Methods: This case-control study investigated adverse life-events as risk factors for self-immolation patients admitted to a burn center serving the western region of Iran. Variables inves-tigated included the following adverse life-events: unplanned pregnancy, infertility, homelessness, financial hardship, problems with friends, intimate relationship break-up , school or university failure, anxiety about school/university performance, problems at work, personal history of suicide attempts, family history of suicide attempts, individual history of mental disorders, and malignant disease. Results: Financial hardship (OR=3.35, 95% CI=1.19-9.90), intimate relationship break-up (OR=5.45, 95% CI=1.20-11.99), and personal history of suicide attempts (OR=7.00, 95% CI=1.38-35.48) were associated with increased risk of self-immolation. Conclusions: This study suggests that financial hardship, intimate relationship break-ups, and personal history of suicide attempts are risk factors for self-immolation. Other variables studied did not play a role as individually protective or risk factors for self-immolation. Further study is needed to substantiate findings of this study and direct research toward tailoring culturally sensitive, empirically-supported interventions for prevention of self-immolation.

Psychosocial stress and vulvovaginal Candidiasis among female sex workers in Banyumas PurposeThis study aimed to determine the relationship between psychosocial stress with candidiasis vulvovaginalis (KVV) incidence in female sex workers (FSW).MethodsThe research design was a case control study conducted in health center clinics in the Banyumas District. The sample size was 164 FSW (82 cases & 82 control). The research instrument was structured questionnaires, Social Readjustment Rating Scale (SRRS), laboratory equipment and microscopes for inspection KVV. Data analysis used logistic regression tests to calculate odds ratios (OR), confidence interval (CI), and p value.ResultsThe multivariate analysis showed that stress was not KVV risk factors, and the risk factors that contribute to the occurrence of KVV in FSW were oral sex (OR = 3.31, 95% CI = 1.60 to 6.83, p-value = 0.001) and smoking more than 10 cigarettes/day (OR = 2.33, 95% CI = 1.2 to 4.59, p-value = 0.014).ConclusionsThe risk factors of KVV were oral sex and smoking ≥ ten cigarettes/day. We recommend to avoid oral sex and smoking < ten cigarettes/day to avoid the risk of KVV infection., Latar belakang: Kandidiasis vulvovaginal (KVV) adalah infeksi mukosa yang disebabkan oleh spesies Candida dan merupakan salah satu masalah klinis yang paling umum pada wanita usia produktif. Wanita pekerja seks (WPS) merupakan kelompok berisiko tinggi untuk mengalami KVV. Prevalensi KVV di Indonesia pada WPS berkisar antara 12-33%. Kejadian KVV pada WPS di Kabupaten Banyumas tahun 2011 (33,3%5), 2012 (54,6%), 2013 (61%). Stres dapat melemahkan sistem imun, sehingga meningkatkan kerentanan terhadap penyakit termasuk KVV. WPS juga memiliki kerentanan terhadap stres. Penelitian ini bertujuan untuk mengetahui hubungan antara stres psikososial dengan kejadian KVV pada WPS.Metode: Penelitian analitik observasional dengan rancangan case control dilakukan di klinik IMS di Kabupaten Banyumas. Besar sampel sebanyak 164 WPS (82 kasus dan 82 kontrol). Instrumen penelitian adalah kuesioner terstruktur, kuesioner stress Social Readjustment Rating Scale (SRRS), timbangan berat badan, mikrotoise, serta peralatan laboratorium dan mikroskop untuk pemeriksaan KVV. Analisis data menggunakan logistic regression untuk menghitung nilai odds ratio (OR), confidence interval (CI), dan p-value. Hasil: Hasil analisis multivariabel menunjukkan bahwa stres tidak signifikan secara statistik. Analisis multivariabel menunjukkan bahwa faktor risiko yang berkontribusi dalam terjadinya KVV pada WPS adalah melakukan hubungan seksual dengan seks oral (OR = 3,31, 95% CI = 1,60-6,83, p-value = 0,001) dan merokok lebih dari 10 batang/hari (OR = 2,33, 95% CI = 1,2-4,59, p-value = 0,014).Kesimpulan: Faktor risiko KVV adalah hubungan seksual dengan seks oral dan merokok ≥ 10 batang/hari. Direkomendasikan untuk menghindari hubungan seksual dengan cara seks oral dan merokok dengan jumlah < 10 batang/hari untuk menghindari risiko infeksi KVV.

Background: Uterine rupture is a major public health problem in low-income countries including Ethiopia. In Ethiopia, its prevalence is low, but it results in devastative health problems of the mother and her baby. Even though the Ethiopian government and nongovernmental organizations tried to strengthen the health care system, significant adverse maternal and fetal outcome is still associated with uterine rupture. The aim of this study was to identify determinants of uterine rupture in Jinka and Arba Minch General Hospitals. Methods: The study was conducted in Jinka and Arba Minch General Hospitals, and the data collection period was 15 to 30 November 2018. A case–control study design was used with simple random sampling of 1:4. Data were collected using data extraction sheets. Variables with p Result: Uterine rupture occurred in 112 cases with 448 controls. Women referred from health facilities (adjusted odds ratio = 8.0, 95% confidence interval: 3.5–17.8), multiparous women (adjusted odds ratio = 12.7, 95% confidence interval: 4.2–39.0), duration of labor more than 18 h (adjusted odds ratio = 11.5, 95% confidence interval: 5.5–24.1), malpresentation (adjusted odds ratio = 3.5, 95% confidence interval: 1.0–8.0) and gestational age of ⩾37 weeks (adjusted odds ratio = 5.2, 95% confidence interval: 1.4–19.3) were independent factors associated with uterine rupture. Conclusion: Mothers referred from health facilities, multiparous women, duration of labor more than 18 h, gestational age of ⩾37 weeks and malpresentation were significantly associated with uterine rupture. Early referral, encouraging family planning, proper use of partograph, early identification and appropriate intervention for malpresentation are recommended.

Related factors for cervical cancer incidence in Dr. Sardjito Hospital in YogyakartaPurposeThis study aimed to determine the factors associated with the incidence of cervical cancer in Dr. Sardjito Hospital.MethodsA case control study was conducted from July to October 2016. A total of 105 cases and 105 controls were included in the study. Cases were patients suffering from cervical cancer based on doctor's diagnosis, and controls were patients who do not have cervical cancer. Sampling was done by consecutive sampling technique. Data were analyzed by chi-square and logistic regression tests.ResultsFactors associated with incidence of cervical cancer in Sardjito hospital were the first age variable for sexual intercourse ≤ 20 years with aOR of 2.41 (95% CI: 1.35-4,29; p=0.003) and use of oral contraceptive/pill with aOR of 3.40 (95% CI: 1.46-7.92; p=0.004), while the number of pairs, parities, pads, circumcision and smoking were not associated with the incidence of cervical cancer.ConclusionWomen who have not been sexually active can vaccinate for HPV. Also, they need to use condoms when having sex. Women aged 30-49 years (sexually active) are expected to be able to follow the early detection program of cervical cancer with visual inspection method of acetic acid which can now be done in health centers and have a pap smear examination at least once a year., Tujuan: Penelitian ini bertujuan untuk mengetahui faktor yang berhubungan dengan kejadian kanker serviks di RSUP Dr. Sardjito Daerah Istimewa Yogyakarta.Metode: Studi case control dilakukan pada bulan Juli-Oktober 2016. Sebanyak 105 kasus dan 105 kontrol dilibatkan dalam penelitian ini. Kasus adalah pasien yang menderita kanker serviks berdasarkan diagnosis dokter , dan kontrol adalah pasien yang tidak menderita kanker serviks. Pengambilan sampel dengan teknik consecutive sampling. Data dianalisis dengan uji chi-square dan regresi logistik. Hasil: Faktor yang berhubungan dengan kejadian kanker serviks di RSUP Dr. Sardjito adalah variabel usia pertama kali berhubungan seksual ≤ 20 tahun dengan aOR sebesar 2,41 (95% CI = 1,35-4,29; p=0,003) dan penggunaan kontrasepsi jenis oral/pil dengan aOR sebesar 3,40 (95% CI = 1,46-7,92; p=0,004), sedangkan jumlah pasangan,paritas, pembalut, sirkumsisi dan merokok tidak berhubungan dengan kejadian kanker serviks.Implikasi praktis: Wanita yang belum aktif seksual dapat melakukan vaksinasi HPV. Perlu menggunakan kondom ketika berhubungan seksual. Bagi wanita usia 30-49 tahun (aktif seksual) diharapkan untuk dapat mengikuti program deteksi dini kanker serviks dengan metode inspeksi visual asam asetat (IVA) yang sekarang bisa dilakukan di Puskesmas dan menjalankan pemeriksaan papsmear minimal 1 kali dalam setahun.

Members of the I-MOVE+ project - Portugal: Baltazar Nunes, Ana Paula Rodrigues, Raquel Guiomar (Infectious Diseases Department, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal), Victor Gomes, Filipa Quaresma, Luis Vale, Teresa Garcia, Teresa Bernardo, Liliana Dias, Paula Fonseca, Helena Amorim, João Rolo, Helena Pacheco, Paula Branquinho, Rita Côrte-Real (Centro Hospitalar de Lisboa Central, Lisbon, Portugal),José Poças, Paula Lopes, Maria João Peres, Rosa Ribeiro, Paula Duarte, Ermelinda Pedroso, Sara Rodrigues, Ana Rita Silvério, Diana Gomes Pedreira, Marta Ferreira Fonseca, (Centro Hospitalar de Setúbal, Setúbal, Portugal). We conducted a multicentre test-negative case-control study in 27 hospitals of 11 European countries to measure 2015/16 influenza vaccine effectiveness (IVE) against hospitalised influenza A(H1N1)pdm09 and B among people aged ≥ 65 years. Patients swabbed within 7 days after onset of symptoms compatible with severe acute respiratory infection were included. Information on demographics, vaccination and underlying conditions was collected. Using logistic regression, we measured IVE adjusted for potential confounders. We included 355 influenza A(H1N1)pdm09 cases, 110 influenza B cases, and 1,274 controls. Adjusted IVE against influenza A(H1N1)pdm09 was 42% (95% confidence interval (CI): 22 to 57). It was 59% (95% CI: 23 to 78), 48% (95% CI: 5 to 71), 43% (95% CI: 8 to 65) and 39% (95% CI: 7 to 60) in patients with diabetes mellitus, cancer, lung and heart disease, respectively. Adjusted IVE against influenza B was 52% (95% CI: 24 to 70). It was 62% (95% CI: 5 to 85), 60% (95% CI: 18 to 80) and 36% (95% CI: -23 to 67) in patients with diabetes mellitus, lung and heart disease, respectively. 2015/16 IVE estimates against hospitalised influenza in elderly people was moderate against influenza A(H1N1)pdm09 and B, including among those with diabetes mellitus, cancer, lung or heart diseases. The I-MOVE+ project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 634446. info:eu-repo/semantics/publishedVersion

Background Although disability is considered the main cause of low bone mineral density (BMD) in multiple sclerosis (MS), other factors related to the disease process or treatment could also be involved. The aim of this study was to assess whether patients with MS are more likely to develop low BMD (osteopenia or osteoporosis) than patients with the non-inflammatory neurological diseases Hereditary Spastic Paraplegia (HSP) and Hereditary Ataxia (HA). Methods We performed a case control study comparing BMD (spine, hip and total body) and biochemical measures of bone metabolism in 91 MS patients and 77 patients with HSP or HA, matched for age, gender and disability. Both patient groups had lived with the disease for at least 10 years. Results In total 74.7% of the patients with MS and 75.3% of the patients with HSP or HA had osteopenia (−2.5

Introduction:Adenocarcinoma in situ (AIS), formerly bronchioloalveolar carcinoma, is an uncommon subtype of lung adenocarcinoma and accounts for approximately 3% to 4% of lung cancers. Compared with other lung cancer histologies, AIS patients are less likely to be smokers, yet associations with other lung cancer risk factors and differences by sex have not been determined.Methods:A total of 338 AIS patients and frequency-matched controls from the parent study (cases = 6039, controls = 2073) were included in these analyses. Odds ratios and 95% confidence intervals as estimates of the relative risk were obtained from multivariable unconditional logistic regression analyses.Results:Risk of AIS was associated with ever smoking (OR = 2.7, 95% confidence intervals: 2.1, 3.6), increased 20% to 30% for each 10-year increase in pack-years of smoking and decreased with increased years since quitting (p for trend

A case control study on farm level was conducted at the Clinic for Ruminants, LMU Munich, to identify possible risk factors associated with the observed increase in numbers of calves showing clinical signs of Bovine Neonatal Pancytopenia (BNP) since 2006 in southern Germany. Interviews were conducted between August 2008 and June 2010. The characteristics of 56 dairy farms with at least one confirmed case of BNP (thrombocytopenia and leukocytopenia and/or typical findings in post-mortem examination and bone marrow histology) were compared with those of two sets of 50 control dairy farms each, with no history of BNP. The first set of 50 control farms was selected randomly from veterinary practices which had never observed a BNP case on the farms they serviced. The second set of 50 control farms was matched by the veterinary practices which had provided case farms. Two separate analyses were conducted: (1) case farms (n = 56) vs. randomly selected control farms (n = 50) and (2) case farms (n = 56) vs. a matched set of control farms (n = 50). All variables with p

INTRODUCTION: stillbirths are more common than the death of a baby after birth. In 2012, Tamale Metropolitan Area in the Northern Region of Ghana reported 35 stillbirths per 1,000 deliveries. This study was therefore conducted to determine the sociodemographic, obstetric and maternal medical health related risk factors associated with stillbirths. METHODS: a 1:1 unmatched case control study was conducted in the Tamale Metropolis. Cases were defined as singleton lifeless babies delivered by resident mothers in Tamale Metropolis at or after 28 weeks of gestation from 1 st January, 2012 to 31 st December, 2013. Controls were those who had live babies within the same period. We abstracted data from maternal health record booklets used in index pregnancies. We also conducted personal interviews with mothers on home visits. We estimated both crude and adjusted odds ratios, 95% confidence intervals and p values. RESULTS: a total of 368 mothers (184 cases and 184 controls) participated in the study. Maternal age of ≤ 24 years, prolonged labour (> 12 hours) and diastolic blood pressure of less than 80mmHg in late pregnancy were significant determinants of stillbirths (aOR = 3.0, 95% CI 1.08 – 8.39; aOR = 3.5, 95% CI 1.94 – 6.61; aOR =2.2, 1.04 – 4.54 respectively). CONCLUSION: low diastolic blood pressure in late pregnancy, young maternal age and prolonged labour were the key determinants of stillbirths in the Tamale Meetropolis. Improvement of community moral practices and discouraging early marriage will help reduce the menace of stillbirths. Monitoring of blood pressure and labour should be prioritized.

Background Infection is a complication of TRUS prostate biopsy, despite the use of antimicrobial prophylaxis. Worryingly the rate of infectious complications following TRUS biopsy has been shown to be increasing. We aimed to determine the rate, severity, risk factors, standard patterns of care and microbiology resistance profiles associated with TRUS biopsy sepsis. Methods A retrospective case–control study was conducted. Using electronic coding all patients who presented to Cabrini Hospital with sepsis following a TRUS biopsy from 2009 to 2013 were identified. Validated cases were matched to controls in a ratio of 1:3. Eligible controls were required to have undergone a TRUS biopsy at the same surgical institution as the case and in the closest period of time. Demographic, procedural and patient related data-points were recorded for all patients using hospital and urologist records. Univariate logistic regression models were constructed and used to determine risk factors associated with infection. Results 71 cases developed sepsis following TRUS biopsy and were matched to 213 controls. The average rate of sepsis over the 5-year study period was 1.5 %. A SOFA score ≥ 2 was identified in 28 % of cases. We found a high prevalence of antimicrobial resistant E. coli, with 61 % of blood culture isolates classified as Multidrug resistant organisms. Eight different prophylactic antimicrobial regimens were identified with 33 % of cases receiving ineffective antimicrobial prophylaxis. Statistically significant risk factors included previous antimicrobial use and prior international travel within the six months prior to biopsy. Conclusions TRUS biopsy is an elective procedure and as such needs to be associated with minimal morbidity. The patterns of care surrounding periprocedural variables for TRUS biopsies were non-uniform and diverse. A wide variety of different prophylaxis regimens and bowel preparation routines were recorded. Patients with risk factors for sepsis may represent a better target population for intervention with alternative preventative strategies. Alternative preventative options include augmented prophylaxis, tailored prophylaxis or the TP biopsy approach either as a first line biopsy modality or based on epidemiological risk factors.

Antenatal care is designed to promote, protect, and maintain the health during pregnancy and reduce maternal and neonatal mortality. The scope of antenatal care also includes the detection and special care for high risk cases as well as the prediction and prevention of complications during pregnancy and childbirth. Complications of pregnancy and childbirth causes of neonatorum asphyxia. Neonatorum asphyxia is a condition where the baby can not breathe spontaneously and regularly after birth. Neonatorum asphyxia cases in Mojokerto district has 46.9% in 2010 and 39.7% in 2014. This aim of this study was to analyze the effect of the quality of antenatal care to neonatorum asphyxia in Mojokerto. The type of this study was observational analytic with case control design with a sample of cases and controls amounted to 80 babies. Data was analyzed using univariate, bivariate and multivariate analysis with logistic regression. The results of this study showed that the quality of antenatal care was significant with neonatorum asphyxia (OR = 8,556; 95% CI:2,777–26,358). Confounding variables associated with neonatorum asphyxia were maternal occupation (OR = 4,558;95% CI:1,391– 14,298), primary education (OR = 21,620; 95% CI: 1,932–241,886), secondary education (OR = 20,977; 95%CI: 1,819–241,872). The conclusion quality of antenatal care has effect of nenatorum asphyxia. Suggestions can be drawn based on the results of this study are for health workers are expected to do health education to the public and families about the importance of antenatal care and antenatal care services that should be obtained from health workers.Keywords: quality of antenatal care, neonatorum asphyxia, case control

Background Several epidemiologic studies have suggested an association between Parkinson’s disease (PD) and exposure to heavy metals using subjective exposure measurements. Objectives We investigated the association between objective chronic occupational lead exposure and the risk of PD. Methods We enrolled 121 PD patients and 414 age-, sex-, and race-, frequency-matched controls in a case–control study. As an indicator of chronic Pb exposure, we measured concentrations of tibial and calcaneal bone Pb stores using 109Cadmium excited K-series X-ray fluorescence. As an indicator of recent exposure, we measured blood Pb concentration. We collected occupational data on participants from 18 years of age until the age at enrollment, and an industrial hygienist determined the duration and intensity of environmental Pb exposure. We employed physiologically based pharmacokinetic modeling to combine these data, and we estimated whole-body lifetime Pb exposures for each individual. Logistic regression analysis produced estimates of PD risk by quartile of lifetime Pb exposure. Results Risk of PD was elevated by > 2-fold [odds ratio = 2.27 (95% confidence interval, 1.13–4.55); p = 0.021] for individuals in the highest quartile for lifetime lead exposure relative to the lowest quartile, adjusting for age, sex, race, smoking history, and coffee and alcohol consumption. The associated risk of PD for the second and third quartiles were elevated but not statistically significant at the α = 0.05 level. Conclusions These results provide an objective measure of chronic Pb exposure and confirm our earlier findings that occupational exposure to Pb is a risk factor for PD.

The major aim of the paper is to give an epidemiologist's viewpoint on several points related to the evaluation of the costs of migraine and to answer some questions that are important if one wishes to decrease the burden of this disease in the general population. In spite of favourable criteria for the management of migraine, and for epidemiologic and economic studies, the relationship between migraine and cost is not so easy to study. The main reason is that this relation is not determinist, which is a condition for the validity of cost-of-illness studies. Personality of migraineurs, belief in efficacy of the healthcare system, efficacy of the first treatment and attitude of the physician interfere with the relationship between migraine and cost. In our opinion, this fact justifies, in addition to cost-of-illness studies, a comparative approach between migraineurs and non-headache subjects to better appreciate the incremental cost related to migraine

Introduction: vaccine preventable diseases account for about 17% of deaths among children below five years in Kenya. Immunization is one the most cost-effective ways of reducing child mortality and morbidity worldwide. In Kenya, national full vaccination coverage today stands at above 80%. However there continue to be pockets of low full vaccination coverage like the catchment area of Alupe Sub-District Hospital which pose a threat to the rest of the country. Methods: this was a case-control study at Alupe Sub-District Hospital, Western Kenya. Sixty one (61) cases and 122 controls were sampled from the facility maternal and child health register by systematic random sampling and traced to their households. Cases were defined as children 12-23 months resident in Kenya who received at least one infant vaccine at the facility but were not fully vaccinated at the time of the study, while controls were children 12-23 months who were fully vaccinated by the time of the study. Pretested structured questionnaires were used for data collection. Data entry and analysis was done using Epi-Info 3.5.4 statistical software. Results: independent determinants of infant vaccination completion were the child's age < 18 months (AOR 4.2(1.8-9.6), p

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria and often attacks lung tissue. Based on observations, the condition of settlements in the Mulyorejo District is very dense and sanitation is not good. This can lead to the occurrence of environmental-based diseases, namely pulmonary TB disease. This research is observational research with a case-control study design. Analysis of the data used is to see the value of OR (Odds Ratio). This research was conducted at the Public health center (PHC) of Mulyorejo on May 23 - November 23, 2016. The sampling technique uses purposive sampling with a ratio of 1: 2, namely 5 houses with pulmonary tuberculosis and 10 houses without pulmonary tuberculosis. Data collection using observation sheets, measurement of physical quality of air, and air sampling using the Haz-Dust model EPAM-5000, then dust samples were sent to the Institute of Tropical Diseases Airlangga University for the examination of Mycobacterium tuberculosis bacteria in the air with PCR Aerosol. Data analysis uses the distribution of frequency tables and crosstab. The results showed that Mycobacterium tuberculosis in the air (OR = 2.667) and physical condition of the home (OR = 2.667) were risk factors for pulmonary TB. It is suggested that the community should improve the physical condition of the house, especially the addition of mechanical ventilation to facilitate air circulation because ventilation affects the temperature and humidity, for houses whose walls are close to neighboring walls can make air vents on the roof. Further research is needed by using more samples and research is needed to find out the factors that cause the Mycobacterium tuberculosis bacteria in the air in the respondent's house both patients and non-patients.

Ellen Eyi Klutsey,1 Augustine Ankomah2 1School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Volta Region, 2Department of Population, Family and Reproductive Health School of Public Health, University of Ghana, Legon, Accra, Ghana Background: Induced abortion rates remained persistently high in the Volta Region of Ghana in the 5 years from 2006 to 2011. Some hospitals, both rural and urban, report induced abortion-related complications as one of the top ten conditions in hospital admissions. This study explored demographic and other factors associated with induced abortion, and also assessed awareness of abortion-related complications among women of reproductive age in the Volta Region. Methods: A quantitative, hospital-based, unmatched case-control study was performed. The Volta Region was stratified into two health administration zones, ie, north and south. For each zone, hospitals were stratified into government and private hospitals. Employing simple random sampling, one private and three government hospitals were selected from each zone. This study is therefore based on eight hospitals, ie, six government hospitals and two private hospitals. Results: Marital status, employment status, number of total pregnancies, and knowledge about contraception were found to be associated with induced abortion. Multiple logistic regression showed a 4% reduction in the odds of induced abortion in married women compared with women who were single (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.07–0.22). Unemployed women of reproductive age were found to be 0.35 times less likely to seek induced abortion compared with their employed counterparts (OR 0.35, CI 0.19–0.65). It was also observed that women with their second pregnancies were 3.8 times more likely to seek induced abortion and women with more than two pregnancies were 6.6 times more likely to do so (OR 3.81, CI 1.94–7.49 and OR 6.58, CI 2.58–16.79, respectively). Women with no knowledge of contraceptive methods were 4.6 times likely to seek induced abortion (OR 4.64, CI 1.39–15.4). Compared with women who had not had induced abortion, women with a high number of pregnancies and no contraceptive knowledge were more likely to have induced abortion. Conclusion: It was found that lack of knowledge about contraceptives and being single or employed were associated with increased likelihood of induced abortion. It was also found that women with a higher number of pregnancies have a greater odds of induced abortion. No association was found between induced abortion and maternal age, education, contraceptive use, or religion. Keywords: induced abortion, case control, maternal mortality, hospital-based, Volta Region, Ghana

Background Few studies have systematically reported the relationship between the risk of breast cancer and family history of other cancers. This study was designed to systematically determine the relationship between breast cancer risk and family history of other cancers in first-degree relatives. Methods Between January 2006 and June 2011, 823 women diagnosed with breast cancer were included, and age-matched women diagnosed with benign breast disease were selected as controls. Family history of other cancers in first-degree relatives was recorded by trained reviewers. Multivariate logistic regression was applied to analyze the relationships. Results A family history of esophagus cancer (OR: 2.70, 95% CI: 1.11 – 6.57), lung cancer (OR: 2.49 95% CI: 1.10 – 5.65), digestive system cancer (OR: 1.79, 95% CI: 1.14 – 2.79) and any cancer (OR: 2.13, 95% CI: 1.49 – 3.04) in first-degree relatives was directly associated with increased breast cancer risk. In subgroup analysis, the risk of hormone receptor positive breast cancer was increased in subjects with a family history of lung cancer (OR: 3.37, 95% CI: 1.45 – 7.82), while the risk of hormone receptor negative breast cancer was increased in subjects with a family history of esophagus cancer (OR: 6.19, 95% CI: 2.30 – 16.71), uterus cancer (OR: 6.92, 95% CI: 1.12 – 42.89), digestive tract cancer (OR: 2.05, 95% CI: 1.03 – 4.10) and gynecology cancer (OR: 6.79, 95% CI: 1.46 – 31.65). Additionally, a significant increase in breast cancer was observed with a family history of digestive system cancer for subjects 50 y and younger (OR: 1.88, 95% CI: 1.03 – 3.43), not for subjects 50 y older (OR: 1.67, 95% CI: 0.86 – 3.25). Conclusions Breast cancer aggregates in families with several types of cancer especially for digestive system cancer. The influence of a family history of other cancers seems more likely to be limited to hormone receptor negative breast cancer.

Pneumonia is an acute infection disease which remains the main killer of children under 5 years old worldwide. Based on Unicef’s report, 17% of all children death is caused by pneumonia. Indonesia was in 10th position of the highest incidence of pneumonia and diarrhea which caused the death of children under 5 years old in 2013. In Gane Luar Public Health Center, there were at least 3 patients with pneumonia every month during 2014. The risk factors are less exclusive breastfeeding, malnutrition, low birth weight, less coverage of measles vaccine, indoor air pollution, and the high level of occupation density. The purpose of this research was to determine the relationship between exclusive breastfeeding, nutrition status, the type of house flooring, and pneumonia incidence in children under 5 in working area of Gane Luar Public Health Center, South Halmahera. A case control study was conducted to each 25 samples of case and control which were collected by simple random sampling technique during July-December 2014. Data were collected through a questionnaire using interview method, observation, and physical examination, and then it’s analyzed by Regression Logistic, Chi Square, and Odds ratio to check for strength of association between variables at 95% confidence level. The results indicated that nutrition status was significantly related to Pneumonia incidence (p = 0.019 ; OR 3.795), however exclusive breastfeeding (p = 0.29) and type of house flooring (p = 0.086) weren’t. In conclusion, the nutrition status was significantly related to the incidence of Pneumonia in working area of Gane Luar Public Health Center.

Background NP (NP) especially YAP (ventilator-associated pneu- monia) is the most common infection in intensive care unit, which correlates with the increasing of morbidity and mortality. There are some risk factors for development ofNP, the most important one is duration of mechanical ventilator and reintubation. Objective To determine the correlation between NP and use of mechanical ventilator in pediatric intensive care unit (PICU). Methods A matched case control study was conducted at Dr. Sardjito Hospital on all patients admitted to the PICU from 2004 until 2006. Case group was defined as all patients who had NP; age and sex matched control group included all patients not diagnosed as NP. Statistical analysis was done by using chi-square and t-tests as appropriate. Logistic regression analysis was done to determine the role of risk factors. Results One-hundred and forty-one patients were included in this study. The incidence of NP was 25. 7%. There was associa- tion between using mechanical ventilator (OR 1.08; 95%CI 1.07; 8.20, P=0.036) and duration of using mechanical ventilator more than four days (OR 1.75, 95%CI 1.87;18.02) with development of NP. There was a significant difference in event free survival of NP between those using mechanical ventilator group and those not using mechanical ventilator group (P

Abebe Megerso,1 Sileshi Garoma,1 Tolosa Eticha,2 Tilaye Workineh,1 Shallo Daba,3 Mihretu Tarekegn,3 Zelalem Habtamu31Department of Public Health, Adama Hospital Medical College,2Department of Pediatrics and Child Health, Adama Hospital Medical College, 3Oromia Regional Health Bureau, HIV/AIDS prevention and Control Division, Addis Ababa, EthiopiaPurpose: It is known that antiretroviral treatment (ART) reduces mortality from acquired immunodeficiency syndrome related causes. Patient's lost to follow-up (LTFU) in this treatment poses a paramount problem to the public and health care services. Information on predictors of loss to follow-up is scarce in this study area and similar settings. Therefore, this study aimed at identifying correlates of loss to follow-up in ART among adult patients in the Oromia region of Ethiopia.Methods: A case–control study was conducted between February 2015 and April 2015 using medical records. The stratified sampling technique was used to select health facilities. The number of patient records to be included in the study was proportionally allocated to each stratum based on their patient proportion in the regional data. Specific health facilities from which to include the records were randomly selected from a list of the health facilities per stratum. All adult patient records registered as LTFU (416) in the selected health facilities during the 12-month period prior to the data collection date, and 832 patients with good adherence to ART were included. Data were double-entered into Epi Info 7 and analyzed using SPSS 20. Descriptive statistics and binary logistic regression were used to report the results. Qualitative data were thematically analyzed using open code computer software.Results: Age 15–24 years (adjusted odds ratio [AOR], 19.82 95% CI: 6.80, 57.73); day laborers (AOR, 5.36; 95% confidence interval [CI]: 3.23, 8.89), rural residents (AOR, 2.35; 95% CI: 1.45, 3.89), World Health Organization clinical stage IV (AOR, 2.29; 95% CI: 1.45, 3.62), baseline CD4

During the early weeks of the cholera outbreak that began in Haiti in October 2010, we conducted a case–control study to identify risk factors. Drinking treated water was strongly protective against illness. Our results highlight the effectiveness of safe water in cholera control.

International audience; Water access and sanitation has worsened in Gaza strip since the conflict between Israel and Palestine in January 2009. This study aimed to investigate the relationship between attendance for diarrhea to a Primary Health Care Center (PHCC) in Gaza strip and several potential risk factors including water access. A matched case control study with prospective data record was performed. Cases were patients attending a PHCC for diarrhea, and controls were patients attending for any other cause with no diarrhea within the previous three months or since birth. We matched 133 cases and 133 controls, for date of inclusion, age, gender. All patients attended PHCC and were included in January/February 2010. A stool analysis for bacteria and parasites was performed for cases. Of the 266 patients, 62% (166) have to buy water from a private provider. In multivariate analysis, four variables were independently predictive of diarrhea: public water access (OR: 0.046; 95% CI: 0.005-0.454; P=0.0083), poultry or rabbits at home, and presence of cooker at home. A bacterial cause was found in 5.5% (7) and Giardia duodenalis in 20% (26). Treatments did not comply with WHO recommendations. Efforts should be made to improve water access and to implement guidelines for a better management of diarrhea in Gaza strip. (C) 2011 Royal Society of Tropical Medicine and Hygiene