Renal dysfunction, increased xanthine oxidase activity and oxidative stress in placenta contributes to the elevated uric acid levels in preeclampsia (PE).To determine serum uric acid and creatinine in hypertensive disorders of pregnancy and correlate with fetal outcome.Pregnant women ≥32 weeks of gestation. Study population included 3 groups, 31 normotensive pregnant (NP) women as controls, 30 pregnant women with gestational hypertension (GH) and 30 with PE.P-value <0.001 and <0.001) respectively. Receiver operation characteristics curves demonstrated greater sensitivity and specificity for uric acid  in PE than for creatinine . Uric acid had strong and negative correlation with fetal birth weight in PE , where as creatinine had negative but weak correlation .Serum uric acid and creatinine levels were significantly elevated in PE (6.26±1.19 and 0.94±0.26 mg/dL) when compared with Pregnancy induced hypertension (PIH) (4.27± 1.0 and 0.66 ±0.19 mg/dL) and NP (4.25 ± 0.8 and 0.63± 0.13 mg/dL) (Serum uric acid is a better diagnostic and predictive marker for PE and fetal outcome respectively. Gestational hypertension (GH), preeclampsia (PE), and eclampsia are a part of a spectrum of hypertensive disorders that complicate pregnancy as specified by the National High Blood Pressure Education Program (NHBPEP) working group. Though studies have mentioned various parameters in etiopathogenesis of hypertensive disorders of pregnancy, still it remains obscure.Hypertensive disorders complicating pregnancy are the most common and serious medical disorder and constitute up to 2–10% of all pregnancies. Serum uric acid is not only a marker of severity of disease but also contributes to the pathology of disorder.Serum uric acid and creatinine levels are a part of work up for the pregnant women with hypertension. The elevated levels of these parameters were due to decreased urinary clearance secondary to reduced GFR and increased reabsorption.–7 Very few studies have given an optimum cutoff for the both in predicting hypertensive disorders of pregnancy.,8Various studies have reported elevated levels of serum uric acid and creatinine in hypertensive disorders of pregnancy and also its effects on maternal and fetal outcomes.The primary purpose of this study is to derive a cutoff for serum uric acid and creatinine in predicting hypertensive disorders of pregnancy (GH and PE) and also to look for its effect on fetal birth weight.This is a prospective study carried out in MediCiti Institute of Medical Sciences. Pregnant women with gestational age above 32 weeks, attending the antenatal clinic for regular checkups in department of obstetrics were enrolled in this study. The study populations were divided into 3 groups, 30 pregnant women diagnosed as having GH, 30 women has PE, and 31 normotensive pregnant women (NP) were considered as controls. All the participants were age matched. GH and PE were defined according to the International Society for the Study of Hypertension in Pregnancy (ISSHP).GH is defined as denovo hypertension with systolic blood pressure (SBP) ≥140 mmHg and diastolic blood pressure (DBP) ≥90 mmHg after 20 weeks of gestation.PE is GH with proteinuria – 1+ on dipstick or ≥300 mg/day or Pr:Cr ratio as ≥3.0 mg/g.Pregnant women with recurrent abortions, bad obstetric history, twins, preexisting medical disorders – such as diabetes mellitus, essential hypertension, renal disorders, cardiovascular, thyroid disorders, and liver disease – were excluded from the study. A written informed consent was obtained from women agreeing to participate in the study. The institutional ethics committee clearance was obtained. All the cases were followed until the delivery for maternal and fetal outcomes.Blood pressure (BP) was measured by oscillometric digital sphygmomanometer . Two measurements were taken 4 h apart. ISSHP guidelines were followed to measure BP.,10 Blood samples were centrifuged at 10,000 rpm for 10 min and the serum was separated. Serum uric acid and creatinine were estimated immediately on Dade Behring Dimension Xpand plus autoanalyser.Under strict aseptic conditions, 5 mL of blood sample was collected from all the participants by venous puncture, into properly labeled plain polystyrene tubes. For urine protein analysis, 10 mL mid stream urine was collected. Samples were collected, handled, and transported to the lab according to the guidelines given by clinical and laboratory standards institute/National Clinical Chemistry Laboratory Standards. The normal serum reference range for females was 2.6–6.0 mg%. Serum creatinine was estimated by modified kinetic Jaffes method. The normal serum reference range for females was 0.6–1.0 mg%. Biorad QC level 1 and level 2 were run daily, the inter assay coefficient of variance (CV) for uric acid with assigned values of 4.89 and 9.03 mg/dL was 3.9 and 4.2%, respectively. The interassay CV for creatinine with assigned values of 2.16 and 6.39 mg/dL was 2.9% and 3.6%, respectively.Serum uric acid was measured by modified uricase method.Urine proteins were analyzed by semiquantitative dipstick method. Two readings of 1+ (30 mg %) was considered as preeclampsia. All the participants were followed till delivery for maternal and fetal outcome. The weight of the newborn was recorded on digital weighing scale (SECA 354/364).http://www.medcalc.org; 2014). The intergroup analysis was carried out by ANOVA and post hoc analysis. The critical values for maximum sensitivity and specificity were done on receiver operation characteristics (ROC) curves. The association between various parameters in a group was evaluated using Pearson’s correlation coefficient. A 2-tailed probability value of 0.05 was considered as statistically significant.The data were processed on MS excel work sheet and analysis will be carried out using MedCalc Statistical Software version 12.7.8  when compared with GH  and NP , respectively.In NP group, 67% women had full-term normal vaginal delivery (FTNVD) whereas it was 36.7% and 13.4% in PIH and PE groups, respectively. The fetal birth weight was significantly low in PE (2.31 ± 0.5 kg) when compared with NP (2.74 ± 0.58 kg) and PIH (2.8 ± 0.28 kg) groups.The specificity and sensitivity of serum uric acid and creatinine in GH and PE are represented in Comparison of ROC curves of serum uric acid and creatinine in GH and PE are represented in r = −0.59; P = 0.006) with fetal birth weight whereas creatinine had negative but weak correlation  and was not statistically significant.Correlation between fetal birth weight with serum uric acid and creatinine in PE are represented in –7Hypertensive disorders of pregnancy are GH and PE, increase obstetrics risk, such as abruption placenta, preterm labor, eclampsia, and HELLP syndrome. Renal dysfunction in these disorders is due to glomerular endothelial injury causing decrease in GFR. Various studies have mentioned elevated levels of renal markers, such as serum uric acid, creatinine, and urea in PE. and Taefi et al. (5.8 ± 2.0 mg/dL) at 36 weeks of gestation. Uric acid is a metabolite of purine catabolism. Bainbridge and Roberts suggested that hyperuricemia in PE is multifactorial. In PE, elevated levels of uric acid are not only attributed to decreased renal excretion but also to increased oxidative stress resulting from placental ischemia and xanthine oxidase activity. In our study no significant difference in serum uric acid was observed between GH and NP.In our study, we observed a significantly elevated serum uric acid (6.26 ± 1.9 mg/dL) in PE. This is in accordance with the studies carried out by Padma et al. (6.13 ± 1.8 mg/dL) in their study observed sensitivity of 75% and specificity of 76.8% with a cutoff of 5.0 mg%. Powers et al. in their study observed an early elevation of serum uric acid, that is, at 10 weeks gestation in women who later developed PE.In ROC analysis a cutoff value of 4.9 mg/dL had 86.7% sensitivity and 83.9% specificity for serum uric acid. Padma et al. In our study, we found uric acid had significant negative and strong correlation with fetal birth weight in PE. Hawkins et al. in a retrospective cohort demonstrated that increasing level rates of uric acid beyond 5.9 mg/dL are associated with adverse fetal outcome such as small for gestation age and preterm birth. As placental hypoxia contributes to the elevated levels of uric acid in PE, it acts as a better marker for hypoxia of fetal outcomes than maternal distress. Hawkins et al. and Livingston et al. concluded that uric acid is clinically useful in predicting fetal outcome than maternal.The mean fetal weight was significantly low in PE (2.31 ± 0.5 kg) when compared with GH and NP. This is in agreement with the study carried out by Padma et al. (2.3 ± 0.8 kg). In our study, we did not observe significant correlation between creatinine and fetal weight, indicating its limited role in predicting fetal outcome.Serum creatinine is a marker of GFR and renal dysfunction. In our study, we observed elevated levels of serum creatinine in PE when compared with GH and NP. A cutoff of 0.7 mg/dL of serum creatinine had 80% sensitivity and 77.4% specificity. This is in accordance with previous studies.Serum uric acid and creatinine are elevated in PE whereas no significant difference was observed between GH and NP. Serum uric acid had better specificity and sensitivity for PE and also correlated negatively with fetal birth weight. Serum uric acid and creatinine levels vary with gestational age, hence studies should focus on estimating these markers in all trimesters so as to diagnose PE at an early stage and avert maternal and fetal outcome. Small sample size is the limitation of our study.


Neisseria gonorrhoeae strains isolated in Canada during 2010–2014. The proportion of isolates with decreased susceptibility to cephalosporins declined significantly between 2011 and 2014, whereas azithromycin resistance increased significantly during that period. Continued surveillance of antimicrobial drug susceptibilities is imperative to inform treatment guidelines.Antimicrobial resistance profiles were determined for  Neisseria gonorrhoeae, is the second most commonly reported sexually transmitted infection in Canada; ≈13,000 cases occur yearly, and rates have increased from 20.1 cases/100,000 population in 2000 to 39.2 cases/100,000 in 2013  in Winnipeg, Manitoba, Canada, has conducted ongoing monitoring of antimicrobial drug susceptibilities in N. gonorrhoeae to ceftriaxone, azithromycin, and cefixime  were determined by using agar dilution as previously described . A 2 × 2 χ2 test was used to compare proportions of resistance per year to identify significant differences between years .Antimicrobial drug susceptibilities of N. gonorrhoeae infection were reported in Canada; 16,370 (≈28%) were diagnosed by culture. Provincial public health laboratories submitted 6,728 isolates to NML for testing . Sex and age data of patients were available for 6,468 (96.1%) isolates. Of these, 5,221 (80.7%) were from male patients  and 1,247 (19.3%) were from female patients . Source specimens included urethral , rectal (n = 981), pharyngeal (n = 592), cervical (n = 365), vaginal (n = 154), and other sources (n = 85); sources for 2,231 isolates were not given. The sexual orientation of patients and information on cases of treatment failure were not available.From 2010 through 2014, ≈59,400 cases of In 2010, a total of 98 (3.3%) of 2,970 isolates had decreased susceptibility to cefixime. This proportion increased to 4.2%  in 2011, and then decreased significantly to 1.1%  in 2014 . Similar<0.4% (data not shown). Azithromycin resistance increased to 1.2%  in 2010 and then decreased to 0.4%  in 2011. From 2011 to 2014, azithromycin resistance increased significantly to 3.3% . Thirty-eight isolates were identified as part of an outbreak in 1 province. When the outbreak-related isolates were excluded, 2.3% of all the isolates were azithromycin resistant in 2014, still a significant increase (p<0.001) from 2011. In 2014, azithromycin resistance was identified in 5 provinces across Canada. During 2009–2012 in Canada, 5 isolates with a high level of azithromycin resistance (MIC of azithromycin ≥256 mg/L) were identified.Before 2010, the proportion of azithromycin resistance was In 2012, seven isolates with combined decreased susceptibility to cephalosporins and resistance to azithromycin were identified . In 2013, eight  and in 2014 one  of these isolates were identified. These isolates with both decreased susceptibility to cephalosporins and resistance to azithromycin may threaten the success of the currently recommended therapy.N. gonorrhoeae isolates with decreased susceptibility to cephalosporins decreased significantly. The timing of the decrease corresponded to changes in treatment guidelines from monotherapy with third-generation cephalosporins to combination therapy with ceftriaxone/azithromycin. Although causality cannot be attributed to this decline, the higher dose of ceftriaxone plus azithromycin could be more effectively treating gonococcal infections and diminishing the spread of isolates with reduced cephalosporin susceptibility. Similar data have been reported from the United Kingdom and the United States. In 2011, the United Kingdom recommended dual antimicrobial therapy with ceftriaxone (500 mg intramuscularly) and azithromycin  for treatment of uncomplicated gonococcal infection (>0.125 mg/L) declined significantly from 10.8% in 2011 to 5.7% in 2012 and then to 5.2% in 2013 after implementation of the new guidelines (>0.25 mg/L) declined from 1.4% in 2011 to 0.4% in 2013 and decreased susceptibility to ceftriaxone (MIC >0.125 mg/L) declined from 0.4% in 2011 to 0.05% in 2013 (From 2010 to 2014 in Canada, the proportion of Limitations of this study include the representativeness of isolates, because ≈70% of gonococcal infections in Canada are diagnosed by nucleic acid amplification tests (N. gonorrhoeae antimicrobial drug resistance and prevent the emergence of untreatable multidrug-resistant gonorrhea.Continued surveillance of gonococcal antimicrobial susceptibilities is vital to inform treatment guidelines and mitigate the spread of isolates with decreased susceptibility to cephalosporins and resistance to azithromycin. The data we present further support efforts to limit the spread of


This study was conducted to investigate the role of serum procalcitonin and CRP levels in determining etiology, treatment and prognosis in COPD patients with acute exacerbation.Fifty-eight hospitalized COPD patients with acute exacerbation were included in the study between January 2008 and March 2011. The diagnosis of COPD was made according to the GOLD guidelines. Serum CRP and procalcitonin (PCT) levels in the first day of hospitalization and then one month later (in a stable period) were studied from all COPD patients. Patients were classified into 4 groups according to the severity of disease and divided into 2 groups according to the PCT levels( < 0.2 ng/dl and > 0.2 ng/dl).Four (7%) patients were female and 54 (93%) were male. The mean age was 68.1 ± 10.1. Pathogenic bacterial growth was detected in 16 sputum or bronchial lavage samples. MRSA was found in 3 samples, P. aeruginosa in 3, S. maltophilia in 3, and Enterobacter species was detected in 2 samples. Chlamydia pneumoniae serology was positive in 16 (29%) patients. M. pneumoniae was positive in 8 (15%) patients. The rate of M. pneumoniae was highest (40%) in the severe exacerbation group. PCT level was significantly higher in the Chlamydia positive group (40% vs. 22%). The mean CRP level of COPD patients was 6.7 mg/l in acute attack, and 2.0 mg/l in the stable period. The mean PCT level was 0.50 ng/l in acute attack, and 0.09 ng/l in the stable period. Serum PCT level was found as 0.44 ng/l in severe COPD group, and 0.2 ng/ml in the others (p = 0.02). 27 patients with acute exacerbation of COPD were diagnosed with sepsis. Six patients in the study group died. Mortality rate was higher in high PCT group (13.3% vs. 2.5%).PCT level can help for determining acute attack and etiology in COPD patients.


Type 2 diabetes (T2DM) is a serious chronic disease which can be improved with education. Only 6.0% of people with T2DM are offered education and only 1.6% attend.We have designed a cluster trial with a stepped-wedge design (SWD) to test an intervention to increase the uptake to education. This study will include general practices of varying size. There is no published guidance on powering a cluster SWD with varying cluster size. We present the method used to estimate the design effect (DE) which combines the method for calculating the sample size required for a cluster SWD by Woertman et al. with a method for taking into account varying cluster size in a standard cluster trial by Eldridge et al.We assume a median practice size of 347, IQR 201-678, which gives a Coefficient of Variation (CV) of 119.25/348=0.34. Using the method of Woertman gives a DE of 1.41; this doesn't take into account variation in cluster size. Using the method in Eldridge with a CV of zero (no variation in cluster size) gave DE of 18.35; replacing CV with 0.34 gave DE of 20.36. Hence variation in cluster size inflates DE by 2.01 (20.36-18.35). The total DE therefore when taking into account the SWD and variation in cluster size was 3.42 (1.41+2.01).We present a pragmatic way of calculating the DE for cluster SWD with variation in cluster size. Future work should focus on the impact of cluster size variation.


Purpose. To evaluate the efficacy of Ahmed Glaucoma Valve (AGV) implantation in patients with refractory glaucoma in a tertiary hospital in Brazil. Methods. Retrospective case series of patients who underwent AGV implantation. Primary outcome was to assess the rate of failure, which was defined as intraocular pressure (IOP) in two consecutive visits greater than 18 or lower than 5 mmHg (criterion 1) or IOP greater than 15 or lower than 5 mmHg (criterion 2). The secondary outcome was to investigate risk factors for failure. Results. 112 eyes from 108 patients underwent AGV implantation between 2000 and 2012. Mean follow-up time was 2.54 (±1.52) years. Kaplan-Meier survival analysis showed cumulative probabilities of success of 80.3%, 68.2%, and 47.3% at 1, 3, and 5 years using 18 mmHg as endpoint. When adopting 15 mmHg as endpoint, cumulative success rates were 80.3%, 60.7%, and 27.3% at 1, 3, and 5 years, respectively. Multivariate analysis with generalized estimating equations revealed that African American ancestry and early hypertensive phase were risk factors for failure . Conclusion. A success rate of approximately 50% was obtained 5 years after the implantation of an AGV. African American ancestry and early hypertensive phase were associated with increased risk of failure. Glaucoma drainage devices are typically reserved for refractory glaucomas, which are associated with high risk for failure, such as neovascular or uveitic glaucoma or after failed trabeculectomies , 2. AlthRamulu et al. reported an increase from 2728 drainage device surgeries in 1995 to 7744 in 2004 according to Medicare data in the United States , 7. The The “Ahmed Baerveldt Comparison Study” showed cumulative probabilities of failure of 31.3% and 44.7% after 3 and 5 years, respectively, following an AGV surgery . On the This was a retrospective study, evaluating patients with refractory glaucoma who underwent an AGV implantation at Hospital das Clinicas, University of Campinas, Brazil. “Refractory glaucoma” was defined as glaucomas associated with a poor surgical prognosis after trabeculectomy, which remained uncontrolled despite previous filtration surgery and/or laser treatment and/or under maximum tolerated medical treatment. Only patients with at least 1 year of follow-up were included in the study, unless failure occurred before that period. All procedures were performed between January 2000 and November 2012. This study was approved by the Ethics Committee of the University of Campinas and adhered to the tenets of the Declaration of Helsinki. Medical records were retrospectively reviewed for preoperative and postoperative follow-up information, such as occurrence of complications. At each visit during follow-up, subjects underwent a comprehensive ophthalmic examination, including Snellen best corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure (IOP) measurement using Goldmann applanation tonometry, gonioscopy, and dilated fundoscopy examination using a 78-diopter lens. Flat anterior chambers were graded according to the classification proposed by Spaeth .The primary outcome measure of this study was to establish the rates of failure, which was defined by two consecutive visits with IOP greater than 18 mmHg or lower than 5 mmHg (criterion 1) or IOP greater than 15 mmHg or lower than 5 mmHg (criterion 2) after 3 months of surgery. Failure was also defined as the need of an additional glaucoma surgery for IOP control or loss of light perception during follow-up. Severe complications such as tube or plate exposure in which the implant had to be removed were also considered as failure. The secondary outcome of the study was to identify possible risk factors for failure following AGV surgery.2 surface area) and FP7 silicone (184 mm2 surface area). All surgeries were performed with peribulbar anaesthesia. A fornix-based conjunctival flap was fashioned preferably in the superotemporal quadrant. AGV was primed by flushing balanced salt solution through the tube to confirm patency. The anterior edge of the plate was secured with 9-0 nylon sutures to the sclera at least 8 mm from the limbus. A 23-gauge needle was used 1 mm posterior to the limbus to create a track and access the anterior chamber. A rectangular donor scleral patch graft (4 × 6 mm) was fashioned and sutured over the tube using 10-0 nylon sutures. The conjunctiva was also secured with 10-0 nylon sutures. No antimetabolites were used in the procedure. Follow-up visits were scheduled 1 day, 3 days, 1 week, 2 weeks, and 1, 3, 6, 12, and 18 months; after that, patients were followed within a 6-month interval. All patients received a standard regimen of topical antibiotic drops (moxifloxacin hydrochloride) q.i.d, discontinued after 2 weeks. Topical corticosteroids drops  were used initially 6 times daily and tapered gradually over 6 to 10 weeks depending on the degree of inflammation. Glaucoma medications were prescribed according to IOP measurements and the severity of the disease. An early hypertensive phase (EHP) was defined as an IOP increase of more than 21 mmHg within the first 3 months after surgery and after a reduction of IOP to less than 21 mmHg had been achieved during the first postoperative week [Surgeries were performed by experienced attending glaucoma surgeons  or by glaucoma fellows under their direct surgical supervision. The AGV models used were the S2 polypropylene  for analysis . CumulatP = 0.021) (P < 0.001). Mean number of medications decreased from 3.50 ± 0.67 prior to surgery to 2.44 ± 1.27 at the last follow-up (P < 0.001) (The present study included 112 eyes from 108 glaucoma patients who underwent an AGV implant. = 0.021) . Mean IO< 0.001) .Kaplan-Meier analysis utilizing criterion 1 (5 mmHg < IOP < 18 mmHg) showed cumulative survival rates of 80.3%, 68.2%, and 47.3%, after 1, 3, and 5 years, respectively. When criterion 2 was employed (5 mmHg < IOP < 15 mmHg), cumulative survival rates of 80.3%, 60.7%, and 27.3% were observed after 1, 3, and 5 years, respectively. The most common reason for failure was reintervention due to high IOP levels (69.2%) . Among tP = 0.001; P < 0.001, resp.) . African American patients had a risk of 5.51  (CI: 2.32–19.06) and patients with EHP had a risk of 4.88 (CI: 1.74–11.60) for AGV failure  showed that African American  descent , resp.) . Other c failure .P = 0.605), whereas in the Caucasian group, EHP had odds ratio of 7.36 .We also performed a separate analysis to study the effects of EHP on the African American and Caucasian patients. Univariate analysis (based on criterion 1) showed that, in the African American group, EHP was not considered a risk factor for failure , cumulative success rates were 80.3%, 60.7% and 27.3% at 1, 3 and 5 years, respectively. In the current study, the cumulative success rate was different from the results of the “Ahmed Baerveldt Comparison Study” , because they defined failure as IOP more than 21 mmHg [P = 0.030 and P = 0.006, resp.).The secondary outcome of this study was to identify possible risk factors for failure following AGV implantation. According to the multivariate analysis, African American descent was significantly associated with risk of failure. This finding is in agreement with a previous study from Ishida and Netland, where 86 eyes from 43 African Americans and 43 Caucasian patients were followed for an average of 2.5 years after AGV implantation . In theiThe pathophysiological basis underlying racial differences on AGV implant survival is unknown. Several studies confirmed that African American ancestry is characterized by high prevalence and rapid progression of glaucoma , 16. Addβ (TGF-β) [β in African American subjects, suggesting that racial differences on inflammatory cytokines levels might explain differences in failure rates following AGV implant surgeries [Following AGV implantation, a fibrotic response encapsulates the plate of the drainage device, leading to increased aqueous outflow resistance , 20. His (TGF-β) , which m (TGF-β) . Freedma (TGF-β) . In addiurgeries .Our study also found that the hypertensive phase was a risk factor for AGV failure. In our sample, the hypertensive phase occurred in 33 from the total of 112 eyes (29.4%), among which 21 failed (63.6%). Previous studies have reported an incidence of EHP ranging from 56 to 82% following the implantation of a glaucoma drainage device , 25. TheThe material used in glaucoma drainage implants can also play role in fibrous tissue formation and encapsulation . In factP = 0.008) [Two recent prospective clinical trials have investigated the adoption of lower IOP targets during follow-up by initiating early aqueous suppressants treatment following AGV implantation , 29. Pak= 0.008) . Law et P = 0.605). On the other hand, EHP had odds ratio for failure of 7.36  in the Caucasian group, suggesting that lowering IOP with early use of aqueous suppressants might not be as effective in African Americans compared to Caucasians. Future studies should evaluate prospectively the impact of racial differences on the early aqueous suppressants treatment and the onset of EHP.We performed a separate analysis within the Caucasian and African American groups to better investigate the relationship between EHP and race. Among 14 African American patients without EHP, 9 (64.2%) failed. Among the 8 African Americans in which EHP occurred, 6 patients (75.0%) failed. In the Caucasian group, 11 (16.9%) of the 65 patients without EHP failed and 15 (60.0%) from 25 in which EHP occurred failed. These findings suggest that, in the African American group, EHP does not represent a risk factor for failure. In fact, in the univariate analysis, EHP was not considered a risk factor in the African American patients . African American descendants and patients who present EHP in the postoperative period are at greater risk for AGV implantation failure.


Background. Adolescents are prone to various forms of behavioral problems. These behavioral issues in adolescents can have serious consequences for the adolescents. Objectives. The objectives of the study are to determine the causative factors of adolescent problems and specific manifestations. Methods. Behavioral problems were investigated using a random sampling of adolescents from secondary schools in southeast Nigeria from February to April, 2014. A self-administered questionnaire was developed from Health Kids Colorado Questionnaire. Results. A total of 763 subjects completed the questionnaire. Adolescents who reported to have used tobacco 3 to 5 and 6 to 9 times during the last 30 days are just 3.14% and 3.4%, respectively. Nineteen (2.49%) adolescents claimed that they have had sex before but not in the last 3 months. Adolescents who attempted suicide are from 15 years and peaked at 18. Eighty-three (11%) adolescents who are 15 years old attempted suicide in a year; this peaks at 17 years where 235 (30.8%) committed suicide. Majority of adolescents with behavioral disorder are from the upper class family. Conclusion. This study revealed that adolescents exhibit several forms of behavioral problems. Adolescence (which occurs between 10 and 19 years) is a phase of physical, cognitive, and psychological development that generally occurs during the period from puberty to adulthood . It is aAdolescent period is a complex maturational and developmental process which varies across individuals and cultures. Successful passage through this portal to adulthood results in biological maturity, a secure sense of self, the ability to enjoy close friendships and group belonging, and the mental capacity to deal with the onslaught of life's challenges . HoweverThere are several models to explain behavioral attributes among adolescents. This includes psychodynamic models, behaviorist model, ecological system models, and cognitive models. Indeed, an imbalance between any of the two models can trigger behavioral disorder in adolescents . FurtherAdolescents have varying degree of behavioral problems ranging from violent related behaviors, substance use and misuse, and sexual behaviors to bullying. Each of these problems is not without its burden . For insThe problem behaviors in adolescents can have serious consequences for the adolescents, their family and friends, their schools, and society. It has been frequently reported that problem behaviors are the most common reason why adolescents consult psychologist and pediatric psychiatrist .This study is aimed at determining the causative factors of adolescent problems and specific manifestation of behavioral problems among adolescents in Nigeria secondary schools in southeast Nigeria.In Nigeria, there are very few works on behavioral problems among adolescents in secondary schools. This study, therefore, is among the few to be done in this part of the world; the result will complement earlier studies and will also serve as information base for future researches.The study was carried out among adolescents in four secondary schools in Enugu and Ebonyi States of Nigeria.A pretest was done using Command Secondary School, Abakpa Nike, Enugu, because of the ethnic and sociocultural diversity of the student population of the school. The aim was to identify and remove ambiguities in the survey instrument.Health Kids Colorado Questionnaire (Q) was adapted for this study. The instrument was shown to have satisfactory reliability and validity.Three schools were selected in Enugu and Ebonyi metropolis through stratified random sampling method.By a stratified random sampling, a total of 764 students from mixed schools were selected.The questionnaires which were self-administered were completed by the students under strict examination conditions during class hours after explanation of the purpose of the study. Confidentiality was assured by informing the respondents not to write their names on the questionnaires. The class teachers were excluded from the class during the exercise to avoid their possible influence. Questions arising from the questionnaire were answered by the researcher during the exercise.Aims are to identify the various types of behavioral problems in adolescents in secondary schools in Enugu and Ebonyi metropolis and their prevalence. This study is also aimed at determining the sociodemographic pattern and circumstances associated with this disorder. Adolescents who gave consent were included in this study while those without consent and those with psychiatric problems were excluded.The families were assigned to socioeconomic classes using the recommended method (modified) by Warren et al. . The parConsent was specifically approved by the care takers and parents of these children. Written consent was specifically approved by their principals and the students themselves. Participants' consent was also obtained.P value less than 0.05 were accepted as significant for each statistical test.All data were coded, entered, and then analyzed using the Statistical Package for Social Sciences program (SPSS), version 17. Results were presented in cross tabulation and tables. A P = 0.243). Higher proportion (204) of those aging 17–19 years (84.0%) have not taken a prescription drug while fourteen (77.8%) and 368 (73.2%) have not taken drug for those aging 10–13 years and 14–16 years, respectively. The difference was significant statistically (P = 0.022).P = 0.000). More than 202 (83%) of respondents have never missed school, 5 (1.0%) of those aged 14–19 years, and 9 (2.9%) of those aged 17–19 years have missed school for 4 days and above in the past 30 days (P = 0.126).Those aging 17–19 years, 87 (35.8%), have drunk alcohol before for 13 times and above while 95 (18.9%) and 2 (11.1%) have drunk alcohol before for 13 times and above, respectively. The difference was significant statistically (P = 0.001). While 15 (83.3%) of respondents in 10–13 years, 44 (87.5%) in 14 to 16 years, and 187 (77.0%) in 17–19 years have never had sex before, those aging 10–13 years (1 (5.6%)), 14–19 years (5 (1.0%)), and those aging 17–19 years (1 (0.4%)) have had sex with 4 and more persons in the past 3 months. The difference was significant statistically (P = 0.000).About 13 (72.2%) of respondents in 10–13 years, 446 (88.7%) in 14 to 16 years, and 227 (93.4%) in 17–19 years said that it is very important to finish high school while none in those aging 10–13 years and 14–19 years and 3 (1.2%) of those aging 17–19 years said that it is not very important. The difference was significant statistically (P = 0.475). Higher proportions of females 364 (81.3%) have not taken a prescription drug while 222 (74.1%) have not taken drug. Males and females that have taken prescribed drugs were 46 (9.4%) and 19 (7.0%), respectively. The difference was not significant statistically (P = 0.079).P = 0.006). More than 84% of respondents in both sexes have never missed school because of fear in school or way to school in all age groups while 7 (1.4%) males and 5 (1.8%) females have missed school for 4 days and above in the past 30 days (P = 0.374).About 319 (65.0%) of males and 145 (53.1%) of females have never drunk alcohol before while 105 (21.4%) and 79 (28.9%) have drunk alcohol before for 13 times and above for males and females, respectively. The difference was significant statistically (P = 0.061). While 430 (87.6%) of males and 212 (77.7%) of females have never had sex before, 2 (0.4%) of males and 5 (1.8%) of females have had sex with 4 and more persons in the past 3 months. The difference was significant statistically (P = 0.000).Equal proportion (about 90%) of respondents in both males and females said that it is very important to finish high school while none of males and 3 (1.1%) of females said that it is not very important. The difference was not significant statistically (P = 0.367). About 144 (84.0%) in lower and middle class as well as 307 (1.1%) in upper class have not taken a prescription drug while 10.2%, 4.7%, and 8.2% have not taken drug for those in upper, middle, and lower classes, respectively. The difference was significant statistically (P = 0.001).P = 0.002). About 383 (91%) of respondents in upper class, 138 (80.2%) in middle class, and 143 (84.1%) in lower class have never missed school in all age groups while 0.9% in upper, 2.3% in middle, and 2.4% of those in lower classes have missed school for 4 days and above in the past 30 days. The difference was significant statistically (P = 0.008).For those in upper class, 79 (18.7%) have drunk alcohol before for 13 times and above while 51 (29.7%) and 54 (31.8%) have drunk alcohol before for 13 times and above, respectively. The difference was significant statistically (P = 0.013). While about 361 (85.0%) of respondents in upper and lower class as well as 136 (79.1%) in middle class have never had sex before, those in upper class (4 (0.9%)), middle class (2(1.2%)), and lower class (1(0.6%)) have had sex with 4 and more persons in the past 3 months. The difference was not significant statistically (P = 0.438).About 375 (88.9%) of respondents in upper class, 165 (95.9%) in middle class, and 146 (85.9%) in lower class said that it is very important to finish high school while none of those in middle class, 1 (0.2) for upper class, and 2 (1.2%) for lower class said that it is not very important. The difference was significant statistically (P = 0.671). Higher proportion of those aging 17–19 years, 53 (21.8%), have been bullied while 3 (16.7%) and 56 (11.1%) have been bullied in those aging 10–13 years and 14–16 years, respectively, in the past 12 months. The difference was significant statistically (P = 0.001). Of those aging 14–17 years, 375 (74.6%) have not fought in the past 12 months while 165 (67.9%) and 10 (55.6%) have not fought, respectively. The difference was significant statistically (P = 0.008).P = 0.018). A similar proportion of both males and females (about 6.0%) have thought of committing suicide in the past 12 months. The difference was not significant statistically (P = 0.705). About 68 (13.8%) of males and 44 (16.1%) of females admitted that they have been bullied in the past 12 months (P = 0.396).P = 0.514). About 90.0% in upper class, 79.1% in middle class, and 78.8% in lower classes had not been bullied in the past 12 months. The difference was significant statistically (P = 0.000). Of those in upper class, 9 (2.1%) have fought for more than 5 times while 8 (4.7%) and 4 (2.4%) have fought for more than 5 times, respectively, in the past 12 months. The difference was not significant statistically (P = 0.085).n in sample size could also account for these variations in prevalence rates. The use of tobacco in adolescents is reaching troubling levels. It has been reported by World Bank that nearly 82,000–99,000 children and adolescents all over the world begin smoking every day [This study has gone a long way to show that adolescents show variable degrees of behavioral problems. We noted a prevalence of 3.7% among adolescents who use tobacco currently during the last 3 months with majority of them within the age of 14 and 16. This prevalence is similar to the 3.0% recorded in Kano by the NDLEA . The varvery day . About hvery day , 16.We obtained a prevalence of 24.1% among adolescents who took alcohol especially between the age of 14 and 16. This prevalence is higher than 14.5% obtained by Abdulkarim et al. in Ilorin . This hiThe prevalence of drug use among adolescents is found to be 8.5% especially between the age of 14 and 16. This is higher than the 3.5% prevalence obtained by NDLEA [We noted in this study that suicide attempt is a behavioral issue among adolescents with a prevalence of 12.5%. Adolescents who attempted suicide are mainly between the ages of 14 and 18. Majority of them are from the upper class. Several reasons such as depression, alcohol, and drug use were adduced as reasons for this.It has been documented that suicide is the third leading cause of death for adolescents of 15 to 19 years old with a history of depression, a previous suicide attempt, and a family history of psychiatric disorders as notable risk factors .Physical fight and bullying are notable adolescent behavioral trait in this present study. It is more common between the ages of 17 and 19. Interpersonal violence is an important but neglected issue among adolescents. Adolescent physical fighting not only results in injury, disability, and death but is also associated with other potentially harmful behaviors such as substance use and premarital sex .Sexual experimentation is a behavioral problem we noted among adolescents in this study though on a small scale. We found that 0.9% of adolescents claimed they have had sex with more than 4 partners in the last 3 months while those who reported to have had sexual intercourse with at least one or more than 2 partners had a prevalence of 3.8%. This prevalence is very low when compared to a study by the National Survey of Adolescent Health  where 46 percent of whites and 47 percent Hispanic high school students reported having experiments with sex .It is important to note that children's sexuality develops during early and middle childhood.Both sexual ideation and activity increase over the adolescent period . AdolescSchool absenteeism is a form of behavioral problem noted among adolescents. We found that a fraction of adolescents (1.6%) reported to have been absent from school for more than twice in a week while less than one percent do so up to one week in a month. This is very low when compared to the study of Ananthakrishnan and Nalini  in IndiaWhen we looked at gender with its association with substance use as a behavioral issue among adolescent, we noted that males tend to use tobacco, alcohol, and even drugs more than females. Most of literatures reported high male preponderance in all substance use among adolescents. However, more females reported being exposed to sex and admitted that finishing school is not important when compared to their male folks. There are salient gender differences in the psychological impact of variations in the timing of puberty; for instance, early pubertal development in girls is correlated with lower self-esteem and heightened concern over body image . This loWe noted with interest a trend when we correlate the social class of the parents of adolescents with adolescent behaviors. Majority of the parents of adolescents with all forms of behavioral problems are from a high socioeconomic class. In fact, adolescents who have the least behavioral problems have parents from a lower socioeconomic class. There are conflicting reports on the impact of socioeconomic class on adolescent behavior. For instance, Petridou et al.  opined tThis study revealed that adolescents exhibit several forms of behavioral problems. However, a longitudinal study is necessary to determine the changing pattern of this disorder.The limitation of this study lies in the fact that a cross-sectional survey was done. A longitudinal study would have permitted the evaluation of the changing pattern of behavioral problems over time.


Plasmodium falciparum malaria in two sentinel sites in Senegal.In Senegal, a significant decrease of malaria transmission intensity has been noted the last years. Parasitaemia has become lower and, therefore, more difficult to detect by microscopy. In the context of submicroscopic parasitaemia, it has become relevant to rely on relevant malaria surveillance tools to better document malaria epidemiology in such settings. Serological markers have been proposed as an essential tool for malaria surveillance. This study aimed to evaluate the sero-epidemiological situation of P. falciparum infection was diagnosed using microscopy. P. falciparum antibodies against circumsporozoite protein (CSP), apical membrane protein (AMA1) and merozoite surface protein 1_42 (MSP1_42) were measured by ELISA method. A stepwise logistic regression analysis was done to assess factors associated with P. falciparum antibodies carriage.Cross-sectional surveys were carried out in Velingara  and Keur Soce  between September and October 2010. Children under 10 years old, living in these areas, were enrolled using two-level, random sampling methods. 42 and anti-CSP antibody was 38.12, 41.55 and 40.38%, respectively. The seroprevalence was more important in Velingara and increased with age, active malaria infection and area of residence.A total of 1,865 children under 10 years old were enrolled. The overall falciparum malaria prevalence was 4.99% with high prevalence in Velingara of 10.03% compared to Keur Soce of 0.3%. Symptomatic malaria cases (fever associated with parasitaemia) represented 17.37%. Seroprevalence of anti-AMA1, anti-MSP1_The use of serological markers can contribute to improved malaria surveillance in areas with declining malaria transmission. This study provided useful baseline information about the sero-epidemiological situation of malaria in Senegal and can contribute to the identification of malaria hot spots in order to concentrate intervention efforts.http://www.pactr.org).Trial registration number: PACTR201305000551876 ( Plasmodium falciparum antigens have been studied to assess malaria transmission and impact on the host immunity. To assess the level of malaria transmission, a pre-erythrocytic-stage antigen most commonly used is the circumsporozoite protein (CSP) with a short estimated half-life. Antibodies against this protein are correlated to transmission intensity and exposure duration, but not necessarily to plasmodial infections. This protein is labile and disappears quickly in the absence of exposure. P. falciparum erythrocytic-stage antigens, such as merozoite surface protein 1 (MSP) and apical membrane antigen (AMA1) with long half-lives, reflect the cumulative exposure to malaria and can be used as an indicator of the burden of malaria . Malaria prevalence was higher in Velingara at 10.03% [95% CI (8.3–12.7)] (90/866) than in Keur Soce, where it was 0.3% [95% CI (0.06–0.8)] (3/999). Among children with falciparum malaria, 17.37% had fever providing an odds ratio at 1.81 [95% CI (1.13–2.91)]  while in Keur Soce it was 72.07%. The proportion of subjects with fever (axillary temperature ≥37.5°C) at the time of survey was 20.4 and 14.71% in Velingara and Keur Soce, respectively. Overall 42 and CSP antibodies was 15.17 AU and 29.25 UA, respectively; both were higher in Velingara’s population (p < 10−3). Antibodies production was significantly higher among children with P. falciparum infection compared to non-infected children (Table The mean production of anti-AMA1 antibody was 16.04 AU and varied from 16.59 AU in Velingara to 15.57 AU in Keur Soce. No significance difference was noted between the two sites (p = 0.57). MSP1_n p < 10−. Antibod42 and anti-CSP antibodies was at 38.12% [95% CI (35.37–41.03)], 41.55% [95% CI (38.68–44.58)] and 40.38% [95% CI (37.54–43.36)], respectively. The seroprevalence of these antibodies was higher in Velingara compared to Keur Soce (p < 10−3) ; p value = 0.56] and in subjects living in Velingara 46.3% . The seroprevalence of anti-MSP1_42 antibody was 37.3%  in children under 5 years old while it was more important in children over 5 years old 47.57% .Multivariate logistic regression analyses revealed that seroprevalence increased with age, active malaria infection and area of residence. In children over 5 years old, the seroprevalence of anti-AMA1 antibody was 46.1%  and this was more important among female children (38.7%), subjects with stunting (37.97%) and subjects without anaemia (43.88%). Seroprevalence of anti-AMA1 antibody was higher in subjects with 42 antibody was 52.69% . For children over 5 years, the seroprevalence of anti-CSP antibody was 43.53%  compared to other children. Anti-CSP antibody was more important in female children (41%), children with stunting 43.72%  and children with anaemia (40.44%). The prevalence of anti-CSP antibody was associated with active malaria infection. Prevalence of anti-CSP antibody was more important in children with malaria infection 46.24% . The prevalence of anti-CSP antibody was more important in Velingara 52.66%  compared to Keur Soce (29.73%). There is no correlation between seroprevalence of antibody and sex . However, anaemia remained high in both sites. These data are consistent with results from national malaria indicator surveys conducted 2008–2009, which showed similar patterns in terms of P. falciparum carriage and anaemia prevalence [P. falciparum at 2.8% with disparities between the southern part (9.3%) and the central part (2.2%) of the country [This study was conducted to assess the sero-epidemiological situation of malaria in two sentinel sites with different epidemiological profiles in Senegal. The study showed a low prevalence of malaria parasitaemia, although  country . The dif country .P. falciparum, anaemia was closely associated with malaria parasitaemia. Other studies demonstrated that the main factors influencing anaemia occurrence in the central and the southern parts of the country are mainly represented by P. falciparum carriage, malnutrition, sickle cell traits and alpha-thalassaemia [Similar results were found in 2005 with the heterogeneity of malaria in the east and west of Cambodia . Despiteassaemia .42 and CSP antibodies was 38.12, 41.55 and 40.38%, respectively. Significant difference between the two areas was observed with a higher seroprevalence in the southern part (Velingara). Although the serological assessment confirmed malaria heterogeneity as shown by microscopy. Proportion of P. falciparum carriage was significantly lower than antibodies level. These findings are in accordance with what were observed in Madagascar [The overall seroprevalence of AMA1, MSP1_dagascar . In Tanzdagascar . Similardagascar . A high dagascar .These results show that serology could be a good indicator for malaria surveillance. 5% of the total study participant was found positive by microscopy while antibodies excretion increased by at least sixfolds. The study demonstrated that using microscopy alone for malaria surveillance could underestimate malaria burden, particularly in areas with reduced malaria transmission. These data are confirmed by other studies , 23, 27.42 and CSP antibodies increased with age, P. falciparum carriage and the area of residence. Similar results were found in Vanuatu in 2008 and in northern Peru between 2008 and 2010 [P. falciparum infection, the seroprevalence of antibodies is higher compared to those without P. falciparum infection. The association between malaria and level of antibody  has been demonstrated by several immuno-epidemiological studies [The study showed that seroprevalence of AMA1, MSP1_and 2010 , 29. In and 2010 . This waand 2010 , 31. In  studies –39. Comp studies .Gender, Hb level and nutritional status did not play a role in antibody production. This was demonstrated in 2002 in Senegalese preschool children when assessing the immunological consequences of intermittent preventive treatment .Serological markers can be a useful tool for malaria epidemiology characterization particularly in areas with a decrease of malaria and can even contribute to the identification of malaria hot spots in order to concentrate intervention efforts. Others studies suggest that sero-epidemiological analysis will be useful tool in assessing short-term changes in exposure and malaria transmission in area with a low or seasonal transmission. It was demonstrated in Ghana, Kenya and Indonesia , 41.The age of the study population being limited to 10 years constituted a study limitation. To better document the changing profile of malaria epidemiology, it would be relevant to extend the study to the other age groups in order to characterize the burden of the disease in the study areas.Serological markers can be used as complementary tools for malaria survey in areas with a declining pattern of malaria in Senegal. This study provided useful baseline information about the sero-epidemiological situation of malaria in Senegal and can contribute to the identification of malaria hot spots in order to concentrate intervention efforts.


Catheter-associated urinary tract infections (CAUTI) are the most common nosocomial infections.We used a multi-modal interdisciplinary intervention to reduce CAUTI with three key elements: stringent indications for UC insertion, shifting the task to decide on urinary catheter (UC) removal from physicians to nurses and an automatic electronic alert for catheter removal as key elements.Non-randomized intervention study.We included all patients with a newly inserted UC at any time during hospitalization. The 13-months study comprised a baseline and 2 intervention phases. Clinical endpoints included the number of catheter days per 1’000 hospital days, the duration of catheterization as well as the rates of inserted catheters and CAUTI. Process endpoints compared changes in attitudes and knowledge about UC and CAUTI between physicians and nurses.Overall, 9’306 patients were screened for newly inserted UC, of them 513 (5.5%) were included. In these 513 patients, the number of catheter days was reduced from 88.5 to 31.9 days per 1’000 hospital days (p<0.001) with a mean and median reduction of the duration of catheterization from 7.2 to 3.8 and 5 to 3 days, respectively (p<0.001). The number of overall CAUTI was reduced with a risk ratio of 0.31 (95% CI 0.19-0.49) per 1’000 hospital days and of 0.35 (95% CI 0.21-0.57) per 1’000 hospital admissions. Significant changes in task-shifting from physicians to nurses and in indications for UC were documented.Behavioral changes including the empowerment of nurses resulted in significant reductions in the rate and duration of urinary catheterization as well as CAUTI.None declared.


Objective. To evaluate the hematological and biochemistry profile of patients with or without HIV-TB at the Georgetown Chest Clinic, Guyana. Methods. An observational, laboratory based study was designed to assess the relationship of PTB and HIV with patients routine biochemical and hematological values. The study was conducted during the period January 2013 to December 2014; a total sample size of 316 patients was enrolled following exclusion and inclusion criteria. Results. Mean age of study population was 40.1 ± 13.8 (95% CI 38.6–41.7) and most were between 40 and 49 age group . More males were in the study 74.4% (95% CI 69.3–78.8) than females 81% (95% CI 21.1–30.7). 30% (95% CI 25.3–35.3) had a sputum smear grade of 3+ and 62.5% (95% CI 47.0–75.7) showed a CD4 count <200. The study demonstrated significantly low hemoglobin (Hb) 91.7% (95% CI 78.2–97.1), low WBC 27.8% (95% CI 15.8–44.0), high indirect bilirubin 7.4% (95% CI 2.1–23.3), ALT 41.8% (95% CI 28.4–56.7), and AST 72.2% (95% CI 57.3–83.3) among TB-HIV patients. Homelessness RR (relative risk) 2.2 (95% CI 0.48–12.3), smoking RR 1.09 (95% CI 1.01–1.19), and gender  RR 1.2 (95% CI 0.61–2.26) were main associated risk factors. Conclusions. There is slight variation among PTB and PTB-HIV coinfected patients in some hematological and biochemistry parameters. Mycobacterium tuberculosis and Human Immune Deficiency Virus [Clinical TB remains a major global health problem and the second leading cause of death from an infectious disease worldwide. TB has a global incidence of 8.6 million, a mortality of 1.3 million, and sadly a global treatment success rate of only 87% , 3. The cy Virus .Guyana, a lower-middle-income country being ranked as one of the TB high-burden countries in the Americas, sustains a tuberculosis (TB) prevalence (including HIV) of 131 for every 100,000 persons in 2012 . The couTuberculosis and HIV are devastating infectious diseases associated with a low socioeconomic status, with the reputation of bringing stigma and discrimination to their victims and inflicting economic losses to low- and middle-income nations , 7. BothThe purpose of this study is to observe the hematological and biochemical status of pulmonary tuberculosis (PTB) patients with or without Human Immune Deficiency Virus (HIV) coinfection at the Chest Clinic, Georgetown Public Hospital, Guyana.An observational, laboratory based retrospective descriptive study was designed to assess the relationship of PTB and HIV with patients routine biochemical and hematological values. The study was conducted during the period January 2013 to December 2014 at Georgetown Chest Clinic, Guyana. Sample sizes of 316 patients were enrolled following exclusion and inclusion criteria.Inclusion Criterion. All patients who were diagnosed of PTB and PTB + HIV with no past history of TB were considered for the present study.Exclusion Criteria. Patients with the following conditions were excluded from the study:patients under inspection;patients with any type of hepatitis complications at the time of PTB diagnosis;inadequate medical records to allow complete analysis;pregnancy at time of PTB diagnosis;patients with a clinical history of chronic renal failure;hemoglobinopathy;neoplastic disease and collagen vascular disease;deceased patients upon follow-up;malaria and worm infested PTB diagnosis;sputum sample taken after initiation of treatment.+, Cl−, and Na+), aspartate aminotransferase (AST), alanine aminotransferase (ALT), direct bilirubin, total bilirubin, and indirect bilirubin. Hematology parameters evaluated were fasting blood sugar (FBS), hemoglobin concentration, total white blood cell (WBC), and platelet count. Voluntary counselling and general physical evaluation of all the patients were carried out at the center. The patients were then asked questions to determine risk factors, habits, and sociodemographic data .Patients suspected of pulmonary tuberculosis were tested using fluorescence microscopy and treatment begins as soon as PTB is confirmed. An HIV test is done, if patients HIV status is unknown at the time and a RBS is taken to screen for diabetes. CD4 count and sputum smear grade were also investigated. Hematology and biochemistry tests of the patients were performed at the Georgetown Public Hospital Cooperation (GPHC) Laboratory. Parameters evaluated for biochemistry were serum BUN, serum creatinine, serum electrolytes , Ministry of Health, Guyana, to proceed with the study. Individual patients were assigned numbers for identification.All pieces of information were first entered in Excel spreadsheet and later transferred to SPSS 20.0 and JMP for further analysis.A total of 495 TB patients that were not under investigation were selected by the National Tuberculosis Program (NTP) staff. Of these, 37 had Extrapulmonary Tuberculosis (EPTB), 23 had both pulmonary tuberculosis (PTB) and EPTB, 1 had liver disease, 3 females were pregnant, 10 had malaria within a year, before TB diagnosis, and 105 had too little or no lab test available.p < 0.001). The mean age ± SD of subjects was 40.2 ± 13.8 years (95% CI 38.6–41.7). Median age and standard error (SE) and interquartile range (IQR) of the study population were 40 ± 0.77 and 20, respectively  were males and 81  were females  had a CD4 count <200 (p < 0.001). A significant higher number  of patients had a sputum grade of 3+ (p < 0.001)  were HIV positive and 272  were HIV negative with < 0.001) .Tables p < 0.001).This study was a first-time effort to relate hematological and biochemistry parameters among TB patients with or without HIV at the Georgetown Chest Clinic, Guyana. Though this study did not have enough TB-HIV coinfected patients, a concrete conclusion cannot be made.4 > 200. CD4 and CD8 T-cells are important immune components against TB and HIV and reduction in the count could suppress the immunity of the patient [Our study reveals that men were most infected than females and 51% of patients being between the ages of 30 years and 49 years which is a normal trend seen in most parts of the world , 9. This patient .Some studies agree that the mean of the total WBC count in PTB patients is usually normal or not significantly elevated as compared to the normal mean of a population , 12. HowThis study did not show any variation on blood sugar although Bailey and Grant  found thRisk factors play a major role in the magnitude of TB and HIV. There were many risk factors involved in this study, but the magnitude of TB was high among the homeless, smokers, and males. Socioeconomic status is always a major risk factor .There are several limitations that might have affected our conclusions; first, analysis was done based on the data available from the Chest Clinic. Second, a large-scale cross-sectional study might have produced a better conclusion on the laboratory parameters. Finally, other risk factors could have also included in this study.Hematological and biochemistry parameters are important, simple, and cheaper method in analyzing the pattern of health status among PTB patients with or without HIV.


Several trials have demonstrated an association between obesity and asthma severity. Body Mass Index (BMI) is a metric used to estimate the amount of body fat. It’s one of the best methods for population assessment of overweight and obesity. We have investigated the relationship between BMI and asthma severity in an adult asthmatic population from the Clinical Immunology outpatient service of an University Hospital.142 adult patients, diagnosed by clinical spirometric findings as asthmatics, were divided in two groups based on their asthma severity: group 1 [(n= 72): Mild Intermittent and Mild Persistent Asthma] and group 2 [(n= 70): Moderate and Severe Persistent Asthma]. Patients BMI were calculated and compared between both groups.Patients mean age was 49.5 years-old, most of them were female and caucasian. 26.1% of them were former smokers. Mean weight was 66.17kg in group 1 and 69.36kg in group 2. Mean height were 159.23cm and 157.1cm respectively. Mean BMI was significantly higher  in group 2 , comparing to group 1 .In this study, BMI was associated with asthma severity.


Corynebacterium variabile) to convert GFR into insect biomass and organic fertilizer. About 85.5% GA3 in the GFR was removed under the following optimized solid-state fermentation conditions: 60% GFR, 40% rice straw powder, pH 8.5 and 6 days at 26°C. A total of 371g housefly larvae meal and 2,064g digested residue were bio-converted from 3,500g raw GFR mixture contaning1, 400g rice straw in the unit of  dry matter. HFL meal derived from GFR contained 56.4% protein, 21.6% fat, and several essential amino acids, suggesting that it is a potential alternative animal feed protein source. Additionally, the digested GFR could be utilized as an organic fertilizer with a content of 3.2% total nitrogen, 2.0% inorganic phosphorus, 1.3% potassium and 91.5% organic matter. This novel GFR bio-conversion method can mitigate potential environmental pollution and recycle the waste resources.The accumulation of a considerable quantity of gibberellin fermentation residue (GFR) during gibberellic acid A3 (GA3) production not only results in the waste of many resources, but also poses a potential hazard to the environment, indicating that the safe treatment of GFR has become an urgent issue for GA3 industry. The key to recycle GFR is converting it into an available resource and removing the GA3 residue. To this end, we established a co-bioconversion process in this study using house fly larvae (HFL) and microbes ( Fusarium fujikuroi [As a phytohormone, gibberellins play an essential role in plant physiological responses, such as cell division, enlargement and differentiation, organ senescence and abscission . Gibbereujikuroi , thus geThe GFR contains more than 70% water with a special fetid odor. If piled up outdoor for a long time, the GFR not only pollutes the air, soil and groundwater, but also wastes resources. More importantly, there may be more than 2,000 μg / g residual GA3 in GFR (patent no CN 100387553 C). As a plant hormone released into the environment, GA3 could be taken into the body through drinking water, food and other channels. Due to its similar molecular structure to steroids, the potential hazard of GA3 to human health should be considered. GA3, some herbicides and insecticides are classified as endocrine disruptors  . The oraHowever, a great amount of GA3 is released into the environment, which will pose a huge potential risk for human health if GFR is not handled properly; thus, how to recycle the GFR effectively has become an urgent issue. Currently, GFR is usually treated by land filling directly or composting, but there are some problems with these methods. While direct composting of GA3 waste has some viability, most of the protein was converted into inorganic nitrogen, and there was about 80μg / g GA3 remaining in the treated GFR .Musca domestica L.) and Boettcherisca peregrina (Robineau-Desvoidy). One of our previous studies proved that the GFR could be converted into flesh fly biomass for biodiesel production [Our preliminary experiments showed that the rotten GFR was the main breeding ground for several kinds of cyclorrhapha flies, such as housefly , crude fat (14.9%), crude fiber (7.0%), and crude ash (5.6%) . The initial GA3 content of GFR was 140.5 μg / g.Preliminary analysis results showed that rice straw powder (weight / weight) should be added into GFR to modify its properties for the normal growth of housefly larvae. Rice straw pieces used in this experiment were prepared from rice cultivar Huajing 295, a high-yield commercial cultivar adopted in Hubei, China. The straw was ground to 40 mesh and weighed after drying. The as-prepared straw powder contained water (13.6%), crude protein (5.2%), crude fiber (34.7%), and crude ash (11.9%) .Housefly colony has been maintained for more than 20 generations at Huazhong Agricultural University, Wuhan, China . Adults C. variabile Q0029 was originally isolated from the Marine Culture Collection preserved in the State Key Laboratory of Agricultural Microbiology, College of Life Science and Technology, Huazhong Agricultural University, P. R. China. All of the microorganisms in the Marine Culture Collection were cultured in the GA3 medium . Subsequently, C. variabile Q0029 was picked out by dilution plate and spread plate methods and routinely cultivated in the GA3 medium at 30°C. To investigate the GA3 degradative capabilities of C. variabile Q0029 in the GFR, the water in the fresh GFR was adjusted to 90%, and a portion of 50 mL liquid GFR was loaded separately into each of the six 150 mL flasks. Three of the flasks containing 1mL inoculum of the strain C. variabile Q0029 were then cultured, and another three flasks free of C. variabile Q0029 were also cultured as control . 5mL liquid GFR was sampled every 24 h for GA3 determination.Bacterial strain C. variabile Q0029 was cultured in each medium. All of the groups were fermented for 7 d at 26°C. The seed liquid was prepared by inoculating strain C. variabile Q0029 in LB medium at 28°C under shaking (180 rpm) until OD600 = 1. When fermentation was completed, all of the samples were frozen at -20°C for the next use.To improve the GA3 degradation efficiency, three principal factors were optimized: fermentation time, pH value, and the content of straw powder. Based on the preliminary experimental results, three replicates were made for the solid fermentation medium  which consisted of 60% GFR and 40% straw powder with the pH adjusted to 7 by adding sodium hydroxide (NaOH), followed by 7-d fermentation at 26°C and sampling every 24 h. Five groups (three replicates per group) of solid fermentation mediums consisted of 40% straw powder and 65% moisture, using NaOH to adjust the pH as follows: the original (pH 4.0), pH 6.5, pH 8.5, pH 10.5 and pH 12.5. The other five groups of mediums contained 65% moisture at pH 8.5, with GFR mixed separately with 20%, 30%, 40%, 50% and 60% of the straw powder for each group. After adding water and mixing GFR with rice straw, 300g solid medium was loaded in a 1L beaker (per replicate) with gauze for sealing, and 10% (volume / weight) seed liquid of strain C. variabile Q0029. Based on the optimized solid-state fermentation conditions , four groups of GFR containing 20%, 30%, 40%, and 50% straw powder were fermented for about 6 d for HFL medium preparation (3 replicates). Every 10 kg medium was placed in a plastic box (0.65 m × 0.43 m × 0.14 m) in each replicate. After pretreatment, approximately 10,000 naive HFL (incubated on wheat bran about 1day) were cultured in 1 kg medium for 6 d at 26°Cfor bioconversion. The old HFL (3rd instar) and the digested GFR were separated by sieving and weighed. About 4% of the old HFL was put into the cage for pupation. The emergence of adult flies (eclosion of pupae) would occur after 5 d to produce eggs for hatching naive HFL. The main HFL biomass (96%) was weighed and dried at 80°C to constant weight.Each sample  was ground to a homogenous powder with liquid nitrogen. An accurately weighed sample powder of 5.00 g was placed into a 50mL polypropylene centrifuge tube, followed by LC / MS / MS determination by extracting GA3 from the samples as previously reported . Liquid Detection was performed by multiple reaction monitoring (MRM) mode of selected ions on an triple-quadrupole mass spectrometer equipped with a Turbo Ion Spray interface. Mass spectral conditions and the optimal parameters of MRM are listed in Tables i represents the initial amount of absolute GA3 in medium, and Ct represents the amount of absolute GA3 at reaction time t.GA3 reduction was calculated by the following equation:4 dripping method according to GB / T 6436–2002 and phosphorus was analyzed by phosphorus vanadium molybdate yellow colorimetric method from GB / T6437-2002. Zinc and manganese were determined by atomic absorption spectrometry method according to GB / T 13885–2003. The content of amino acids (AA) was determined using an automatic amino acid analyzer  according to GB / T 18246–2000.Specific characteristics of the HFL meal such as crude protein, crude fat and crude ash were analyzed in our laboratory according to AOAC methods 990.03, 920.39 and 942.05, respectively . CalciumP < 0.05 was used as the criterion for statistical significance [The data about GA3 reduction were subjected to one-way analysis of variance for a completely randomized design with three replicates in each treatment. The significance of differences among treatments was tested by Duncan’s multiple-range test and a level of ificance .C. variabile Q0029 strain. No significant changes were observed in GA3 reduction from day 1 to day 4, but a dramatic GA3 reduction occurred from day 4 to day 7. Compared with the control, 78.23% of GA3 was degraded at day 7. It is known that C. variabile is equipped with an extensive set of enzymes, such as lipases and esterases, which participate in degradation of lipids [C. variabile has the capability of biodegrading acid red B with phenyl [f lipids . It was h phenyl . InteresP > 0.05) from 82.4 ± 1.9% to 85.5 ± 2.5% with a rice straw content increase from 20% to 40%. However, the GA3 reduction rate showed a significantly sharp decline (P < 0.05) to 26.4 ± 2.5% with rice straw content approaching 60%. Therefore, a rice straw content of 20%-40% was selected as the optimal content for GA3 biodegradation. Generally, the ascomycetous fungus Fusarium fujikuroi was initially separated from rice seedling as a pathogen, and large amounts of live Fusarium fujikuroi are present in the GFR, which can facilitate the decomposition of the rice straw powder [Fusarium fujikuroi. In addition, we found that water in GFR with a high content of rice straw powder (> 40%) would evaporate more easily than that with a low content of rice straw powder.In this study, three parameters  were optimized for GFR solid-state fermentation. w powder . The posBoettcherisca peregrina larvae and 65.7% digested GFR could be obtained when using the similar medium, but lower reproductively limits the scale of its application [lication , 13.Whenlication . It is nC. variabile played an important role in GA3 biodegradation. The remaining 122 mg GA3 residue in the HFL medium was reduced to about 37.19 mg after the bioconversion step. Thus, it can be concluded that more than 80% of GA3 was degraded in the fermentation step, but the mechanism of GA3 biodegradation in C. variabile and HFL needs to be elucidated in the further study.As shown in C. variabile Q0029, 92.2% GA3 could be removed from GFR.2O5 + K2O) of 6.5% and an organic matter content of 91.5%, which were all within the NY525-2012 standards. As about 17.92μg / g GA3 remains in the digested GFR, the optimal dosage of the digested GFR as an organic fertilizer should be further investigated in the future. It was reported that a low-dosage application of GA3 in Brassica juncea L. seedling was favorable to seed germination and increased individual biomass, while a high-dosage application restrained seed germination and obviously reduced individual biomass [Hermetia illucens L. and white fish meal. The HFL meal derived from GFR contains 56.4% protein, which is higher than H. illucens (43.3%), and close to the white fish meal (60.0%). HFL has been proved to be a potential alternative animal feed protein source in many previous studies [H. illucens, but much higher than that of the white fish meal. HFL oil could be extracted and utilized as a novel feedstock for biodiesel production in our previous study [H. illucens (8.4%). Mineral elements such as calcium (1.1%), zinc (252 mg / kg) and manganese (258 mg / kg) in the HFL meal were obviously lower than those of H. illucens. Phosphorus in the HFL meal (1.6%) was nearly twice that of H. illucens (0.9%), but lower than that of the white fish meal (2.3%). studies , 27. Theus study . Crude aH. illucens and white fish meal. The AA content in the HFL meal was obviously higher than that of H. illucens, indicating that HFL meal had advantages over H. illucens prepupae as an alternative animal feed protein source. Meanwhile, there are many noticeable differences between HFL meal and white fish meal. Lysine in HFL meal was only 2.28%, far below that of white fish meal (4.41%), but the contents of methionine (1.18%) and threonine (2.06%) in the HFL meal were close to those of H. illucens. Generally, the essential amino acids, methionine, lysine and threonine are only present in limited quantities in the crude feed materials, such as wheat bran, peas, rapeseed meal and soybean meal. Therefore, the bioconversion of GFR into HFL biomass can not only mitigate environmental pressure, but also save food.Corynebacterium variabile capable of degrading GA3, and the fermented GFR was then converted into larvae biomass via housefly. More than 90% GA3 residue was removed from GFR by co-conversion of HFL and C. variabile Q0029 under the optimized solid-state fermentation conditions. GA3 in the live HFL derived from the fermented GFR was 0.12 μg / g, suggesting that this HFL might be used as an alternative animal feed protein source. The properties of digested GFR were all within China organic fertilizer standards (NY525-2012). It can be concluded from the comprehensive analysis results that HFL with the assistance of microbes has the potential to recycle GFR into insect biomass and organic fertilizer, and reduce the environmental pollution of the wastes.In this study, the GFR was initially pretreated by solid-state fermentation with one strain of


Perioperative use of Normal Saline is linked to hyperchloraemic or Strong Ion Difference (SID) related acidosis. It has been suggested, that this can be avoided by the use of balanced crystalloid solutions including Ringer's Lactate (RL). Significant changes in SID were noted previously in cardiac surgery, however recent publication disproved the link between SID and hydrogen ion concentration.Our aim was to establish effects of routine use of RL on post-operative changes in SID and whether these changes result in metabolic acidosis. As pH is affected by both respiratory and metabolic components, we attempted to establish link between SID and base excess (BE), thus eliminating the potential compensatory effect of respiratory function.A retrospective analysis of 179 consecutive patients was conducted in tertiary referral university hospital. Approval of institutional ethics committee was obtained for this study. We analysed arterial blood gas samples at the point of patient arrival to ICU and 24 hours after surgery. Statistical analysis was performed using SPSS statistical package for Windows. Pearson correlation was used to establish the link between SID and BE. Paired samples T-test used to compare means between the two time-points.Total volume of intravenous infusions in first 24 hours was 5865( ± 1073) ml, 95% of it was RL. 58 % of patients had metabolic acidosis with the BE of less than (-)2 mmol/L on arrival to ICU. There was significant correlation between SID and BE (p < 0.01). Significant improvement in metabolic acidosis was noted at 24 hours postoperatively, mean BE changed from (-)2.49 to 0.32 mmol/L . All of the improvement in BE is explained by change in SID from mean value of 31.0 to 34.2 mmol/L . Changes in SID were primarily driven by changes in serum sodium concentration that were threefold higher compared to those of chloride - 2.36 ( ± 2.6) mmol (p < 0.001) and 0.84 ( ± 3.2) mmol respectively (p = 0.01). There was no difference in pH between the two groups because of respiratory compensation at the first time-point resulting in significantly lower mean pCO2 of 41.3( ± 6.7) mmHg versus 43.6 ± 5.8 mmHg at 24 hours (p = 0.003).Our data confirms that there is a direct correlation between SID and BE following on pump cardiac surgery. Use of Ringer's Lactate prevented significant hyperchloraemia, but did not eliminate the risk of SID related metabolic acidosis. Change in SID was primarily linked to perioperative changes in serum sodium concentration.


However, population-based data to inform prevention, treatment and control are lacking.Previously considered as a disease of the Using the WHO STEPwise approach to chronic disease risk factor surveillance, a population-based, nationwide cross-sectional survey was conducted between July and September 2009 on participants aged 25–64 years. A multi-stage cluster sample design and weighting were used to produce a national representative data for that age range. Detailed findings on the magnitude of diabetes mellitus and impaired fasting blood glucose are presented in this paper.p < 0.01. In both men and women, prevalence of raised fasting blood glucose or currently on medication for diabetes was 5.6% (95% CI 2.6%- 8.5%). Although the prevalence of diabetes was higher in men than women, 6.5% (95% CI 2.6%-10.3%) vs 4.7% (95% CI 2.4%-7.0%), in rural than urban, 5.4% (95% CI 2.4%-8.4%) vs 4.4% (95% CI 2.8%-5.9%) and in males in rural than males in urban, 6.9% (95% CI 2.8%-11.0%) vs 3.2% (95% CI 0.1%-6.3%), the differences were not statistically significant, p > 0.05. Compared to previous estimates, prevalence of diabetes increased from <1.0% in 1960s to 5.6% in 2009 (this study).Fasting blood glucose measurement was conducted on 3056 participants . The age- sex standardised population-based mean fasting blood glucose was 4.3 mmol/L (95% CI 4.1-4.4 mmol/L) with no significant differences by age, sex and location . The overall prevalence of impaired fasting blood glucose was 4.2% (95% CI 3.0%-5.4%). Prevalence of impaired blood glucose was higher in men than in women, 5.7% (95% CI 3.9%-7.5%) vs 2.7% (95% CI 1.6%- 3.8%), High prevalence of impaired fasting blood glucose and diabetes mellitus call for the implementation of primary healthcare approaches such as the WHO package for essential non-communicable diseases to promote healthy lifestyles, early detection, treatment and control. Diabetes mellitus alongside other non-communicable diseases (NCDs), mainly cardiovascular diseases, cancers and chronic respiratory diseases are increasingly becoming significant public health problems globally. In 2010, the world prevalence of diabetes among adults (aged 20–79 years) was estimated at 6.4%, affecting 285 million adults, and is projected to increase to 7.7%, and 439 to 552 million adults by 2030. Between 2010 and 2030, there will be a 69% increase in numbers of adults with diabetes in developing countries and a 20% increase in developed countries [In sub-Saharan Africa, it was estimated that 12.1 million people were living with diabetes in 2010 and this was projected to increase to 23.9 million by 2030. Type 2 diabetes is the most common form accounting for over 90% of the cases. Type 2 diabetes is becoming more prevalent owing to rising rates of obesity, physical inactivity, urbanisation and nutritional transitions . Due to 2) was less than 7% [In Malawi, studies conducted in 1960s and 1970s demonstrated that diabetes was not an important public health problem then with prevalence of 1% or less . Under-n than 7% . However than 7% . In thisThis study was a nationwide population- household- based cross-sectional survey designed according to a WHO STEPwise approach to chronic disease risk factor surveillance . Sample Enumeration areas (EAs) were used as survey sites. Administratively, Malawi is divided into twenty-eight districts. In turn, each district is sub-divided into smaller administrative units called traditional authorities (TAs). Each TA is sub-divided into EAs by the National Statistical Office (NSO). Enumeration areas are classified as urban or rural. Each EA has demographic data and a sketch map. The sketch map shows the EA boundaries, location of buildings, and other landmarks. The list of all EAs in Malawi from latest (2008) population and housing census was obtained from NSO. This list was used as a sampling frame for the random selection of EAs. According to the WHO NCD STEPS Survey manual Part 2 Study design and sample size, in each EA, 30–50 households could be selected and in each household only one eligible participant could be selected . We settEligible participants were all adults aged 25–64 years. Participants were involved in the study for two days. Day one was for the questionnaire and anthropometric measurements. Day two was for blood pressure measurement and laboratory tests. Formal written consent was obtained. Participants with abnormal physical or laboratory findings as defined below were counselled and referred to their nearest health facility for further action and follow up. Body measurements and laboratory tests were performed by nurses and clinical officers while enumerators conducted the interviews. A total of seven survey teams, each with 8 members were deployed to collect data over a period of 30 days between July and September 2009.Chichewa and Tumbuka).Demographic and lifestyle data were collected using WHO STEPS questionnaire. The questionnaire was programmed on PDA. It consisted of core , expanded  and optional  variables. The medical and health history component included questions on medication, cigarette use, diabetes mellitus and hypertension. The English questionnaire was translated into two main local languages .On the first day of the survey participants were asked to starve overnight. Consenting participants were asked not to consume any food except for water after taking supper/dinner of that day until the survey team came again in morning of the following day (day 2). People converged at the agreed place in their community where finger prick blood samples were taken. Those that complied with the advice (starving overnight) were eligible for finger prick blood sample collection. Fasting blood glucose was measured using Accutrend® Data were collected electronically using PDAs programmed with WHO e-STEPS software. Data on the PDAs were downloaded into the computer installed with WHO NCD STEPS software. The files of each participant were then merged using the participant identity (PID) number cross-checked with participant name, EA number or village/township name and other particulars where necessary. After merging, common variables in the dataset were matched and inconsistencies were corrected.Data were weighted by calculating sample weights for all records using the probability of selection at each stage of sampling. Thus, for each participant his/her weight was calculated by multiplying the probability of EA selection, the probability of household selection, the probability of participant selection within the household and age-sex population distribution in Malawi. The participant’s weight was equal to the inverse of this product. Data analysis was conducted using WHO e-STEPs software and Epi Info, version 3.5.1 . Chi-square tests were used to evaluate differences in proportions and student’s t-test for differences in means.p < 0.05 or t < 0.05.Impaired blood glucose was defined as fasting capillary whole blood value of ≥5.6 mmol/L (100 mg/dl) but less than 6.1 mmol/L (110 mg/dl). Diabetes was defined as fasting capillary whole blood glucose level >6.1 mmol/L (>110 mg/dl) or currently on medication for diabetes mellitus . Results were considered statistically significant, Ethical approval was granted by the Malawi National Health Sciences Research and Ethics Committee. Written informed consent was obtained before participants were enrolled in the study using the WHO NCD STEPS survey consent form.2 or more). Table A total of 5451 eligible adults were selected and approached to participate in the survey. Of these, 245 (4.5%) refused/were not available while 5206 (95.5%) consented and took part in the survey. Of the 5206 participants that took part in the survey, 183 (3.5%) were pregnant women and were excluded in the analysis for this paper to control for the potential influence of pregnancy on blood glucose levels. Complete data for fasting blood glucose measurement were available and analysed for 3056 (60.8%) of the 5023 eligible non-pregnant participants. Of the 3056 participants with complete fasting blood glucose data, 2145  were aged 25–44 years, 2685 (87.9%) were from rural areas, 2619 (85.7%) had primary education or none, 2234 (73.1%) were married or cohabiting, 364 (10.9%) were tobacco smokers, 403 (13.2%) were alcohol drinkers and 669 (21.9%) were overweight or obese (body mass index 25.0 Kg/mThe age- sex standardised population-based mean fasting blood glucose for 3056 participants was 4.3 mmol/L (95% CI 4.1-4.4 mmol/L). There were no significant differences in mean fasting blood glucose by location , age and sex Table .p < 0.01  in 3056 participants was 4.2% (95% CI 3.0%-5.4%). Prevalence of impaired blood glucose was higher in men than women, 5.7% (95% CI 3.9%-7.5%) vs 2.7% (95% CI 1.6%- 3.8%), p > 0.05  or currently on medication for diabetes in 3056 participants was 5.6% (95% CI 2.6%- 8.5%). Although the prevalence was higher in men than women, 6.5% (95% CI 2.6-10.3%) vs 4.7% (95% CI 2.4%-7.0%), in rural than urban, 5.4% (95% CI 2.4%-8.4%) vs 4.4% (95% CI 2.8%-5.9%) and in males in rural than males in urban, 6.9% (95% CI 2.8%-11.0%) vs 3.2% (95% CI 0.1%-6.3%), the differences were not statistically significant, 2) [This study is one of the few large national population-based studies that have provided latest evidence on the status of diabetes mellitus in east and southern Africa region in general, Malawi in particular. In 1960s, diabetes was not an important public health problem in Malawi and the prevalence, then, was less than 1%. Malnutrition, even in adults was the main problem where up one in three adults (36%) were under-nourished or underweight (body mass index <18.5 Kg/m2) -9. Howev2)  and prevp >0.05). Number of participants that were tested for fasting blood glucose was relatively smaller in urban than rural (371 vs 2685). This may have influenced the results. However, it has also be shown that hypertension, tobacco smoking and alcohol consumption were more frequent in rural than urban [affluent, urban or the west” [. Other studies also reported similar findings that prevalence of diabetes was similar in men and women and impaired fasting blood glucose was higher in men than women [This study also demonstrated that in Malawi, diabetes was just as common in rural as in urban areas and in men as in women. Apparently it was higher in rural than urban areas, 5.4% (95% CI 2.4%-8.4%) vs 4.4% (95% CI 2.8-5.9%), in men than in women, 6.5% (95%CI 2.6%-10.3%) vs 4.7% (95% CI 2.7%-7.0%) but the differences were not statistically significant . The under representation of men in this age group was due to some being away from home at the time of the survey. It was not known if this group had different survey characteristics. All the other age groups were representative of the national population. There were no differences in the refusal/non-availability between males and females and no replacements were made. About 88% of all the 3,056 participants that were tested for fasting blood glucose were from rural areas. This was not due selection bias but was in line with the population distribution in Malawi which is 85% rural [Over-representation of females (70.2%) was one of the limitations of this study. However, it was unlikely that this had an influence on the results because data were weighted (standardised) for age and sex to national population. The over representation of females was not by study design because at household level, eligible participants were randomly selected using the Kish sampling method built-in the PDAs. Refusals/non-availability  out of 5,451 eligible participants), was another limitation of this study. Specifically, males aged 25–34 years were the ones that were under-represented based on 2008 National Statistical Office population figures  used this study for blood glucose testing were not standardized, quality controlled and capillary was not compared with venous plasma blood tests. However, the machines were calibrated every day using the glucose control strips as per instructions on the use of machines. Diagnosis of diabetes was based on fasting glucose test only. Without oral glucose tolerance test (OGTT) results, the estimated prevalence of 5.6% could be lower than the real prevalence.The other limitation was that the Accutrend Not all participants who consented and adhered to fasting were tested for blood glucose ). Technical factory fault of the biochemistry machines (Accutrend plus®) led to about 40% of the participants who gave their informed consent and adhered to fasting advice not to be tested. Two machines were sent back to the manufacturer (Roche). It was uncertain whether the failure to measure fasting blood glucose in all the participants who consented had an influence on the results. The curtailment of testing affected men, women and all age groups equally. Based on number of participants and their ages, the available results for each measurement were standardised for age and sex to the national population. The findings presented in this paper were therefore age-sex adjusted estimates. Nevertheless this population based study captured fasting blood glucose tests for over 3000 adults.This study has presented evidence on high burden of diabetes mellitus, impaired fasting blood glucose and their risk factors in Malawi. Promotion of healthy lifestyles, community awareness, early detection and treatment could prevent and control this public health problem.The authors declare that they have no competing interests.KPM, CM and DK conceived and designed the study. KPM, CM and DK conducted the study. KPM analyzed the data: KPM, CM and DK wrote the manuscript: All the authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6823/14/41/prepub