Nutritional assessment of servicemen in relation to area of duty and feeding habits: a Pakistani prospective

Abstract The present study was carried out to determine incidence of overweight and obesity in Pakistani servicemen with reference to their area of duty, feeding habits and also to identify risk factors. Accordingly, 2,501 servicemen selected from all over Pakistan using multiple stage stratified sampling protocol. Nutrition assessment performed using body mass index (BMI), waist to hip ratio (WHR) and dietary assessment using food frequency questionnaire. Collected data was analyzed using the SPSS version 25. Regression was used to find risk factors of obesity and WHR. Results indicated that about 1/4th of servicemen were smokers. Approximately, 1/5th of them were overweight and about one quarter were eating fruits and vegetables for 3 days/ week and 4 days/week, respectively. Only 1/3rd of them were physically active for at least 40 minutes per day. Age and fruits intake were significantly predicting BMI with a direct relation and vegetable intake was negatively correlated to BMI of the servicemen. Age and rank were significant predictors of WHR while, physical activity was negatively correlated to WHR. It is concluded and suggested from our study that there is a need to modify eating patterns and habits as well as improving physical activity on daily basis for healthy and long life of the servicemen.

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Os benefícios da laserterapia de baixa intensidade associados a exercícios domiciliares em idosos com osteoartrite de joelho / The benefits of low-intensity laser therapy associated with home exercises in elderly knee osteoarthritis

INTRODUÇÃO: A Osteoartrite (OA) é uma doença musculoesquelética com predomínio na população idosa. O tratamento com Laserterapia tem sido um dos métodos seguros e não invasivos para o tratamento da OA. OBJETIVO: Observar a influência na dor, rigidez e função em idosos antes e depois da aplicação da laserterapia associados a exercícios domiciliares. MÉTODOS: Dez pacientes idosos com OA de joelho, submetidos a 12 sessões de Laserterapia, 3 vezes por semana e orientados a realizarem exercícios domiciliares durante o período do estudo. Foi utilizado o Laser de baixa potência Class 3B Chattanooga, com energia total de 36J (divididos em 6 pontos- 6J por ponto) conforme a dosagem da World Association of Laser Therapy (WALT). Para mensuração do quadro álgico foi utilizados a Escala Visual Analógica (EVA); Índice de Osteoartrite de Western Ontario (WOMAC) e Índice de Lequesne para dor, rigidez e funcionalidade. Os exercícios domiciliares foram explicados e demonstrados pelo avaliador e orientado a realizar 3 vezes por semana durante 12 sessões. RESULTADOS: Observamos que após aplicações de Laserterapia e exercícios domiciliares, não houve melhora na EVA, porém com melhora significativa nos quesitos WOMAC geral (p=0,01) e função (p=0,001) enquanto os demais não houve significância (p>0,5) quando avaliados por meio do t-test, já na comparação entre questionários houve correlação forte em WOMAC e LEQUESNE com a Correlação de Pearson. CONCLUSÃO: Pode-se concluir que a Laserterapia associada a exercícios domiciliares não evidencia melhora significativa do quadro álgico através da EVA, podendo ser uma resposta subjetiva com dificuldade de compreensão pelos pacientes, porém foi observado melhora significativa na evolução funcional do paciente medidas pelos questionários WOMAC e LEQUESNE nos pacientes com OA de joelho.

INTRODUCTION: Osteoarthritis (OA) is a musculoskeletal disease with predominance in the elderly population. Laser therapy has been one of the safe and non-invasive methods for treating OA. OBJECTIVE: To observe the influence on pain, stiffness and function in the elderly before and after the application of home exercise laser therapy. METHODS: Ten elderly patients with knee OA who underwent 12 laser therapy sessions 3 times a week. The Chattanooga Class 3B Low Power Laser was used, with a total energy of 36J (divided into 6 points - 6J per point) according to the dosage of the World Association of Laser Therapy (WALT). We used the Visual Analog Scale (VAS) for pain; Western Ontario Osteoarthritis Index (WOMAC) and Lequesne Index for pain, stiffness and functionality. Home exercises were explained and demonstrated by the evaluator and instructed to perform 3 times a week during 12 sessions. RESULTS: We observed that after laser therapy and home exercises, there was no improvement in VAS but there was significant improvement in the general WOMAC (p = 0.01) and function (p = 0.001), while the others were not significant (p> 0, 5), when compared to the t-test, when compared to the Pearson correlation, there was an improvement in the WOMAC and LEQUESNE questionnaires. CONCLUSION: It can be concluded that after applying home exercise laser therapy, there was no significant improvement in pain through VAS, which may be a subjective response with difficulty for patients to understand, but there was a significant improvement in the patient's functional evolution measured by the questionnaires. WOMAC and LEQUESNE in patients with knee OA.

Development process of an assessment instrument on the level of difficulty perceived by caregivers for the elderly / Proceso de desarrollo de una evaluación de la evaluación en el nivel de dificultad percibido por los caregivers para los ancianos / Processo de desenvolvimento de um instrumento de avaliação sobre o nível de dificuldade percebido pelos cuidadores para os idosos

The objective of this study was to build an instrument to assess the level of difficulties perceived by caregivers for the elderly. Methods: cross-sectional study, semi-structured interview carried out with informal caregivers for the elderly. In the first phase of this study, a semi-structured interview was conducted with the first sample of informal caregivers. From these results, an assessment instrument of level of difficulty felt by the informal caregiver while performing the care was built. In the second phase, the instrument was used with the second sample of informal caregivers to assess its internal consistency through Cronbach's Alpha coefficient. Results: the instrument was constituted by eleven domains and forty-eight items. Each item was to be ranked from 1 to 5, representing the best and the worst score, respectively. Internal Consistency analysis of the instrument was performed using Cronbach's alpha coefficient. The Cronbach's alpha values revealed a good internal consistency to the eleven domains of the instrument, with the coefficient ranging from .74 to 1.00. These values are considered good or even excellent. The total Cronbach's Alpha coefficient value of this instrument is .98. Conclusion: the analysis of the Cronbach's alpha values showed good internal consistency for the eleven domains of the instrument, i.e., the answers on the instrument are coherent with its questions. The assessment instrument reached its go in assessing the difficulty informal caregivers feel when caring for the elderly. It is recommended that the instrument is reproduced in a target population representative for external validity.

El objetivo de este estudio fue construir un instrumento para evaluar el nivel de dificultad percibido por los cuidadores para los ancianos. Métodos: estudio transversal, entrevista semiestructurada llevada a cabo con cuidadores informales para personas mayores. En la primera fase de este estudio, se realizó una entrevista semiestructurada con la primera muestra de cuidadores informales. A partir de estos resultados, se construyó un instrumento de evaluación del nivel de dificultad que sintió el cuidador informal al realizar la atención. En la segunda fase, el instrumento se utilizó con la segunda muestra de cuidadores informales para evaluar su consistencia interna a través del coeficiente alfa de Cronbach. Resultados: el instrumento estuvo constituido por once dominios y cuarenta y ocho ítems. Cada ítem debía clasificarse de 1 a 5, lo que representa el puntaje mejor y el peor, respectivamente. El análisis de consistencia interna del instrumento se realizó utilizando el coeficiente alfa de Cronbach. Los valores alfa de Cronbach revelaron una buena consistencia interna en los once dominios del instrumento, con un coeficiente que oscila entre .74 y 1.00. Estos valores se consideran buenos o incluso excelentes. El valor total del coeficiente alfa de Cronbach de este instrumento es .98. Conclusión: el análisis de los valores alfa de Cronbach mostró una buena consistencia interna para los once dominios del instrumento, es decir, las respuestas en el instrumento son coherentes con sus preguntas. El instrumento de evaluación llegó a su fin para evaluar la dificultad que sienten los cuidadores informales al cuidar a los ancianos. Se recomienda que el instrumento se reproduzca en un representante de población objetivo para la validez externa.

O objetivo deste estudo foi construir um instrumento para avaliar o nível de dificuldade percebido pelos cuidadores para com os idosos. Como métodos, estudo transversal, entrevista semiestruturada realizada com cuidadores informais de idosos. Na primeira fase deste estudo, foi realizada uma entrevista semiestruturada com a primeira amostra de cuidadores informais. A partir desses resultados, foi construído um instrumento de avaliação do nível de dificuldade sentido pelo cuidador informal durante a realização do cuidado. Na segunda fase, o instrumento foi utilizado com a segunda amostra de cuidadores informais, para avaliar sua consistência interna, por meio do coeficiente Alfa de Cronbach. Como resultados, o instrumento foi constituído por onze domínios e quarenta e oito itens. Cada item deveria ser classificado de 1 a 5, representando a melhor e a pior pontuação, respectivamente. A análise da Consistência Interna do Instrumento foi realizada por meio do coeficiente Alfa de Cronbach. Os valores do Alfa de Cronbach revelaram uma boa consistência interna para os onze domínios do instrumento, com o coeficiente variando de 0,74 a 1,00. Esses valores são considerados bons ou até excelentes. O valor do coeficiente Alfa de Cronbach total deste instrumento é de 0,98. Concluindo, a análise dos valores do alfa de Cronbach mostrou boa consistência interna para os onze domínios do instrumento, ou seja, as respostas no instrumento são coerentes com suas questões. O instrumento de avaliação chegou a avaliar a dificuldade que os cuidadores informais sentem quando cuidam dos idosos. Recomenda-se que o instrumento seja reproduzido em uma população-alvo representativa de validade externa.

Performance Evaluation of Unexpected Antibody Screening Test Including Di(a) Cell Using 3% Surgiscreen Sub-Code D in Korean Multi-Transfused Patients / 대한수혈학회지

BACKGROUND: The Dia antigen has been found to have a relatively higher incidence among Korean populations. However, the current popular antibody screening panels contain no Dia positive cells. To prevent hemolytic transfusion reaction, screening for unexpected antibody plus screening for Dia positive cells should be performed. In this study, we evaluate the performance of the 3% Surgiscreen Sub-code D (Ortho-Clinical Diagnostics, USA) manufactured as a 3-cell panel including Dia cell versus the ID-DiaCell I-II (DiaMed, Switzerland) as a 2-cell panel plus ID-DiaCell Dia+ (DiaMed, Switzerland) in screening for irregular red blood cell alloantibodies. METHODS: From December 13, 2013 to April 24, 2014, we tested the 3% Surgiscreen by the AutoVue Innova system and the ID-DiaCell in parallel to evaluate reagent sensitivity in detecting irregular antibodies in multi-transfused patients' plasma or serum. Identification of unexpected antibody tests was performed for positive screening results. RESULTS: Antibody-positive rates were 4.2% (79/1885) and 4.6% (87/1885) for antibody screening with the 3% Surgiscreen and the ID-DiaCell, respectively. Among the 1885 samples, 1875 (99.5%) showed concordant results between the 2 methods, while 10 results differed. From the 10 discrepancies, 1 result was positive only on the 3% Surgiscreen. The prevalence of anti-Dia antibody was 10.1% and 9.2% in the 3% Surgiscreen and the ID-DiaCell, respectively. CONCLUSION: The 3% Surgiscreen manufactured as 3-cell showed a high concordance rate ompared to standard methods. The prevalence of anti-Dia showed no difference between the 2 reagents.

Unexpected Antibody Screening Tests Including Di(a) in Patients with a History of Multiple Packed Red Cell Transfusion / 대한수혈학회지

BACKGROUND: The Di(a) antigen has been detected with a relatively higher incidence among Koreans with a frequency of 6.4 to 14.5%. In South Korea, commonly used unexpected antibody screening panels do not include Di(a) antigen positive cells. We screened patients who previously received multiple packed red cell transfusion using two cells without Di(a) antigen and three cells including Di(a) antigen to evaluate the effectiveness of three screening cells. METHODS: A total of 307 patients who had received packed red cell transfusion more than three times during the last 6 months in our hospital were enrolled. They were employed for unexpected antibody screening test using two sets of screening cells not including Di(a) antigen and three sets including Di(a) antigen by LISS/Coombs gel card. RESULTS: Among 307 patients, 12 were positive using two cells and 15 were positive using three cells. Three patients showed discordant result and one of them was positive for the cell including Di(a) antigen (0.33%). Antibody identification was performed using the panel which does not include Di(a) antigen and it was negative for all of the antigens listed on the panel so that the presence of anti-Di(a) was suspected. CONCLUSION: It can be difficult to use three cells including Di(a) antigen for all patients due to cost, however, use of three cells is recommended in patients with multiple transfusion history.

Eleven Years' Experience with Unexpected Antibody Screening Tests Including a Di(a) Cell in Transfusion Candidates / 대한수혈학회지

BACKGROUND: The Di(a) antigen has been detected with a relatively higher incidence among the Korean and Southeast Asian population. A 'Type and Screen' procedure is recommended for efficient transfusion, therefore, we perform antibody screening tests using antibody screening panels containing a Di(a) cell. The purpose of this study was to report on the experience of unexpected antibody screening test including a Di(a) cell in the Korean population. METHODS: We analyzed the results of antibody screening testing and identification performed during the recent 11-year period from January 2002 to December 2012. A commercially available three-cell antigen panel (Diacell I, II, Di(a); DiaMed, Murten, Switzerland) was used for antibody screening. Antibodies were identified using a LISS/Coombs gel card and NaCl/Enzyme card, using the DiaMed-ID system (DiaMed, Murten, Switzerland). RESULTS: The frequency of unexpected antibodies was 1.23% (1,918/156,161); the most frequently detected antibodies were anti-E (292 samples), followed by anti-E,c (127 samples), anti-Le(a) (103 samples), and anti-Di(a) (91 samples). CONCLUSION: Results of this study showed that the most identified unexpected antibodies were clinically significant, and, in particular, anti-Di(a) antibodies are detected frequently in the Korean population. Thus, unexpected antibody screening test including a Di(a) cell is thought to be helpful in Korea for safe transfusion.

A Case of Hemolytic Disease of a Newborn by an Anti-Di(a) Antibody Treated with Intravenous Immunoglobulin / 영남의대학술지

Hemolytic disease in a newborn that causes early jaundice is common. It is often due to the Rh (D) and ABO incompatibility, but rarely due to unexpected antibodies. Among these unexpected antibodies, the anti-Di(a) antibody rarely occurs. The anti-Di(a) antibody was observed in the serum and red-cell eluate of an infant, and in the serum of his mother. The frequency of the appearance of the Di(a) antigen in the Korean population is estimated to be 6.4-14.5%. This paper reports a case of hemolytic disease in a newborn associated with the anti-Di(a) antibody. A full-term male infant was transferred to the authors' hospital due to hyperbilirubinemia the day after his birth. The laboratory data indicated a hemoglobin value of 11.6 g/dL, a reticulocyte count of 10.6%, a total bilirubin count of 14.4 mg/dL, a direct bilirubin count of 0.6 mg/dL, and a positive result in the direct Coombs' test. Due to the identification of an irregular antibody from the maternal serum, an anti-Di(a) antibody was detected, which was also found in the eluate made from the infant's blood. The infant had been treated with phototherapy and intravenous immunoglobulin since the second day after his birth and was discharged due to an improved condition without exchange transfusion. Therefore, in cases of iso-immune hemolytic disease in a newborn within 24 hours from birth who had a negative result in an antibody screening test, the conduct of an anti-Di(a) antibody identification test is recommended due to the suspicion of an anti-Di(a) antigen, followed by early administration of intravenous immunoglobulin.

An Experience with Unexpected Antibody Screening Tests using a Panel That Included Di(a) Cells in Koreans / 대한수혈학회지

BACKGROUND: In Korea, a screening panel of cells from abroad without Di(a) positive cells has been commonly used when a patient has an unexpected antibody screening test. It has been reported that Di(a) occurs with a frequency of 6.14 to 14.5% among Koreans. However, the current popular antibody screening panels contain no Di(a) positive cells. In this study, we evaluate the clinical usefulness of the Di(a) Cell Panel (Diagnostic Grifols, Barcelona, Spain) for Koreans. METHODS: A total of 3,372 pretransfusion samples were employed for unexpected antibody screening testing using panels of cells by the DG Gel microtube column agglutination system, including additional Di(a) cells (Diagnostic Grifols, Barcelona, Spain). The positive cases in this system were confirmed again with DiaMed Di(a) antigen positive panel cells (DiaMed Ag, Cresssier, Morat, Switzerland) and this was followed by sequence- based Diego genotyping. RESULTS: The positive detection rate of an unexpected antibody screening test using SeraScan Diana I and II was 1.07% (36/3372), and seven samples were reactive (1+~2+) with the SeraScan Di(a) panel cells (0.21%). However, among the 5 available genotyped samples, two cases were typed as Di(a-b+). CONCLUSION: Even though there is discrepancy between the genotype and the two antibody screening kits, the addition of Di(a) positive cells as unexpected antibody screening panel cells is recommended.

A Case of Severe Hemolytic Disease of the Newborn Due to Anti-Di(a) Antibody / 대한진단검사의학회지

Here we report a severe case of hemolytic anemia of the newborn with kernicterus caused by anti-Di(a) antibody. A full term male infant was transferred due to hyperbilirubinemia on the third day of life. Despite single phototherapy, the baby's total bilirubin had elevated to 30.1 mg/dL. After exchange transfusion, total bilirubin decreased to 11.45 mg/dL. The direct antiglobulin test on the infant's red cells was positive. The maternal and infant's sera showed a negative reaction in routine antibody detection tests, but were positive in Di(a) panel cells. The frequency of the Di(a) antigen among the Korean population is estimated to be 6.4-14.5%. Anti-Di(a) antibody could cause a hemolytic reaction against transfusion or hemolytic disease of the newborn. We suggest the need for reagent red blood cell panels to include Di(a) antigen positive cells in antibody identification test for Korean.

The Clinical Significance of Antibody Screening Test Including Di(a+) Panel Cell in Asian-Mongoloid Populations

The Di(a) antigen is well known as one of the antigens with low incidence among Caucasians; however, it has been discovered with a relatively higher incidence among Mongoloid populations. Thus, it has been speculated that the incidence of unexpected antibody against the Di(a) antigen might be relatively higher among these populations. Hemolytic transfusion reactions (HTRs) and hemolytic disease of the newborns (HDNs) caused by anti-Di(a) have been reported sporadically. However, there has been no prospective study on the incidence of anti-Di(a) in Mongoloid populations particularly. The authors conducted a series of antibody screening tests on 11,219 Korean individuals for 25 months, by using three kinds of screening cells including Di(a) cell. Anti-Di(a) was detected in 8 patients, seven of whom had a history of transfusions or were multigravida. The incidence of anti-Di(a) measured in this study was higher than expected, ranked third among unexpected antibodies identified during the period of the study, so it is strongly recommended that the Di(a+) panel cell must be incorporated into antibody screening test for safer transfusion in Asian-Mongoloid populations.