Pub Date : 2024-03-27DOI: 10.47372/yjmhr.2024(13).2.3
Abeer M. Gawi, Anisa M. Abood
Introduction: High performance liquid chromatography (HPLC) is emerging as the method of choice for initial screening and diagnosis of hemoglobinopathies. The use of alkaline and acid gel electrophoresis may result in incorrect diagnosis of hemoglobinopathies. The aim of the study is to investigate the hemoglobin pattern using the HPLC and to correlate the hematological profile with the types of hemoglobin. Methods: A cross-sectional study was conducted in Aden Diagnostic Center from July– December 2022. Over a six-month period, 250 samples of patients aged between six months to thirty years, were evaluated by HPLC for detection of hemoglobinopathies using the Lifotronic Hemoglobin Analyzer H9: β-thalassemia Analysis Mode. Red blood cell and red cell indices were determined using automated hematology analyzer. Results: A total of 152 samples (60.8%) showed different abnormal hemoglobin variants. Sixty-four (25.6%) were diagnosed to have sickle cell anemia, 46 (18.4%) as sickle cell trait, two (0.8) as beta – heterozygous thalassemia based on high level of HbA2 (>3.9%), four (1.6%) as beta – homozygous thalassemia (HbF 25–91%), 18 (7.2%) as compound heterozygous state of sickle - β+ thalassemia, 17 (6.8%) as beta thalassemia trait, and one (0.4%) sample had HbD variant on HPLC was diagnosed as HbD trait. Conclusion: H9-HPLC is suitable for the routine investigation of hemoglobinopatheis because it is very powerful tool in the evaluation of Hb variants, rapid assay time and accurate quantification.
{"title":"Hemoglobin Variants in Patients Attending Aden Diagnostic Center by High Performance Liquid Chromatography","authors":"Abeer M. Gawi, Anisa M. Abood","doi":"10.47372/yjmhr.2024(13).2.3","DOIUrl":"https://doi.org/10.47372/yjmhr.2024(13).2.3","url":null,"abstract":"Introduction: High performance liquid chromatography (HPLC) is emerging as the method of choice for initial screening and diagnosis of hemoglobinopathies. The use of alkaline and acid gel electrophoresis may result in incorrect diagnosis of hemoglobinopathies. The aim of the study is to investigate the hemoglobin pattern using the HPLC and to correlate the hematological profile with the types of hemoglobin. Methods: A cross-sectional study was conducted in Aden Diagnostic Center from July– December 2022. Over a six-month period, 250 samples of patients aged between six months to thirty years, were evaluated by HPLC for detection of hemoglobinopathies using the Lifotronic Hemoglobin Analyzer H9: β-thalassemia Analysis Mode. Red blood cell and red cell indices were determined using automated hematology analyzer. Results: A total of 152 samples (60.8%) showed different abnormal hemoglobin variants. Sixty-four (25.6%) were diagnosed to have sickle cell anemia, 46 (18.4%) as sickle cell trait, two (0.8) as beta – heterozygous thalassemia based on high level of HbA2 (>3.9%), four (1.6%) as beta – homozygous thalassemia (HbF 25–91%), 18 (7.2%) as compound heterozygous state of sickle - β+ thalassemia, 17 (6.8%) as beta thalassemia trait, and one (0.4%) sample had HbD variant on HPLC was diagnosed as HbD trait. Conclusion: H9-HPLC is suitable for the routine investigation of hemoglobinopatheis because it is very powerful tool in the evaluation of Hb variants, rapid assay time and accurate quantification.","PeriodicalId":486205,"journal":{"name":"Yemeni Journal of Medical and Health Research","volume":"22 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140375333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.47372/yjmhr.2024(13).2.6
Mohammed A. Goban, Khaled A. Zain
Introduction: Once a medicine is registered and marketed, healthcare systems rely heavily on spontaneous reporting of adverse drug reactions (ADRs) to monitor the safety of drugs. ADRs reporting is considered a cornerstone of pharmacovigilance (PV) system. Underreporting has been a major obstacle and poses a great challenge to PV activities that negatively influence public health. Therefore, this study aimed to assess pharmacists' knowledge, attitude and practice toward ADRs reporting in Aden City - Yemen. Methods: A comparative cross-sectional study was conducted during November and December 2022 in Aden city. A self-administered, pretested questionnaire- comprised of sections on pharmacists’ characteristics, knowledge of PV concepts and ADR reporting process, attitudes towards ADR reporting and practice of ADR reporting- was administered to selected community and hospital pharmacists. Data were summarized using descriptive statistics and the Pearson’s Chi-square test was used to examine the differences between both groups of pharmacists. Results: Four hundred pharmacists participated in the study. Three quarters of them were males. About half of them correctly identified PV definition and purposes as well as ADR definition, but 38.5% and 37.8% were heard about national ADR scheme/guideline and aware of the existence of an ADR system in Yemen respectively. Only 29.3% and 10.8% showed adequate knowledge of PV concepts and ADRs reporting process respectively. The majority showed positive attitude towards PV and ADR reporting, 97.8% agreed that reporting process can benefit the public health, 94.3% contributes to drug safety and 87.3% agreed that PV should be taught in detail to health care professionals. However, in practice, 48.3% and 41.5% of pharmacists had ever diagnosed an ADR and encountered one or more ADRs in their daily practice respectively and only 12.3% of them had ever reported an ADR. The differences between community and hospital pharmacists by their overall knowledge, attitude scores and in ADR reporting practice were statistically insignificant. Conclusion: The majority of community and hospital pharmacists had inadequate knowledge and poor practice, with a positive attitude towards ADRs reporting. Therefore, strategies to improve knowledge and practices regarding ADR reporting should be implemented. Regular mandatory education and continuous in job training should be provided to all pharmacists and others health care professionals.
{"title":"Knowledge, Attitude and Practice on Adverse Drug Reactions Reporting among Pharmacists in Aden","authors":"Mohammed A. Goban, Khaled A. Zain","doi":"10.47372/yjmhr.2024(13).2.6","DOIUrl":"https://doi.org/10.47372/yjmhr.2024(13).2.6","url":null,"abstract":"Introduction: Once a medicine is registered and marketed, healthcare systems rely heavily on spontaneous reporting of adverse drug reactions (ADRs) to monitor the safety of drugs. ADRs reporting is considered a cornerstone of pharmacovigilance (PV) system. Underreporting has been a major obstacle and poses a great challenge to PV activities that negatively influence public health. Therefore, this study aimed to assess pharmacists' knowledge, attitude and practice toward ADRs reporting in Aden City - Yemen. Methods: A comparative cross-sectional study was conducted during November and December 2022 in Aden city. A self-administered, pretested questionnaire- comprised of sections on pharmacists’ characteristics, knowledge of PV concepts and ADR reporting process, attitudes towards ADR reporting and practice of ADR reporting- was administered to selected community and hospital pharmacists. Data were summarized using descriptive statistics and the Pearson’s Chi-square test was used to examine the differences between both groups of pharmacists. Results: Four hundred pharmacists participated in the study. Three quarters of them were males. About half of them correctly identified PV definition and purposes as well as ADR definition, but 38.5% and 37.8% were heard about national ADR scheme/guideline and aware of the existence of an ADR system in Yemen respectively. Only 29.3% and 10.8% showed adequate knowledge of PV concepts and ADRs reporting process respectively. The majority showed positive attitude towards PV and ADR reporting, 97.8% agreed that reporting process can benefit the public health, 94.3% contributes to drug safety and 87.3% agreed that PV should be taught in detail to health care professionals. However, in practice, 48.3% and 41.5% of pharmacists had ever diagnosed an ADR and encountered one or more ADRs in their daily practice respectively and only 12.3% of them had ever reported an ADR. The differences between community and hospital pharmacists by their overall knowledge, attitude scores and in ADR reporting practice were statistically insignificant. Conclusion: The majority of community and hospital pharmacists had inadequate knowledge and poor practice, with a positive attitude towards ADRs reporting. Therefore, strategies to improve knowledge and practices regarding ADR reporting should be implemented. Regular mandatory education and continuous in job training should be provided to all pharmacists and others health care professionals.","PeriodicalId":486205,"journal":{"name":"Yemeni Journal of Medical and Health Research","volume":"5 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140374075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.47372/yjmhr.2024(13).1.1
W. M. Al-Qashbari, M. A. Al-Baghdadi
Introduction: Pseudomonas aeruginosa is a common bacterial pathogen with wide spread distribution in health care settings. It is a multidrug resistant pathogen recognized for its ubiquity and intrinsically advanced antibiotic resistance mechanisms. This study aims to find out the isolation rate and to determine antimicrobial susceptibility patterns, and level of multidrug resistance from nosocomial and environmental isolates of P. aeruginosa. Methods: A cross-sectional study was carried out over a 6-months period from September 2022 to February 2023 and a total of 217 samples were enrolled which included 130 different clinical specimens from patients with nosocomial infections and 87 samples of hospital environment at different departments in four hospitals in Aden governorate, Yemen. The isolates were identified by biochemical tests as well as the susceptibility patterns which were tested by 22 types of antibiotics. All data were analyzed using SPSS statistics version 22 with a significance level of P<0.05. Results: The P. aeruginosa were isolated from 23.1% of clinical specimens and 32.2% from environmental samples. The statistical analysis showed no statistically significant difference between clinical and environmental samples in prevalence (P˃0.05). The most effective antibiotic against clinical isolates was Pipracillin/tazobactam with only 6.7% resistance value. In contrast, the most effective antibiotic against environmental strains was ciprofloxacin without any resistance value. The resistance to other antibiotics was found to be high or completely resistant. Ninety percent of clinical P. aeruginosa isolates and 96.4% of environmental isolates were multidrug resistant.
{"title":"A Comparative Study on the Antibiotics’ Resistance in Nosocomial and Environmental Isolates of Pseudomonas Aeruginosa in Aden, Yemen, 2023","authors":"W. M. Al-Qashbari, M. A. Al-Baghdadi","doi":"10.47372/yjmhr.2024(13).1.1","DOIUrl":"https://doi.org/10.47372/yjmhr.2024(13).1.1","url":null,"abstract":"Introduction: Pseudomonas aeruginosa is a common bacterial pathogen with wide spread distribution in health care settings. It is a multidrug resistant pathogen recognized for its ubiquity and intrinsically advanced antibiotic resistance mechanisms. This study aims to find out the isolation rate and to determine antimicrobial susceptibility patterns, and level of multidrug resistance from nosocomial and environmental isolates of P. aeruginosa. Methods: A cross-sectional study was carried out over a 6-months period from September 2022 to February 2023 and a total of 217 samples were enrolled which included 130 different clinical specimens from patients with nosocomial infections and 87 samples of hospital environment at different departments in four hospitals in Aden governorate, Yemen. The isolates were identified by biochemical tests as well as the susceptibility patterns which were tested by 22 types of antibiotics. All data were analyzed using SPSS statistics version 22 with a significance level of P<0.05. Results: The P. aeruginosa were isolated from 23.1% of clinical specimens and 32.2% from environmental samples. The statistical analysis showed no statistically significant difference between clinical and environmental samples in prevalence (P˃0.05). The most effective antibiotic against clinical isolates was Pipracillin/tazobactam with only 6.7% resistance value. In contrast, the most effective antibiotic against environmental strains was ciprofloxacin without any resistance value. The resistance to other antibiotics was found to be high or completely resistant. Ninety percent of clinical P. aeruginosa isolates and 96.4% of environmental isolates were multidrug resistant.","PeriodicalId":486205,"journal":{"name":"Yemeni Journal of Medical and Health Research","volume":"17 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140374347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.47372/yjmhr.2024(13).2.1
Abdulla S. Alhanshi, Yahya Almualm, Nawal S. Banafa
Introduction: Eating disorders have serious implication on all aspects of physical, psychological, and social health if left untreated. Adolescents and college students are more affected group with this disorder. The study aimed to identify eating disorders attitudes and behaviors among university students and compare with certain variables among students at Hadhramout University in Mukalla, Yemen. Methods: A descriptive cross-sectional study was carried out during the period November 2022 until June 2023. The total number of participants was 369 students in the following faculties: Medicine and Health Sciences, Nursing, Faculty of Engineering, Law, Women, and Administrative Sciences. Data were gathered by a self-administered questionnaire prepared for this purpose. Results: More than half of the participants were male (56.9%). A total of 314 (85.1%) students scored ≥20 points on the EAT-26 which was considered to be at low risk of disordered eating attitudes while 55 (14.9%) scored< 20, indicating a high risk of developing eating disorders. In addition, most of the students have normal weight (53.1%), underweight (22.5%) and obese represented 8.1%. Although the number of students from the scientific colleges was more than the students from the literature, the percentage of eating disorders attitudes was more prevalent among the literature faculties. Conclusion: There is a growing number of university students with eating disorders. The university classes represent an ideal setting for growing eating disorders due to the influences of peers. Eating disorders attitudes progress to behavioral symptoms. The researchers recommend further studies with a large sample across multiple colleges and universities in Yemen. Comprehensive education programs among students are also necessary.
{"title":"Eating Disorders Attitudes and Behaviors among Hadhramout University Students in Mukalla, Yemen","authors":"Abdulla S. Alhanshi, Yahya Almualm, Nawal S. Banafa","doi":"10.47372/yjmhr.2024(13).2.1","DOIUrl":"https://doi.org/10.47372/yjmhr.2024(13).2.1","url":null,"abstract":"Introduction: Eating disorders have serious implication on all aspects of physical, psychological, and social health if left untreated. Adolescents and college students are more affected group with this disorder. The study aimed to identify eating disorders attitudes and behaviors among university students and compare with certain variables among students at Hadhramout University in Mukalla, Yemen. Methods: A descriptive cross-sectional study was carried out during the period November 2022 until June 2023. The total number of participants was 369 students in the following faculties: Medicine and Health Sciences, Nursing, Faculty of Engineering, Law, Women, and Administrative Sciences. Data were gathered by a self-administered questionnaire prepared for this purpose. Results: More than half of the participants were male (56.9%). A total of 314 (85.1%) students scored ≥20 points on the EAT-26 which was considered to be at low risk of disordered eating attitudes while 55 (14.9%) scored< 20, indicating a high risk of developing eating disorders. In addition, most of the students have normal weight (53.1%), underweight (22.5%) and obese represented 8.1%. Although the number of students from the scientific colleges was more than the students from the literature, the percentage of eating disorders attitudes was more prevalent among the literature faculties. Conclusion: There is a growing number of university students with eating disorders. The university classes represent an ideal setting for growing eating disorders due to the influences of peers. Eating disorders attitudes progress to behavioral symptoms. The researchers recommend further studies with a large sample across multiple colleges and universities in Yemen. Comprehensive education programs among students are also necessary.","PeriodicalId":486205,"journal":{"name":"Yemeni Journal of Medical and Health Research","volume":"73 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140376151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.47372/yjmhr.2024(13).1.6
Nada M. Badi, Huda O. Basaleem
Introduction: Since March 2015, children's nutrition in Yemen is increasingly threatened and acute malnutrition is now at serious levels across the country. This study aimed to determine the association between nutritional status and lifestyle practices of basic-public school children in Aden-Yemen. Methods: A cross-sectional study was conducted in January 2022 on a randomly selected basic public schools’ children aged 6-10 years. Lifestyle practices including breakfast consumption at home, physical activity, screen time and sleeping time were assessed by a self-administered questionnaire filled by the parents. Measurement of Z-score was done for height-for-age, weight-for-age and body-mass-index for-age to define stunting, underweight, thinness, overweight and obesity respectively. The data were processed and analyzed using SPSS-25 and World Health Organization’s (WHO) Anthro plus program. Results: The study involved 930 students having the following prevalence: 26.9% for stunting; 32.5% for underweight and 23.1% for thinness. In addition, 1.2% were obese and 3.2% were overweight. According to the binary logistic regression, children aged >8-10 years were more likely to be stunted (AOR=5.269; 95% CI:3.339-8.313), underweight (AOR=9.156; 95% CI: 5.631-14.890) and thin (AOR=3.901; 95% CI: 2.400-6.339) compared to younger age. Male children were more likely to be stunted (AOR= 1.496; 95% CI: 11.091-2.053), underweight (AOR=3.026; 95% CI: 2.195-4.172) and thin (AOR=8.001; 95% CI: 5.313-12.048) compared to female children. Less than daily consumption of breakfast increased the risk of stunting (AOR=1.505; 95% CI:1.109-2.042), underweight (AOR=4.724; 95% CI:3.421-6.524) and thinness (AOR=6.053; 95% CI:4.033-9.084) compared to daily breakfast consumption. Children sleeping < 9 hours was associated with increased risk of stunting (AOR=1.479; 95% CI:1.093-2.001) and thinness (AOR=1.548; 95%CI:1.102-2.176) than sleeping ≥ 9 hours. Additionally, increasing likelihood of overweight (AOR= 50.848 ;95% CI: 6.211-416.301) and obesity (AOR= 8.977;95% CI: 1.098-73.422) was observed among children play outside < 1 hour compared to playing ≥ 1 hour. Furthermore, increasing risk of overweight was associated with children’s screen time ≥ 2 hours compared to < 1 hours (AOR=12.034 ;95% CI: 2.311-62.668). Conclusion: Stunting, underweight and thinness are major nutritional problems among basic public-school children in Aden. Unhealthy dietary and bad lifestyle practices associated with malnutrition indicators. This calls for attention by policymakers to address the challenges of malnutrition and implementing urgent intervention for awareness raising to maintain healthy lifestyle among school children.
{"title":"Lifestyle Practices Predictors of Nutritional Status among Basic Public-School Children in Aden, Yemen","authors":"Nada M. Badi, Huda O. Basaleem","doi":"10.47372/yjmhr.2024(13).1.6","DOIUrl":"https://doi.org/10.47372/yjmhr.2024(13).1.6","url":null,"abstract":"Introduction: Since March 2015, children's nutrition in Yemen is increasingly threatened and acute malnutrition is now at serious levels across the country. This study aimed to determine the association between nutritional status and lifestyle practices of basic-public school children in Aden-Yemen. Methods: A cross-sectional study was conducted in January 2022 on a randomly selected basic public schools’ children aged 6-10 years. Lifestyle practices including breakfast consumption at home, physical activity, screen time and sleeping time were assessed by a self-administered questionnaire filled by the parents. Measurement of Z-score was done for height-for-age, weight-for-age and body-mass-index for-age to define stunting, underweight, thinness, overweight and obesity respectively. The data were processed and analyzed using SPSS-25 and World Health Organization’s (WHO) Anthro plus program. Results: The study involved 930 students having the following prevalence: 26.9% for stunting; 32.5% for underweight and 23.1% for thinness. In addition, 1.2% were obese and 3.2% were overweight. According to the binary logistic regression, children aged >8-10 years were more likely to be stunted (AOR=5.269; 95% CI:3.339-8.313), underweight (AOR=9.156; 95% CI: 5.631-14.890) and thin (AOR=3.901; 95% CI: 2.400-6.339) compared to younger age. Male children were more likely to be stunted (AOR= 1.496; 95% CI: 11.091-2.053), underweight (AOR=3.026; 95% CI: 2.195-4.172) and thin (AOR=8.001; 95% CI: 5.313-12.048) compared to female children. Less than daily consumption of breakfast increased the risk of stunting (AOR=1.505; 95% CI:1.109-2.042), underweight (AOR=4.724; 95% CI:3.421-6.524) and thinness (AOR=6.053; 95% CI:4.033-9.084) compared to daily breakfast consumption. Children sleeping < 9 hours was associated with increased risk of stunting (AOR=1.479; 95% CI:1.093-2.001) and thinness (AOR=1.548; 95%CI:1.102-2.176) than sleeping ≥ 9 hours. Additionally, increasing likelihood of overweight (AOR= 50.848 ;95% CI: 6.211-416.301) and obesity (AOR= 8.977;95% CI: 1.098-73.422) was observed among children play outside < 1 hour compared to playing ≥ 1 hour. Furthermore, increasing risk of overweight was associated with children’s screen time ≥ 2 hours compared to < 1 hours (AOR=12.034 ;95% CI: 2.311-62.668). Conclusion: Stunting, underweight and thinness are major nutritional problems among basic public-school children in Aden. Unhealthy dietary and bad lifestyle practices associated with malnutrition indicators. This calls for attention by policymakers to address the challenges of malnutrition and implementing urgent intervention for awareness raising to maintain healthy lifestyle among school children.","PeriodicalId":486205,"journal":{"name":"Yemeni Journal of Medical and Health Research","volume":"98 51","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140377624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.47372/yjmhr.2024(13).1.2
Mohaned G. Al-Khamri, Omer A. Baselm
Introduction: Heart failure (HF) is a multifactorial disorder characterized by impaired cardiac function, systemic inflammation and neurohormonal activation. It is a major cause of morbidity and mortality worldwide and has significant impacts on the quality of life, cost and longevity. This study was conducted to investigate the value of admission glycated hemoglobin (HbA1c) and associated factors among non-diabetic patients with heart failure. Methods: This is a descriptive prospective-hospital based study included 42 non-diabetic patients with HF on first occasion for admission at three major Aden hospitals for the period (January1st–December 31st, 2021). After thorough clinical history and examination, patients were investigated for random blood sugar, lipid profile, Pro Brain Natriuretic Peptide (Pro-BNP), HbA1c and followed till hospital discharge. Results: HF in non-diabetic patients predominates in males (81.0%) with a mean age of 56.0 ±11.5 years. The main associated factors were arterial hypertension (47.6%), coronary artery disease (9.5%), Khat chewing (57.1%), smoking (31.0%), obesity (28.6%), and family history of HF (21.4%). patients presented with New York Heart Association (NYHA) class III (47.6%) and low ejection fraction of ≤40.0% (76.2%). The median Pro-BNP was 2166.0 pg/mL, the mean admission HbA1c was 5.8% and the case fatality rate was 4.8%. The mean body mass index (BMI) was increasing with increasing level of admission HbA1c. HbA1c of 6.0-6.4% was associated with mortality cases and had significant positive association with BMI and significant negative association with total cholesterol. Conclusion: The admission HbA1c of 6.0-6.4% was associated with HF hospitalization and mortality in non-diabetic patients. This association is independent of age, gender, hypertension, hypercholesterolemia, glycemia, and clinical outcome suggesting direct effects of BMI on the development of high HbA1c level in non-diabetic patients with HF.
{"title":"The Value of Admission Glycated Hemoglobin and Associated Factors in Non-Diabetic Patients with Heart Failure in Aden","authors":"Mohaned G. Al-Khamri, Omer A. Baselm","doi":"10.47372/yjmhr.2024(13).1.2","DOIUrl":"https://doi.org/10.47372/yjmhr.2024(13).1.2","url":null,"abstract":"Introduction: Heart failure (HF) is a multifactorial disorder characterized by impaired cardiac function, systemic inflammation and neurohormonal activation. It is a major cause of morbidity and mortality worldwide and has significant impacts on the quality of life, cost and longevity. This study was conducted to investigate the value of admission glycated hemoglobin (HbA1c) and associated factors among non-diabetic patients with heart failure. Methods: This is a descriptive prospective-hospital based study included 42 non-diabetic patients with HF on first occasion for admission at three major Aden hospitals for the period (January1st–December 31st, 2021). After thorough clinical history and examination, patients were investigated for random blood sugar, lipid profile, Pro Brain Natriuretic Peptide (Pro-BNP), HbA1c and followed till hospital discharge. Results: HF in non-diabetic patients predominates in males (81.0%) with a mean age of 56.0 ±11.5 years. The main associated factors were arterial hypertension (47.6%), coronary artery disease (9.5%), Khat chewing (57.1%), smoking (31.0%), obesity (28.6%), and family history of HF (21.4%). patients presented with New York Heart Association (NYHA) class III (47.6%) and low ejection fraction of ≤40.0% (76.2%). The median Pro-BNP was 2166.0 pg/mL, the mean admission HbA1c was 5.8% and the case fatality rate was 4.8%. The mean body mass index (BMI) was increasing with increasing level of admission HbA1c. HbA1c of 6.0-6.4% was associated with mortality cases and had significant positive association with BMI and significant negative association with total cholesterol. Conclusion: The admission HbA1c of 6.0-6.4% was associated with HF hospitalization and mortality in non-diabetic patients. This association is independent of age, gender, hypertension, hypercholesterolemia, glycemia, and clinical outcome suggesting direct effects of BMI on the development of high HbA1c level in non-diabetic patients with HF.","PeriodicalId":486205,"journal":{"name":"Yemeni Journal of Medical and Health Research","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140374359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.47372/yjmhr.2024(13).1.3
Muna A. Alwan, Saied M. Ismaiel
Introduction: Chronic renal failure (CRF) is associated with aberrations in the metabolism of minerals, such as calcium, phosphates, sodium, and potassium and other biochemical parameters. Various studies have identified parathyroid hormone (PTH) as the main regulator of minerals and biochemical parameters homeostasis. This study was conducted to evaluate the biochemical profile in CRF patients on hemodialysis in Aden. Methods: This study is a descriptive, cross sectional study, conducted in Aden Hemodialysis Center for the period Jan.1st to June 30th, 2022. Included 82 patients with CRF on HD. The data collected included demographic with clinical data, and blood samples taken for complete blood count and serum creatinine; urea; sodium; potassium; total calcium, ionized calcium; phosphate; alkaline phosphatase, and parathyroid hormone. Results: More male were found than female patients with CRF (67.1% vs. 32.9% respectively), with a mean age of 48.8 ± 12.6 years. The mean body mass index was (23.3 ± 4.7 kg/m2) and the mean duration of CRF was (4.8 ± 2.9 years). For renal function, the mean serum creatinine, urea, and estimated creatinine clearance were (9.9 mg/dl, 128.6 mg/dl, and 7.1 mL/min per 1.73 m2 respectively). For minerals, the mean serum sodium, potassium, chloride, phosphorus, calcium and ionized calcium were (134.4 mmol/L, 5.04 mmol/L, 104.1 mmol/L, 4.37 mg/dl, 9.4 mg/dl, and 1.12 mmol/L, respectively). The mean Calcium x Phosphorus product was in the recommended range (40.7mg2/dl2). The mean alkaline phosphatase was (286.2 U/L), and the mean parathyroid hormone was (322.7 pg/ml). Secondary hyperparathyroidism (PTH level of ≥130 pg/ml) was detected in (58.5%) of them. Parathormone concentration showed significant positive correlation to alkaline phosphatase (r: 0.640, p:0.001) in patients with CRF on hemodialysis. Conclusion: This study concluded that in patients with CRF on HD, there is an increase level of alkaline phosphatase which is considered as an adjunct marker of high-turnover bone disease associated with disturbed level of calcium and phosphorus that increase serum PTH level.
{"title":"Serum Biochemical Evaluation of Patients with Chronic Renal Failure on Hemodialysis","authors":"Muna A. Alwan, Saied M. Ismaiel","doi":"10.47372/yjmhr.2024(13).1.3","DOIUrl":"https://doi.org/10.47372/yjmhr.2024(13).1.3","url":null,"abstract":"Introduction: Chronic renal failure (CRF) is associated with aberrations in the metabolism of minerals, such as calcium, phosphates, sodium, and potassium and other biochemical parameters. Various studies have identified parathyroid hormone (PTH) as the main regulator of minerals and biochemical parameters homeostasis. This study was conducted to evaluate the biochemical profile in CRF patients on hemodialysis in Aden. Methods: This study is a descriptive, cross sectional study, conducted in Aden Hemodialysis Center for the period Jan.1st to June 30th, 2022. Included 82 patients with CRF on HD. The data collected included demographic with clinical data, and blood samples taken for complete blood count and serum creatinine; urea; sodium; potassium; total calcium, ionized calcium; phosphate; alkaline phosphatase, and parathyroid hormone. Results: More male were found than female patients with CRF (67.1% vs. 32.9% respectively), with a mean age of 48.8 ± 12.6 years. The mean body mass index was (23.3 ± 4.7 kg/m2) and the mean duration of CRF was (4.8 ± 2.9 years). For renal function, the mean serum creatinine, urea, and estimated creatinine clearance were (9.9 mg/dl, 128.6 mg/dl, and 7.1 mL/min per 1.73 m2 respectively). For minerals, the mean serum sodium, potassium, chloride, phosphorus, calcium and ionized calcium were (134.4 mmol/L, 5.04 mmol/L, 104.1 mmol/L, 4.37 mg/dl, 9.4 mg/dl, and 1.12 mmol/L, respectively). The mean Calcium x Phosphorus product was in the recommended range (40.7mg2/dl2). The mean alkaline phosphatase was (286.2 U/L), and the mean parathyroid hormone was (322.7 pg/ml). Secondary hyperparathyroidism (PTH level of ≥130 pg/ml) was detected in (58.5%) of them. Parathormone concentration showed significant positive correlation to alkaline phosphatase (r: 0.640, p:0.001) in patients with CRF on hemodialysis. Conclusion: This study concluded that in patients with CRF on HD, there is an increase level of alkaline phosphatase which is considered as an adjunct marker of high-turnover bone disease associated with disturbed level of calcium and phosphorus that increase serum PTH level.","PeriodicalId":486205,"journal":{"name":"Yemeni Journal of Medical and Health Research","volume":"4 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140375108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.47372/yjmhr.2024(13).2.5
Anis Z. Kahtan, Samira A. Mahmood
Introduction: Vitamin D plays a crucial role in the pathogenesis and management of type 2 diabetes mellitus (T2DM). However, limited data are available regarding the status of vitamin D among T2DM patients attending healthcare centers, particularly in the Aden Diabetic Center, Yemen. The study aimed to assess the prevalence of vitamin D deficiency among T2DM patients and explore its association with potential factors such as demographics, diabetes characteristics body mass index (BMI). Methods: A descriptive cross-sectional study was conducted on 138 T2DM patients attending Aden Diabetic Center (ADC) between May and July 2023. Data on age, sex, diabetes characteristics (diabetes duration, family history of diabetes, and medication use), RBS, BMI, and serum vitamin D level were measured. Vitamin D status was categorized as deficient, insufficient, or sufficient based on established cutoffs. Descriptive statistics and chi-square tests were used for data analysis. Results: Majority of patients had vitamin D deficiencyy (73.2%) and the remaining had insufficient (17.4%), and sufficient (9.4%) status. Males comprised 53.6% and females 46.4%. Mean age was 53.70±12.93 years, with the highest proportion (60.9%) were in the age group 40-60 years. Majority of the patients (62.3%) had T2DM duration ≥ 5 years, and 89.1% were receiving diabetes medications, and 68.8% had a family history of DM. The mean RBS level was 220.13±86.90 mg/dl, with more than half (55.6%) having RBS levels ≥ 140 mg/dl. Also, the mean BMI was 27.00±5.90 kg/m², and more than half of the patients had overweight and obesity. The study found no significant association between serum vitamin D levels with age, diabetes characteristics, or BMI categories, while a significant association to sex was observed (P = 0.006). Conclusion: The study highlights the high prevalence of vitamin D deficiency among T2DM patients attending the ADC in Aden. The majority of patients were found to have deficient levels of vitamin D, with limited differences based on age, diabetes characteristics, and BMI. The significant association between vitamin D levels and sex, indicating that sex may contribute to the risk of deficiency in T2DM patients. These findings emphasize the importance of assessing and addressing vitamin D status in T2DM patients to optimize their overall health and diabetes management.
导言维生素 D 在 2 型糖尿病(T2DM)的发病和治疗过程中起着至关重要的作用。然而,有关在医疗中心就诊的 T2DM 患者(尤其是也门亚丁糖尿病中心的患者)维生素 D 状况的数据却很有限。本研究旨在评估 T2DM 患者中维生素 D 缺乏症的患病率,并探讨其与人口统计学、糖尿病特征体重指数 (BMI) 等潜在因素的关系。研究方法对 2023 年 5 月至 7 月期间在亚丁糖尿病中心(ADC)就诊的 138 名 T2DM 患者进行了描述性横断面研究。研究人员测量了年龄、性别、糖尿病特征(糖尿病病程、糖尿病家族史和用药情况)、RBS、BMI 和血清维生素 D 水平等数据。根据既定的临界值,维生素 D 状态被分为缺乏、不足或充足。数据分析采用了描述性统计和卡方检验。结果大多数患者维生素 D 缺乏(73.2%),其余为不足(17.4%)和充足(9.4%)。男性占 53.6%,女性占 46.4%。平均年龄为(53.70±12.93)岁,其中 40-60 岁年龄段的比例最高(60.9%)。大多数患者(62.3%)的 T2DM 病程≥ 5 年,89.1%的患者正在接受糖尿病药物治疗,68.8%的患者有糖尿病家族史。平均 RBS 水平为 220.13±86.90 mg/dl,超过半数(55.6%)患者的 RBS 水平≥ 140 mg/dl。此外,平均体重指数(BMI)为 27.00±5.90 kg/m²,半数以上患者超重和肥胖。研究发现,血清维生素 D 水平与年龄、糖尿病特征或 BMI 类别无明显关联,但与性别有明显关联(P = 0.006)。结论这项研究表明,在亚丁 ADC 就诊的 T2DM 患者中,维生素 D 缺乏症的发病率很高。研究发现,大多数患者的维生素 D 水平不足,而年龄、糖尿病特征和体重指数之间的差异有限。维生素 D 水平与性别之间存在明显关联,这表明性别可能导致 T2DM 患者缺乏维生素 D 的风险。这些发现强调了评估和解决 T2DM 患者维生素 D 状态以优化其整体健康和糖尿病管理的重要性。
{"title":"Vitamin D Among Type 2 Diabetic Patients Attending Aden Diabetic Center During May-July 2023: A Descriptive Study","authors":"Anis Z. Kahtan, Samira A. Mahmood","doi":"10.47372/yjmhr.2024(13).2.5","DOIUrl":"https://doi.org/10.47372/yjmhr.2024(13).2.5","url":null,"abstract":"Introduction: Vitamin D plays a crucial role in the pathogenesis and management of type 2 diabetes mellitus (T2DM). However, limited data are available regarding the status of vitamin D among T2DM patients attending healthcare centers, particularly in the Aden Diabetic Center, Yemen. The study aimed to assess the prevalence of vitamin D deficiency among T2DM patients and explore its association with potential factors such as demographics, diabetes characteristics body mass index (BMI). Methods: A descriptive cross-sectional study was conducted on 138 T2DM patients attending Aden Diabetic Center (ADC) between May and July 2023. Data on age, sex, diabetes characteristics (diabetes duration, family history of diabetes, and medication use), RBS, BMI, and serum vitamin D level were measured. Vitamin D status was categorized as deficient, insufficient, or sufficient based on established cutoffs. Descriptive statistics and chi-square tests were used for data analysis. Results: Majority of patients had vitamin D deficiencyy (73.2%) and the remaining had insufficient (17.4%), and sufficient (9.4%) status. Males comprised 53.6% and females 46.4%. Mean age was 53.70±12.93 years, with the highest proportion (60.9%) were in the age group 40-60 years. Majority of the patients (62.3%) had T2DM duration ≥ 5 years, and 89.1% were receiving diabetes medications, and 68.8% had a family history of DM. The mean RBS level was 220.13±86.90 mg/dl, with more than half (55.6%) having RBS levels ≥ 140 mg/dl. Also, the mean BMI was 27.00±5.90 kg/m², and more than half of the patients had overweight and obesity. The study found no significant association between serum vitamin D levels with age, diabetes characteristics, or BMI categories, while a significant association to sex was observed (P = 0.006). Conclusion: The study highlights the high prevalence of vitamin D deficiency among T2DM patients attending the ADC in Aden. The majority of patients were found to have deficient levels of vitamin D, with limited differences based on age, diabetes characteristics, and BMI. The significant association between vitamin D levels and sex, indicating that sex may contribute to the risk of deficiency in T2DM patients. These findings emphasize the importance of assessing and addressing vitamin D status in T2DM patients to optimize their overall health and diabetes management.","PeriodicalId":486205,"journal":{"name":"Yemeni Journal of Medical and Health Research","volume":"39 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140373599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.47372/yjmhr.2024(13).2.4
Ali Bawahal, Huda O. Basaleem
Introduction: Langerhans cell histiocytosis (LCH) is a very rare disorder, and usually considered a disease of childhood. It is rarely observed in adults. Its etiopathogenesis remains to be elucidated. One possible etiological cause is a reactive proliferation of Langerhans cells following chemotherapy or radiotherapy for Hodgkin's disease (HD). Eosinophilic granuloma is the benign accumulation of histiocytes located primarily in the bones, but which also affects other organs, including the skin, lungs and lymph nodes. The time interval between LCH occurrence and previous lymphoma is variable. The occurrence of eosinophilic granuloma in a patient with Hodgkin disease has rarely been reported. Objective: This case report aimed to describe the clinic-pathological, histopathological, immunohistochemical and other features of LCH and to analyze LCH clinical features for improving diagnosis and decreasing misdiagnosis rate. Case report: In this report, a 38-year-old female presented with LCH twenty-two months after diagnosis and treatment of nodular sclerosing HD. The patient presented with generalized lymphadenopathy and general weakness. The Langerhans cells diffusely infiltrated in the inguinal lymph node and the tumor cells were positive for CD1a and S-100 expression. The patient received chemotherapy and show complete remission. Conclusion: LCH has a very rare occurrence following HD in adult. The definitive diagnosis depends on pathological biopsy and immunohistochemistry. Although specific therapeutic approach hasn't been well established, combined chemotherapy for multisystem lesions and surgical operation or radiotherapy for unifocal lesions may improve the therapy.
简介朗格汉斯细胞组织细胞增生症(LCH)是一种非常罕见的疾病,通常被认为是一种儿童疾病。成人很少发病。其发病机制仍有待阐明。一种可能的病因是霍奇金病(HD)化疗或放疗后朗格汉斯细胞的反应性增生。嗜酸性肉芽肿是组织细胞的良性聚集,主要位于骨骼,但也会影响其他器官,包括皮肤、肺和淋巴结。LCH 发生与既往淋巴瘤发生之间的时间间隔是不固定的。霍奇金病患者发生嗜酸性肉芽肿的报道很少。目的:本病例报告旨在描述 LCH 的临床病理学、组织病理学、免疫组化及其他特征,并分析 LCH 的临床特征,以提高诊断率和降低误诊率。病例报告:在本报告中,一名 38 岁女性在诊断和治疗结节性硬化性 HD 22 个月后出现 LCH。患者出现全身淋巴结肿大和全身乏力。朗格汉斯细胞弥漫浸润腹股沟淋巴结,肿瘤细胞CD1a和S-100表达阳性。患者接受化疗后病情完全缓解。结论成人 HD 后发生 LCH 非常罕见。明确诊断取决于病理活检和免疫组化。虽然具体的治疗方法尚未明确,但对多系统病变进行联合化疗,对单灶病变进行外科手术或放疗,可能会改善治疗效果。
{"title":"Langerhans Cell Histiocytosis Following Hodgkin Lymphoma in Adult: A Case Report","authors":"Ali Bawahal, Huda O. Basaleem","doi":"10.47372/yjmhr.2024(13).2.4","DOIUrl":"https://doi.org/10.47372/yjmhr.2024(13).2.4","url":null,"abstract":"Introduction: Langerhans cell histiocytosis (LCH) is a very rare disorder, and usually considered a disease of childhood. It is rarely observed in adults. Its etiopathogenesis remains to be elucidated. One possible etiological cause is a reactive proliferation of Langerhans cells following chemotherapy or radiotherapy for Hodgkin's disease (HD). Eosinophilic granuloma is the benign accumulation of histiocytes located primarily in the bones, but which also affects other organs, including the skin, lungs and lymph nodes. The time interval between LCH occurrence and previous lymphoma is variable. The occurrence of eosinophilic granuloma in a patient with Hodgkin disease has rarely been reported. Objective: This case report aimed to describe the clinic-pathological, histopathological, immunohistochemical and other features of LCH and to analyze LCH clinical features for improving diagnosis and decreasing misdiagnosis rate. Case report: In this report, a 38-year-old female presented with LCH twenty-two months after diagnosis and treatment of nodular sclerosing HD. The patient presented with generalized lymphadenopathy and general weakness. The Langerhans cells diffusely infiltrated in the inguinal lymph node and the tumor cells were positive for CD1a and S-100 expression. The patient received chemotherapy and show complete remission. Conclusion: LCH has a very rare occurrence following HD in adult. The definitive diagnosis depends on pathological biopsy and immunohistochemistry. Although specific therapeutic approach hasn't been well established, combined chemotherapy for multisystem lesions and surgical operation or radiotherapy for unifocal lesions may improve the therapy.","PeriodicalId":486205,"journal":{"name":"Yemeni Journal of Medical and Health Research","volume":"23 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140375577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.47372/yjmhr.2024(13).2.2
Halah N. Hazaea, Hanan H. Omer
Introduction: Ongoing research is examining the possible role of blood groups in the etiopathogenesis of various medical conditions including type-2 diabetes mellitus (T2DM). The purpose of this research is to identify association of ABO and Rh blood group in patients with T2DM in the Diabetic Center Aden, Yemen, 2022. Methods: A cross-sectional study was conducted in the National Blood Transfusion and Research Center (N.B.T.R.C), Aden between May- September 2022. A total of 226 blood samples were collected from type -2 diabetic patients aged ≥ 18 years in the Diabetic Center, Aden, Yemen. Results: There most common blood group was blood group O (+) followed by A (+) and the least common was blood group AB(-). No association was found between ABO and Rh blood group with either the sex or family history in type-2 diabetic Patients. The most frequent complication observed in the different groups is the neuropathy complications (46.8%) followed by retinopathy complications (40.7%) and finally nephropathy complications (12.5%). Conclusion: No significant association in T2DM patients between ABO – Rh with sex or family history and the most frequent microvascular complication is neuropathy.
{"title":"Association between ABO-Rh Blood Groups and Type-2 Diabetes Mellitus in Aden, Yemen, 2022","authors":"Halah N. Hazaea, Hanan H. Omer","doi":"10.47372/yjmhr.2024(13).2.2","DOIUrl":"https://doi.org/10.47372/yjmhr.2024(13).2.2","url":null,"abstract":"Introduction: Ongoing research is examining the possible role of blood groups in the etiopathogenesis of various medical conditions including type-2 diabetes mellitus (T2DM). The purpose of this research is to identify association of ABO and Rh blood group in patients with T2DM in the Diabetic Center Aden, Yemen, 2022. Methods: A cross-sectional study was conducted in the National Blood Transfusion and Research Center (N.B.T.R.C), Aden between May- September 2022. A total of 226 blood samples were collected from type -2 diabetic patients aged ≥ 18 years in the Diabetic Center, Aden, Yemen. Results: There most common blood group was blood group O (+) followed by A (+) and the least common was blood group AB(-). No association was found between ABO and Rh blood group with either the sex or family history in type-2 diabetic Patients. The most frequent complication observed in the different groups is the neuropathy complications (46.8%) followed by retinopathy complications (40.7%) and finally nephropathy complications (12.5%). Conclusion: No significant association in T2DM patients between ABO – Rh with sex or family history and the most frequent microvascular complication is neuropathy.","PeriodicalId":486205,"journal":{"name":"Yemeni Journal of Medical and Health Research","volume":"46 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140376914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}