European Journal of Medical and Health Sciences

Factors Explaining Japan’s Low COVID-19 Mortality: Comparison with Rich and Democratic Countries

Zameer Shervani — 2025-01-09

The novel coronavirus (SARS-CoV-2) caused a large number of deaths during the COVID-19 pandemic. The pandemic had a greater impact on wealthy and developed countries. Considering the per capita deaths and fatality-to-case ratio, also known as the case fatality ratio (CFR), Japan was among the least affected countries. The CFR of Japan was compared with nine other democratic and wealthy countries: the US, Italy, Spain, France, Austria, Germany, Canada, Australia, and South Korea. Japan’s CFR was the second lowest at 0.2%, only behind South Korea with 0.1%. The highest rates were recorded by the US and Canada, each at 1.1%. The per capita (per 100,000 people) fatality rate of Japan was 57.72 deaths, whereas the US had six times more deaths compared to Japan. We calculated the mortality (fatality) rates based on the cumulative deaths as of March 16, 2023, when the pandemic was mostly over. The amount of GDP spent on healthcare in Japan, mask awareness, the stringency index (SI), vaccinations, urbanization, life expectancy (LE), and the age cohorts of the population were examined to determine the factors that resulted in a low mortality rate in Japan during the pandemic.

Orthopedic War-Related Injuries in Gaza: In-Depth Insights from within the Strip

Ahmad Almigdad — 2025-01-11

Gaza has been under continuous attack for over a year, resulting in widespread destruction and a severe humanitarian crisis. The bombings have caused mass casualties and devastating injuries, with buildings collapsing and overwhelming the healthcare system. Attacks on hospitals, arrests of medical staff, and severe shortages of medical supplies have hindered the delivery of life-saving treatments, forcing hospitals to provide only basic care. Due to a lack of specialized staff and equipment, treatment delays and infection risks have increased, and emergency measures such as amputations are often used. This review highlights the critical medical situation in Gaza, focusing on the challenges faced by medical staff, the impact of war-related injuries, and the broader health consequences caused by infrastructure damage and limited access to healthcare.

Association of First-Trimester Low PAPP-A Levels (<0.2 MoM) with Maternal and Fetal Outcomes

Sara Masihi — 2025-01-10

Background and Aim: First-trimester screening is routinely performed globally to detect chromosomal abnormalities using non-invasive methods such as nuchal translucency (NT) measurements, pregnancy-associated plasma protein A (PAPP-A), and β-human chorionic gonadotropin (β-hCG). Recent studies have highlighted that low PAPP-A levels may be associated with adverse pregnancy outcomes, including pre-eclampsia, intrauterine growth restriction (IUGR), and pre-term delivery. Generally, low PAPP-A is defined as below 0.4 multiples of the median (MoM) or under the 5^th percentile. However, extremely low PAPP-A, defined as levels below 0.2 MoM or under the 1st percentile, significantly increases the risk of adverse outcomes. This category has received less attention in research. Our study aims to investigate the correlation between PAPP-A levels below 0.2 MoM and adverse pregnancy outcomes.

Materials and Methods: A retrospective cross-sectional study was conducted on 10,256 pregnant women who underwent first-trimester screening at Imam Khomeini Hospital in Ahvaz between January 2010 and April 2024. PAPP-A and β-hCG levels were measured, and factors such as maternal age, weight, parity, and abortion history were assessed. Data were obtained using the Fetal Medicine Foundation (FMF) software and medical records. Statistical analysis was performed using SPSS version 26.

Results: Out of 10,256 pregnancies, 6,040 (6.4%) had PAPP-A levels below the 5th percentile, while 45 women had PAPP-A levels below 0.2 MoM. The average age of these women was 30.4 ± 4.812 years. Among those with PAPP-A < 0.2 MoM, 2.2% had trisomy 21, 6.7% had IUGR, 26.7% experienced gestational hypertension, and 15.6% developed pre-eclampsia. Trisomies 13 and 18 were not observed in the study population.

Conclusions: Pregnant women with PAPP-A levels below 0.2 MoM showed increased incidences of trisomy 21, pre-eclampsia, gestational hypertension, and IUGR. Although low PAPP-A appears to contribute to both maternal and fetal complications, it cannot be used independently to predict adverse pregnancy outcomes. Further large-scale studies are required to better understand the implications of extremely low PAPP-A on pregnancy outcomes.

Effectiveness of Exercise Therapy for Patients with Prostate Cancer Focusing on High-intensity Interval Training: A Narrative Review

Shigenori Ito — 2024-12-25

Prostate cancer (PC) is the most frequently diagnosed cancer in men, and the population of survivors continues to increase. Although PC has a slower progression rate and a relatively favorable prognosis compared to other cancers, new strategies are needed to enhance outcomes after diagnosis and treatment. The effectiveness of exercise therapy in the prevention and treatment of PC is well documented. The significance of exercise for patients with PC includes prevention of disease progression, maintenance of physical fitness, and enhancement of muscle strength before surgery, as well as during chemotherapy and radiotherapy, all of which contribute to improving prognosis after treatment. High-intensity interval training (HIIT) is a well-established training protocol for long-distance runners that has also been applied to cardiovascular and metabolic diseases as a relatively novel and promising approach. HIIT, which involves high-intensity aerobic exercise, is known to enhance cardiorespiratory fitness, cardiac function, and insulin resistance to a greater extent than moderate-intensity training. Recent studies have demonstrated that HIIT effectively improves cancer cell growth inhibition and decreases prostate-specific antigen levels in both localized PC under active surveillance and metastatic castrate-resistant PC. However, the HIIT protocol should be tailored to each patient's condition and physical fitness level upon implementation. If accumulating evidence confirms the ability of HIIT to enhance physical fitness and suppress PC growth, the benefits to patients with PC would be substantial, and expected to be widespread.

Thrombocytopenia Due to Plasmodium falciparum Infection and Its Association with Clinical Symptoms, Wad Medani Teaching Hospital, Sudan

Ahmed Alsiddig Ebraheem — 2025-01-11

Background: Malaria is an endemic disease in Sudan, particularly in Gezira State. Malaria causes a significant decrease in the number of platelets in patients. This deficiency can be studied by considering clinical symptoms and parasite levels. This is a study of thrombocytopenia due to Plasmodium falciparum infection and its association with clinical symptoms in Gezira State, Sudan.

Methods: A cross-sectional hospital-based study was conducted at Wad Medani Teaching Hospital among Plasmodium falciparum-infected partic- ipants. Malaria was examined using thick and thin blood film of Giemsa staining preparations. Platelet count, WBC count, and hemoglobin level were measured by an automated blood analyzer (Sysmex). Parasitemia levels were calculated according to plus criteria as (+), (++), (+++), and (++++).

Results: In total, 200 Plasmodium falciparum patients were enrolled. The most commonly observed malaria symptoms were fever, headache, and vomiting, with rates of 94 (188/200), 76% (152/200), and 60.5% (121/200), respectively. In most cases, 80.5% (161/200) were categorized as level (+) of parasitemia. Regarding the hematological investigations, decreased hemoglobin levels were detected in 22% (44/200) cases. Leucopenia and leucocytosis were reported in 8% (16/200) and 20% (40/200) of patients, respectively. Thrombocytopenia was observed among 51% (102/200) of studied patients and categorized as mild 29.5 (59/200), moderate 14% (28/200), and severe 7.5% (15/200). Thrombocytopenia was significantly associated with joint pain (0.016) and skin pallor (0.030). Also, platelet count was significantly associated with TWBCs (p = 0.001) count, while no association was observed between platelet count and degree of parasitemia.

Conclusion: Despite the frequency of low platelet counts due to Plasmodium falciparum malaria in the current study, there were no severe consequences for patients, such as bleeding. The significant association between thrombo- cytopenia and malaria symptoms, such as joint pain and skin pallor, can be studied in more detail.