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Jun 2026 DOI 10.14302/issn.2766-8681.jcsr-26-6296
Background Acute diarrhea is the major cause of health public problem among paediatric patients in Tanzania. And in Low income countries (LICs), studies have shown, Acute watery Diarrhea (AWD) is the cause of morbidity and mortality which can be prevented by immediate identification and treatment of complications. Methods A prospective cohort study was done between December 2021 and April 2022 to determine the risks, complications, management strategies and predictors of mortality among paediatric patients ≤12 years of age with severe diarrhea. We excluded those who arrived in cardiac arrest at the Emergency Medicine Department (EMD) of Muhimbili National Hospital (MNH). Proportion was used to summarize the counts and frequency of participants who were at risk of complications and management strategies given and for predictors of outcomes. A Modified Poisson log linear model with a robust estimation test was used to test for significant associations between predictors and outcomes. Multivariate logistic regression was used to adjust for confounders. Results A total 6,570 paediatric patients presented to EMD during study period, and we recruited 144 (2.2%). The median age was 1 (IQR 0.7-2.0) years and most were male 86 (59.7%). Among the study participants with diarrhea, 120 (83.3%) had dehydration, acidosis 60 (42.3%), hypoglycemia 8 (5.6%), hypokalemia 76 (53.1%), and Acute renal failure 11 (7.6%). Those patients with complications received appropriate management, including IV crystalloid solution given to 131 (90.97%), and correction of acidosis 60 (42.3%), hypoglycemia correction with IV dextrose 10% 6 (4.2%), and hypokalemia and infections were corrected with IV potassium chloride 52 (36.1%) and IV antibiotic treatment 84 (58.3%) respectively. Conclusion Pediatric patients under 2 years of age are at high risk of severe diarrhea with dehydration as compared to other ages. Early referral and availability of point care tests are essential in early recognition of accompanied complications.
Jan 2019 DOI 10.14302/issn.2471-7061.jcrc-18-2446
Introduction: Cardiac complications are a major cause of perioperative morbidity and mortality in patients undergoing colorectal cancer surgery. A quick and reliable system for predicting postoperative cardiac morbidity is needed to predict cardiac events in order to improve outcome in surgery. The aim of this study was to investigate the role of the biochemical marker NT-proBNP in the prediction of postoperative all-cause mortality, cardiac-related mortality and cardiovascular events in patients undergoing colorectal cancer resections. Methods: 100 consecutive patients undergoing colorectal cancer surgery were prospectively recruited. Blood samples were taken preoperatively, 24h, 48h and 5-7 postoperative days to measure NT-proBNP levels. The predictive power of NT-proBNP levels was assessed using Receiver Operating Characteristics (ROC) curves. Results: Cardiac-related morbidity and mortality was 9%. Of eleven deaths, 5 were cardiac-related. Preoperative NT-proBNP was a good predictor of death with ROC area under curve (AUC) of 0.83 (95% C.I. 0.673, 0.993) a strong predictor of cardiac death with AUC of 0.914 (95% C.I. 0.823, 1.000) and a good predictor of cardiac complications with AUC of 0.875 (95% C.I. 0.757, 0.993). NT-proBNP levels 24 hours and 48 hours postoperatively were also strongly predictive of postoperative cardiac morbidity and mortality. Conclusion: Pre- and postoperative NT-proBNP have a role in predicting postoperative death and cardiac complications. This may have significant implications in the planning of postoperative care for high-risk patients.
Feb 2016 DOI 10.14302/issn.2476-1710.jdt-15-762
Bipolar disorder (BD) is a chronic psychiatric illness impacting patient functioning and quality of life. Medication produces improvement in many patients and remission in some, but there is minimal understanding about why some patients improve and others do not. Our goal was to identify demographic, psychosocial and comorbid variables associated with outcomes in BD. Charts of 121 outpatients treated with medication and supportive psychotherapy were reviewed. Forty four percent attained euthymia for 12 months while 56% did not. Poorer outcome was associated with economic stress, missed appointments, life stress, and presence of pain (p < 0.05). Those employed were more likely to improve (p < 0.02). Patients with BP-II reported more frequent life stressors, headache and use of alcohol (p <0.05) and were less likely to achieve euthymia than BP-I. Gender, education, and co-morbid medical illness did not affect results. Our findings suggest that poorer outcome is related to psychosocial factors. Increased attention to these variables may increase providers’ ability to manage challenging patients with BD.
Apr 2026 DOI 10.14302/issn.2994-6743.ijstd-25-5899
Background Sexually transmitted infections (STIs) continue to rise globally, with >1 million new cases reported daily in 2020. In England, newly diagnosed STIs increased by 23.8% in 2022 compared to 2021. Many infections remain asymptomatic yet contribute to infertility, pregnancy complications, and neonatal morbidity. While routine screening often focuses on Chlamydia trachomatis, broader detection is limited by laboratory turnaround times and restricted test panels. Methods We analysed 6003 home-collected urine and/or swab samples submitted for sexual health screening in the UK. Samples were tested in the laboratory for 10 bacterial and viral pathogens. A total of 5859 urine and 1627 swab samples were processed, with paired samples assessed for diagnostic agreement. Results The most common infections detected in urine were Ureaplasma urealyticum (12.1%), Mycoplasma hominis (8.6%), and Chlamydia trachomatis (2.4%). Swabs showed similar prevalence, with Ureaplasma urealyticum (11.6%) most frequent, followed by Mycoplasma hominis (10.4%) and HSV-2 (4.4%). Paired urine–swab samples demonstrated strong agreement, though swabs improved HSV detection. Conclusions Ureaplasma urealyticum was the most prevalent STI detected, yet only Chlamydia trachomatis is routinely screened in England. Comprehensive laboratory testing of home-collected samples could reduce the hidden burden of STIs, infertility, pregnancy complications, and neonatal infections, while offering confidential and accessible diagnostics.
Mar 2026 DOI 10.14302/issn.2994-6743.ijstd-26-6060
Objective To describe the clinical features and real-world treatment of people living with human immunodeficiency virus (PLHIV) using fixed-dose or free combinations of 2-drug regimens (2DR) of antiretroviral therapy (ART). Design Italian retrospective cohort study. Methods Data were extracted from PLHIV who initiated or switched to 2DR: Group 1 (fixed dose), Group 2 (free combination). Results Group 1 was younger and more predominantly male, and had shorter time from AIDS-defining diagnosis to 2DR-ART and from diagnosis to baseline, a lower prevalence of resistance, and fewer comorbidities than Group 2. Median baseline viral load was <50 copies/mL in both groups, but Group 1 had a higher mean due to outliers. The most common ART classes before switching to 2DR were Integrase Strand Transfer Inhibitor (INSTI)-based (48.97%), Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)-based (22.73%), and Protease Inhibitor (PI)-based (16.53%). Distribution varied: Group 1: INSTI-based (53.13%), NNRTI-based (24.31%), and PI-based (15.04%); Group 2: INSTI-based (29.41%), PI-based (23.53%), and NNRTI-based (15.29%). After switching, Group 1 was on dolutegravir/lamivudine (79,33%) and dolutegravir/rilpivirine (20,67%); Group 2 mostly on INSTI-PI (52.81%), followed by NNRTI combinations, mainly with doravirine (19.10%). Duration of ART after switching was shorter in Group 1. Conclusion Italian PLHIV on 2DR fixed-dose combinations were younger, virologically suppressed individuals at baseline, with a shorter lead time from diagnosis, lower prevalence of resistance and lower comorbidity rate compared to those on free combinations. These findings underscore an unmet need for 2DR fixed-dose combinations, as the free combinations were predominantly utilized for more challenging populations.
Dec 2025 DOI 10.14302/issn.2473-1005.jdoi-25-5870
This narrative literature review investigates the clinical feasibility of maxillary sinus lift using the lateral window (or traumatic) technique, employing a grafting material composed of hydroxyapatite associated with beta-tricalcium phosphate. The study is based on the premise that bone resorption and sinus pneumatization—common in edentulous posterior maxillae—pose a challenge to achieving primary stability during dental implant placement. Given the limitation imposed by reduced residual bone height, bone-grafting surgical techniques become necessary to enable implant-supported rehabilitation. The objective of this work is to analyze, through a literature review, the efficacy of combining synthetic biomaterials as an alternative to autogenous bone grafts, which are considered the gold standard in implant dentistry. A bibliographic search was conducted in the PubMed and LILACS databases and through the VHL portal, prioritizing articles addressing the biological properties of alloplastic grafts, the indications of the lateral window technique, and the clinical success rates of implants placed in previously grafted areas using such materials. The findings demonstrated that hydroxyapatite associated with beta-tricalcium phosphate exhibits favorable osteoconductive characteristics, such as adequate porosity and gradual resorption, while allowing the formation of viable bone within a clinically acceptable timeframe. The combination of these materials eliminates the need for a second surgical site, reduces morbidity, and maintains treatment predictability. It is concluded that the lateral window technique associated with synthetic biomaterials is a safe and effective alternative for patients with maxillary bone atrophy, capable of promoting suitable bone beds for dental implant placement and stabilization, with lower surgical risk and satisfactory clinical outcomes.
Dec 2025 DOI 10.14302/issn.2997-1977.jd-25-5754
With more than 150,000 affected infants annually, Nigeria bears the largest burden worldwide of sickle cell disease (SCD), making it a significant public health concern. The management of SCD in Nigeria is challenging, despite advancements in medical research and increased knowledge. This review examines the numerous issues surrounding SCD in the nation, including the financial burden on affected families, the lack of specialized care facilities, the absence of newborn screening programs, the sociocultural stigmatization of SCD, and restricted access to high-quality healthcare. Additionally, inadequate public health education and a lack of coordinated national policies result in delayed diagnosis and suboptimal treatment outcomes. We also highlighted recent efforts and recommendations aimed at improving early detection, comprehensive care, and community support. Addressing these challenges through expanded health education and enhanced healthcare infrastructure is essential to reducing morbidity and mortality associated with SCD in Nigeria.
Nov 2025 DOI 10.14302/issn.3070-3379.jwc-25-5549
This short communication/mini-review immensely emphasizes human health to explicate and elucidate management of the global scourge associated with the determinants and impact of vulnerabilities to extreme hydrologic events and climate change in the absence of risk reduction and their concomitant sequelae. The most effective approach for risk reduction associated with biodiversity, environmental, and health vulnerabilities due to climate change and extreme hydrological events, an ecological framework must take into cognizance exposure, vulnerability, and resilience. This framework emphasizes the significance of understanding the inextricable linkage between ecosystems and human communities are exposed and susceptible to hazards, sensitivity to these hazards, and capacity to cope, adapt and recuperate. Risk reduction incorporates structurally attenuating exposure, strengthening resilience, and sustainably enhancing overall vulnerability management. Extreme weather and climate-associated incidents impinge on human health with consequential morbidity, mortality and socioeconomic challenges and constraints. Climate change and extreme event have altered the frequency, intensity, geographic distribution, and propensity as drivers for change in the future. The indicted variables include hydrological events, such as precipitation, floods and droughts as well as heat waves, wildfires, global warming, extreme temperatures, and hurricanes. The pathways inextricably-linked with extreme events to economic dissipation, human health prognosis and outcomes remain inexplicably diverse and complex; and thus, difficult to predict due to their emergence and reemergence from local, societal and environmental factors which influence disease burden.
Jul 2025 DOI 10.14302/issn.3070-1937.ijbt-25-5616
Objectives Blood transfusions in cardiac surgery are associated with increased morbidity and mortality. The purpose of this study is to identify potential benefits of ANH in high-risk cardiac surgery. Design This was a prospective, randomized, controlled study. Setting The study was performed at a tertiary care university hospital. Participants 61 patients who underwent complex cardiac surgery with cardiopulmonary bypass (CPB) were enrolled in the study. Measurements and Main Results After randomization, 32 patients were assigned to the ANH arm, and 29 patients were assigned to the control group. ANH was associated with a lower incidence of total perioperative pRBC transfusion (0.6 ± 1.2 units vs 2.7 ± 6.8 units; p = 0.030/0.049). Total perioperative transfusion of all other fractionated blood products, including platelets (0.8 ± units vs 1.9 ± 2.4 units; p=0.010), cryoprecipitate (0.5 ± 0.7 vs 1.3 ± 2.0; p=0.016) and FFP (0.5 ± 1.0 vs 2.3 ± 6.2 units; p=0.013), was significantly lower in the ANH group compared to controls. Participants in the ANH group received significantly fewer intraoperative transfusions of pRBC (0.4 ± 1.2 vs 2.6± 7.0 units; p=0.037), platelets (0.8 ± 1.2 units vs 1.9 ± 2.4 units; p=0.013, logtrans), FFP (0.4 ± 0.9 vs 2.5 ± 6.4 units; p=0.003) and cryoprecipitate (0.5 ± 0.7 vs 1.3 ± 2.1 units; p=0.012, logtrans). With respect to secondary clinical outcomes, ANH participants had statistically shorter ICU (3.7 ± 1.9 vs 5.4 ± 3.6 days; p=0.020) and hospital (6.7 ± 2.1 vs 9.5 ± 7.7 days; p = 0.048) length of stays Conclusions ANH in complex cardiac surgical patients is safe and may be effective in reducing the allogenic blood product transfusion of PRBCs, FFP, platelets and cryoprecipitate in the perioperative period.
May 2025 DOI 10.14302/issn.2694-2283.jsem-25-5529
Background Septic arthritis is a potentially limb or life-threatening joint infection that requires prompt recognition and intervention to reduce morbidity and mortality. While intra-articular joint injections are commonly performed for osteoarthritis and other arthropathies, they carry a rare but significant risk of iatrogenic infection, particularly when performed in the presence of unrecognized joint or periarticular infection. Case Presentation We report a case of a 52-year-old female with a history of traumatic brain injury and chronic right knee pain who developed severe knee swelling, pain, and systemic symptoms following an intra-articular corticosteroid injection performed without ultrasound evaluation/guidance. Post-procedure, she presented with fever, elevated inflammatory markers, and purulent knee effusion. Operative washout revealed a purulent tract extending from the knee joint capsule to the lateral thigh. Cultures from joint aspiration and intraoperative samples grew Streptococcus dysgalactiae. Blood cultures were negative. The patient reported frequent cat scratches to the affected knee and described an unusual sensation of the injection needle tracking laterally during the joint injection. She was treated with surgical drainage and a four-week course of amoxicillin, with full clinical recovery. Discussion This case highlights an unusual presentation of septic arthritis with extra-capsular extension likely due to iatrogenic needle tracking during joint injection. The causative organism, S. dysgalactiae, is an uncommon pathogen in septic arthritis, and the presumed source was contiguous spread from untreated cellulitis, possibly related to cat scratches/bites. The absence of predisposing comorbidities and negative blood cultures further support a local rather than hematogenous source. The case emphasizes the importance of thorough clinical evaluation and consideration of infection prior to joint injections, as well as the potential benefits of ultrasound guidance to minimize procedural complications. Conclusion Careful history, physical examination, and appropriate imaging are essential prior to joint interventions to avoid iatrogenic complications. This case illustrates the rare but serious risk of extra-capsular extension of septic arthritis following intra-articular injection and emphasizes the need for vigilance in identifying underlying infection before proceeding with invasive procedures.
Jan 2025 DOI 10.14302/issn.3066-8042.jac-24-5273
The objective of this focused literature review includes establishing and explaining the high correlation between sleep issues and ADHD. Through a systematic review of sources, a high correlation between sleep issues in those with ADHD was established with multiple theories lending explanation to this comorbidity. Neurological pathways in the brain already afflicted by the disorder of ADHD may cause direct effect on sleep pathways in their dysfunction. Other comorbid sleep conditions were found to occur in high frequency with ADHD however, a common etiology of these issues is yet to be established. The major conclusion of this study includes that there are multiple mechanisms through which sleep disturbances may be caused in ADHD patients, all of which must be considered in future research.
Jun 2024 DOI 10.14302/issn.2574-450X.jom-24-5114
Objective We aimed to assess outcomes in patients undergoing sequential intragastric balloon (IGB) treatment for obesity. Methods Consecutive patients who underwent treatment between May 2014 and February 2023 were identified. We recorded outcomes including: weight at 3-monthly intervals, progression to definitive bariatric procedure and morbidity. Results 45 patients were identified. Median weight loss with first IGB was 15.2kg (8.8%). 11 patients (26.7%) had a second IGB, with median weight loss of 3.3kg (1.9%). 21 patients (46.7%) were suitable for definitive surgery after first IGB treatment. One further patient (2.2%) was suitable for surgery after a second IGB. During first IGB, median weight loss was observed during the each of the first three quartiles (months 0-3: 10.1kg; months 3-6: 2.3kg; months 6-9: 4.2kg). There was a median 2kg weight gain during months 9-12. Conclusions Greatest weight loss was achieved during first IGB treatment. Sequential IGB treatment did not lead to beneficial weight loss or progression to surgery. Weight loss with first IGB was not uniform across the 12 month period of treatment, with net weight gain during the last quartile.
May 2024
This exploratory study investigates factors and consequences of underdiagnoses or late diagnoses of attention deficit hyperactivity disorder (ADHD) in females favoring males in the referral, diagnosis, and treatment processes resulting in gender disparities. A literature review in PubMed, PsychINFO, PsychArticles, and PsychiatryOnline from 2010 to 2023 underscores significant implications of delayed ADHD diagnosis in females, hindering timely access, support, and interventions during critical developmental years. Factors associated with underdiagnosis of ADHD among girls include gender differences in symptomology presentation, comorbidity, and gender bias among parents, teachers, and healthcare providers. We highlight the role of ethnicity and cultural factors. This bias prevents girls from receiving necessary ADHD support and treatment, impacting their health, social, and economic outcomes into adulthood. We summarize strategies to urgently address gaps in ADHD research and practice. Raising awareness among communities, healthcare providers, educators, and parents is vital to alleviate these gender disparities. By illuminating factors contributing to delayed diagnoses, the study informs policymakers and stakeholders, facilitating targeted interventions to improve early detection and treatment outcomes for females with ADHD.
May 2024
Waterborne diseases pose a significant global public health threat, particularly in sub-Saharan Africa, where frequent outbreaks occur. These diseases stemming from contaminated drinking water, poor waste management, and insufficient hygiene contribute to high morbidity and mortality in children under 5 years old. A study addressed waterborne diseases in N'Djamena, Chad's 3rd and 9th districts, through decision-making strategies. The research employed various methods, including a household survey using questionnaires, workshops, semi-structured interviews, and focus group discussions. Additionally, documentary research provided essential data for analysing the situation of diseases in the community. Epidemiological data from 2019- 2022 indicated a substantial prevalence of diseases such as diarrhoea, dysentery, skin infections, typhoid, abdominal pain, and malaria, with notable mortality, especially among children. Among surveyed households, 50% believed the consumed water was contaminated, attributing it to faecal matter, while 28% and 22% linked the diseases to inadequate hygiene and unsanitary conditions, respectively. The study advocates for comprehensive strategies, including improving water treatment efficiency, implementing safe waste management, promoting hygiene, and vaccination. Active involvement of all stakeholders, with municipal authorities leading, is crucial for effective implementation and combating waterborne diseases.
Apr 2024 DOI 10.14302/issn.2329-9487.jhc-24-5040
Objective Hypertensive crisis is an increasingly frequent medical condition in our context. Its management in medical emergencies is a real challenge for physicians. Few data on hypertensive crisis are available in Chad. The aim of this study was to investigate the epidemiological, clinical and prognostic characteristics of hypertensive crisis in the medical emergency department of Reference National Teaching Hospital in N'Djamena. Patient and methods This was a prospective cohort study running from 1er March 2020 to October 31 2020. Patients presenting with a sudden and severe rise in blood pressure (systolic ≥ 180 mmHg and/or diastolic ≥ 110 mmHg) with or without acute target-organs damage, had been consecutively included and followed up over a period of one (01) month. Epidemic and clinical characteristics on admission, and morbidity and mortality parameters during the course of the disease were collected. The Kaplan-Meier method and the Cox model were used to analyze survival and factors associated with death, with a significance level of p<0.05. Results Of the 3978 hypertensive patients admitted to medical emergencies, 252 had a hypertensive crisis, i.e. a prevalence of 6.3%. Two hundred and seventeen (217) patients were included in the study, divided into 149 cases (69%) of hypertensive emergency and 67 cases (31%) of hypertensive hypertensive urgencies. The mean age of the patients was 55.2 ± 14 years (20 and 80 years) and 67% were male. Hypertension was known in 138 patients (64%). At least one complication was present on admission in 69% of patients. Complications were classified as cardiac (50.7%), neurological (38.2%), kidney impairment (46.5%) and ocular (46.1%). The average number of antihypertensive drugs used was 2 ± 0.83 14. Calcium antagonists (86.5%), diuretics (35.5%), converting enzyme inhibitors or angiotensin II receptor antagonists (33.3%) and betablockers (18%) were the pharmacological classes prescribed. Good compliance during follow-up was observed in 124 patients. One-month survival was 84% for all patients, with a 16% mortality rate. Factors associated with death were the duration of hypertension, and the occurrence of cardiovascular, renal dysfunction and ocular disease (p < 0.05). Conclusion Hypertensive crisis is a frequent pathology in sub-Saharan Africa, with high morbidity and mortality. Prevention requires early detection and effective management of hypertension.
Feb 2024 DOI 10.14302/issn.2641-4538.jphi-24-4976
This article explores links between endometriosis, mental health, and quality of life. It reviews symptom burden, comorbidity patterns, and multidisciplinary care approaches.
Dec 2023 DOI 10.14302/issn.2329-9487.jhc-23-4848
Introduction Rheumatic heart disease is mostly common in low-income or developing parts of the world, such as Sub-Saharan Africa, with a high morbidity and mortality rate. There are few data that are available in Chad on rheumatic heart disease. Our objective was to study the clinical, echocardiographic, therapeutic, and progressive aspects of rheumatic heart disease at the Renaissance University Hospital Center and the National Reference Teaching Hospital in N’Djamena, Chad. Patient and methods This was a prospective, multicenter and observational cohort study, covering a consecutive series of patients consulted and/or hospitalized for rheumatic heart disease, documented by an echocardiogram from January 2015 to January 2021. Results Among the 4456 patients consulted and/or hospitalized, 398 cases of rheumatic heart disease (8.9%) were collected, and 364 patients had met the inclusion criteria. The mean age was 31.2 ± 14.4 years, and 193 patients (53%) were female. On admission, heart failure was present in 214 patients (58.8%), ischemic stroke in 10 patients (2.7%) and supraventricular arrhythmias such as atrial fibrillation in 94 patients (25.8%) and atrial flutter in 6 patients (1.6%). Mitral regurgitation was observed in 49.7% (n=181) of cases, aortic regurgitation in 33.2% (n=121), mitral stenosis in 31.3% (n=114), and aortic stenosis in 7.7% (n=28). At least two valvular disorders were combined in 48.4% of cases. A surgical intervention such as a heart valve replacement and/or valvuloplasty was performed in 80 patients (22.2%). At least one rehospitalization was noted in 56.9% of patients. Forty-two of the 150 patients free of heart failure at inclusion (28%) had experienced the first episode of decompensated heart failure during follow-up. On the other hand, in 119 patients (55.6%), it was the second episode of decompensated heart failure. Other progressive complications included atrial fibrillation (13.8%), thromboembolic complications (6.3%), infective endocarditis (6.0%) and prosthetic valve dysfunction (1.4%). Altogether, the mortality rate was 10.4%. It was 9.9% in non-operated patients compared to 12.5% in operated patients (p=0.49). Conclusion The present study shows that morbidity and mortality of rheumatic heart disease remain high in our context and often affect children, young adults, and women. Treatment is essentially based on cardiac surgery which is not available in Chad.
Dec 2023 DOI 10.14302/issn.2381-862X.jwrh-23-4750
Background Preconception care is a crucial aspect of maternal and child healthcare services that aims to mitigate adverse pregnancy outcomes and enhance the desired health outcomes for women, newborns, and children. Despite the continuous multi-sectoral efforts in preconception care, maternal mortality and morbidity remain significant health concerns globally. This study aimed to assess the knowledge and practice of preconception care and its associated factors among women of reproductive age in Bheerkot Municipality, Nepal. Methodology A community-based descriptive cross-sectional study was conducted among 215 reproductive-age women to assess knowledge and practice regarding preconception care in Bheerkot Municipality, Nepal. Structured questionnaires were designed in the Nepali language and used in face-to-face interviews. We used a simple random sampling technique to collect quantitative data. In a statistical analysis, we employed the Chi-squared test and logistic regression analysis to identify possible predictors using the odds ratio and considered variables with p<0.05 statistically significant at a 95% confidence interval. Result Out of the 215 women who participated in the study, only 46.9% had a good knowledge of preconception care. Approximately half (43.7%) of the respondents had never practiced preconception care. Among respondents who had practiced preconception care before, 47.9% reported good practice, and 52.1% reported poor practice. Age of the respondent (χ2=14.2063, P=0.000823, df=1), marital status (χ2=17.9851, P=0.000022, df=1), time to reach a health facility (χ2=30.1371, P=0.00001, df=1), and age at first pregnancy (χ2=4.7975, P=0.0285, df=1) were statistically associated with knowledge about preconception care. Women who have foreign employment as a major source of family income and whose age is from 25 to 34 years were more likely to have a better practice of preconception care than their counterparts (COR 3.5000, CI 1.3343 to 9.1805, P = 0.0109) and (COR 3.4000, CI 1.1646 to 9.9265, P = 0.0252), respectively. Additionally, out of those who practiced preconception care, most respondents (93.4%) have practiced it in government health facilities. Conclusion Respondents had relatively poor knowledge and practice of preconception care. Collaboration of governmental health institutions between multiple sectors at local levels for more education and information and a specific national protocol or policy formulation would be beneficial in improving preconception care in Nepal.
Apr 2023 DOI 10.14302/issn.2694-1201.jsn-23-4385
Background Traumatic brain injury in pediatrics is one of the commonest causes of morbidity, disability and mortality worldwide. In low- and middle-income countries Study showed that death of pediatrics from traumatic brain injury was 7.3%. However, there is limited data towards the outcome of traumatic brain injury and its associated factors in Ethiopia. Objective To assess the outcome of traumatic brain injury and associated factors among pediatrics patients in Amhara National Regional State Comprehensive Specialized Hospitals, Ethiopia. Methods An institution based retrospective cross-sectional study was conducted among 423 pediatrics patients from January 1, 2019 to December 30, 2021, and data extraction period was from May 16 to June15, 2022. Systematic random sampling technique was employed to select the study participants. Data were collected from patient charts and registry books by using a data extraction tool. Data were entered into the Epi-info version 7 and analysis was done by SPSS Version 25. Both Bi-variable and multi-variable analyses were employed to identify factors associated with outcome of traumatic brain injury. Result From 423 sampled study participant charts 404 of them had complete information with response rate of 95.5% and included in the final analysis. The overall unfavorable outcome of traumatic brain injury at discharge was found that 12.13% (95% CI: 9.1% - 15.7 %). Sever traumatic brain injury (AOR: 5.11(CI :1.8-14.48), moderate traumatic brain injury (AOR:2.44(CI:1.07-5.58), Hyperglycemia (AOR: 3.01 (CI:1.1-8.04), sign of increased intracranial pressure (AOR:7.4(CI:3.5-15.26), and medical comorbidity (AOR: 2.65(CI:1.19-5.91) were predicted of unfavorable outcome of traumatic brain injury pediatrics patient. Conclusion and recommendations twelve present of traumatic brain injury results unfavorable outcome. Sever and moderate form of traumatic brain injury, hyperglycemia, signs of increased intracranial pressure, and medical comorbidity were factors associated with unfavorable outcome of traumatic brain injury in children. Therefore, it is preferable to improve accesses to acute and post-acute care services to lower the unfavorable outcome of traumatic brain injury in children.
Mar 2023 DOI 10.14302/issn.2474-3585.jpmc-23-4442
Objective Women have continued to bear a heavy burden of cardiovascular disease morbidity and mortality with hypertension as the flagship. This is partly because as the modifiable cardiovascular disease risk factors are falling in rate, gender specific risk factors have persisted. One of them is age at first pregnancy and delivery. Methods In order to contribute to this discourse, we secondarily analysed data generated in a previous field study on risk factors for cardiovascular diseases in free living adults in Plateau State, Nigeria. The women were divided into four groups and we looked at blood pressure at the time of study from the perspective of age at first pregnancy. Reults It was found that those who had their first pregnancy in the late teenage years had the lowest mean arterial blood pressure many years down the line; better than those who started child bearing earlier and those who started later. There was also significant within and between group differences in the blood pressures (p = 0.000). Conclusion To stem the tide of female hypertension later in life, child bearing should not start in the early teenage years nor be unnecessarily delayed. Sociocultural conditions that promote early teenage marriage and pregnancy should be discouraged.
Mar 2023 DOI 10.14302/issn.2379-7835.ijn-22-4116
Background In Low Middle-Income Countries (LIMCs), malnutrition, especially undernutrition is one of the leading causes of childhood mortality and morbidity. Poor complementary feeding practices are among the most notable contributors to poor nutritional indicators in children under five. This article provides an output of secondary data analysis of the Cost of Diet (CoD) and Optifood component of National Complementary Feeding Assessment conducted by UNICEF Pakistan along with Pakistan Demographic Health Survey (PDHS) 2018. Methods For correlation of Optifood data and CoD data with PDHS data of CF, GraphPad software, MS Excel was used along with manual quantifications. The analysis of DHS-2018 data was conducted using STATA software. Univariate analysis included comparison of categorical variables i.e. various individual, household and community level parameters with that of outcome variables of minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum dietary diversity (MAD) using chi-square test. Findings The overall rate of MMF was 56.6% among children of 6-23 months of age with MDD in 18.6% and MAD in 13.8% of children. Percentage of annual cost spent on nutritious diet for MDD, MMF and MAD varies from 27.86% to 43.08% across all the provinces. Children aged 6–8 months and 9–11 months often consumed infant milk and cereals, while children aged 12–23 months often consumed eggs and grain products. Consumption of dairy products was highest in Punjab, Sindh, AJK, and Islamabad, that of grains roots and tubers was highest in KPK, FATA and GB. Conclusion Considering CF practices in Pakistan are inadequate as indicated by poor MDD, MMF, and MAD, therefore it is imperative that a holistic approach using both communication and non-communication based interventions is to be employed through active stakeholder engagement.
Feb 2023 DOI 10.14302/issn.2641-5526.jmid-23-4450
Acute appendicitis is one of the most common surgical emergencies globally, with a lifetime incidence of 8.6% in men and 6.7% in women. While acute appendicitis should be managed promptly to reduce the morbidity associated with perforated appendicitis, morbidity from negative appendicectomy is similar to morbidity from uncomplicated appendicitis. Computer tomography is widely used to aid in the diagnosis of acute appendicitis, however, is costly, often has a slow turn around time, and is associated with exposure to ionising radiation. In contrast, ultrasound is cheap, widely available, requires minimal patient preparation, and does not require exposure to ionising radiation. Ultrasonography is becoming increasingly used for adult patients in emergency settings. The literature has estimated the sensitivity of ultrasound for acute appendicitis in adult patients as between 39-96.4%. The sensitivity and specificity of ultrasound for the diagnosis of acute appendicitis is significantly increased when the appendix is visualised. In cases of a non visualised appendix, indirect ultrasound signs can improve the sensitivity to 93.9% and specificity to 85.7%. The variation in sensitivity and specificity for ultrasound in the diagnosis of acute appendicitis in adults may be due to multiple factors. Ultrasonographer experience, a retrocaecal appendix and obesity have all been described. Given the availability, cost and potential to reduce the rate of negative appendicectomy, ultrasound should be considered as the first line imaging modality for adult patients presenting with suspected AA.
Sep 2022
Background Cardiovascular disease, and ischemic heart disease (IHD), is a major cause of morbidity and mortality in the very elderly patients worldwide. In the developing countries like Bangladesh it has been increasing with time. Due to life style, food habits and urbanisation. These patients represent a rapidly growing cohort presenting for percutaneous coronary intervention (PCI), now constituting more than one in five patients treated with PCI in real-world practice. Materials and Methods From July 2020 we included 152 patients with IHD purposively in Cardiology department of Bangabandhu Sheikh Mujib Medical University Dhaka, Bangladesh undergone PCI who were divided into 2 groups according to age: e” 75 years (n = 51) and <75 years (n = 101). Baseline clinical characteristics, indications for coronary intervention, in hospital outcomes were obtained. Study endpoint was Renal impairment, MI, LVF, emergency revascularization and death. Results Very elderly patients were more frequently male (86.2%) and nonsmoker at present (41.1% vs. 63.3%, p=0.003), had higher prevalence of hypertension (60.7% vs. 50.4%, p<0.13), and more often presented with NSTEMI (54.9% vs. 23.7%, p<0.001). Elderly group had higher incidence of TVD and LM disease (37.2% vs. 26.7% and 9.8% vs. 2.9%, p=0.07) and more incidence of ostial (17.6% vs.5.9%,p=0.007) and calcified lesions (31.3% vs. 14.8%, p=0.004). Procedural success (TIMI III) were high in both groups, but still lower in the elderly as compared to younger group (96% vs. 97%, p=0.65). Very elderly patients had higher incidence of post PCI bleeding, CIN, MI, LVF and death (9.8% vs.5.9%, 7.8% vs.3.9%, 5.8% vs.5.9%, 9.8% vs. 4.9% and 5.8%vs.3.9%,p=0.07), whereas emergency revascularization were higher in younger group (5.8% vs. 6.9%, p=0.07). Conclusion Very elderly patients aged ≥80 years face more vascular site complications during PCI, usually have more LM and TVD with more ostial and calcified lesions in comparison with younger group. Though procedural success is similar with younger group, they face more post PCI CIN, LVF and MI. Repeat revascularization was higher in younger group.
Aug 2021 DOI 10.14302/issn.2578-2371.jslr-21-3912
Background Liver disease has caused significant morbidity and mortality worldwide. Its epidemiologic and clinical pattern, however, is not well characterized in sub-Saharan countries. Objective This study aimed to describe demographic, clinical characteristics, and patterns of liver disease in a community hospital in Addis Ababa, Ethiopia. Method A retrospective hospital-based study was conducted on patients with liver disease admitted at Ras Desta Damtew memorial hospital, in Addis Ababa-Ethiopia, from February 2015 to April 2020. Result Of the total 212 patients majority, 78.8% were male, 49.1% of patients were in the age range of 31-50 with a median age of 42. The most common initial clinical presentation was ascites (87.7 %), and more than half of patients (56.6%) had a history of alcohol misuse documented on their medical charts. Chronic liver disease (cirrhosis) was found in 177 (83.5%), and Hepatocellular Cancer accounted for 7.5% of the patients. Alcohol misuse caused 45% of chronic Liver Disease, followed by Hepatitis B virus infection. Conclusion Chronic liver disease is the most common form of liver disease, and the most affected were middle-aged men. The common cause of chronic liver disease was alcohol followed by hepatitis B virus infection.
Aug 2021 DOI 10.14302/issn.2379-8572.joa-21-3913
This article has been retracted on 20 January 2022. VIEW THE RETRACTION NOTICE (https://doi.org/10.14302/issn.2379-8572.joa-25-5850) Back ground and Objectives Tonsillectomy is the most common surgical procedure in specialty of otorhinolaryngology. Therefore there are frequent premises regarding this procedure to be improved from different aspects, indications, time of surgery, techniques, safety measures, and postoperative care. Hence the tonsils and peritonsillar tissues are highly vascular zone that supplied by direct branches of external carotid artery thus the post-tonsillectomy bleeding remains one of significant issues in relation to this widely performed procedure. The post-tonsillectomy bleeding needs frequently to be postulated for its incidence, prevalence, etiology, predisposing factors, management and prevention. This subject constitutes one of most risky aspects that increase wariness of the surgeons regarding this commonly conducted procedure. Although there are huge numbers of presentative literatures coming from American as well as western institutes that tried to put guidelines for purpose of prevention and management of post-tonsillectomy bleeding but broadly at our middle-east region and locally at our Libyan society we found for some extent difficulties to apply all these guidelines. For this reason this issue has been take the wider spectrum of ENT surgeons’ concentration, discussions, and researches. Therefore this study was conducted prospectively and for long time to confirm the possible predisposing factors that could be responsible for increasing the risk of post-tonsillectomy bleeding at our region and in the same time to illustrate the concluded recommendations to prevent the occurrence of this important complication. Patients and Methods 2880 patients aged from 8 months to 85 years presented at ENT department-AL-hawari ENT and urology teaching center- Benghazi-city – Libya as well as AL-thowra central teaching hospital and AL-tarahom private center – Elbyda city – Libya at period in between September 2003 to March 2015 as cases of chronic adeno-tonsillitis and solitary acute as well as chronic related palatine tonsillar disease with variable patterns of indications for tonsillectomy namely snoring and apnea attacks, recurrent attacks of acute tonsillitis, persistent otitis media with effusion, recurrent attacks of acute suppurative otitis media, failure to thrive, recurrent attacks of chest infection, mal-occlusive dental deformity, unilateral enlarged tonsils, post-traumatic avulsed tonsils, history of quinsy abscess and persistent halitosis. All patients were assessed intra-operatively and post-operatively too for any evidences of primary, reactionary, or secondary hemorrhage in relation to wide spectrum of factors as patient's demographic, medical, and socio-habitual factors, in addition to technical as well as post-operative care factors. Results This presenting study confirmed that the most common type of post-tonsillectomy bleeding was the secondary variety (71%) as compared to primary (22%) and reactionary (7%) among all presented post-tonsillectomy bleeding cases. Although through this presenting serial study there were multifactorial pre-dispositions elucidated for secondary post-tonsillectomy hemorrhage but as general poor post-operative care can be considered as the cornerstone for the pathogenesis of this significantly raised incidence of secondary post-tonsillectomy bleeding this may be in form of inadequate patient's hydration and nutritional supply (47%), poor patient's antibiotic compliance (23%), and child's maternal negligence (19%). The time of surgery was found to be another important pre-disposing factor for post-tonsillectomy bleeding, it was postulated that the incidence of reactionary as well as secondary post-tonsillectomy hemorrhage significantly increased at summer and autumn seasons (69%) as compared to other seasons. The place of surgery was another interesting proposed studied factor among this serial presentation it was observed that the incidence of post-tonsillectomy bleeding among patients who operated at AL-hawari ENT and urology teaching center-Benghazi-city significantly higher (63%) than that among cases who interfered at AL-thowra central teaching hospital and AL-tarahom private center – Elbyda city. Conclusion Generally speaking, post-tonsillectomy bleeding is considered as one of important issues in ENT and one of significant post-tonsillectomy complications which may create a critical morbidity that may rarely extend to post-operative mortality. Hence the most common pattern of post-tonsillectomy bleeding is the secondary type; however this type of post-tonsillectomy hemorrhage is pre-disposed and induced by many factors. Most of these factors are treatable and curable thus the prophylaxis against this significant complication can be achievable.
Mar 2021 DOI 10.14302/issn.2577-2279.ijha-21-3746
Background The neonatal morbidity and mortality is very high in the Sudan, the umbilical cord association and contribution to this is planned to be answered. Therefore the present study was designed to provide some information on the morphological variations of human umbilical cord via gross anatomical assessment and their correlation with foetal factors such as foetal weight and length. Methods A prospective hospital - based study conducted in Wad Madani Maternity Teaching Hospital Department of Obstetrics and Gynecology between July 2014 and March 2018 Results The mean diameter of the 371 umbilical cords was 2.1±0.24cm. Length was 53.8±3.8 cm length ranging from 48 – 62 cm and 10 (2.7%) of 371 umbilical cords were uncoiled. of which, 1 (0.3%) cords were with absent Wharton’s Jelly. The mean neonatal indices were 2.95 kg, 33.19 cm and 44.42 cm for weight, head circumference and length respectively. There was just significant strong positive correlation between umbilical cord length and length of neonates. Also Umbilical cord diameter had a positive correlation with length of neonates and negative correlation with weight of neonates and APGAR Score. Conclusion The present study suggests that ‘normal’ cord length should be between 40 cm and 70 cm in length. Umbilical cord diameter had a positive correlation with fetal length and negative correlation with fetal weight and APGAR score. The diameter range of 1-2 cm suggests that a normal cord must not exceed 2 cm in diameter. However the umbilical cord index had negative correlation with length of neonates.
Mar 2021 DOI 10.14302/issn.2474-3585.jpmc-20-3557
Background Breast cancer is one of the most common types of cancer affecting women globally. It has shown increasing morbidity and mortality rates over the past years. Several screening methods ranging from simple breast self-examination to a highly sensitive test procedures for early detection and treatment are available, but uptake is a challenge. Lack of a national screening programme in the country makes available regional screening programme unsuccessful. This study aims to assess the factors affecting the uptake of breast cancer screening programme among female staff in a tertiary hospital, Southwest Nigeria. Method This descriptive cross-sectional study involves 375 participants selected by a stratified random sampling technique, with proportional allocation to population size and the use of a semi-structured questionnaire. Respondents were questioned on their basic knowledge of breast cancer symptoms, risk factors and treatment, over a score of 50 and above, were set as the cut-off mark to determine good knowledge of breast cancer. Patients attitudes towards breast cancer screening as well as factors affecting uptake were also measured. Descriptive statistical analysis was done using SPSS-20 while the predictors of the uptake of screening were determined using logistic regression at p ≤ 0.05. Results There were 360 respondents, comprising of 13.3% clinical and 86.7% non-clinical female staff within the age bracket of 20 to 58 years (38.2±0.42 years). Out of the respondents, 97.8% have heard about breast cancer but only 52.3% had been screened while 65.5% had “Good knowledge” of breast cancer. Positive attitude to breast cancer screening was displayed in 52.5% while over 90% claimed to be practicing breast self-examination. Only 36.1% of respondents above 40 years old have had mammography done. Most frequent barriers to screening uptake include cost, poor accessibility to screening facilities, shyness (unfamiliar screener), unavailability of female doctors, careless attitude, fear of cancer and other more pressing family problems. Using logistic Regression at p ≤ 0.05, females with a negative attitude, young unmarried (less than 30years) and lack of easy accessibility to screening facilities were significant factors affecting uptake of breast cancer screening services. Conclusion Due to knowledge-uptake gap of breast cancer screening revealed in this study. It is therefore obvious from these findings that a concerted effort is needed to actively remove these barriers by repeated education, training and re-training strategies among health workers and to improve their uptake and level of advocacy and campaign for breast cancer screening among their patients and clients.
Feb 2021 DOI 10.14302/issn.2474-7785.jarh-21-3752
Background Falls injuries continue to contribute to numerous premature deaths as well as high disability levels, and excess morbidity rates among older adults, worldwide. But can vitamin D account for excess falls injuries among older adults? This review specifically focuses on what is known about vitamin D in the context of postural stability or balance control, both fairly consistent independent predictors of falls among older adults. Methods and Procedures Drawn largely from a review of current relevant English language peer reviewed research publications published over the last 10 years detailing the relationship between vitamin D levels and balance control among the elderly, as this relates to falls injuries, evidence for any emerging consensus on this controversial topic was sought. Used to conduct the search were various key word combinations including: falls injuries and older adults, vitamin D or vitamin D deficiency and balance or postural control. The database used predominantly to provide input into this largely descriptive assessment and narrative overview was PUBMED. Results The prevailing data show falls injuries currently constitute a widespread costly major impediment to successful aging and longevity for many older adults, despite numerous efforts to prevent this disabling set of events over the past two to three decades. However, no consistent association appears to exist between the variables of vitamin D, falls, and balance attributes in the older population-despite years of research, regardless of study approach, and a strong rationale for hypothesizing a clinically meaningful relationahip. Conclusion It is not possible to arrive at any universal recommendation concerning the value of vitamin D supplementation as regards its possible influence on balance capacity among older adults in the realm of falls prevention efforts, as has been frequently proposed. However, until more definitive research is conducted, there still appears sufficient justification for considering the screening of vulnerable aging adults for serum vitamin D levels, along with balance impairments, and intervening as required in the case of deficits in either or both of these possible falls determinants.
Oct 2020 DOI 10.14302/issn.2379-7835.ijn-20-3610
Aim To assess the sanitation and hygienic practices of women and its effects on the nutritional status of the mother and preschool children of the Lodha tribal community in two districts of West Bengal. Methods A cross-sectional study was conducted during November, 2014 - December, 2018 of 941 Lodha mothers and 1043 of their preschool children in Paschim Medinipur and Jhargram districts. All information was collected by using KAP questionnaire following interview and group discussion. Mother nutritional status was assessed based on body mass index (BMI) and mid upper arm circumference (MUAC). A child was classified as underweight, stunting and wasting as weight-for-age, height-for-age and weight-of -height Z-score below -2 standard deviation of WHO standard. Results This study found 35% of the households used safe drinking water. Almost 97.2% of the mother had the low hand wash score and about 67.1% of them had an average WaSH score. Overall, 41.6% and 1.6% mothers were suffered from undernutrition (BMI <18.5 kg/m2) and overweight/obesity (BMI≥25kg/m2). Whereas, 48.9% women were undernourished based on MUAC<22.0cm. Moreover, the overall prevalence of wasting, stunting and underweight of preschool children was 31.9%, 62.1% and 61.3%, respectively. The WaSH score of family was significantly associated with child stunted and underweight. Conclusion There is a good association between poor household WaSH practices with child undernutrition and morbidity. Hence, there is an urgent need to develop the comprehensive knowledge, attitude and practice (KAP) guidelines in their language to educate them about appropriate water storage, retrieval methods, sanitation and hand washing practices.
Sep 2020 DOI 10.14302/issn.2379-7835.ijn-20-3369
Background Since swine flu has been declared pandemic in 2009 it has become a major challenging public-health problem associated with high morbidity and mortality. 25(OH)D deficiency is also pandemic and has been reported to be clinically correlated with decreased immunity and respiratory infections. The possible role of vitamin D in infections is implied from its impact on the innate and adaptive immune responses. This study is planned to evaluate clinical significance of 25(OH)D status on course and outcome in hospitalized cases of swine flu and to compare it with normal healthy subjects living in the same vicinity to evaluate if vitamin D is having any protective effect. Material & Methods Present prospective cross-sectional study was conducted on 79 RT-PCR confirmed cases of swine flu admitted during recent epidemic. All patients were evaluated thoroughly by clinical history physical examination and laboratory investigations as per Performa and followed-up during hospital stay. 25-hydroxyvitamin D (25(OH)D) estimation was done by electro-chemiluminescent Assay in all the cases and it was also done in 36 normal healthy family members of study patients living in the same vicinity (control group). Results High prevalence (70.9%) of low (≤30ng/ml) status of 25(OH)D was observed in cases of swine flu as compared to control group. 25(OH)D status was associated with severity of illness. Mean value of 25(OH)D in mechanically ventilated patients was 9.81±6.43 while it was 22.76±11.35 ng/ml in patients who do not required ventilation (p<0.05). Mean 25(OH)D level in patients who stayed in hospital for <5 days was 28.60±8.79 ng/ml, 24.18±11.67 for 6-10 days and 8.23±2.12 for >10 days (p<0.01). Mean value of 25(OH)D in patients who died was 9.59±5.90 ng/ml as compared to 23.13±11.62 ng/ml who survived (p<0.01). Conclusion Our study suggests that 25(OH)D may have preventive role for swine flu infection. Low level of 25(OH)D is associated with high morbidity in terms of increase requirement for mechanical ventilation, multiorgan dysfunction and long duration of hospital stay. 25(OH)D deficiency is associated with high mortality in swine flu. 25(OH)D status should be given due consideration in high risk patients especially during winter season.
Sep 2020 DOI 10.14302/issn.2694-2283.jsem-20-3539
The following document provides important information that everybody know about physical exercise as a means of managing COVID-19. It addresses the health benefits of physical exercise on our body’s immune system, and stress reduction. Already today in the entire world, coronavirus is now the leading causes of morbidity and mortality. It kills thousands of peoples per day worldwide and continues its impact on the governments and the society. Nowadays it is the greatest public health problem in most countries in the world. Since its identification on Jan, 7 by the chines scientists named the pathogen as a novel coronavirus. In the current situation COVID-19 is rapidly spreading worldwide and the number of cases and deaths are rising up speedily. The spread of the virus is a headache to the government in general and the society in particular. The nature of the virus disallowed contacting with one another, working together, meeting, and other activities the majority of government and private business organizations are enforced to discontinue their work. The growing burden of the virus would place millions of jobs at risk an additional 8.8 million people in working poverty around the world. The danger of the disease and loss of employment leads the majority at stress. A chronically stressed person impairs the organism’s ability to mount a strong immune response with a resultant increase in morbidity and mortality.
Aug 2020 DOI 10.14302/issn.2381-862X.jwrh-20-3444
Background In Ethiopia, the levels of maternal and infant morbidity and mortality are among the highest in the world. This is attributed to, among other factors, none use of modern health care services by women. According to the 2011 Ethiopian Demographic Health Survey, more than seven in ten mothers did not receive antenatal care at all. Objectives The objective of this study was to determine level and identify factors influencing maternal antenatal care services utilization among mothers who gave birth in the last twelve months in Gelemso town west Hararghe Oromia, Ethiopia. Methods A community-based cross sectional study design was conducted on 347 study participants in Gelemso town west Hararghe Oromia Ethiopia from July 15, 2017 to August 15, 2017 G.C.A probability to proportional to size sampling technique was used to select the study population in two urban Kebeles. Data were collected using a pre tested structured questionairs. Descriptive results were presented using frequencies, and numerical summary measures. Bivariate analysis was carried out to assess the association between outcome variable and each in dependent variables. Odds ratio with 95% confidence level was estimated to identify factors associated with Antenatal Care (ANC) utilization using multivariable logistic regression. The statistical significance was declared at p- value < 0.05. Result The response rate this study was 98%. The prevalence of antenatal care service utilization was 64.6%. About 146 (42.1%) of the pregnant mother started antenatal care visit during the second trimester of pregnancy and a significant proportion 289(83.3%) had less than the recommended four visits. Educational status (AOR;15.19:CI 95%,6.006,38.417), husband attitude (AOR;1.995:CI 95%,1.016,3.916), marital status(AOR:4.587:CI 95%,1.888,11.146), planned pregnancy (AOR:4.938:CI 95%,2.514,9.702) were major factors associated with antenatal care service utilization. Conclusion Though more than half mother used antenatal care service in the study setting, two in ten of the mothers did not have the minimum number of visits recommended by World Health Organization. Promotion of information, education and communication in the community should be strengthened is to sustain antenatal care service utilization in the community.
Aug 2020 DOI 10.14302/issn.2381-862X.jwrh-20-3439
Background Pregnancy and parturition are events of considerable significance in the life cycle of women. Though it is supposed that the quality of care during labor, birth, and postpartum period plays a great role for adverse outcomes of birth, various reports claimed that cesarean delivery carries a higher maternal and fetal morbidity and mortality compared to vaginal delivery. Therefore, this study assessed the Rate, Maternal and Fetal Outcome of Cesarean delivery performed by IESO at Shenen Gibe General Hospital, Jimma south west Ethiopia. Integrated Emergency surgical officer is a health professional qualified and authorized to perform emergency obstetrical-gynecological and emergency general surgical procedures. The training has started in 2010 in 3 universities and 10 affiliated sites with intake of 43 students. The MSc program in integrated emergency surgery is intended to achieve one of the millennium development goals (MDG): reducing the overwhelming maternal mortality ratio and perinatal mortality rate at the local and national level. (1) Methods Hospital based two-year retrospective descriptive cross-sectional study design was employed and data collected from November to December 2019 in shenen Gibe General Hospital ,Jimma south west Ethiopia. A total of 185 mothers who delivered by cesarean delivery from December 2017 to December 2018 and complete data were included in the study. Data were extracted using structured data collection format and cleaned, and entered into Epi data software version 3.1 and exported into SPSS version 26 for further descriptive analysis. Result Among 2115 deliveries in the two years of retrospective data, a total of 186 mothers were delivered by cesarean section, giving cesarean delivery rate 8.8 %. The leading indication for cesarean delivery was fetal distress (24.2%). Among the total cesarean delivery, 22 neonates were died, giving the proportion of neonate mortality rate 16.8%. One mothers were died following cesarean delivery, giving maternal mortality rate following cesarean delivery 12 per 1000 live births. The leading cause for maternal mortality was hemorrhagic shock Conclusion However, cesarean delivery rate in this study was within the WHO recommended range, the health outcome of mothers and neonates’ following cesarean delivery was not acceptable. The neonatal and maternal mortality following cesarean delivery was 16.8% and12 per 1000 live births respectively. The main cause of neonatal death was birth asphyxia.
Jul 2020 DOI 10.14302/issn.2379-7835.ijn-20-3488
Esophagectony remains a high-risk surgical procedure. Esophageal cancer is often associated with a weight loss. The best nutritional condition is crucial for successful oesophageal surgery. The increased septic complications and costs have limited the wide use of total parenteral nutrition. Currently, enteral nutrition is the preferred nutrition method following esophagectomy. However; jejunostomy-tube was associated with rare major complications that may lead to discontinuing nutrition. Choosing an enteral feeding route after esophagectomy depends greatly on the surgeon preference. The safety and benefits of early oral feeding on outcomes after major gastrointestinal surgery have been well documented. However, the surgical community is still reticent about initiating early oral feeding after esophageal surgery. Despite the limited number of published reports, comparative trials have clearly shown the feasibility, safety with no increase in morbidity rate.In this brief review, we tried to discuss the different routes of nutritional support after oesophagectomy with providing the current insights on early oral feeding.
Jun 2020 DOI 10.14302/issn.2641-4538.jphi-20-3442
The Covid-19 pandemic has swept rapidly from Wuhan, China to the entire globe in less than six months, infecting over 7 million people and claiming the lives of over 500,000. In the United States, greater than 2 million individuals have become infected and over 110,000 people killed. With no evidence of slowing of the coronavirus that causes Covid-19, public health authorities must prepare for possible sustained transmission of Covid-19, or a second wave into the Fall 2020, but with the presence of the influenza A virus. In the Fall 2020, schools will reopen from kindergarten to 12th grade. Dual pandemics or epidemics will result in high morbidity and mortality not observed when either virus was solely active. Community leaders, educational administrators and public health systems must be prepared for simultaneous outbreaks of both Covid-19 and influenza. Although there are no clinical studies that have evaluated the benefits on the use of face masks during an epidemic or pandemic, public health non-pharmaceutical intervention (NPIs) measures should include the routine use of face masks during school sessions. Using face masks with other NPI may interrupt viral transmission as it has been established that respiratory viruses, such as Covid-19 and the influenza virus are transmitted via respiratory droplets, aerosols, and environmental surface contact.
May 2020 DOI 10.14302/issn.2692-1537.ijcv-20-3344
Identifying the epidemiological characteristics of COVID-19 disease will help to make appropriate decisions and thus control the epidemic. Although many details, such as the source of the virus and its ability to spread between people remain unknown, an increasing number of cases show the signs of human-to-human transmission. The purpose of this review is to introduce the reservoir hosts, and the possible role of distributions of bat coronaviruses in China, and eventually to aim to predict virus natural hotspots and their cross-species transmission potential. Why bats can maintain coronaviruses long-term without showing clinical symptoms of diseases and what is allowing bats to have a higher tolerance against viral diseases. We need to unveil the mystery of unique bat immunity. Although bats are not in close contact with humans, spillover of viruses from bats to intermediate animal hosts like civet is thought to be the most likely mode to cause human infection. It appears that the coffee beans which are a rich source of chlorogenic acid are acting as a reservoir host and causative agent, and at the same time as a defense agent to create resistance in the consumers (bats and animals). It is assumed that the intake of chlorogenic acid should be capable of protecting human from contamination or severe morbidity.
Apr 2020 DOI 10.14302/issn.2372-6601.jhor-20-3189
This article has been retracted on 29 January 2021. VIEW THE RETRACTION NOTICE (https://doi.org/10.14302/issn.2372-6601.jhor-25-5854) In Côte d'Ivoire, sickle cell disease affects 14% of the population. It is responsible for significant morbidity and mortality. Transfusion is a significant element in the management of major sickle cell anemia, which exposes them to post-transfusion hemochromatosis. The biological diagnosis is based on the determination of serum iron and the transferrin saturation coefficient (CST). As the determination of the CST was not available in our exercise context in Côte d'Ivoire, we determined only the ferritinemia. The interest of this work lies in the therapeutic implication linked to the identification of patients at risk of hemochromatosis because chelators are difficult to access for most patients. This was a prospective, descriptive and analytical study, on polytransfused sickle cell patients, followed at the transfusion therapy unit (UTT) of the CNTS of Abidjan, from 2010 to 2018. We included 78 sickle cell patients, all ages and genders who have received at least ten transfusions. The ferritinemia assay was carried out by ELISA. Transfusion exchange, with 59% of cases, was the most used mode of transfusion. The mean ferritinemia was 1719.19 ng / ml. Hyperferritinemia was found in 63% of patients. Most of the patients were on a long-term transfusion program with an average of 27.5 bags of red blood cell concentrates. Thirty-two patients had received at least 20 bags of red blood cell concentrates. We noted 21 patients treated, including 3 with deferoxamine and 18 treated with oral deferasirox. We have identified 33 sickle cell anemia patients at risk for hemochromatosis. The determinants of the risk of hemochromatosis were the high number of blood bags and the method of transfusion.
Jan 2020 DOI 10.14302/issn.2690-4721.ijcm-19-3154
Background The morbidity and mortality associated with the multi drug resistant Gram negative bacterial infections pose a significant and growing challenge to clinical practitioners. Klebsiella pneumoniae, which is a substantial nosocomial pathogen and confer high levels of resistance to broad-spectrum antibiotics including carbapenems. The aim of this study is to determine the resistance profiles of Klebsiella pneumoniae strains isolated from various clinical specimens. Material and Method In this study, the antibiotic susceptibility profiles of 2452 Klebsiella pneumoniae strains isolated from various clinical specimens between July 2015 and November 2019 were considered retrospectively. Blood culture vials were incubated in Bac T / Alert 3D automated system, other samples were cultured on blood and Eosin Methylene-blue (EMB) medium. The identification and antibiotic susceptibility tests of the isolated bacteria were performed by VITEC 2 Compact ID-AST cards (BioMérieux, Marcy l’Etoile, Fransa) and the results were evaluated according to the standards of the Europian Committee on Antimicrobial Susceptibility testing (EUCAST). The first sample of each patient was included in the study. The strains with inappropriate results were re-studied with gradient agar diffusion test (BioMérieux, Marcy l’Etoile, Fransa). Results The study included a total of 2452 Klebsiella pneumoniae strains and the distribution of samples was as follows: 894 (36, 5 %) blood, 790 (32, 2%) bronchial lavage, 211 (8,6 %) wound, 148 (6 %) drainage, 148 (6 %) peritoneal fluid, 95 (3, 9 %) tracheal aspirates, 64 (2,6%) catheter, 62 (2,5 %) urine, 40 (1,6%) other samples (pleural fluid, cerebrospinal fluid, throat ). In this study, antibiotic susceptibility test results indicated that the resistance to tigecycline was lowest (0, 3%). High colistin resistance ratio (33, 5 %) in carbapenem-resistant Klebsiella pneumoniae was considered to be of concern. Conclusion In this study, high rates of resistance to carbapenems were noteworthy. Determination of hospital antimicrobial resistance rates will be useful in developing antibiotic use policies of each hospital, in the treatment of causative agents, in selecting antibiotics according to antimicrobial susceptibility.
Sep 2019 DOI 10.14302/issn.2578-2371.jslr-19-3028
Intestinal tuberculosis diagnosis is often difficult because of non-specific symptoms, miming many other conditions such as malignancy, infectious disease, and inflammatory bowel disease. Free intestinal perforation is an uncommon but life-threatening complication of intestinal tuberculosis, associated with high morbidity and mortality.
Mar 2019 DOI 10.14302/issn.2642-9241.jrd-18-2499
Distant metastases generally indicate disseminated disease and the standard treatment for these patients is palliative chemotherapy. Retrospective series showed that selected patients with metastatic lung cancer and a solitary extrathoracic disease could be effectively treated with curative intention by resection of both primary tumor and the single site of metastatic disease. According to current data, adrenalectomy might be considered as an alternative option for patients with isolated adrenal metastases. Significant morbidity and mortality may be happened by these procedures, and a cautious analysis of pros and cons should be discussed with the patient. We present a review of the literature and updated recommendations focusing lung cancer with solitary adrenal metastasis.
Jan 2019 DOI 10.14302/issn.2643-0282.imsj-18-2448
Fungal infections increased substantially in the last years, becoming a relevant public health problem. Many of these infections account for high rates of morbidity and mortality. The emergence of resistant fungal clinical isolates have also motivate studies to find new antifungal therapies. Candida albicans is an oportunistic pathogen and affects a great number of immunocompromised patients worldwide. The marine ecosystem has been considered a rich source of bioactive metabolites due to the complexity and originality of its structures. Proteins and peptides from marine organisms have been shown to have antiviral, anti-inflammatory, antimalarial, anticancer, antimicrobial and antifungal properties. Arenicins are antimicrobial peptides isolated from the marine lugworm Arenicola marina with 21 amino acid residues in a β-hairpin structure. Dihydrofolate reductase, exo-b-(1,3)-glucanase and sterol 14α-demethylase are essential C. albincas enzymes that take part in DNA, cell wall and membrane metabolism, respectively. The present study evaluates the interaction of arenicin with important enzymes of C. albicans related to cell wall, ergosterol and DNA metabolism in order to elucidate possible molecular targets. We showed through an in silico approach, that a single compound from a marine worm (A. marina), can bind to three C. albicans essential proteins. The interaction occurs in regions inside the active site or at least near, with amino acid residues evaluated as hot spots. Arenicin is a new promising antifugal drug. The next step is to investigate protein-protein interactions performed by DHFR, EBG and CYP51 and assess whether arenicin is able to disrupt essential interaction or not.
Jul 2018 DOI 10.14302/issn.2690-4837.ijip-18-2238
Background Colonization with methicillin-resistant Staphylococcus aureus (MRSA) is recognized as an association towards development of infections that may cause of morbidity among people living with Human Immunodeficiency Virus (PLWHIV). We report on the prevalence, antibiotic susceptibility pattern and risk factors associated with MRSA carriage among PLWHIV at Nyenga hospital, Buikwe district in central Uganda. Materials and Methods We conducted a cross-sectional study among PLWHIV attending Nyenga hospital anti-retroviral therapy (ART) clinic. Nasopharyngeal swab was collected from each participant, cultured to isolate Staphylococcus aureus, and drug susceptibility testing (DST) performed. Sociodemographic data and medical history was recorded. Results We enrolled 219 PLWHIV; of these, 58.4% (N=128) were females. The majority of participants (95.0%) were on ART. Ninety-eight (44.75%) of the nasopharyngeal swabs had growth, of which 41 (41.84%) were S. aureus. Of these, 11 (5.02%, 95% confidence interval: 3.67-7.02) were MRSA. Of 41 isolated S. aureus strains, only 8 (19.51%) were susceptible to all antibiotics tested. A total of three (7.32%) were multi-drug resistant (MDR), while one1 (2.43%) was a possible extensively drug resistant (XDR) strain. Deteriorating immunologic state as indicated by a low CD4 count showed a significant association with the MRSA colonization. Conclusion These results are reassuring that MRSA colonization is high among PLWHIV. As most of the antibiotics in use were resistant, it raises concerns of intricate clinical management in a low resource set up.
Jun 2018 DOI 10.14302/issn.2372-6601.jhor-18-2139
Pulmonary hypertension (PH) has become an increasingly recognized complication in sickle cell anaemia (SCA) and is a major cause of morbidity and mortality. Though the burden of SCA in sub-Saharan Africa is high, there is paucity of data on SCA-associated PH with little or no attention given to it in routine patient care. The current study therefore sought to determine the prevalence of PH and its associated risk factors among adult patients with SCA. This was a cross-sectional study involving 76 clinically stable, hydroxyurea-naive participants. We obtained socio-demographic and clinical history. Measurement of Tricuspid Regurgitant jet Velocity (TRV) was obtained via transthoracic echocardiography and lung function was assessed using spirometry and pulse oximetry. Other investigations were complete blood counts, free plasma haemoglobin, serum urea and creatinine. Twenty-five (32.9%) of study participants had elevated TRV (≥ 2.5m/s) on Doppler echocardiography, which was suggestive of raised pulmonary artery systolic pressure. There were significant associations between elevated TRV and steady-state haemoglobin (p < 0.001), blood urea level (p = 0.030), presence of chronic leg ulcers (p = 0.043) and oxygen saturation (p < 0.001) and these may be identifiable and modifiable risk factors for selective screening with echocardiography in a resource poor setting.
Nov 2017 DOI 10.14302/issn.2641-5526.jmid-17-1762
Despite widespread use of Geographic Information System (GIS) technology to strengthening health systems, the application of GIS to health systems strengthening in resource-poor Sub-Saharan Africa remains rare. Over the June 2012 to December 2013 period, the Ghana Health Service (GHS) conducted a pilot application of GIS to health systems development in one rural impoverished district of the Upper East Region (UER). Workers were deployed to gather coordinates of health care facilities throughout the UER. Coordinates were linked to routine health information data, and utilized to generate maps for guiding task prioritization. For example, geocoded Community-based Management of Severe Acute Malnutrition (CMAM) program data were used to target services in communities where the prevalence of childhood acute malnutrition was relatively high. GIS was pivotal in tracking and responding to infectious disease morbidity from causes such as diarrheal diseases and tuberculosis. UER Regional Health Administration (RHA) authorities are currently utilizing GIS to map antenatal care coverage, skilled birth deliveries, neonatal mortality, still births, family planning service caseloads as well as for targeting programmatic action. Experience emerging from this trial attests to the value of GIS in contributing to efforts to strengthen health systems in rural impoverished regions of Africa.
Jul 2017 DOI 10.14302/issn.2474-7785.jarh-16-1067
Aim Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in hospital with orthopaedic surgery already an established risk factor. This study aims to establish the length of time that a patient is at risk of sustaining a VTE post orthopaedic surgery. Method A retrospective case series of all patients who underwent orthopaedic surgery between 2010 and 2014 whom re-presented with a VTE within one year of their initial operation. Demographic, operative and clinical information was obtained in order to identify potential risk factors. Results 53 patients were identified as having a VTE within one year of discharge. The majority (63.4%) underwent lower limb arthroplasty. 29% of the cohort had either a family or personal history of VTE, 79% had ischaemic heart disease (IHD), hypertension or both. The average body mass index (BMI) of the cohort was 31.4; above the UK national average. 56.6% of the cohort developed a pulmonary embolism (PE) and 49% developed a deep vein thrombosis (DVT). Co-occurring DVT and PE was diagnosed in 5.6% of patients. The average length of time for readmission for patients to re-present at hospital with a PE was 122 days (range 4-361) and 107 days (range 7 – 360) with a DVT. Conclusion This study confirms the existence of pre-established risk factors for developing VTE including obesity, personal and family history of DVT, cardiovascular disease and lower limb arthroplasty. These risk factors are recognised despite patients receiving post-operative thromboprophylaxis. The findings of this study extend the current research by suggesting that patients presenting with known risk factors of developing VTE may be at risk for longer than the current guidelines cover for the administration of thromboprophylaxis. We propose further studies are needed to identify any potential requirements for more extensive VTE prophylaxis in this population.
Mar 2017 DOI 10.14302/issn.2474-7785.jarh-17-1420
Dehydration in acute care is associated with increased morbidity and mortality. However, no standard approach to hydration assessment exists in clinical settings. The pilot study aimed to explore total body water content as means for immediately assessing hydration status in clinical settings. People aged 60 years or more, voluntarily admitted to a tertiary teaching hospital’s Geriatric and Rehabilitation Unit were eligible for participation. Total body water assessment by tracer dilution was compared with standard clinical assessment of hydration status. The study participants (78.6±8.5 years, 6/14, 43% male) clinically assessed with poor hydration (3/14) had a higher percentage of body weight as water (59.0±2.3 vs 50.6±6.4%), and lower mean weight (54.1±12.9 vs 77.5±24.1 kg) and lower body mass index (20.0±3.7 vs 30.2±6.5 kg/m2) than the well-hydrated (11/14). Weight (n=14) and body mass index (n=11) explained a substantial proportion of variation in total litres of body weight as water (r=0.92, R2=0.85; r=0.80, R2= 0.64) and percentage of body weight at water (r=0.6, R2= 0.36; r=0.72, R2= 0.52) respectively. This pilot study revealed higher percentages of body weight as water amongst those clinically assessed with poorer hydration. Future regression analysis of total body water and hydration needs to adjust for the potential confounding effect of weight and body mass index. Implications for practice from this preliminary study indicate that findings did not support single point measurements of either total body water or percentage of body weight as water as potentially simple methods for clinically assessing hydration status amongst older hospitalised people.
Feb 2017 DOI 10.14302/issn.2997-2086.jfs-16-1098
We report a twin gestation with one fetus afflicted by a left sided Extra-Lobar Sequestration (ELS) in a morbidly obese mother. The ELS was complicated by a left pleural effusion in the second trimester unresponsive to maternal steroid administration. We discuss the need for repeat shunt placement, in the setting of maternal morbid obesity and twin gestation. Shunt replacement was necessary secondary to dislodgement. Delivery at 34 weeks gestation was followed by successful surgical removal of the ELS. At one year follow up the infant has complete expansion of the left lung with no morbidity.
Jan 2017 DOI 10.14302/issn.2379-7835.ijn-16-1408
Despite the agreed global and national stunting reduction targets, Uganda has made very little progress. Understanding context-specific risk factors for stunted growth is therefore pertinent to designing programs to address the problem. A cross-sectional study was conducted in 32 randomly selected villages in Buhweju district, Southwest Uganda. Data entry, cleaning and analysis were carried out using Statistical Package for Social Sciences (SPSS) version 21. A regression analysis was conducted to examine the associations between potential risk factors and stunted growth. The survey covered 256 households and anthropometric measurements were taken for 221 children aged 6–59 months. The majority of the households (66%) in the district were food insecure and had a low socioeconomic status (84%). The prevalence of stunting in Buhweju district was 51%, which is significantly higher than the regional and national averages. Only 28% of the children were exclusively breastfed in the first 6 months of life, and only 10% of them received the minimum acceptable diet (MAD). The findings of this study demonstrate that reductions in stunted growth at national or regional levels has not necessarily translated into similar trends in rural areas of Uganda. The notable contributors to stunting in these areas include morbidity, sub-optimal infant and young child feeding (IYCF) practices, low consumption of animal-source foods, food insecurity, lack of access to high-quality drinking water, sanitation and hygiene (WASH) facilities and poverty. Increased investment in both nutrition specific and sensitive interventions is therefore crucial to address these risk factors.
Jan 2017 DOI 10.14302/issn.2476-1710.jdt-16-1324
An important step in the validation of disorder-specific etiological models is the examination of the predictive specificity of proposed vulnerability factors. It may advance the understanding of the emergence of comorbidity and the identification of at risk-populations for mental disorders. To enhance the currently limited evidence on the specificity of Beck´s cognitive diathesis-stress model of depression, the present study investigated longitudinal effects of dysfunctional attitudes and stressful life events on the development of depressive, eating disorder and aggressive symptoms in children and adolescents. A large sample of initially asymptomatic children and adolescents completed self-report symptom measures at study entrance and again approx. 20 months later, and reported stressful life events during the study interval. Stressful life events proved to be a risk factor to all investigated symptom domains. Dysfunctional attitudes at T1 were prospectively related to depressive symptoms, aggressive behavior and weight concerns at T2. However, types of associations varied as dysfunctional attitudes showed linear associations with weight concern, but nonlinear effects on depressive and aggressive symptomatology. Findings of the current study thus suggest that dysfunctional attitudes are not uniquely related to the development of depressive symptomatology in children and adolescents, but may contribute to adverse outcomes in various symptom domains. Thus, intervention efforts based on Beck´s vulnerability - stress model of depression may turn out to be useful in reducing vulnerability to a variety of outcomes in children and adolescents.
Jan 2017 DOI 10.14302/issn.2577-137X.ji-16-1139
We describe seasonal influenza-like illness (ILI) outbreaks in long-term care facilities in the Health Service Executive (HSE) East area of Ireland in the 2013/2014 influenza season, risk factors associated with outbreak duration and attack rates, and management challenges. Separate questionnaires were distributed to 28 facilities who reported an outbreak and to public health specialists leading outbreak management, with a 79% response rate. Mean outbreak duration (21 vs 17 days; p=0.046) was longer in facilities with staff vaccination rates of <40%. Facilities with a high attack rate (≥50%) were less likely to have an outbreak plan (p=0.03). Smaller facilities (under 50 residents) had a higher attack rate (50% vs 23%, p=0.003) even when controlled for staff vaccination rate (p=0.01). Prior to the outbreak, resident vaccination rates were high (82%, above the World Health Organization target of 75%) but staff vaccination rates were low (39%). Reported challenges to ILI outbreak management in long term care facilities included visitor restrictions, staff education issues, outbreak notification delays and lack of outbreak lead in facilities. Targeted public health-assisted planning, training and response, comprising of staff vaccination, education, written policies, with early notification and prompt response would facilitate a more co-ordinated approach to the management of outbreaks, and reduction in infection rates and consequent morbidity.
Sep 2016 DOI 10.14302/issn.2473-1005.jdoi-16-1196
Background and Context: Autologous bone grafts require a second surgical exposure to harvest the graft with a significant risk of post-operative complications and donor site morbidity. Employment of allografts potentially eliminates donor site morbidity but carries the potential of causing foreign body immune reactions with a high rate of rejection and failures. Hence, Alloplasts have emerged as novel materials to overcome the drawbacks of autogenous and allogenous bone grafts. Today’s advanced dentistry is enterprising a putty form of calcium phosphosilicate (CPS) into several aspects of reconstructive domain of dentistry including the sinus augmentation procedures, osseous regeneration of periodontal bone defects, cystic cavity defects and alveolar socket preservation. This eccentric multifaceted study was planned as an honest effort on the path of proving the efficiency of CPS as an alloplastic bioactive graft material and aimed at quantitative evaluation of regenerated bone radiographically using Cone Beam Computed Tomography (CBCT) scans following sinus augmentation procedures. Materials and Methods: A total of 20 sinus augmentations were carried-out in 17 patients satisfying the criteria (inclusion and exclusion) requiring placement of implants in atrophic maxilla and in other situations of anatomic constraints. The graft material used was calcium phosphosilicate (CPS) putty (Nova bone dental putty, Novabone products, Alachua, Fla). The residual bone height was recorded using CBCT scans and a computer based software where the measurements were made from the crest of the ridge till the sinus floor lining. The patients were assessed clinically at immediate post-operative, 1 week, 1 month, 3 months and 6 months follow-up recalls post-operatively. Radiographic assessment for bone height was done pre-operatively and at 6 months follow-up recall post-operatively using Cone Beam Computer Tomography scans. Results: The post-treatment bone height (11.76+0.97mm) was found to be significantly higher than the pre-treatment bone height (6.8 +0.70mm) in indirect sinus augmentation procedures (t=14.4, p<0.005). In case of direct sinus augmentation group also, the post-treatment bone height (11.27 +0.71mm) came-out to be significantly higher than the pre-treatment bone height (2.44 +0.81mm) (t=32.17, p<0.005). The post-treatment bone grafted sinus floor measurements (1107.6 + 155.6mm) were also found to be significantly higher than the original sinus floor measurements of bone density (Grayscale values) (412+ 65.5mm) (t=16.6, p<0.001) in case of indirect sinus augmentation procedures. Similarly, the post-treatment bone grafted sinus floor measurements (1169.6+136.7mm) were found to be significantly higher than the original sinus floor measurements of bone density (Grayscale values) (416.4+ 0.70mm) (t=17.9, p<0.001) in case of direct sinus augmentation group. Conclusion: Calcium Phosphosilicate (CPS) was accepted well at the recipient sites without any complications demonstrating its efficiency and reliability in sinus augmentation procedures.
Jul 2016 DOI 10.14302/issn.2471-7061.jcrc-14-575
Aim: To analyze the factors involved in and the results of stoma reversal after an emergency Hartmann's operation. Methods: A multicenter retrospective study from the Valencian Society of Surgery of patients who had undergone an emergent Hartmann’s operation from 2004 to 2008. An analysis of the reversal rate and related factors, delay, and morbidity of reconstruction was performed. Results: Three hundred sixty-two patients were studied. The most frequent initial diagnosis was colorectal cancer, followed by complicated acute diverticulitis; the primary surgical indication was acute peritonitis. After a median follow-up of 52 months, 151 patients (41.7%) underwent surgery to reverse the stoma at a median of 10 months after initial surgery. Diagnosis of diverticulitis or trauma, peritonitis as the surgical indication, and non-advanced tumors were associated with reversal. Multivariate analysis showed that only age and tumor stage were predictive of reversal. Postoperative complications occurred in 44% of the cases, and wound infection was the most common. There were 9 (6%) anastomotic leaks. Thirteen patients (8.6%) retained a permanent or temporary stoma after the attempted reconstruction. Conclusion: Hartmann’s reversal after emergency surgery is performed in less than half of all such patients and has significant morbidity.
Jul 2016 DOI 10.14302/issn.2329-9487.jhc-16-1020
Background: Hypertension is a public health problem with high mortality and morbidity globally. A rapid assessment of hypertensive patients at Harare Central Hospital Outpatients Department (OPD) in June 2013 revealed that 41% of patients had uncontrolled hypertension. We, therefore, explored the factors associated with uncontrolled hypertension among hypertensive patients at Harare Hospital. Methods: A one-on-one unmatched case-control study was conducted among 118 cases and 118 controls. A case was a person aged 18years and above on hypertensive treatment for ≥6months with mean Blood Pressure (BP) ≥ 140/90mmHg while a control was 18years and above on hypertensive treatment ≥6 months with mean BP<140/90mmHg. Interviews were used to collect information on socio-demographic, treatment, health system, condition, and patient-related factors. Written informed consent was obtained from all study participants. Medication adherence was measured with Morisky medication adherence scale-8. Results: The median ages for cases were 49 years (IQR: 41-63) and 48 years (IQR: 42-62) for controls. Almost 57% were women with 23% living in rural areas. Most cases (94%) and controls (78%) added salt to meals. Rural women were less likely to have uncontrolled BP compared to urban women (OR=0.7; 95%CI: 0.35, 1.37). Lack of exercise, adding salt to meals and eating fruits/vegetables less than three times/week were associated with uncontrolled BP. Independent factors associated with uncontrolled BP were low adherence to medication, aOR 22.03 (95%CI: 9.10,53.5), receiving health education, aOR 0.24 (95%CI: 0.11 , 0.53), exercises aOR 0.33 (95%CI: 0.15,0.73) and on medical insurance aOR 2.69 (955CI: 1.12,6.44). Conclusions: Common risk factors for hypertension were associated with uncontrolled BP. Since these are modifiable factors there is a need to implement interventions that will encourage healthy living in this population to improve treatment outcomes.
May 2016 DOI 10.14302/issn.2473-1005.jdoi-15-730
Objectives: Periodontal disease is associated to widespread systemic inflammation, and further to both cardiovascular morbidity and mortality. Data from intervention studies demonstrated the beneficial effects of periodontal therapy in reducing vascular diseases. The present study was aimed to explore whether low-level Laser therapy as an adjunct to scaling and root planning reduces serum levels of inflammatory cytokines. Material and Methods: Thirty patients were enrolled. All recruited participants underwent blood sampling and dental inspection for periodontal indexes measurement. Plaque index, gingival index and probing depth were employed as measures of periodontal disease. Afterwards, patients underwent scaling and root planning plus low-level Laser therapy. Inflammatory biomarkers and periodontal indexes were measured before treatment and twenty weeks after treatment. Results: Plaque index, gingival index and probing depth largely improved at the follow-up visit, resulting more than halved from the baseline. Furthermore, a significant reduction of serum interleukin-1 beta has been observed (1.1 SD 2.1 vs 0.5 SD 1.3, P = 0.04), whereas serum interleukin-6 levels remained substantially unchanged. Blood C-reactive protein levels decreased at the follow-up, but not reaching statistical significance. Conclusions: therapy addressed to a local improvement of periodontal disease gives a reduction of systemic inflammation, possibly beneficial for cardiovascular health.
Dec 2015 DOI 10.14302/issn.2470-0436.jos-15-818
Purpose: Vitamin A deficiency (VAD) is still a major nutritional problem of public health importance among the rural pre-school children in India, even after the implementation national vitamin A prophylaxis programme for prevention of nutritional blindness and ICDS have been in operation for more than three decades. The purpose of this communication is to assess the prevalence of ocular manifestations of vitamin A deficiency among rural pre-school children of north India. Methods: A community based cross-section study; adopting multi-stage random sampling procedure was carried out by NNMB among rural pre-school children of four north Indian states viz. Maharashtra, Madhya Pradesh, Orissa and West Bengal. A total of 36,111 rural pre-school children of 1-5years (Boys: 18408; Girls: 17703) were covered for this study. Results: The prevalence of conjunctival xerosis (2.5%), the first ocular sign of VAD and Bitot’s spot (0.9%), an objective ocular sign of VAD was higher than the cut-off values suggestive of public health nutritional problem among the rural children. While, the prevalence of night blindness, the first symptom VAD was reported among 0.5% of rural children. Similarly, the proportion of rural pre-school children with sub-clinical VAD was 64%, suggestive of severe public health importance. Conclusion: The prevalence of ocular manifestation and sub-clinical vitamin A deficiency was high among the rural children of north India. Therefore, rural communities are encouraged to consume diets rich in vitamin A and administer massive dose vitamin A solution to the children of under five for the prevention and control of vitamin A deficiency and its adverse impact on child morbidity and mortality.
Dec 2015 DOI 10.14302/issn.2471-7061.jcrc-15-661
Following multivisceral pelvic resections, the pelvis and perineum are often reconstructed using myocutaneous flaps. Abdominal wall defects after harvesting rectus abdominis flaps can be reinforced with mesh. Primary reconstruction using synthetic mesh was presently evaluated. Fifty-eight patients who underwent multivisceral pelvic resection and perineal reconstruction with a vertical rectus abdominis myocutaneous (VRAM) flap, January 2004 to February 2014, were retrospectively reviewed. The abdominal wall was reinforced in 26. Demographics, treatment procedures, surgical procedures, length of hospital and ICU stay, early and late morbidity at the recipient and donor sites were recorded. Patients with mesh reinforcement were significantly younger than those without. There were no further significant differences in patient demographics or treatment procedures between the two groups. In 31% of the patients with mesh, surgery was performed on two consecutive days, although total operating time did not differ significantly. Patients without mesh bled more. Surgery was associated with considerable morbidity, without significant differences in overall complication rate between the two groups. At the recipient site, wound infection/dehiscence was the most common early complication. The group with mesh had higher rate of total flap necrosis necessitating re-operation. At the donor site, wound infection /dehiscence, hernia, or bulge were recorded. Patients with mesh had lower rates of donor site morbidity. Perineal reconstruction with VRAM flap and primary abdominal wall reinforcement with mesh is feasible after multivisceral resection. Our study indicates that primary use of mesh can be applied in potentially contaminated surgical fields in oncologic patients without increasing morbidity and with improved long-term cosmetic results.
May 2015 DOI 10.14302/issn.2574-4496.jtc-14-395
Background: Medullary Thyroid Cancer (MTC) is a rare malignancy, accounting for less than 3% of all thyroid cancers and causes significant morbidity and mortality. MTC is often due to an underlying mutation of the RET proto-oncogene, which can result in additional endocrinopathies that must be screened for pre-operatively. The project aim was to determine if surgical training background influenced patient pre-operative evaluation for MTC. Methods: A retrospective review was performed of patients undergoing thyroidectomy for MTC at a single academic institution. Patients were analyzed based on who performed the initial operative procedure, a surgeon with specific endocrine surgery training or a surgeon without. Results: From 1994 to 2011, 37 patients with MTC were identified. Thirty percent were managed by an endocrine surgeon and 70% by a non-endocrine surgeon. A complete thyroid work-up was done for all the patients managed by an endocrine surgeon vs. 38.5% of the non-endocrine surgeon patients (p<0.01). Appropriate preoperative endocrine screening was performed in 91% of the endocrine surgeon patients vs. 50% of the non-endocrine surgeon patients (p= 0.03). RET mutation genetic testing was done for all endocrine surgeon patients vs. 85% of non-endocrine surgeon patients (p= 0.30). Conclusion: Endocrine trained surgeons recognize and appropriately manage the complexity of MTC and associated endocrinopathies, more often than surgeons without an endocrine surgery background. This may result in optimized management of these patients.
Nov 2014 DOI 10.14302/issn.2379-8572.joa-14-561
Pleomorphic adenomas are uncommon tumors of the nasal cavity. They arise from minor salivary glands, and usually originate from the nasal septum. The tumors are more common in middle-aged females. We present a series of 8 cases of intranasal pleomorphic adenomas. Seven of these tumors originated from the nasal septum, and only one of them originated from the lateral nasal wall. Histopathologic examination of the tumors showed that these tumors have higher epithelial and lower stromal components compared to pleomorphic adenomas of major salivary glands. Endoscopic resection was performed in all cases and the patients were followed up for one year. No recurrences or complications were observed in this series. Endoscopic resection is recommended as the treatment of choice because of its proven efficacy and low morbidity.
Jul 2013 DOI 10.14302/issn.2324-7339.jcrhap-12-150
Aims and Objectives: The incidence of cryptococcal meningitis caused by Cryptococcus neoformans has risen markedly over the past 20 years as a result of theHIV epidemic and increasing use of immunosuppressive therapies. The objectives of this study were to isolate and identify Cryptococcus neoformans from clinically suspected cases of fungal meningitis by conventional techniques and evaluate the role of C-reactive protein (CRP) as a serum or urine biomarker for the diagnosis and monitoring of patients with cryptococcal meningitis. Materials and Methods: Direct microscopic examination of the CSF samples from clinically suspected cases of fungal meningitis was done by India Ink staining for the capsule demonstration and isolation of the Cryptococcus neoformans was done by inoculation of the sample on Sabourauds dextrose agar. Latex agglutination test for the presence of cryptococcal antigen was done on sera, CSF and urine samples. C Reactive Protein levels were estimated in sera and urine. Result: Cryptococcal meningitis was diagnosed in 12 cases by culture and/or India Ink staining and/or latex agglutination assay for antigen detection in CSF. Only 8 (66.67%) and 1 (8.33 %) out of 12 samples were positive for cryptococcal antigen in sera and urine respectively. Whereas all the 12 patients were positive in the sera for CRP above the detection threshold limit, only 1 (8.33 %) patient had raised CRP in urine. CRP was raised two weeks after initiation of antifungal therapy in 3 of the above 12 sera and all these 3 cases turned out to be recurrent cases of cryptococcal meningitis. Conclusion Given the high incidence, morbidity and mortality associated with cryptococcal meningitis, it would be ideal if a screening test could be used to exclude this diagnosis based on the presence of biomarkers in serum or urine which would mean less discomfort for the patient in addition to decreased laboratory examination costs.
May 2013 DOI 10.14302/issn.2324-7339.jcrhap-12-137
Background: HAART has resulted in significant decline in morbidity and mortality from HIV. However, it is unclear if the trends have continued in the current HAART era. An understanding of healthcare utilization patterns is important for optimization of care and resource allocation. We examined the diagnoses for hospitalizations of patients with HIV and their clinical and demographic profile years after the introduction of HAART. Methods: A retrospective audit of the HIV admissions from July 2009 through June 2010. The case notes of all the adult admissions where one of the discharge diagnoses was HIV infection was reviewed. Data including the demographics, date of diagnosis, treatment and the follow up details, admission outcome and the final diagnosis were extracted from the case notes. Results: Over the 12 months period there were 154 admissions where one of the discharge diagnosis was HIV infection, and this accounted for 2.9% of all medical admissions in adults. 103(67%) admissions were in persons who were known to be HIV infected prior to the current admission. HIV infection was diagnosed for the first time during the current admission in 51(33%) cases. Nearly two-thirds of those hospitalized, had a CD 4 cell counts of < 200/µL and 63 (66%) had a viral load greater than 50,000 copies/ml. Over all, opportunistic infection was the commonest (47%) discharge diagnosis, followed by serious bacterial infections and HIV nephropathy. The median duration of hospitalization was 6 days (Range 2 to 71 days). There were 49 (32%) deaths. Conclusions: A significant proportion of patients admitted with HIV infection were still diagnosed on admission and were found to be severely immunosuppressed. An opportunistic infection continues to be the commonest discharge diagnosis in HIV infected patients.
Distant metastases generally indicate disseminated disease and the standard treatment for these patients is palliative chemotherapy. Retrospective series showed that selected patients with metastatic lung cancer and a solitary extrathoracic disease could be effectively treated with curative intention by resection of both primary tumor and the single site of metastatic disease. According to current data, adrenalectomy might be considered as an alternative option for patients with isolated adrenal metastases. Significant morbidity and mortality may be happened by these procedures, and a cautious analysis of pros and cons should be discussed with the patient. We present a review of the literature and updated recommendations focusing lung cancer with solitary adrenal metastasis.