Student's Journal of Health Research Africa

MORPHOLOGY OF DISTAL THIRD OF CLAVICLE IN DRY BONE AND CORRELATION WITH LENGTH: A CROSS-SECTIONAL STUDY.

2024-06-05T09:35:20+00:00

Background

The human clavicle is the only transversely placed cancellous bone long bone of the body. The fracture of the distal end of the clavicle accounts for 12% to 15% of all fractured clavicles. Approximately 25% of distal clavicle fractures are unstable. This study aims to measure the dimensions and proportions of the distal third of the clavicle and correlate these measurements with the total length of the bone to aid in the development of better surgical interventions and prosthetics.

Methods

In this study, 40 left-side & 40 right-side human clavicles were included. The total length of the bone, the distance of the medial border of the conoid tubercle, and the center of the trapezoid tuberosity from the lateral edge of the clavicle were measured. Analysis of data was done by SPSS version 22 for Windows.

Results

The mean total length of right & left clavicle was125.5±11.9mm & 136.5±10.4mm. The mean length of the medial border of the conoid tubercle (CD) from the lateral edge was 43.0±7.3mm &43.5±4.9mm and the mean length of the center of the trapezoid tuberosity (TD) from the lateral edge was 18±4.1mm &18± 4.10mm of right & left clavicle respectively. The average of the mean of the proportion of the medial border conoid tubercle from the lateral edge of the clavicle & the total length of the clavicle was 0.33±0.045 & that of the center of the trapezoid tuberosity was 0.14±0.025.

Conclusion

The mean length of the left clavicle is more. The CD &TD will provide a guide for resection of the distal end of the clavicle in fracture and displacement of the acromioclavicular joint during repair.

Recommendation

Future research should involve larger, diverse samples to validate findings and refine surgical techniques, considering anatomical variations for improved patient outcomes.

EXAMINING THE LIVER ENZYMES IN NON-ALCOHOLIC FATTY LIVER DISEASE (NAFLD) PATIENTS: A CROSS-SECTIONAL STUDY.

2024-05-08T18:42:55+00:00

Background:

Up to the present, the detection of non-alcoholic fatty liver disease (NAFLD) is done using biopsy. The exploration of a painless substitute, such as biomarkers, is a rationale for investigation. Earlier research has evaluated that patients with diabetes or overweight do not affect liver enzymes causing chronic liver problems. The goal of this research is to examine the liver enzymes in the case of NAFLD.

Materials and Methods:

This is cross-sectional research in which 80 subjects were included which was carried out at Katihar Medical College in Katihar, Bihar, India. Patients were divided into four categories according to their BMI, category 1 (obese), category 2 (type 1 obesity), category 3 (type 2 obesity), and category 4 (type 3 obesity), excluding the patients who have hepatitis and consume alcohol.

Results:

Most of the patients had type 2 obesity in which 18 males and 13 females were present. 7 male and 12 female patients had type 1 obesity. Male patients were 48 and female patients were 32The disease was prevalent in both genders.

Conclusion:

In the present study, it was concluded that there are variations in liver enzymes and the significance of sex, body weight, and dysfunction in lipid profile to examine the threat of patients with non-alcoholic fatty liver disease.

Recommendation:

Biopsy is the best mode for the detection of NAFLD and other ultrasound such as an MRI scan or CT scan can also be done for the diagnosis of hepatic dysfunction.

A CROSS-SECTIONAL STUDY ON THE CLINICAL SIGNIFICANCE OF CREATININE, BLOOD UREA, AND CYSTATIN C IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND LUPUS NEPHRITIS.

2024-05-29T14:54:09+00:00

Background

The study aims to determine the clinical significance of renal biomarkers—specifically serum creatinine, cystatin C, and blood urea—in patients diagnosed with systemic lupus erythematosus (SLE), with a particular focus on evaluating their association with renal involvement and disease severity.

Methods

A total of 140 participants were enlisted, 70 of whom were SLE patients and 70 of whom were age- and sex-matched controls. Along with proteinuria levels, serum levels of creatinine, cystatin C, and blood urea were important variables that were assessed. Statistical analysis was also done to determine significance.

Results

Serum cystatin C levels were significantly elevated in SLE patients (mean 1.25 mg/L) compared to controls (mean 0.95 mg/L), p < 0.001. Similarly, serum creatinine (mean 1.02 mg/dL in SLE vs. 0.88 mg/dL in controls, p = 0.003) and blood urea levels (mean 35.6 mg/dL in SLE vs. 28.4 mg/dL in controls, p < 0.001) were higher in SLE patients. Proteinuria levels were markedly higher in SLE cases (mean 225 mg/day) compared to controls (mean 15 mg/day), p < 0.001. Serum cystatin C levels and proteinuria levels in SLE patients exhibited a favorable association, according to Pearson correlation analysis (r = 0.68, p < 0.001).

Conclusion

Serum creatinine, cystatin C, and blood urea are elevated in SLE patients with lupus nephritis, with cystatin C showing a strong association with proteinuria levels, indicating its potential as a sensitive biomarker for early renal impairment. These findings underscore the importance of incorporating cystatin C in routine assessments for better management of lupus nephritis.

Recommendations

Further, longitudinal studies are recommended to validate the predictive value of cystatin C and explore its role in guiding therapeutic interventions in lupus nephritis. The routine use of these indicators in clinical practice can help patients with SLE manage their renal involvement and detect it early.

DOES PREOPERATIVE SURGICAL SITE HAIR REMOVAL FOR ELECTIVE ABDOMINAL SURGERY HAVE AN IMPACT ON SURGICAL SITE INFECTION? AN OBSERVATIONAL STUDY.

2024-06-30T13:11:04+00:00

Background

The surgical site infection and the role of hair on the surgical site play an important role in avoiding the stated complication. This study is conducted to determine the effect of shaving on the occurrence of surgical site infection

Method

This was a prospective observational study conducted for a year. The participants who underwent abdominal surgery participated in the surgery. One of the two groups before the surgery had shaved, and the other did not shave. The occurrence of surgical site infection, the grading of the wound, and the grading of the pain were compared statistically among both groups.

Results

The study included 100 participants with a mean age of 43.5 years and a mean BMI of 22.88 kg/m². SSIs were reported in 11% of cases, with no statistically significant difference between the shaved and unshaved groups. Wound grading and pain assessment also showed no significant differences.

Conclusion

This study concluded that shaving did not have any effect on the occurrence of surgical site infection after the surgery.

Recommendation

Shaving should be avoided before performing the surgery; this decreases the chances of post-operative complications such as surgical site infection

Clinical Characteristics of Non-proteinuric Kidney Disease in Patients with Type 2 Diabetic in India: A Cohort Study

2024-06-30T15:23:03+00:00

Background: The study aims to examine the clinical profile and progression of non-proteinuric diabetic kidney disease (NP-DKD) in type 2 diabetic patients in India and compare it with proteinuric diabetic kidney disease.

Methods: A cohort study of 120 patients over 18 years old was carried out. Individuals were divided into proteinuric (n=68) and non-proteinuric (n=52) groups based on uPCR or 24-hour urine protein levels. Data on demographics, clinical parameters, and biochemical investigations were gathered at baseline and during follow-ups at six months and one year. Renal function was assessed using eGFR, and proteinuria was monitored. Statistical analyses were performed.

Results: The proteinuric group exhibited a significantly lower baseline eGFR (45.8 ± 12.6 ml/min/1.73 m²) compared to the nonproteinuric group (62.4 ± 8.7 ml/min/1.73 m², p < 0.001). Over one year, the proteinuric group had a larger mean decline in eGFR (8.5 ± 3.4 ml/min/1.73 m²) than the nonproteinuric group (4.2 ± 2.1 ml/min/1.73 m², p < 0.001). ACEi/ARB therapy substantially reduced proteinuria in the proteinuric group (p < 0.01). Hyperkalemia was more prevalent in the proteinuric group (22.1%) compared to the nonproteinuric group (7.7%, p = 0.03).

Conclusion: NP-DKD poses a significant risk for renal function decline, similar to proteinuric DKD. ACEi/ARB therapy effectively reduces proteinuria but needs careful monitoring for hyperkalemia. Early detection and tailored management are crucial for improving NP-DKD patient outcomes.

Recommendations: Regular monitoring of renal function and proteinuria, along with the use of ACEi/ARB therapy, should be considered for all diabetic patients, with particular attention to those with NP-DKD. Further research is ought to explore additional therapeutic options and improve diagnostic techniques for NP-DKD.

EXAMINING BRAIN TISSUE OXYGEN LEVELS AND METABOLIC ACTIVITY IN FOCAL AND DIFFUSE TRAUMATIC BRAIN INJURY: A CROSS-SECTIONAL STUDY.

2024-05-09T09:19:26+00:00

Background:

The study aimed to determine if the response pattern varied based on the type of injury and probe location by examining cerebral metabolism and oxygen levels using microdialysis (MD) and the novel near-infrared spectroscopy (NIRS) probe.

Methods:

The cross-sectional study included twenty Traumatic Brain Injury (TBI) patients with a Glasgow Coma Scale score of ≤8 was included. Advanced neuromonitoring techniques, including microdialysis and brain tissue oxygenation monitoring, were employed to assess cerebral metabolism and oxygen levels. Statistical analysis involved mean, standard deviations, ANOVA, and Mann–Whitney U test.

Results:

The study included 20 TBI patients (mean age 45 ± 10 years, predominantly male). Mean intracranial pressure (ICP) was 18.5 ± 4.2 mmHg, and cerebral perfusion pressure (CPP) was 65.2 ± 5.8 mmHg. Brain tissue oxygenation (BtipO2) averaged 22.6 ± 3.5 mmHg. Significant differences in BtipO2 were found between focal (25.0 ± 3.0 mmHg) and diffuse TBI (18.0 ± 2.5 mmHg) (p < 0.05). Higher BtipO2 was observed with ICP < 20 mmHg and CPP > 60 mmHg. Microdialysis showed varying levels of lactate (4.2 ± 1.0 mmol/L), pyruvate (1.8 ± 0.5 mmol/L), glucose (2.5 ± 0.7 mmol/L), glutamate (10.3 ± 2.2 μmol/L), and glycerol (0.6 ± 0.3 μmol/L). Further Mann-Whitney U tests showed notable BtipO2 fluctuations at specific intervals.

Conclusion:

Comprehensive monitoring of intracranial parameters and cerebral metabolism provides crucial insights for TBI management. Tailored treatment strategies guided by advanced neuromonitoring techniques can improve patient outcomes by addressing brain tissue vulnerability and metabolic disturbances.

Recommendations:

It is recommended to integrate advanced neuromonitoring techniques into routine TBI management protocols. Personalized treatment approaches based on individual patient profiles should be implemented.

Influence of Cardiac Autonomic Neuropathy in Relation with HBA1c Values: A Prospective Cross-Sectional Study

2024-06-30T15:17:01+00:00

Background: One common adverse effect of diabetic mellitus (DM) is cardiac autonomic neuropathy (CAN), affecting cardiovascular function and often linked to poor glycemic control measured by hemoglobin A1c (HbA1c) values. The study seeks to investigate the association between CAN and HbA1c variability, predict CAN development and progression based on HbA1c levels, and assess the impact of glycemic control on autonomic dysfunction in DM patients.

Methods: A prospective study was carried out involving 100 Type 2 DM patients. Inclusion criteria included age ≥18 years, Type 2 DM duration ≥10 years, and ≥4 HbA1c measurements. CAN was evaluated using the Cardiovascular Autonomic Score Scale (CASS). Descriptive statistics, logistic regression, correlation analysis, and multiple linear regression analysis were used for data analysis.

Results: The mean age of participants was 58 years, with 60% males. Key findings include significant differences in CA parameters between patients with and without CAN (p < 0.001). Factors like mean HbA1c (OR 1.32, p < 0.001), adjusted HbA1c standard deviation (OR 2.45, p < 0.001), BMI (OR 1.18, p = 0.017), duration of DM (OR 1.27, p = 0.002), hypertension (OR 3.21, p = 0.002), coronary artery disease (OR 2.55, p = 0.012), and diabetic retinopathy (OR 1.89, p = 0.039) were substantially associated with composite autonomic scoring.

Conclusion: The study highlights the critical role that cardiovascular risk factors and glycemic management play in the onset and progression of CAN in patients with Type 2 DM. Older age, longer DM duration, higher BMI, hypertension, and coronary artery disease were significantly associated with increased composite autonomic scoring, indicating a greater severity of autonomic neuropathy.

Recommendations: Intensive glycemic management and targeted interventions addressing cardiovascular risk factors are recommended to mitigate CAN risks and improve outcomes in Type 2 DM patients.

Combination of didactic lectures with problem-based learning sessions in Anatomy

2024-06-30T12:06:20+00:00

Background: Anatomy and its functional application in clinical practice require a thorough understanding of the subject is required. During the initial college years didactic method of teaching is followed which limits the understanding of its application further in a clinical setting. Problem-based learning session aids in a better understanding of the anatomy.

Method: The students of the first year of medical college were taken for study. The batch of 200 students were taught endocrinology then they were given a problem-based questionnaire based on the current knowledge. They were divided into small groups for discussion and the method was evaluated based on the feedback received from the students.

Results: 80% of the students gave the feedback that a judicious mixture of didactic lecture and problem-based learning helped them in clearing their final exams. 70% of the students gave the feedback that problem-based learning helped them understand the subject better. Only 7% of the students reported that a mixture of both methods was not very helpful.

Conclusion: It is not possible to teach and learn anatomy with a single approach. A mixture of multiple approaches such as didactic teaching as well as problem-based learning helps in a better understanding of the subject and makes it easier for its application in clinical practice.

Recommendation: Along with didactic lectures, problem-based learning methodology should be implemented in an academic setting to further enhance the outcomes of learning in the clinical setting

congenital Heart Defects and Non-Cardiac Malformations in Patients with a Normal Karyotype

2024-06-28T06:56:21+00:00

Background: Congenital heart defects (CHDs) are the most general type of birth defect, frequently associated with non-cardiac malformations, even in patients with normal karyotypes. Understanding these associations can enhance diagnosis, management, and outcomes. The study investigated the prevalence and types of non-cardiac malformations in patients with CHDs and normal karyotypes, and to identify significant associations between these anomalies.

Methods: A retrospective observational study was conducted. The study included 300 patients with CHDs and normal karyotypes. Data were collected from medical records, including demographic information, types of CHDs, and non-cardiac malformations. Statistical analysis was performed, employing chi-square tests and logistic regression.

Results: The study found that 33.3% of patients had musculoskeletal anomalies, 28.3% had genitourinary anomalies, and 21.7% had gastrointestinal anomalies. Significant associations were observed between VSD and musculoskeletal anomalies (χ² = 12.5, p < 0.01) and ASD and genitourinary anomalies (χ² = 5.8, p = 0.02). A family history of anomalies was a significant predictor of multiple congenital anomalies (OR = 3.2, 95% CI: 1.8-5.7, p < 0.001). Surgical interventions led to favorable outcomes in 83.3% of patients.

Conclusion: This study highlights the prevalence of non-cardiac malformations in patients with CHDs and normal karyotypes and identifies significant associations between specific CHDs and non-cardiac anomalies. These findings underscore the importance of a multidisciplinary approach in managing these patients.

Recommendations: Future research is needed to explore the genetic and developmental mechanisms underlying these associations. A multidisciplinary approach should be implemented in clinical practice to improve diagnosis and management of patients with CHDs and associated non-cardiac malformations.

ASSESSING THE SAFETY OF EARLY DIURETIC ADMINISTRATION IN DYSPNEA PATIENTS WITHOUT A FINAL DIAGNOSIS OF ACUTE HEART FAILURE: AN OBSERVATIONAL STUDY.

2024-06-27T09:29:39+00:00

Background

Dyspnea is a frequent and distressing symptom leading to emergency department (ED) visits, often associated with various cardiopulmonary conditions. Diuretics are commonly used in the early management of dyspnea, particularly when acute heart failure (AHF) is suspected. This study investigated the safety of early diuretic administration in dyspnea individuals who are not finally detected with AHF, focusing on thirty-day mortality and readmission rates.

Methods

A prospective observational study involved 180 dyspnea patients from the BASEL-V registries. Patients were allotted into two groups: those who received diuretics at the ED (n=90) and those who did not (n=90). Thirty-day readmission was the secondary endpoint, while thirty-day mortality was the primary one. T-tests, chi-square testing, Wilcoxon rank-sum tests, and multiple imputations for missing data were used to evaluate the data.

Results

The study involved 180 patients, with a mean age of 65 ± 12 years in the treated group and 66 ± 13 years in the untreated group. 61.1% of the treated group and 58.9% of the untreated group were male. The groups had similar rates of hypertension (treated: 50%, untreated: 46.7%), diabetes (33.3%, untreated: 35.6%), and chronic renal disease (22.2%). The treatment group had 11.1% 30-day mortality and the untreated group 8.9% (p = 0.62). The treatment group had 22.2% 30-day readmissions and the untreated group 20% (p = 0.70). Baseline characteristics were similar between groups.

Conclusion

Early diuretic administration in dyspnea individuals without a final diagnosis of AHF does not significantly impact thirty-day mortality or readmission rates. The practice appears to be safe in this patient population.

Recommendations

Larger sample sizes and longer follow-up times are required for future research to validate these results and offer more definite recommendations on the use of diuretics in patients with dyspnea who do not have AHF.

CORRELATION OF FIRST DIGIT DACTYLOGRAPHY WITH RETINAL VASCULAR PATTERNS: AN OBSERVATIONAL STUDY.

2024-06-24T14:33:45+00:00

BACKGROUND

The retina is the only bodily area where the microvascular bed is visible, making it perfect for studying sequestration non-invasively in vivo and real life. Therefore, the present study was designed to find a correlation between 1st digit patterns with retinal vascular patterns.

MATERIALS & METHODS

The present study was conducted on 200 subjects. Digital photographs of the fundus of the eyes were taken with a fundus camera. Eyes were divided into superior and inferior quadrants on both the nasal and temporal sides of the eyes, then, the retinal vasculature was studied and analyzed. 1stdigit prints were taken and dermatoglyphic patterns were observed using a magnifying glass. Data obtained by studying retinal vascular patterns were compiled and findings were compared with 1st digit prints. Then, all the data so collected was recorded, tabulated, and analyzed.

RESULT

39% of subjects had loop patterns, 36.5% had whorls, and 1.5% had arches on their first digit. Retinal vasculature was more extensive on the temporal side in 87.5% of subjects. Subjects with loops on both thumbs had a higher mean number of branches in the superotemporal quadrant of the left eye (mean = 9.36, SD = 3.12), while those with whorls had more branches in the superotemporal quadrant of the right eye (mean = 9.34, SD = 2.87). These findings indicate a notable correlation between first-digit fingerprint patterns and retinal vascular branching.

CONCLUSION

This is the first published paper showing an important observation as both biometrics are genetically regulated. However, this correlation whether causal or effective cannot be explained as further research is needed and this data may provide a reference for future research.

RECOMMENDATIONS

Further research using advanced biometric tools is recommended to explore the causal relationship between fingerprint patterns and retinal vascular branching, potentially enhancing the efficacy of biometric identification methods.

Incidence of Prediabetes and Diabetes in Women with Previous Gestational Diabetes and Non-Alcoholic Fatty Liver Disease: A Prospective Study

2024-06-30T15:42:11+00:00

Background: Non-alcoholic fatty liver disease (NAFLD) and gestational diabetes mellitus (GDM) are two common metabolic disorders that have similar pathophysiological mechanisms, including chronic inflammation and resistance to insulin. The objective of this research was to examine the prevalence of prediabetes and diabetes in females who had previously experienced GDM and NAFLD, and to determine the variables linked to the advancement of glycaemic categories within this cohort.

Methods: The study included 230 women who were evaluated for NAFLD at a baseline postpartum visit. The participants were categorized based on their GDM status during pregnancy and NAFLD presence. Incidence rates of prediabetes and diabetes were calculated, and significant predictors of glycaemic progression were identified. Data collection included medical history, anthropometric measurements, and biochemical parameters. Statistical analyses were performed using Stata 15.0.

Results: In 98 (42.6%) of the women, prediabetes or diabetes developed over a median follow-up of three years. Compared to women with either illness alone or neither, women with both GDM and NAFLD had substantially higher incidence rates per 100 woman-years (14.2). The prevalence of NAFLD, age over 35, postpartum overweight/obesity, and family history of diabetes were important indicators of glycaemic development. Cardiometabolic risk variables showed notable declines in females with NAFLD and GDM.

Conclusion: Females with GDM and NAFLD are at high risk for prediabetes and diabetes. Glycaemic progression is predicted by age, postpartum BMI, family history of diabetes, and NAFLD. These findings suggest targeted surveillance and early intervention to avoid diabetes and manage cardiometabolic hazards in this high-risk group.

Recommendations: Regular screening for glycaemic status and cardiometabolic risk factors should be prioritized in females with a history of GDM and NAFLD. Lifestyle interventions focusing on weight management and metabolic health are essential to reduce the progression to prediabetes and diabetes in this high-risk group.

A CROSS-SECTIONAL STUDY ON PATTERN AND MORTALITY OF CHEST INJURIES AMONG VICTIMS OF ROAD TRAFFIC ACCIDENT AT MORTUARY SNMMC, DHANBAD, JHARKHAND.

2024-06-30T13:42:20+00:00

Background

Road traffic accidents (RTAs) have a major impact on low- and middle-income countries and are one of the world's top causes of morbidity and mortality. Chest injuries from RTAs contribute substantially to trauma-related deaths and disabilities due to their severity and complexity. This study aimed to analyze the patterns and mortality of chest injuries among victims of road traffic accidents, over a six-month period.

Methods

A cross-sectional study including 100 RTA victims with substantial chest injuries was carried out. SPSS version 21.0 was used to gather and examine information on the kind and frequency of chest injuries, related injuries, duration of hospital stay, treatment taken, and patient outcomes. Among RTA victims receiving hospital treatment, major chest injuries were the criterion for inclusion; minor injuries and those who had passed away at the scene were not included.

Results

Rib fractures were the most common chest injury (45%), followed by pulmonary contusions (30%), pneumothorax (15%), hemothorax (10%), flail chest (8%), and cardiac contusions (7%). Associated injuries included extremity fractures (40%), head injuries (25%), abdominal injuries (20%), spinal injuries (15%), and facial injuries (18%). Sixty percent of patients required operative treatment, with an average hospital stay of 15 days. The mortality rate was 45%. Significant correlations were found between the type of chest injuries and age, gender, and associated injuries.

Conclusion

Chest injuries from RTAs are a critical public health concern, with high mortality rates and significant associated injuries. The findings highlight the need for improved trauma care and targeted preventive measures to reduce the incidence and severity of chest injuries.

Recommendations

Enhancing pre-hospital care, establishing more trauma centers, and improving training for trauma care personnel are essential steps to reduce mortality and improve outcomes for RTA victims with chest injuries.

ENDOSCOPIC SEPTOPLASTY VERSES STANDARD SEPTOPLASTY IN MANAGEMENT OF DEVIATED NASAL SEPTUM: A RANDOMIZED PROSPECTIVE STUDY

2024-06-19T16:00:33+00:00

Background

One of the common issues that otolaryngologists deal with is nasal obstruction caused by a deviated nasal septum. Many surgical techniques have been tried to treat the same condition. The purpose of the research was to compare the results and risks of endoscopic and standard septoplasty.

Methods

This research is randomized and potential. The study included 100 individuals with symptomatic deviated nasal septum; 50 of the patients had standard septoplasty, and the remaining patients had endoscopic septoplasty. There was little difference between the two surgeries' functional results.

Results

In this investigation, intraoperative hemorrhage occurred in 12 patients in the category undergoing standard septoplasty, but only in 4 patients undergoing endoscopic septoplasty. 6 patients undergoing endoscopic septoplasty and 12 patients undergoing standard septoplasty experienced mucosal tears. Synechae development between the inferior turbinate and septum was observed in four patients undergoing standard septoplasty.

Conclusion

Concerning complications, there was a notable distinction. The results of endoscopic septoplasty were superior in terms of complications. Endoscopic septoplasty makes it simpler to treat detached spurs and posterior deviations. The risks associated with endoscopic septoplasty are lower.

Recommendations

Based on the findings of this study, it is recommended that endoscopic septoplasty be preferred over standard septoplasty for patients with symptomatic deviated nasal septum due to its lower complication rates and superior postoperative outcomes.

Morphometric study of Anterior Horn of the lateral ventricle of the brain and its correlation with age, gender and side: A CT study

2024-06-30T12:15:45+00:00

Background: The anterior horn of the ventricles undergoes peculiar changes as the brain ages. Enlargement of the ventricle horn has been associated with advanced ageing. This study attempts to correlate the ventricle size with age, gender and side of the hemisphere.

Method: This was a prospective observational study in which 250 computed tomography images of the brain were analyzed thoroughly. The anterior horn of the lateral ventricle was measured using a dicomworks software. The age range of the participants was 20–80 years.

Results: The anterior horn of the ventricle increased in size for both hemispheres as age increased, especially at the age of 61–80 years. Men had a larger anterior horn compared to women. The anterior horn of the lateral ventricle on the left side is enlarged compared to the anterior horn on the right side.

Conclusion: The anterior horn of the lateral ventricle is prone to enlargement if it is from the left side, in the male gender, and as the age increases, the enlargement of the ventricle horn becomes prominent.

Recommendation: while diagnosed with neurological diseases, enlargement of the lateral ventricles should be analysed as per the age and gender of the patients

Predicting Difficult Laparoscopic Cholecystectomy Using Cystic Duct Dissection Time

2024-06-30T15:12:19+00:00

Background: Laparoscopic cholecystectomy (LC) has emerged as the preferred surgical approach for gallstone disease due to its minimally invasive nature. However, predicting the difficulty of this procedure remains crucial for surgical planning and patient safety. In order to provide a safe and successful procedure, the study aims to analyse quantitative characteristics that predict difficult laparoscopic cholecystectomy (DLC) and the use of various bailout procedures.

Methods: A prospective cohort study was conducted at MDB Autonomous State Medical College, Deoria, India, from July 2021 to July 2022. Fifty patients undergoing laparoscopic cholecystectomy were included based on specific criteria. Demographic, clinical, and surgical variables were collected, and statistical analyses were performed to identify predictors of difficult laparoscopic cholecystectomy (DLC).

Results: The study revealed significant associations between urgent cholecystectomy and the use of bailout procedures (OR = 2.75, p = 0.012). Multinomial logistic regression also showed significant predictors of operative time, including BMI (β = 0.287, p = 0.008) and previous surgical history (β = -0.215, p = 0.036). An ROC curve analysis demonstrated moderate predictive accuracy (AUC = 0.78) for operative time in predicting DLC.

Conclusion: Preoperative assessment of BMI, previous surgical history, and operative time can aid in predicting the difficulty of laparoscopic cholecystectomy. These findings underscore the importance of comprehensive evaluation and surgical planning to ensure safe and successful outcomes.

Recommendations: Clinicians should consider incorporating preoperative predictors, such as BMI and surgical history, into their decision-making process for laparoscopic cholecystectomy. Future studies may further validate these predictors and explore additional factors influencing surgical difficulty.

AN OBSERVATIONAL STUDY OF BACTERIOLOGICAL AND ANTIBIOTIC SUSCEPTIBILITY PROFILE OF URINARY TRACT INFECTIONS IN DIABETIC AND NON-DIABETIC PATIENTS IN A TERTIARY HEALTH CENTRE.

2024-06-30T16:16:52+00:00

Background

Considering the compromised immunity and increased virulence of the pathogenic microorganisms in diabetics, they are more susceptible to infections. Especially, urinary tract infections affect the renal functioning of diabetics.

Methods

This was an observational comparative study conducted for 26 months. The people with positive urinary cultures with diabetes and without diabetes were recruited for the study. The haematological analysis was done along with fasting sugar, postprandial sugar, and glycosylated haemoglobin. The demography of the participants was recorded. Patients who had positive urine cultures underwent X-rays and ultrasounds to confirm the presence of infection. The susceptibilities of the microorganisms were studied. The data obtained was compared statistically.

Results

Out of the 181 patients, 117 were found to have E. coli. The predisposing factor for males was benign prostrate hypertrophy; for females, it was an indwelling catheter. Patients with HbA1c levels less than 6.5% become more vulnerable to urinary tract infections. E. coli was found to be susceptible to ampicillin, norfloxacin, cotrimoxazole, and cephalosporin. Fever was the most common symptom among diabetics with a UTI.

Conclusion

The host factors found to be associated with UTI are female sex, the presence of diabetes, poor glycaemic control, and the presence of fever. An elevated HbA1C correlates with the occurrence of UTI. The most common uropathogenic was E. coli.

Recommendation

Diabetics should be routinely and thoroughly monitored for the presence of urinary tract infections. Especially if HbA1c is less than 6.5%.

ASSESSING THE EFFICACY OF TWO SEVERITY SCORING SYSTEMS IN PREDICTING PROGNOSIS FOR ACUTE KIDNEY FAILURE, BHAGALPUR: A COHORT STUDY.

2024-05-29T16:17:40+00:00

Background

Acute kidney failure (AKI) causes waste buildup and fluid-electrolyte imbalances due to rapid renal function loss, necessitating accurate outcome prediction using APACHE II and SOFA scores due to its high morbidity and death. The study aims to compare the predictive accuracy of the SAPS 3 and APACHE IV severity scoring systems in forecasting mortality among patients with AKI admitted to the intensive care unit (ICU).

Methods

The cohort study involves 150 AKI ICU patients. Detailed medical histories, systemic exams, and pertinent blood testing were collected. SAPS 3 and APACHE IV scores were determined within one hour and 24 hours of ICU admission, respectively. Mortality rates were predicted using calculators. SPSS 20 was used for statistical analysis.

Results

The study comprised 150 patients with an average age of 58 years; 65% were male. Common co-morbidities were hypertension (42%), diabetes mellitus (28%), and cardiovascular disease (18%). Mean SAPS 3 and APACHE IV scores were 52 and 46, respectively. Predicted mortality rates were 30% (SAPS 3) and 28% (APACHE IV), with an observed mortality of 30%. Deceased patients had higher mean scores (SAPS 3: 62, APACHE IV: 58). ROC analysis showed AUCs of 0.85 for SAPS 3 and 0.82 for APACHE IV. Sensitivity and specificity were 76% and 82% (SAPS 3), and 72% and 79% (APACHE IV). Both scores were considerably related to mortality (p < 0.001).

Conclusion

Both SAPS 3 and APACHE IV scoring systems demonstrated good predictive accuracy for mortality in AKI individuals admitted to the ICU, with no significant difference in their performance.

Recommendations

Further research should explore integrating machine learning algorithms and additional biomarkers to enhance the predictive accuracy of these scoring systems. Continuous evaluation and refinement are essential to improve their utility in clinical practice.

FLUORESCENCE IN SITU HYBRIDIZATION TO DETERMINE THE GENOMIC CHANGES IN CHROMOSOME 17 AND P53 GENE IN ORAL LEUKOPLAKIA PATIENT IN INDIAN POPULATION: A CROSS-SECTIONAL STUDY.

2024-06-10T17:02:12+00:00

Introduction

Oral cancer, especially squamous cell type, is common, with 274,000 instances annually. The risk of oral cancer from leukoplakia, a white patch at least 5 mm in size, has been extensively investigated. Globally, leukoplakia prevalence ranges from 2.6% to 4.1%. It usually develops after 30, peaks over 50, and is associated to tobacco, alcohol, and betel quid use. Leukoplakia-related chromosomal abnormalities can be revealed by Fluorescence in situ hybridization (FISH).

Objective

The goal of research is to clarify the genetic mechanisms behind the development of leukoplakia by examining p53 gene changes and numerical aberrations in chromosome 17 in Indian populations.

Material and methods

In this cross-sectional study, FISH was used to diagnose 50 cases of Oral leukoplakia (OLP), utilizing the " Locus Specific Identifier (LSI) TP53/Centromere Enumeration Probe (CEP) 17 FISH Probe Kit " to determine the copy number for CEP 17 (green) at the centromere of chromosome 17 and LSI TP53 (orange) at chromosome 17p13.1.

Results

Three of the fifty cases in the analysis show molecular change. In roughly 4% of instances, p53 gene amplification and chromosome 17 polysomy were present, while 2% of cases only had p53 gene deletion. In the investigation, grade 3 and grade 4 oral leukoplakia showed all aberrations, and the highest 18 subjects (n=18) out of 50 individuals (36%) had a tobacco and/or smoking addiction.

Conclusion

The research illuminates molecular abnormalities in “chromosome 17” and the “p53” gene in Indian OLP patients. The study helps bridge research and clinical practice to improve oral leukoplakia genetic diagnosis and management. This will enhance patient outcomes by preventing such events.

Recommendations

Implement routine screening for genetic alterations in chromosome 17 and the p53 gene in patients with oral leukoplakia to enhance early detection and targeted intervention strategies.

EXPLORING THE CORRELATION OF FASTING BLOOD GLUCOSE, SERUM UREA, SERUM CREATININE, AND DIABETES DURATION IN TYPE 2 DIABETIC PATIENTS: A CROSS-SECTIONAL STUDY

2024-05-29T15:16:49+00:00

Background

The relationship between fasting blood glucose (FBG), serum creatinine, serum urea, and the course of diabetes provides crucial insights into the management and progression of type 2 diabetes (T2DM). The study compared the clinical and biochemical characteristics of individuals with T2DM to those of age- and sex-matched healthy controls.

Methods

Two groups of seventy people were created: thirty-five with a diagnosis of T2DM and thirty-five age- and sex-matched healthy controls. Using conventional laboratory techniques, blood samples were taken to test the levels of serum creatinine, urea, and fasting blood glucose. A significance level of P < 0.05 was applied when performing statistical analysis using the software SPSS-16.

Results

The mean age of participants was 50 years, with a standard deviation of 8.2 years. The T2DM group had a substantially higher mean fasting blood glucose level (154.7 ± 33.6 mg/dl) than the control group (92.3 ± 10.5 mg/dl) (p < 0.001). Additionally, the T2DM group had higher serum urea levels (32.5 ± 8.1 mg/dl) than the control group (21.6 ± 4.2 mg/dl) (p < 0.01). Comparably, the T2DM group had higher blood creatinine levels (1.2 ± 0.3 mg/dl) than the control group (0.9 ± 0.2 mg/dl) (p < 0.05).

Conclusion

The study found significant correlations between elevated serum urea, FBG, and serum creatinine levels with the course of diabetes in T2DM patients. These markers are indicative of poor glycemic control and renal impairment, highlighting the importance of regular monitoring and early intervention to prevent complications.

Recommendations

Early detection and management of diabetic nephropathy requires regular screening of FBG, serum urea, and serum creatinine in T2DM patients. Intensive glycemic control can enhance patient outcomes and minimize diabetes-related kidney damage.

A CROSS-SECTIONAL STUDY ON SEXUAL DIMORPHISM IN SHAPE HYOID BONE- A CADAVERIC STUDY IN NORTH INDIAN POPULATION.

2024-06-24T14:15:45+00:00

Introduction

The hyoid bone is of great forensic importance as its fracture is an acclaimed indicator of strangulation, particularly manual strangulation. Hyoid bone can also be fractured in hanging, automobile accidents, pathological destruction due to tumors, forcible swallowing, muscular pressure, and falls from height. The study aims to examine and classify the shapes of the hyoid bones in a North Indian population, with a specific focus on identifying sexual dimorphism.

Material and method

The material for the present study comprised 30 dried Hyoid bones (M: F::15:15). Each hyoid bone was examined as a whole and the shape of the hyoid bones was observed.

Results

The commonest type in males was U & D shaped seen in 40% of each while in females the commonest type was H shaped seen in 67% of specimens. The classical type U was seen only in 27% of female subjects.

Conclusion

Classical forms of convectional description (Type U &V) are not the most frequent. Type U was seen in 6(40%) male & 2(13.3%) female bones while Type V was seen in none.

Recommendation

Forensic experts should consider the shape of the hyoid bone, particularly its sexual dimorphism, during autopsies to improve the accuracy of determining the cause of death in strangulation cases. Additionally, further research with larger sample sizes across different populations is recommended to validate these findings and enhance the understanding of hyoid bone morphology and its forensic implications.

A PROSPECTIVE STUDY ON MENINGOENCEPHALITIS IN BIHAR: EPIDEMIOLOGY TRENDS AND DIFFERENT TYPES.

2024-03-31T17:22:13+00:00

Background:

Acute meningitis and encephalitis (AME) pose a significant public health concern due to their association with central nervous system (CNS) infection. Understanding the seasonality, incidence rate, and causative agent of AME is essential for effective management and prevention strategies. The study examines Acute meningitis and encephalitis incidence, seasonality, causal microorganisms, and clinical manifestation patterns.

Methods:

In the prospective observational study, a total of 120 participants presenting with symptoms suggestive of CNS infection were enrolled. Inclusion criteria encompassed acute onset symptoms accompanied by fever, headache, vomiting, and meningeal signs or changes in mental status. Data collection included demographic, clinical, and vaccine history, along with biochemistry test results. Samples were collected for further testing, and data analysis such as mean and standard deviation was done using SPSS version 20.0.

Result:

The study revealed a mean age of 35 years with a balanced gender distribution. The incidence rate of AME was calculated at 15 cases per 100,000 population per year, with a peak incidence observed during the monsoon season. Viral etiologies, particularly viral encephalitis virus, accounted for 66.7% of cases, while bacterial pathogens, including Neisseria meningitidis and Haemophilus influenzae type b, comprised 33.3%. Common clinical manifestations included fever, headache, and vomiting, with elevated CRP levels and abnormal WBC counts noted in a significant proportion of cases. Tuberculous Meningitis emerged as the most common diagnosis, followed by Purulent Meningitis and other viral etiologies.

Conclusion:

The study provides valuable insights into the epidemiology and clinical characteristics of AME, highlighting the importance of comprehensive surveillance and diagnostic strategies. Early detection and targeted interventions are essential for mitigating the burden of AME and improving patient outcomes.

Recommendations:

Enhanced vaccination coverage, especially against encephalitis and bacterial pathogens, and rigorous surveillance and prompt diagnosis, are recommended to manage AME outbreaks and effectively reduce associated morbidity and mortality.

AN AUTOPSY BASED STUDY OF SOCIO-DEMOGRAPHIC PATTERNS IN FATAL BURN INJURIES: A CROSS-SECTIONAL STUDY.

2024-06-10T11:32:10+00:00

Background

On a global scale, fatal burn injuries result in considerable morbidity and mortality. To enhance prevention strategies and outcomes, it is imperative to comprehend the demographics of burn-related fatalities, incident particulars, and relevant contributing factors. The study analyzed various demographic variables such as age, sex, occupation, socioeconomic status, and fire source that are associated with fatal burn injuries, leveraging recent investigations and case analyses.

Methods

During the cross-sectional examination, an analysis was conducted on 334 cases of lethal burn injuries. Information concerning demographic variables, incident characteristics, burn injury severity, and time elapsed until initial medical care was received, was gathered through questionnaires and post-mortem examinations.

Results: The study revealed a predominance of females (76.1%) among burn injury victims, with the highest incidence observed in the age group of 21-40 years (47.9%). Cooking-related activities were the primary cause of burn injuries (55.7%), with a significant proportion occurring at home (78.4%). Over half of the victims experienced severe burns covering more than 40% of their total body surface area (TBSA).

Conclusion

Demographic, environmental, and behavioral factors affect Indian fatal burn injuries. Prevention needs household safety, fire prevention, and public knowledge. Improved healthcare infrastructure, particularly burn care facilities and prompt interventions, improves outcomes. To reduce fatal burn injuries, preventive, immediate medical care, rehabilitation, and social support are needed.

Recommendations

The suggestions encompass the enactment of extensive fire safety educational initiatives, the formation of dedicated burn treatment facilities, and the inclusion of psychological assistance and recovery services within the continuum of care.

PREMATURE GRAYING OF HAIR IN PATIENTS WITH SCHIZOPHRENIA SPECTRUM DISORDER: AN INCIDENTAL FINDING OR AN ASSOCIATION? A CASE SERIES.

2024-06-21T02:20:32+00:00

Background

Healthy hair is a sign of general well-being and youth, serving as an aesthetic tool and means of nonverbal communication. Premature graying of hair (PGH) is perceived as a sign of aging driven by oxidative stress, a cytotoxic effect of reactive oxygen species (ROS) on follicular melanocytes. This study reports a few cases of premature graying of hair in young individuals with behavioral disturbances suggestive of schizophrenia spectrum disorder.

Methodology

This case series involved 14 subjects aged 18 to 25 years, diagnosed with premature graying of hair by dermatologists, excluding other cutaneous and systemic causes. The subjects exhibited symptoms indicative of schizophrenia spectrum disorder. Detailed clinical evaluations and histories were collected, including family psychiatric history, substance use, and duration of behavioral changes.

Result

Social withdrawal and severe psychotic symptoms such as self-isolation, excessive rumination, suspiciousness, hostility, unprovoked anger, and auditory hallucinations created socio-occupational dysfunction. Behavioral problems may precede or follow PGH. An intricate link exists between oxidative stress and schizophrenia spectrum disorders. Genetic risk factors and substance use were involved in several cases. Hereditary and environmental factors contribute to psychiatric disorders and tobacco and cannabis use in families. Schizophrenia and premature hair greying are linked to oxidative stress, suggesting it may unify pathogenesis and early therapies.

Conclusion

Oxidative stress appears to be a central factor linking premature graying of hair and schizophrenia. The findings suggest that premature graying may be an early indicator of schizophrenia, warranting further investigation and early intervention strategies.

Recommendations

Premature graying of hair should be considered a red flag for early schizophrenia intervention. Further studies are needed to explore oxidative stress markers and their potential use in the early detection and intervention of schizophrenia. Enhancing antioxidant defenses may be a novel approach to managing high-risk individuals.

SERUM ANTIOXIDANT DERANGEMENTS AS DIAGNOSTIC AND PROGNOSTIC MARKER IN BIPOLAR DISORDER: A COHORT STUDY.

2024-06-30T12:35:48+00:00

Background

Bipolar disorder causes recurrent mania/hypomania and depression. According to the inflammatory idea, oxidative stress and antioxidants may be imbalanced throughout this illness. This study investigates the role of non-enzymatic antioxidants - serum uric acid, serum albumin, and serum bilirubin in different phases of bipolar disorder and compares them with healthy controls.

Method

Three groups were studied in this cohort research. One group had bipolar affective disorder patients with manic episodes, the second with depressed episodes, and the third with healthy controls. Serum uric acid, albumin, and bilirubin were measured before and after 4 weeks of treatment. The YRMS scale was used for manic episodes and the HAM-D scale was used for depressive episodes to assess disease severity.

Results

The study included 107 participants: 53 bipolar maniacs, 24 bipolar depressives, and 30 healthy controls. Bipolar mania was associated with considerably higher uric acid levels (5.40 mg/dl) compared to bipolar depression (4.09 mg/dl) and healthy controls (3.16 mg/dl) (p<0.001). Serum albumin levels were lower in bipolar depression (3.08 mg/dl) compared to mania (4.37 mg/dl) and healthy controls (4.60 mg/dl) (p<0.001). Results found no difference in serum bilirubin (p=0.367). Serum uric acid was reduced in bipolar mania (4.08 mg/dl) and depression (3.24 mg/dl) after 4 weeks (p<0.001), but albumin rose in depression (4.03 mg/dl) (p<0.001). Bipolar depression also increased serum bilirubin (0.72 mg/dl, p=0.01).

Conclusion

These findings suggest a potential role for serum uric acid and albumin as biomarkers in bipolar disorder, reflecting oxidative stress in these patients. This might also have a role in monitoring the progress and treatment of the patients.

Recommendation

Antioxidants can play a significant role in bipolar disorder but more research work is required. Further research with larger cohorts, consideration of confounding factors, and including measurement of more antioxidant molecules is essential to validate these findings.

THE INFLUENCE OF PHARMACOTHERAPY INTERVENTION ON PERCEIVED SOBRIETY IN REHABILITATION CENTER AND HOSPITAL IN WAKISO AND KAMPALA DISTRICTS, UGANDA.

2024-06-04T13:52:28+00:00

Background

Pharmacological therapies diminish the level of perceived sobriety, improve the quality of life, reduce intake and affect, demand for alcohol. Physicians prescribe medications for patients to manage withdrawals, foster sobriety, and decrease alcohol and other substance use. The study objective was to examine the influence of pharmacotherapy intervention on perceived sobriety in Butabika National Referral Hospital Kampala and Serenity Rehabilitation Center Wakiso Districts, Uganda to address the challenges of perceived sobriety.

Methodology

The study was guided by the post-positivist paradigm. The research adopted a cross-sectional research design with a mixed-method approach known as simultaneous triangulation. Using purposive sampling and simple random sampling, questionnaires and interview guides were used for data collection. 338 respondents participated in the study. SPSS was used for analyzing Quantitative data, and Pearson’s product-moment correlation coefficient was employed in testing the hypothesis. Primary data was collected using self – self-administered questionnaires, focused group discussions, observational checklists, and documentary reviews to obtain in-depth results.

Results

The results showed pharmacotherapy intervention and perceived sobriety r=0.723, which was positive with probability value p=0.000 < a=0.01 suggesting a significant correlation. Therefore, the stated Null Hypothesis was rejected which implies that pharmacotherapy intervention significantly positively correlates with perceived sobriety. “Most patients respond to Pharmacotherapy intervention, it controls withdrawal effects, alcohol addicts are given treatment (detoxification) at the initial phase, later are encouraged to attend group and individual counseling sessions to manage psychological challenges and social issues that may have led them into the use of alcohol”.

Conclusion

pharmacotherapy intervention has a significant positive correlation with perceived sobriety. Therefore, a change in pharmacotherapy positively affects perceived sobriety.

Recommendation

The study recommended that District Health Officers should encourage psychiatric doctors and nurses to understand that, one single intervention (pharmacotherapy) cannot facilitate long-term recovery but rather integrate with other recovery interventions.

ASSESSMENT OF THE KNOWLEDGE AND ATTITUDE OF MOTHERS TOWARDS POSTPARTUM DEPRESSION IN SELECTED SAGAMU COMMUNITY HEALTH CENTERS, OGUN STATE. A CROSS-SECTIONAL STUDY.

2024-04-23T15:50:57+00:00

Background

Postpartum depression (PPD) is of significant public health concern due to the alarming prevalence and adverse consequences among women globally. This study assessed the knowledge and attitudes of mothers towards postpartum depression in selected health care centers in Sagamu community health centers in Ogun State.

Methods

The study utilized a cross-sectional quantitative design. 152 women were selected for the study, a researcher-developed questionnaires were used to collect data from respondents. SPSS version 25 was used for data analysis, and descriptive and inferential statistics were used to present the findings of the study.

Results

Findings from the study revealed that most of the respondents 40.8% were between the ages of 21-25 years old. The majority (66.4%) of the respondents were knowledgeable about postpartum depression and only 58.5% of the respondents indicated a positive attitude toward postpartum depression. Stressful life events during the postpartum period, financial difficulties, sleep deprivation, and traumatic birth experiences were identified as factors responsible for PPD having over 80%. Furthermore, findings also revealed that there is a relationship between the knowledge and attitude of mothers towards postpartum depression (r=0.516, p-values=0.000).

Conclusion

In conclusion, mothers in the two selected Sagamu community health centers had a high level of knowledge and only about half had positive attitudes towards the knowledge of PPD.

Recommendation

There should be an increase in awareness of postpartum depression by healthcare providers among mothers, especially during antenatal visits to reduce stigma and promote help-seeking behavior to improve maternal and child health. Moreover, partners and family members can support and encourage women dealing with postpartum depression.

CAMPUS-BASED STRATEGIES TO ADDRESS SUICIDE BEHAVIOURS AMONGST STUDENTS AT INSTITUTIONS OF HIGHER LEARNING IN SOUTH AFRICA: A NARRATIVE REVIEW.

2024-04-04T16:23:16+00:00

Suicide rates among adolescents and youth are increasing regardless of the interventions to lower the risks. Therefore, preventing suicides at institutions of higher learning is a top concern for public mental health. This paper explores strategies that may be adopted to reduce suicidal thoughts among students in South Africa. The study analyzed previously published data on student suicide at institutions of higher learning. The purposive sampling technique was used by the researchers to collect secondary data from various research platforms that were specifically focused on the topic at hand. A non-empirical research design was used where information from Google Scholar, Jstor, EbscoHost, Proquest, Scopus, and Sabinet were sampled and reviewed using keywords and phrases related to suicide, strategies, and behaviors to filter relevant data. This review highlights that there are a variety of causes for students' suicidal thoughts, and these causes are individualized. Suicide prevention strategies such as gatekeeper training programs for suicidal behaviors, implementation of suicide prevention awareness programs within campuses, digitalization of the programs, counseling, and psychotherapy are some of the strategies that universities can adopt to reduce suicidal thoughts among students. Given the complexity of suicide, prevention must be done with extreme prudence and urgency. The more the complexity of the suicide process is understood, the more the need for consistent, significant efforts to empirically support and evaluate the prevention strategies. It is therefore imperative to implement comprehensive and multi-sector preventative programs to minimize these risk factors and enhance protective variables to the greatest extent possible.

ANALYSING RETROSPECTIVE DATA: AGE AND GENDER DISPARITIES IN HSV-2 INFECTION PREVALENCE AMONGST PATIENTS IN KWAZULU-NATAL.

2024-02-02T04:01:43+00:00

Background

Herpes simplex virus type 2 (HSV-2) is a significant global public health concern, contributing to a substantial disease burden. Understanding the prevalence of HSV-2 infections and potential gender disparities is crucial for developing effective prevention and control strategies. This study compares the prevalence of HSV-2 infections between men and women aged 15-49 years.

Methods

This retrospective study analyzed data from 182 patients, both men and women aged 15-49 years, who tested positive for HSV-2. The data were sourced from the Inkosi Albert Luthuli Central Hospital laboratory database. Descriptive statistics calculated prevalence rates, and chi-square tests determined significant gender differences. The age groups were divided into five-year intervals to assess prevalence variations across different stages of adulthood.

Results

The analysis revealed notable differences in infection rates between genders. Among females, HSV-2 prevalence ranged from 4.9% in the 15-19 age group to 20.3% in the 20-24 age group, displaying a significant increase during early adulthood. The rates stabilized around 10.4% for ages 25-34, increased to 12.6% for ages 35-39, declined to 8.2% for ages 40-44, and further decreased to 3.6% for ages 45-49. In contrast, among males, HSV-2 prevalence started at 3.3% for ages 15-19, decreased to 2.7% for ages 20-24, steadily increased to 6.6% for ages 30-34, and slightly declined but remained relatively high at 4.4% for ages 35-39, 3.8% for ages 40-44, and 2.7% for ages 45-49.

Conclusion

The study demonstrates a substantial gender disparity in HSV-2 infection rates among individuals aged 15-49 years, with a significantly higher prevalence observed in females. These findings highlight the need for targeted interventions and public health strategies to address the higher burden of HSV-2 infections in women.

Recommendations

Targeted public health strategies and education campaigns should focus more on women, particularly in early adulthood, to reduce HSV-2 transmission rates.

AWARENESS OF INDOOR AIR POLLUTION AND FACTORS ASSOCIATED WITH THE USE OF UNCLEAN COOKING FUELS AMONG RESIDENTS OF MBALALA TOWN, MUKONO DISTRICT, UGANDA: A CROSS-SECTIONAL STUDY.

2024-05-02T12:43:51+00:00

Background

In most low- and middle-income countries, many households still rely on unclean cooking fuels (such as firewood and charcoal) despite the associated indoor air pollution exposure. We assessed people’s awareness of indoor air pollution and factors related to the use of unclean cooking fuels among residents of Mbalala town, Mukono district.

Methods

This was a descriptive cross-sectional study in which we collected both quantitative and qualitative data. Quantitative data were collected on socio-demographic characteristics, awareness of indoor air pollution (effects, causes, risks, control measures), and cooking practices (including the use of clean/unclean cooking fuels) from 385 respondents. We computed the proportions of respondents who were aware of indoor air pollution, and who used unclean fuels, and determined the factors associated with using a modified Poisson regression model. Qualitative data were collected from 10 key informants (community leaders and village health teams) and analyzed manually following a thematic framework approach.

Results

The mean age was 32.5 years (SD: ±11.5). Three-quarters of the respondents (75.3%, n=290) were aware of indoor air pollution. Awareness of indoor air pollution was associated with being 46 years or older, being male, having a tertiary/University education, and earning between US$104 and US$209 monthly. Ninety-four percent (n=350) used unclean cooking fuels. Use of unclean cooking fuels was significantly lower among men than women, and among respondents with primary/secondary education than those without education. Qualitative findings showed that participants used unclean cooking fuels because they were cheaper and accessible. Restrictions on the use of electric appliances by landlords and lack of electricity limited the use of gas cookers or other electric appliances.

Conclusion

Despite the high awareness of indoor air pollution, nearly all respondents reported using unclean cooking fuels.

Recommendation

Community sensitization on the health risks associated with the continued use of unclean cooking fuels is urgently needed.

A CROSS-SECTIONAL SURVEY WAS CONDUCTED TO ASSESS THE COMMUNITY-RELATED DETERMINANTS INFLUENCING THE UTILIZATION OF ADOLESCENT SEXUAL REPRODUCTIVE HEALTH SERVICES IN TONG PING AREA JUBA, SOUTH SUDAN.

2023-02-18T18:52:08+00:00

Background:

The study examined the community-related determinants influencing the utilization of ASRH services in the Tong Ping area, Juba South Sudan.

Methodology:

A cross-sectional survey research design whereby 177 adolescents (18-19 years) were interviewed. A probability sampling procedure was used to target the sample population. Quantitative data was organized and analyzed through utilization of the Statistical Package for Social Sciences and findings were presented using the percentage tables. Bivariate and Multivariate analyses were used to identify factors that categorically and jointly influence the utilization of ASRH.

Result:

The study established that community perception of reproductive health services was positively associated with utilization (P=0.049). The study further found out that there are limited or no public health facilities to provide ASRH in Tong Ping which led to expensive utilization. The study indicated that there are limited health facilities that offer almost no adolescent health care to the users.

The study indicated that adolescents have to move long distances to access health services. Tong Ping residents have to travel to either Juba Teaching Hospital or Munuki PHCC to access public treatment. This turns out to be very long distances that require transport costs.

However, it found out that the healthcare-seeking behavior makes it difficult to utilize adolescent healthcare services because of the perception in communities that whoever uses reproductive healthcare is a prostitute. It is a taboo for adolescents to seek health services related to reproductive health.

Conclusion:

Younger adolescents are inquisitive and have been adequately reached with SRH information and services. Due to cultural beliefs like early marriages, utilization of SRH has been hampered because the assumed users are compromised. Health care is usually sought more in critical conditions than preventive.

Recommendation:

Active sensitization of adolescents should be done through boosting peer education.

SOCIETAL-SPECIFIC FACTORS RELATED TO ADHERENCE TO ROUTINE NON-PHARMACOLOGIC INTERVENTIONS AMONG PATIENTS WITH CHRONIC ILLNESSES ATTENDING LUWEERO HEALTH CENTER IV.

2023-10-23T19:23:09+00:00

Background:

The study aims to determine societal-specific factors related to adherence to routine non-pharmacologic interventions among patients with chronic illnesses attending Luweero HC IV.

Methodology:

A cross-sectional survey design using questionnaires was adopted to collect data from 326 patients with chronic illnesses visiting Luweero Health Centre IV. This district is located approximately 47 miles from north Kampala. This center was chosen based on the number of patients having chronic illnesses, attending and receiving services. A simple random sampling technique was used to select patients, and only those who met inclusion criteria were interviewed. Purposive sampling was used to select 5 health professionals in charge of chronic illnesses.

Results:

Out of the 326 patients who participated in the study, adherence to routine non-pharmacologic interventions due to societal-specific factors was lowest (33.3%) amongst patients with cultural beliefs and highest (74.4%), amongst patients who have no cultural beliefs, highest (61.0%) amongst patients who believed that non-pharmacological treatment takes long, unlike amongst patients whose belief is that herbs and traditionalist treat best 36.2%. The lowest among patients whose cultural practices are ritual performances done on patients by traditionalists is 43.2% and the highest amongst patients whose cultural practice is taking herbs is 78.8%.

Conclusion:

All societal factors at multivariate analysis were found to have an impact on adherence to routine non-pharmacological interventions.

Recommendation:

Non-pharmacologic interventionists to design and institute group visiting mechanisms, especially among patients who are unmarried if routine adherence is to be improved.

KNOWLEDGE, ATTITUDE, AND PRACTICES TOWARDS THE CARE OF EPILEPTIC PATIENTS BY THEIR CARETAKERS ATTENDING THE OUTPATIENT DEPARTMENT IN KAPCHORWA HOSPITAL, KAPCHORWA DISTRICT. A CROSS-SECTIONAL STUDY.

2023-07-08T14:27:37+00:00

Background:

The specific objectives were to determine the knowledge, and assess attitudes towards the care of epileptic patients among their caretakers, and to explore the common treatment practices done by the caretakers of epileptic patients attending outpatient departments in Kapchorwa Hospital, Kapchorwa District.

Methodology:

A facility-based cross-sectional study that involved both quantitative and qualitative methods was used. 50 respondents were selected using simple random sampling and interviewed using a questionnaire with closed-ended questions.

Results:

The majority (56%) of the respondents were aged >35, female (64%), Sabinys (84%), Majority (84%) of the participants had heard about epilepsy and more than half (58%) didn’t know about the cause of epilepsy. The majority (96%) of them could recognize when their patients got an attack, less than half (46%) reported that loss of consciousness helped them notice an attack among their patients and less than half (40%) reported that emotional distance made their patients get an attack. The majority (64%) of the participants reported that epileptic patients are normal people, the majority (60%) reported their patients should not be employed, less than half (48%) rushed their patients to the hospital and most (36%) reported lying their patient down as the first aid they gave.

Conclusion:

Knowledge of the care of epileptic patients by their caretakers was fairly satisfactory their attitude and practices towards the care of epileptic patients were most likely to expose their patients to some degree of stigma and low self-esteem due to their belief that they are mad people, should not be employed nor get married.

Recommendations:

Health workers attending to epileptic patients and their caretakers at the outpatient department of Kapchorwa Hospital should continue to health educate caretakers to increase awareness about the cause, symptoms, and treatment options for epileptic patients and to decrease the negative attitude of the community.

KNOWLEDGE, ATTITUDE, AND PRACTICES TOWARDS ALCOHOL ABUSE AMONG MEN AGED (20-45) YEARS IN KILHUBO VILLAGE, NGAMBA SUB COUNTY, BUNDIBUGYO DISTRICT. A CROSS-SECTIONAL STUDY.

2023-07-08T14:07:10+00:00

Background

This study aimed to assess "Knowledge, Attitude, and Practices on alcohol abuse among men in Kilhubo Village Bundibugyo District." The specific objectives were: to assess knowledge towards alcohol abuse among men aged 20-45 years, to assess attitude towards alcohol abuse among men aged 20-45 years, and to assess practices towards alcohol abuse among men aged 20- 45 years.

Methodology

A cross-sectional study design was used, and the target population was men aged 20-45 years. A sample size of 70 participants was used and data was obtained by using questionnaires, data were entered into, analyzed, and presented information pie charts, tables, and graphs.

Results

Findings from knowledge towards alcohol abuse among me aged 20-45 years revealed that 82%had ever heard of alcohol abuse and knew its side effects, most (65%) knew possible reasons why alcohol is abused outlining some as stress, ready availability, and 34% heard information about alcohol abuse from churches and community events. Regarding results from attitude, 92.9% had a negative attitude, and 76.7% had a positive attitude about alcohol abuse as abusers themselves. Findings from practice revealed that 57.1% drank locally brewed alcohol and 46% drank from bars.

Conclusion

Generally, the researcher concluded that the majority had ever heard of alcohol abuse and knew its side effects, knew possible reasons why alcohol was abused outlining some as stress, readily availability, heard information about alcohol abuse from churches and community events, had a negative attitude, those who had positive attitude alcohol abuse were abusers themselves, drunk locally brewed alcohol and drunk from bars.

Recommendation

The researcher recommended that the Ministry of Health should be in touch with the government together with the community members to increase awareness of the effects of alcohol and its outcomes.

ATTITUDE TOWARDS CERVICAL CANCER SCREENING AMONG WOMEN 25-49 YEARS IN ENTEBBE MUNICIPALITY, WAKISO DISTRICT. A CROSS-SECTIONAL STUDY.

2023-02-18T09:38:46+00:00

Background:

The study aims to assess attitudes towards Cervical Cancer Screening and how they influence the likelihood of women accessing screening services in Entebbe Municipality.

Methodology:

The study used a cross-sectional study. Participants were chosen from each division using proportionate sampling, yielding a total of 246 participants in both divisions. Data from study participants were collected using an interviewer-administered questionnaire. The collected data was cleaned, coded, and entered into an MS Excel spreadsheet 2013, after which it was exported to EPI-INFO Version 7 statistical software for Windows for analysis.

Results:

Respondents had a poor attitude which negatively influenced the uptake of cervical cancer screening. The majority would go for a cervical cancer screening test if given the chance (81.3%, 200%). 148 (60.16%) have never been encouraged by their partners or others to go for Cervical Cancer Screening, (68.29%, n=168) presented a neutral response concerning the affordability of Cervical Cancer Screening. (59.76%, n=147) mentioned screening is pleasant, not embarrassing and (56.50%, n=139) were neutral about the painful procedure for Cervical cancer screening. 68(27.87) of the respondents were Single, were married 150(61.48), 6(2.46) were Co- habiting, 17(6.97) were separated and 3(1.23) were Divorced. 28(28.13) had no formal education, 54(21.95) Primary, 128(52.03) Secondary and 44(17.89) had Tertiary level education.

Conclusions:

Women of childbearing age have not yet embraced and owned the responsibility and initiative to utilize and motivate their fellow women to utilize the available cervical cancer screening campaigns even though they know the associated benefits.

Recommendation:

Continuous sensitization of the community about the benefits of cervical cancer screening should be rolled out and maintained throughout the whole country while emphasizing reassuring women that the examination procedure will still protect their dignity and values.

A CROSS-SECTIONAL ASSESSMENT ON SOLID WASTE MANAGEMENT PRACTICES IN MUBENDE MUNICIPALITY, UGANDA.

2024-04-17T09:25:16+00:00

Background:

Mubende Municipality is a developing municipality located in Uganda's central region. As a result of urbanization, the human population has increased. The rise in population due to industrialization and farming has resulted in increased municipal solid waste (MSW) accumulation. The purpose of this study was to assess solid waste management practices in Mubende municipality, Mubende District.

Methods:

A cross-sectional descriptive design was employed in the study. The South Division, West Division, and East Division are the three municipal divisions where the study was conducted. A simple random sampling technique was used in the investigation to select 400 respondents at random from each of the three divisions. The study's data was collected through observations, interviews, and questionnaires. Data were analyzed using descriptive statistics.

Results:

The sources of MSW in Mubende District were 50.5% households, 21.5% markets, 13.25% commercial areas, 11.5% industries, and 3.25% institutions. Organic waste accounts for the majority of solid waste generated in Mubende (34.50% agricultural waste and 23.0% food waste). Food scraps from households made up 23.00% of municipal solid waste. Plastics and polythene are also considered solid waste accounting for 16.75% and 13.75% respectively. The most common methods of waste management were landfills 45% and burning 27.50%.

Conclusion:

Organic waste accounts for the majority of solid waste generated in Mubende Municipality. Mubende Municipality's preferred solid waste management methods are landfilling, open burning, composting, and indiscriminate dumping. However, these methods are frequently mismanaged, as evidenced by the visible heaps of rotting garbage and scattered and uncollected solid waste.

Recommendation:

Mubende Municipality officials should consider building and maintaining solid waste collection points to prevent waste from spreading throughout open spaces, streets, and water streams. This will reduce the amount of solid waste dispersed and the resulting unsanitary conditions at central collection sites.

SELF-MANAGEMENT GOAL SETTING AMONG WOMEN DIAGNOSED WITH GESTATIONAL DIABETES MELLITUS; A CROSS-SECTIONAL STUDY IN A LOW-INCOME SETTING IN CENTRAL UGANDA.

2024-03-24T16:30:22+00:00

Background:

Copying with a diagnosis of Gestational Diabetes Mellitus (GDM) is very stressful and the task of GDM Self-management is challenging given the circumstances that surround the diagnosis amidst the challenges of pregnancy. In Uganda, little is known about how women diagnosed with the condition manage it through pregnancy. The study assessed the prevalence of self-management goal setting and associated factors among women diagnosed with Gestational Diabetes Mellitus in a low-income setting in central Uganda.

Methodology:

A cross-sectional study was done among 245 women who attended antenatal care in the selected 16 health facilities within Wakiso district, central Uganda who were diagnosed with GDM during their visit to the Clinics from July 2021 to May 2022. Data was collected using telephone interviews, and analyzed using SPSS, the results were reported in the form of tables and figures. Data was collected from March 2023 to May 2023.

Results:

The majority 123(53.9%) of the respondents were aged between 28 to 37 years old. Only 17% (n=41) of women diagnosed with GDM managed to set a self-management goal. The common self-management goals set include doing 1-2 Ultrasound scans during pregnancy to monitor the baby 82.93%(n=34%), followed by doing regular exercises 63.41% (n=26) and eating a regular diet every day 53.66% (n=22).

Conclusion:

Only a small proportion of women diagnosed with GDM can set self-management goals with common goals being doing Ultrasound scans, regular exercise, and eating regular diets.

Recommendation:

There is a need for public health specialists to study the factors that might be associated with setting self-management goals in a low-income setting of Wakiso district, Uganda.

THE ROLE OF BACTERIAL TRANSLOCATION AND MICROBIOTA IN INTESTINAL BLOCKAGE: AN EXPERIMENTAL STUDY.

2024-06-04T20:10:29+00:00

Background:

The objective of this study is to investigate bacterial typing (BT) in the context of infectious diseases (I.O.), including the identification of pathogens, their transmission routes, and common characteristics.

Methods:

The study included 90 albino male rats in three groups: control (GI), simple ileal blockage (GII), and strangulated (GIII). Various surgical procedures were conducted under intramuscular ketamine anesthesia. Biochemical analysis measured CRP, IL-10, and oxidant and antioxidant activities. Histopathology assessed mucosal injury and inflammatory cell infiltration. Bacteriological examination identified bacterial species and CFU by cultivating tissue and blood samples.

Observation:

Strangulated intestinal obstruction increased bacterial proliferation, oxidative stress indicators, and IL-10 response, according to the study. The mean CFU/g of luminal bacteria count was 8.8 × 108 in GI, 5.6 × 1010 in GII, and 1.4 × 1012 in GIII. Mean MDA levels were 5.5 ± 0.5 in GI, 12.0 ± 1.9 in GII, and 21.9 ± 1.0 in GIII. The mean GPx levels were 125 ± 30 in GI, 165 ± 40 in GII, and 150 ± 35 in GIII. The mean IL-10 levels were 50 ± 15 in GI, 36 ± 12 in GII, and 9 ± 3 in GIII. Bacterial translocation was polymicrobial, with 49% in GII and 60% in GIII. Most enteric bacteria were E. coli, 42.2% in GII and 45.5% in GIII.

Conclusion:

Intestinal obstruction causes bidirectional bacterial translocation through a systemic portal, with a three-hit model primarily responsible for the ensuing inflammatory response. A non-selective marker of possible I.O. cases is the C-reactive protein. The C-reactive protein serves as an indicator of both Impaired blood flow to the tissues and the level of BT.

Recommendations:

Further studies should focus on developing more specific markers for early diagnosis of intestinal obstruction subtypes and exploring potential therapeutic interventions to manage bacterial translocation effectively

A RETROSPECTIVE ANALYSIS OF SELECTIVE HISTOLOGICAL EXAMINATION VERSUS ROUTINE HISTOLOGICAL EXAMINATION AFTER CHOLECYSTECTOMY FOR GALLBLADDER STONES.

2024-06-19T15:12:22+00:00

Background

The usual histological examination is carried out after the cholecystectomy procedure has been completed to determine whether or not the patient has a malignancy. There is a very low probability that cancer will be discovered during a routine checkup after cholecystectomy. The study aims to investigate the incidence of gall bladder cancer among patients who have had cholecystectomy surgeries.

Method

A retrospective study was conducted and the data of the patients who underwent cholecystectomy for gallbladder stones were included in this study. The patients in which incidental gall bladder cancer was recorded were compared with the patients with no gall bladder cancer in terms of the morphology of the gall bladder, histopathology of the gall bladder specimen, and other clinical features. The risk factors associated with gall bladder cancer were determined.

Results

Out of 1198 cases analyzed, 4 patients (0.33%) had IGBC. The average age was 53 years, with malignancy patients averaging 72 years and benign cases 43 years. Among IGBC patients, 3 were female and 1 male, showing a significant correlation with female gender (p < 0.05). Emergency cholecystectomy was performed in 143 cases, with 3 (2.1%) having cancer, compared to 1 in the elective surgery group (p = 0.02). All cancer patients exhibited macroscopic abnormalities like thickened walls, polyps, ulceration, and calcification. The average survival time for IGBC patients was 15 months, with treatments including chemotherapy and radiotherapy.

Conclusion

Risk factors associated with gall bladder cancer identified in this study include female gender, advanced age, conversion of the surgery, emergency surgery, and macroscopic abnormalities in the gall. Selective histopathology for diagnosis of gall bladder cancer in patients undergoing cholecystectomy is effective and does not compromise the health of the patients.

Recommendation

Selective histopathology should be preferred over routine histopathological examination after cholecystectomy.

Pregabalin vs. Duloxetine for Postoperative Analgesic Requirements Following Lower Limb Orthopaedic Surgery

2024-06-30T16:29:16+00:00

Background: Pregabalin and duloxetine have been used as an analgesic after lower lumbar trauma surgeries. The effectiveness of both drugs is not compared in the literature. Here the response rate of rescue is compared between both analgesics.

Method: In total, the 60 patients who underwent the lower lumbar trauma surgery were considered for this study. They were divided into two groups one of them received pregabalin 6 and the other received duloxetine. The method of surgery was similar in both groups. The response rescue rate was measured and compared. The patient’s satisfaction score, visual analogue score, total analgesia induced, and movements after the surgery were also studied.

Results: The rescue response analgesia was required in the pregabalin group after 24 hours in 60% of the patients. Whereas the duloxetine group required analgesia after 24 hours in 50% of the patients The second dose was required after 72 hours in 6.6% of the patients in the pregabalin group. In the duloxetine group second dose was required in 10% of the patients after 40 hours.

Conclusion: The dose requirement and the other parameters when compared statistically there was no significant difference obtained in the pregabalin group and duloxetine group.

Recommendation: Pregabalin and duloxetine can be used effectively in postoperative lower limb surgeries without any significant difference

Comparative Study Between Laparoscopic Versus Appendectomy in Obese Patients

2024-06-30T14:58:57+00:00

Background: The two main surgical therapies for appendicitis are laparoscopic appendectomy (LA) and open appendectomy (OA). Appendicitis is a major surgical emergency. As obese individuals have a higher risk of surgical complications, choosing the best course of action is essential. In order to produce recommendations based on solid information, this study compares the results of LA versus OA in obese people.

Methods: Ninety patients with appendicitis with a BMI of 30 or more were randomised into two groups: the OA group, which included 45 individuals, and the LA group, which included 45 patients. SPSS Statistics Version 23.0 was used to gather and analyse data on demographics, postoperative complications, length of hospital stay, surgical time, pain levels, and recovery durations.

Results: In comparison to the OA group, the LA group experienced considerably shorter hospital stays (2.1 ± 0.7 days) and operative times (45.3 ± 10.1 minutes vs. 60.4 ± 12.3 minutes, p < 0.001). The LA group experienced less postoperative complications (11.1% vs. 26.7%, p = 0.04). The LA group also had reduced pain levels 24 hours after surgery (3.5 ± 1.4 vs. 5.6 ± 1.7, p < 0.001). Readmission rates and delayed complications were among the long-term outcomes that did not significantly differ across the groups.

Conclusion: When compared to OA, LA is linked to shorter operating and recovery periods, less pain during surgery, and fewer problems in obese patients. These results validate LA as the recommended surgical treatment for obesity-related appendicitis.

Recommendations: Due to its benefits in terms of efficiency and safety, LA ought to be the norm for treating appendicitis in obese patients. It is advised to perform more studies with larger sample sizes and longer follow-up times in order to validate these results and evaluate long-term effects.

Evaluation of Laparoscopic Cholecystectomy Difficulty During the COVID-19 Pandemic Using Externally Validated Prediction Models: A Retrospective Cohort Study

2024-06-30T14:38:35+00:00

Background: The COVID-19 pandemic has posed significant challenges to surgical procedures, including laparoscopic cholecystectomy. Assessing the difficulty of these surgeries during the pandemic is crucial for optimizing outcomes and resource allocation. This study aims to evaluate the difficulty of laparoscopic cholecystectomy during the COVID-19 pandemic using externally validated prediction models.

Methods: A total of 120 patients who underwent laparoscopic or open cholecystectomy were included. The CholeS and Randhawa scoring systems were used to predict operative difficulty. Data on demographics, clinical presentation, laboratory results, and surgical outcomes were collected and analyzed using SPSS version 21.0.

Results: The mean age of patients was 45.3 years, with 48.3% male and 51.7% female. The mean CholeS score was 8.5, and the mean Randhawa score was 7.1. Operative difficulty was classified as easy (33.3%), difficult (54.2%), and very difficult (12.5%). Significant correlations were found between higher preoperative scores and increased operative difficulty, longer operation duration, and higher complication rates. Odds ratios for CholeS and Randhawa scores predicting operative difficulty were 1.25 (95% CI: 1.12-1.39) and 1.30 (95% CI: 1.15-1.45), respectively.

Conclusion: Externally validated prediction models effectively assess the difficulty of laparoscopic cholecystectomy during the COVID-19 pandemic. Higher preoperative scores were associated with increased operative challenges and complications.

Recommendations: Preoperative risk stratification using the CholeS and Randhawa scores should be integrated into clinical practice to improve surgical planning and patient outcomes. Further prospective studies with larger sample sizes are recommended to confirm these findings.

The Effect of Oral Nutritional Supplements on Nutritional Risk in Post-Discharge Patients After Colorectal Cancer Surgery: A Randomized Clinical Trial

2024-06-30T14:27:42+00:00

Background: Colorectal cancer surgery often leaves patients at nutritional risk, impacting their recovery and quality of life. Oral nutritional supplements (ONS) may offer benefits in improving nutritional status and overall health outcomes in these patients. This study aimed to evaluate the impact of ONS on post-discharge patients at nutritional risk following colorectal cancer surgery.

Methods: A randomized clinical trial was conducted, including a total of 160 patients with a Nutritional Risk Screening 2002 (NRS 2002) score of 3 or higher were randomized into the ONS group (n=80) and control group (n=80). The ONS group received dietary advice and Nutren® Optimum for three months, while the control group received only dietary advice. Nutritional outcomes, readmission rates, chemotherapy tolerance, and quality of life (QoL) were assessed.

Results: Out of the 160 enrolled patients, 148 completed the study. The ONS group showed significant improvements in weight (63.5 ± 10.2 kg vs. 61.0 ± 9.8 kg, p=0.048), BMI (23.4 ± 3.2 kg/m² vs. 22.0 ± 3.4 kg/m², p=0.018), serum albumin (3.8 ± 0.4 g/dL vs. 3.5 ± 0.5 g/dL, p<0.001), and hemoglobin levels (12.5 ± 1.1 g/dL vs. 11.8 ± 1.3 g/dL, p=0.002) compared to the control group. The ONS group also had lower readmission rates (10.8% vs. 24.3%, p=0.034) and higher chemotherapy tolerance (83.8% vs. 70.3%, p=0.047). QoL scores were significantly better in the ONS group across multiple domains.

Conclusion: The use of ONS significantly improves nutritional status, reduces readmission rates, enhances chemotherapy tolerance, and improves the quality of life in post-discharge patients following colorectal cancer surgery.

Recommendations: Incorporating ONS into the post-discharge care plan for colorectal cancer patients at nutritional risk is recommended to enhance recovery and improve health outcomes.

Comparing Techniques for Abdominal Rectopexy in Rectal Prolapse: A randomized controlled study

2024-06-30T13:58:35+00:00

Background: Abdominal rectopexy is a surgical option for rectal prolapse, but various techniques exist, prompting the need for comparative studies to assess their efficacy and safety. The study aimed to compare different techniques of abdominal rectopexy for rectal prolapse treatment, evaluating their effectiveness, safety, and long-term outcomes.

Methods: A randomized controlled trial design was employed. Forty participants meeting inclusion criteria (full-thickness rectal prolapse, ability to participate, informed consent) were included. Exclusion criteria encompassed irreducible prolapse, age below 18, and pregnancy. Randomization, stratification, and blinding techniques were used to minimize bias. Primary outcomes included bowel function, quality of life (QoL), recurrence rates, and surgical complications, assessed using validated measures and statistical analyses.

Results: Forty participants were randomized into perineal (n=20) or abdominal (n=20) groups. Both groups showed significant improvement in bowel function postoperatively (p < 0.001), with increased bowel movements, faster evacuation, and reduced incomplete evacuation. QoL scores significantly improved across all dimensions (p < 0.001). Recurrence rates were 10% in the perineal group at 1 year and increased to 15% at 3 years. Minor complications occurred in 20% of perineal and 15% of abdominal cases within 30 days, with no major complications.

Conclusion: Abdominal rectopexy techniques demonstrate improved bowel function and QoL, but long-term recurrence rates require monitoring. Both perineal and abdominal approaches show safety and efficacy, with considerations for recurrence and minor complications.

Recommendations: Continued follow-up and larger studies are recommended to validate findings and guide clinical practice.

PREDICTING DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY USING CYSTIC DUCT DISSECTION TIME: A COHORT STUDY.

2024-06-02T18:23:10+00:00

Background:

Laparoscopic cholecystectomy (LC) has emerged as the preferred surgical approach for gallstone disease due to its minimally invasive nature. However, predicting the difficulty of this procedure remains crucial for surgical planning and patient safety. To provide a safe and successful procedure, the study aims to analyze quantitative characteristics that predict difficult laparoscopic cholecystectomy (DLC) and the use of various bailout procedures.

Methods:

A prospective cohort study was conducted at MDB Autonomous State Medical College, Deoria, India, from July 2021 to July 2022. Fifty patients undergoing laparoscopic cholecystectomy were included based on specific criteria. Demographic, clinical, and surgical variables were collected, and statistical analyses were performed to identify predictors of difficult laparoscopic cholecystectomy (DLC).

Results:

The average age of the participants was 49.2 ± 6.7 years. The study revealed significant associations between urgent cholecystectomy and the use of bailout procedures (OR = 2.75, p = 0.012). Multinomial logistic regression also showed significant predictors of operative time, including BMI (β = 0.287, p = 0.008) and previous surgical history (β = -0.215, p = 0.036). A ROC curve analysis demonstrated moderate predictive accuracy (AUC = 0.78) for an operative time in predicting DLC.

Conclusion:

Preoperative assessment of body mass index, previous surgical history, and operative time can aid in predicting the difficulty of laparoscopic cholecystectomy. These findings underscore the importance of comprehensive evaluation and surgical planning to ensure safe and successful outcomes.

Recommendations:

Clinicians should consider incorporating preoperative predictors, such as BMI and surgical history, into their decision-making process for laparoscopic cholecystectomy. Future studies may further validate these predictors and explore additional factors influencing surgical difficulty.

A COHORT STUDY COMPARING THE SHORT-TERM OUTCOME OF NEWBORN INFANTS: SPINAL VERSUS GENERAL ANAESTHESIA IN ELECTIVE CESAREAN SECTION.

2024-06-18T19:20:44+00:00

Background:

During C-sections, general anesthesia is required to guarantee the safety of the fetus and the mother. In this retrospective cohort investigation, average variations in hematocrit and predicted loss of blood, newborn Apgar evaluation at one and five minutes, and postoperative hemodynamic parameters (prior- and following surgery systolic blood pressure, heart rate) were used to compare maternal and fetal results among general and spinal sedation for C-sections. The study aims to compare maternal and fetal outcomes between spinal anesthesia and general anesthesia in elective cesarean sections.

Methods:

A retrospective study was performed on information collected from electronic health records of 227 pregnancies with one child between X to Y; 200 instances were given to the spinal category (n = 100) or general category (n = 100), and 27 cases were excluded.

Results:

The overall organization's afterward hemodynamic results (SBP: 136 ± 16.5 vs. 120 ± 12.5 mmHg, heart rate: 93.0 ± 17 vs. 71.0 ± 12.5 beats per min, P < 0.001) were significantly greater than those of the spinal category. Furthermore, a statistically significant distinction was observed (P < 0.001) between the prior and afterward hematocrit in the overall category compared to the spinal category (4.8 ± 3.5% vs. 2.3 ± 4.0%, each). In the overall category, compared to the spinal category, there was a greater percentage of newborns with 5-min Apgar scores < 7 (6/141 [4.3%] vs. 0/146 [0%], accordingly, P = 0.012).

Conclusion:

Compared to the spinal category during cesarean sections, the general category is linked to greater maternal loss of blood and a higher percentage of infants with 5-minute Apgar evaluation < 7.

Recommendations:

Based on the study's findings, it is recommended to prefer spinal anesthesia over general anesthesia for elective cesarean sections to minimize maternal blood loss and improve neonatal Apgar scores.

Impact of Preoperative Hair Removal on Surgical Site Infection in Elective Abdominal Surgery

2024-06-30T14:47:29+00:00

Background: Hair removal before surgery is common to avoid surgical site infections. The impact of this approach on SSI rates, especially in elective abdominal procedures, is debatable. This study aims to evaluate the impact of preoperative hair removal on the incidence of SSI and postoperative pain in patients undergoing elective abdominal surgeries.

Methods: A prospective comparative cohort study involved two hundred patients undergoing elective abdominal surgery were divided into two groups: Group A (preoperative hair shaving) and Group B (no preoperative hair shaving). Demographic data, SSI incidence, and pain during dressing changes were recorded and analyzed using chi-square, Fisher's exact test, and Mann–Whitney U test.

Results: The incidence of SSI in Group A was 8% on day 7, 10% on day 14, and 12% on day 30, compared to 4%, 6%, and 8%, respectively, in Group B. However, these differences were not statistically significant (p > 0.05). Pain during dressing changes was significantly higher in Group A, with a mean VAS score of 3.8 ± 1.2 compared to 2.7 ± 1.1 in Group B (p < 0.001). Subgroup analysis revealed no significant difference in SSI rates between clean and clean-contaminated surgeries within each group. Clean surgeries in Group A had an SSI rate of 4%, while Group B had 2%. Clean-contaminated surgeries had an SSI rate of 16% in Group A and 12% in Group B, with no statistically significant differences (p > 0.05).

Conclusion: Preoperative hair removal increases dressing change pain but does not affect elective abdominal surgery SSI rates. The findings show that standard preoperative hair removal may not be necessary and might be reconsidered to improve patient comfort.

Recommendations: Further research with larger sample sizes and extended follow-up periods is recommended to confirm these findings and develop evidence-based guidelines for preoperative hair removal practices.

Exploring Pulmonary Embolism in Emergency Department Patients Presenting with Chest Pain: A Retrospective Multicenter Study

2024-06-27T09:39:21+00:00

Background:

Emergency department (ED) visits due to chest pain are common, and they can be caused by a wide range of differential diagnoses, including potentially fatal illnesses like pulmonary embolism (PE). Recent advancements in diagnostic strategies have aimed to improve the accuracy and efficiency of identifying the underlying cause of chest pain, thereby optimizing patient management and outcomes. This study aimed to assess the diagnostic accuracy and clinical outcomes associated with current protocols for evaluating chest pain.

Methods:

A retrospective multicenter study was carried out over one year. A total of 200 patients presenting with chest pain were included, and data were collected regarding demographic characteristics, clinical presentations, diagnostic procedures (including D-dimer, CT pulmonary angiography), and outcomes.

Results:

The participants had a mean age of 56.3 years (± 12.7), with 60% males and 40% females. Common comorbidities included hypertension (47.5%) and diabetes (30%). Symptom duration averaged 12.5 hours (± 6.3). Past medical histories included coronary artery disease (15%) and prior DVT/PE (5%). Among the cohort, 25% of patients underwent diagnostic testing for PE, with 60% of these cases confirming the diagnosis. Factors such as age (>65 years), comorbidities (especially cardiovascular diseases), and specific chest pain characteristics (pleuritic and sharp quality) were significantly associated with a higher likelihood of initiating diagnostic workup for PE.

Conclusion:

The study underscores the complexity of diagnosing PE among people presenting with chest pain, emphasizing the utility of integrated clinical assessment and advanced imaging techniques. Improved adherence to standardized diagnostic algorithms and risk stratification tools could enhance diagnostic accuracy and optimize patient care outcomes.

Recommendations:

Based on the findings, it is recommended to integrate high-sensitivity biomarkers and structured risk assessment tools (e.g., HEART score, PERC rule) into routine ED practice to expedite diagnostic decision-making and improve resource utilization.

A Narrative Review on Advancements and Challenges in Palliative Care for Elderly Patients with Hip Fractures

2024-06-30T15:50:22+00:00

Background: Hip fractures in the elderly are a major public health issue, with a rising incidence due to the aging global population. These fractures not only cause significant physical disability but also lead to psychological and social challenges, with a high associated mortality rate. Surgical decision-making in hip fracture repair is complex, requiring careful consideration of the patient's overall health, comorbidities, and life expectancy.

Objective: This review aims to explore the multifaceted approach to managing hip fractures in the elderly, focusing on surgical decision-making, the role of palliative care, and the balance between curative and palliative treatment strategies.

Review Summary: The review discusses the epidemiology and risk factors of hip fractures, highlighting the need for preventive strategies. It delves into the surgical decision-making process, examining the criteria for intervention and the outcomes of different surgical approaches. The role of palliative care is emphasized, focusing on pain management, quality of life, and support for families and caregivers. The review underscores the importance of a multidisciplinary approach in managing these patients, involving both surgical intervention and comprehensive palliative care.

Future Implications and Clinical Policy Development: The findings suggest a need for evolving clinical policies that integrate palliative care principles into the management of hip fractures in the elderly. Future implications include developing standardized protocols for surgical decision-making and enhancing palliative care services to improve patient outcomes.

A Cross-Sectional Study on Long-Term Effects of Ligation of Inter-Sphincteric Fistula Tract (LIFT) for Treating Trans-Sphincteric Anal Fistula

2024-06-30T13:52:16+00:00

Background: The Ligation of Inter-Sphincteric Fistula Tract (LIFT) procedure represents a significant advancement in the treatment of trans-sphincteric anal fistulas (TSAF), balancing effective treatment with the preservation of sphincter integrity. The technique primarily aims to maintain continence while achieving a high rate of healing by identifying and ligating the fistula tract within the intersphincteric space, thereby minimizing damage to the sphincter muscles. The study seeks to estimate the long-term efficacy and outcomes of the LIFT procedure as a management strategy for TSAF.

Methods: A cross-sectional study was carried out and involved sixty participants with trans-sphincteric peri-anal fistulas of cryptoglandular origin confirmed by MRI fistulogram were included. The surgical procedure involved identifying, ligating, transecting, and excising the fistula tract within the inter-sphincteric space. Data on peri-operative infection rates, healing time, discomfort levels, fecal continence, and recurrence rates were collected and analyzed using SPSS software version 22.

Results: The study included 60 participants (40 males, 20 females) with an average age of 42.5 years. The average healing time post-surgery was 32.4 days. The peri-operative infection rate was 8.3%, and the recurrence rate was 5%. No significant changes were noted in fecal continence post-surgery. The degree of discomfort and recovery time had a strong positive link, according to Pearson's correlation test.

Conclusion: The LIFT procedure is an effective and safe treatment option for TSAF, demonstrating high healing rates, low recurrence, and preservation of continence.

Recommendations: Future research should explore modifications of the LIFT technique to further reduce discomfort and improve healing times. Long-term follow-up studies are recommended to assess the durability of surgical outcomes.

Comparison of the left and right sides of patella: Anatomic differences

2024-06-30T16:33:20+00:00

Background: The bone in the knee patella is particularly important for conducting surgeries in the knee region. The dimensions and measurements of the patella might vary depending on the population and even the sides. This study is carried out to determine the difference in the patella, specifically between the two sides.

Method: In total 20 patella from the right side and 20 patella from the left side were taken for the study. The height, width, thickness of the ridge, and distance from the articular facets were determined for each of them. The data obtained was subjected to statistical analysis. Mean and standard deviation were recorded. The statistical significance of the difference was determined between the left and the right sides.

Results: Statistically it was found that there was no difference between the various parameters associated with the patella. However, it was found that the distance from the medial articular facet and the lateral articular facet was significantly different with the p-values of 0.138 and 0.136 respectively. The findings of this study were from the studies carried out previously.

Conclusion: There is no significant difference in the dimensions and features of the patella on comparing the patella of the left side and right side. The one significantly different feature was the distance between the medial articular facet and the lateral articular facet.

Recommendation: The anatomy of the patella particularly the distance for the medial and lateral articular facet should be evaluated before conduction surgeries in the knee region.

Exploring Anatomical Variations of the Brachiocephalic Artery and Their Clinical Significance: A Study Utilising Cadaveric Specimens

2024-06-30T15:36:40+00:00

Background: The brachiocephalic artery (BCA) is a critical vascular structure that streams blood to the right side of the head, neck, and upper limb. Anatomical variations in the BCA can significantly impact clinical practices, including surgical procedures, diagnostic imaging, and the management of vascular diseases. The study investigated the anatomical differences of the BCA and their clinical relevance through a comprehensive morphometric analysis using cadaveric specimens.

Methods: 60 cadavers that had been embalmed with formalin were examined. Every cadaver's torso length was measured starting from the seventh cervical vertebra's spine and ending at the imaginary line that connects the iliac crests. The BCA was made visible by dissecting the thoracic area, and its length was determined from the point of origin to the points where it split into the right subclavian artery (RSA) and the right common carotid artery (RCCA). SPSS version 21.0 was used to analyse the data.

Results: The mean torso length was 70.3 ± 5.6 cm, and the mean BCA length was 4.2 ± 0.8 cm. Variants of the BCA were categorized into three types: Type A (50%), Type B (33.3%), and Type C (16.7%). Variations in the origin of the BCA were observed, with the typical origin in 75% of cases, Variant Origin 1 in 16.7%, and Variant Origin 2 in 8.3%. A considerable positive correlation was found between torso length and BCA length (r = 0.68, p < 0.01).

Conclusion: This study highlights the variability in BCA anatomy and its correlation with torso length. These findings have important implications for clinical and surgical practices, emphasizing the need for personalized approaches based on individual anatomical differences.

Recommendations: Clinicians and surgeons should consider these anatomical variations during preoperative planning and diagnostic imaging to improve patient outcomes.

Morphometric investigation of infraorbital foramen in human dry skulls and its clinical implications

2024-06-30T16:24:29+00:00

Background: The passage on both eth sides of the mandible bone known as the infraorbital foramen is the one through which the infraorbital vein, artery, and nerve pass. The surgical procedures in which blocking of the infraorbital nerves takes place are complicated due to the varying anatomy of the foramen. This study is conducted to determine the changes associated with gender, age, and population in the anatomy of infraorbital foramen.

Method: This study was prospectively carried out on the skulls in the anatomy department. The age, gender, and specific details regarding the infraorbital foramen such as origin, shape, dimensions, and the distance of the foramen from the anatomical landmarks taken into consideration during surgery.

Results: In all 28 skulls were studied. The location for IOF was in line with the second premolar tooth in 56% of the cases, and between the first and second in 23% of the cases. The oval shape was found in 40% of the cases and a semilunar shape in 28% of the cases. Opening was medially downward in 51% of the cases and medially in 32% of the cases. The average diameter from the transverse section of the skull was 3.30 mm and from the vertical section, it was 3.16 mm. Statistically, no difference was observed in the size, dimensions, and origin of the infraorbital foramen amongst the genders.

Conclusion: The anatomical features of the infraorbital foramen might vary from one individual to the other. Evaluation before performing surgery and anaesthesia can prevent further complications and improve the outcomes of the surgery.

Recommendation: The location of the infraorbital foramen from the significant anatomical landmarks should be studied thoroughly before performing surgery on each individual.

Title- Epidermal inclusion cyst- Usual and unusual sites

2024-06-19T07:55:10+00:00

Background

Epidermal inclusion cysts ( EIC) are the most common cutaneous cysts and can occur anywhere on the body. These cysts can occur anywhere on the body, typically present as nodules directly underneath the patient's skin, and often have a visible central punctum. It commonly result from the trauma to the pilosebaceous unit in the hair bearing area. In areas without hair, these cysts are considered implantation and proliferation of squamous epithelium into the dermis due to injury.

Objective

It is to evaluate the clinicopathologic details of the usual and unusual sites of the Epidermoid cyst.

Material & Method

Patients of epidermal inclusion cyst encountered over a period of 1 year from January 2023 to December 2023 were evaluated. A total of 70 cases were studied retrospectively. The clinical details including age, gender, sites and dimensions were noted. The histopathological findings were evaluated and correlated with the clinical findings.

Result

The highest incidence was observed in the age group of 21–30 years (21.4%, 15/70) and the most common affected region was the head and neck region (60%, 42/70). The size of cysts ranged from 0.3 to 9 cm in diameter with a mean of 2.1 cm. The unusual sites observed in this study were one at the plantar aspect of foot and one at dorsal aspect of foot. Three cases were reported from the upper eyelid, one from the breast, one from the chest, two from the gluteal region, and one from the finger. Histopathological findings included rupture of epidermoid cysts with giant cell reaction.

Conclusion

Epidermoid cysts are common benign intradermal or subcutaneous tumors,

but they can have unusual presentations and histopathological findings. Epidermoid cysts need early diagnosis and treatment as they can cause cosmetic and functional impairment.

CENTRAL CORNEAL THICKNESS IN NORMAL TENSION GLAUCOMA, PRIMARY OPEN-ANGLE GLAUCOMA, AND OCULAR HYPERTENSION: A COHORT STUDY.

2024-06-04T20:23:44+00:00

Background:

Aim: The main goal of this research is to assess the corneal thickness of individuals with primary open-angle glaucoma (POAG), ocular hypertension (OHT), and normal tension glaucoma (NTG).

Methods:

This study was done from June 2022 to May 2024. 150 patients were included in this research. A detailed history of the individuals was recorded, and a clinical examination was done. Further, an optical evaluation was done to diagnose any defect in the cornea. Direct Ophthalmoscope was utilized to rule out any harm to the optic nerve. An indirect ophthalmoscope was used for the detection of any defect in the retina.

Results:

The study found that the majority of patients were aged 51-60 years (47.8%), with 62.7% being male. The distribution of patients included 36.2% normal, 19.8% NTG, 28.7% POAG, and 15.3% OHT. The mean intraocular pressure (IOP) for males was 21.56±5.30 (right eye) and 19.60±4.79 (left eye), while for females it was 21.16±5.47 (right eye) and 20.70±4.06 (left eye), with NTG patients exhibiting significantly lower central corneal thickness (CCT) leading to potential misdiagnoses of POAG and normal cases as NTG and OHT.

Conclusion:

The CCT in normal tension glaucoma cases was notably low. Because of the intra-optical pressure outcome of CCT measurement, a lot of primary open-angle glaucoma cases were wrongly diagnosed as normal tension glaucoma cases and normal cases were wrongly diagnosed as ocular hypertension leading to mistreatment

Recommendation:

Clinicians should routinely measure central corneal thickness to improve the accuracy of glaucoma diagnosis and ensure appropriate treatment.

COMPARISON BETWEEN COAGULATION PROFILE IN NEWBORNS OF NORMAL PREGNANCY, PREECLAMPSIA AND ECLAMPSIA PATIENTS. A CROSS-SECTIONAL STUDY.

2024-06-30T12:53:58+00:00

Introduction

Preeclampsia involves endothelial dysfunction, poor placentation, vasospasm, and hematological changes. These lead to a hypercoagulable state, exacerbated in preeclampsia-eclampsia. Neonates born to hypertensive mother face risks including growth retardation, thrombocytopenia, and other complications, potentially resulting in severe neonatal issues like DIC and serious hemorrhage.

Aim

The aim of this study was to assess and compare the coagulation parameters between newborns born to women who had pre-eclampsia and eclampsia, and those born to normotensive mothers who were healthy and did not have any medical conditions.

Material and method

Present study was a cross-sectional study undertaken from June 2023 to May, 2024. 100 neonates were included in both the study and control group were on Day 1 of birth. Neonates born to mothers with eclampsia, pre-eclamptic toxemia, and gestational hypertension were further classified into the test category.

Results

A noteworthy association was noted between reductions in fetal age and modifications in every coagulation parameter. As PIH severity increased, there was a significant lengthening in partial thromboplastin time with kaolin (PTTK) and thrombin time (TT) values, as well as an increased risk of prematurity and hyperbilirubinemia. Preterm infants had a greater incidence of dissemination of intravascular coagulation (DIC) than mature neonates.

Conclusion

Pregnancy-related hypertension directly affects the unborn child of the affected woman, changing the coagulation parameters and increasing the neonate’s risk of bleeding from a decreased platelet count and a compromised coagulation profile. It has been discovered that preterm babies are more affected than term babies. Because of all these findings, this neonate group needs excellent prenatal care, resuscitation facilities, and regular monitoring of their clotting status.

A STUDY OF STROMAL CD34 AND SMOOTH MUSCLE ACTIN IMMUNOEXPRESSION IN BENIGN AND MALIGNANT BREAST LESIONS AT A TERTIARY CARE CENTER IN NORTHERN INDIA: A CROSS-SECTIONAL STUDY.

2024-06-14T09:23:04+00:00

Background

This study aimed to explore the distribution of CD34 and smooth muscle actin (SMA) positive myofibroblasts within the stroma of different benign and malignant breast lesions.

Material and methods

A total of 98 individuals with breast specimens acquired by surgery or biopsy were studied histopathologically and immunostained for CD34 and SMA using the avidin-biotin-peroxidase method. Appropriate comparisons among the distribution of CD34 and SMA along with statistical analysis were done to compare the sensitivity and specificity of each marker regarding the identification of benign and breast diseases.

Result

The histopathological findings included non-proliferative breast diseases (fibroadenoma, fibrocystic disease, phyllodes, gynecomastia, fibroadenosis), proliferative changes with and without atypia, carcinoma in situ, and invasive breast carcinoma. CD34 was positive in 98.27% of benign and negative in 92.37% of malignant breast diseases. SMA was strongly positive in 6.89% of benign and 80% of malignant breast diseases. In both DCIS and invasive breast carcinomas, there was a consistent loss of CD34 expression alongside a rise in SMA positivity. The sensitivity and specificity of CD34 stromal expression were 98.27% and 92.5%, respectively, while for SMA, they were 87.5% and 86.2%, respectively.

Conclusion

The combined assessment of CD34 and SMA holds promise as a diagnostic tool for recognizing the differences between benign and cancerous breast lesions. However, relying on either marker alone does not yield sufficiently distinct results.

Recommendations

Future studies should include detailed correlation analysis between CD34 and SMA expressions in breast fibroblasts to provide a more comprehensive understanding of their diagnostic value in distinguishing benign from malignant breast lesions.

The Study of PTEN Immunohistochemistry in Endometrial Carcinoma: Diagnostic, Prognostic and Therapeutic Implications

2024-06-30T14:30:27+00:00

Background: Endometrial carcinoma is the most common gynecologic malignancy worldwide, with a rising incidence, especially among postmenopausal women. The identification of reliable prognostic markers is crucial for improving early diagnosis and patient management. PTEN (Phosphatase and TENsin homolog), a tumor suppressor gene, has been frequently associated with endometrial carcinoma, highlighting its potential as a diagnostic and prognostic marker. This study aims to evaluate the expression of PTEN in endometrial tissues diagnosed with hyperplasia and carcinoma, and to correlate PTEN expression with the type and grade of endometrial carcinoma.

Methods: Endometrial tissue samples from 66 patients were analyzed, including 30 cases of endometrioid endometrial carcinoma (EEC), 12 cases of proliferative endometrium (PE), 12 cases of endometrial hyperplasia (EH), and 12 cases of non-endometrioid uterine malignancies (NEUM). PTEN expression was assessed using immunohistochemistry on paraffin-embedded tissue sections, and statistical analysis was performed using SPSS software version 20.

Results: PTEN expression was significantly lower in EEC compared to PE and EH (p = 0.0001). The mean PTEN scores were 235.83 ± 26.79 for PE, 94.17 ± 61.27 for EH, 31.67 ± 58.37 for EEC, and 61.67 ± 79.64 for NEUM. A significant correlation was found between reduced PTEN expression and higher tumor grade, increased myometrial invasion, and advanced tumor stage (p < 0.05).

Conclusion: PTEN expression is significantly reduced in endometrial carcinoma, particularly in higher-grade tumors and those with extensive myometrial invasion. This study underscores the potential of PTEN as a prognostic marker in endometrial carcinoma, which could be instrumental in guiding treatment strategies.

Recommendations: Further studies with larger sample sizes are recommended to validate PTEN as a routine diagnostic and prognostic marker in clinical practice. Additionally, exploring the role of PTEN in targeted therapies could provide new avenues for the treatment of endometrial carcinoma.

Estimating Contrast-Induced Nephropathy Risk with a Simplified Score: A Cohort Study

2024-06-30T15:01:29+00:00

Background: Patients receiving diagnostic and therapeutic procedures employing iodinated contrast media are at a high risk of developing Contrast-Induced Nephropathy (CIN), also known as contrast-induced acute kidney damage (CI-AKI). This study aimed to identify and characterize the risk factors associated with CIN in adult patients undertaking procedures or examinations requiring the intravenous administration of contrast material.

Methods: A cohort study was conducted involving 1200 adult participants undergoing procedures necessitating intravenous contrast medium (CM) administration. A rise in serum creatinine of at least 25% or 0.5 mg/dL during 48–72 hours of CM treatment was the main outcome. Mortality and the need for dialysis were secondary goals. To find risk factors for CIN, data analysis techniques included univariate and multivariate logistic regression.

Results: Of the 1200 participants, 780 (65%) were male with a mean age of 58 years (±10.5). Baseline conditions included diabetes mellitus in 320 (26.7%) and chronic kidney disease (CKD) in 180 (15%). CIN occurred in 180 participants (15%), 22 (1.8%) required dialysis, and 10 (0.8%) died. Univariate analysis identified age (OR = 1.32), diabetes (OR = 2.08), CKD (OR = 3.91), hypotension (OR = 4.62), and contrast volume (OR = 1.17) as significant CIN risk factors. Multivariate analysis confirmed CKD (OR = 3.20) and hypotension (OR = 3.78) as independent predictors. The model's AUC-ROC was 0.82, indicating good discrimination.

Conclusion: This study identifies age, diabetes mellitus, CKD, hypotension, and contrast volume as significant predictors of CIN. CKD and peri-procedural hypotension are independent predictors. The developed model demonstrates good predictive ability, emphasizing the need for targeted preventive strategies.

Recommendations: To reduce CIN risk, it is crucial to screen for and manage CKD and peri-procedural hypotension in patients undergoing contrast-enhanced procedures. Adequate hydration, minimizing contrast volume, and using iso-osmolar contrast agents are recommended preventive measures.

Lipid Dysregulation in Gestational Diabetes Mellitus: Predicting Early Onset and Postpartum Outcomes

2024-06-02T18:03:16+00:00

Background: Gestational diabetes mellitus (GDM) poses significant health risks during pregnancy and beyond, necessitating research into predictive markers and management strategies. Lipid dysregulation, influenced by hormonal changes, plays a pivotal role in GDM pathophysiology.

Objective: The review aims to synthesize current research on lipid dysregulation in GDM, focusing on its predictive value for early onset and postpartum outcomes, and to explore therapeutic implications.

Review Summary: Lipid metabolism undergoes profound changes during pregnancy, further exacerbated in GDM. Elevated triglycerides, altered cholesterol levels, and disrupted lipid ratios are associated with increased GDM risk. Biomarkers like hs-CRP, SHBG, and miRNAs show promise for early GDM prediction. Postpartum lipidomic profiles reveal persisting dysregulation linked to future type 2 diabetes (T2DM) risk. Lactation may mitigate postpartum lipid changes and reduce T2DM risk.

Clinical Policy and Development: The review underscores the importance of monitoring lipid profiles during pregnancy, employing early predictive biomarkers, and implementing personalized management strategies to mitigate GDM risks. Targeted interventions during pregnancy and postpartum lactation could aid in preventing or delaying T2DM onset.

Future Implications: Further research into novel biomarkers, longitudinal lipid profiling, and tailored interventions is warranted to enhance GDM prediction and management, ultimately improving maternal and fetal health outcomes.

EXPLORING SILENT HEART ATTACKS IN TYPE 2 DIABETES PATIENTS FACTORS INFLUENCING OCCURRENCE, BHAGALPUR: A CROSS-SECTIONAL STUDY AT HOSPITALS

2024-05-29T16:29:48+00:00

Background

No chest pain or breathlessness characterizes silent myocardial infarctions (SMIs). These asymptomatic events are especially concerning for type 2 diabetics (T2DM), who are at higher risk for cardiovascular disease. The study investigated the prevalence and factors associated with silent myocardial infarction in asymptomatic Type 2 Diabetes Mellitus patients, focusing on abdominal obesity, glycemic control, and gender during treadmill testing.

Methods

The cross-sectional study included 35 asymptomatic T2DM patients aged 40-60 years, with no clinical evidence of coronary artery disease. Data collection involved detailed medical history, clinical examination, resting ECG, and laboratory investigations. Participants underwent treadmill testing, with the procedure stopped if symptoms occurred. Statistical analysis was done, with significance set at p < 0.05.

Results

The mean age of participants was 52.6 ± 6.8 years, with 51.4% being male. Abdominal obesity was present in 60% of the individuals. Symptoms such as chest pain or shortness of breath occurred in 22.9% during treadmill testing. A significant correlation was found between abdominal obesity and symptoms (p = 0.043), whereas gender was not significantly related (p = 0.321). Mean lab results showed: HbA1c 7.3% (± 0.8), FBS 155.2 mg/dL (± 40.6), and total cholesterol 210.5 mg/dL (± 45.9). No significant difference in mean HbA1c levels was found between symptomatic and asymptomatic subjects (p = 0.179).

Conclusion

The study highlights the significant prevalence of silent myocardial ischemia in asymptomatic T2DM individuals, with abdominal obesity being a notable risk factor for symptom occurrence during treadmill testing. Glycemic control, as indicated by HB1AC levels, did not show a direct influence on symptom presentation during exercise stress testing.

Recommendations

Regular screening for silent myocardial ischemia is suggested for asymptomatic T2DM patients, especially those with abdominal obesity. To prevent silent heart attacks in this high-risk population, weight control, and lifestyle changes should be prioritized.

Influence of Vitamin D Supplementation on Serum Hepcidin Levels among Non-Diabetic Chronic Kidney Disease Patients: A Randomized Study

2024-06-30T14:57:06+00:00

Background: Vitamin D, a fat-soluble vitamin, is necessary for many body processes, such as controlling the metabolism of calcium and phosphorus and preserving strong bones. The objective of the study was to find out how cholecalciferol supplementation affected the levels of haemoglobin, 25(OH)D, and hepcidin in serum in non-diabetic individuals with stage III–IV CKD and vitamin D deficiency.

Methods: 140 individuals with non-diabetic stage III–IV CKD and vitamin D insufficiency, ranging in age from 18 to 70, were enrolled in the study. At baseline and eight weeks, participants were given either a placebo or two oral doses of cholecalciferol (300,000 IU). Assessments for follow-up were carried out after 16 weeks. The levels of serum 25(OH)D and hepcidin were evaluated, respectively. With IBM SPSS Statistics software, version 21.0, statistical analysis was carried out.

Results: A total of 140 people were involved, 70 in each group. Age, gender, and medical parameters were equivalent among the groups' baseline characteristics. At 16 weeks, the cholecalciferol group's serum 25(OH)D levels rose significantly (11.3 ng/ml) in comparison to the placebo group (1.5 ng/ml; p < 0.001). The cholecalciferol group's (Category I) serum hepcidin levels considerably dropped (-3.2 ng/ml) in comparison to the placebo group's (Category II) (-0.5 ng/ml; p = 0.002). In addition, the category I serum haemoglobin levels considerably improved (1.2 g/dL) in comparison to the category II (0.3 g/dL; p = 0.008).

Conclusion: In non-diabetic CKD patients, cholecalciferol administration resulted in considerably higher serum 25(OH)D levels and lower serum hepcidin levels. It also raised haemoglobin levels, suggesting that it might be helpful in treating anaemia linked to chronic kidney disease.

Recommendations: To effectively manage anaemia and other problems in individuals with CKD, more extensive studies are required to confirm these findings and optimise vitamin D administration strategies.

Treatment of Female Urethral Stricture with Ventral-Inlay Buccal Mucosal Graft Urethroplasty

2024-06-30T15:43:42+00:00

Background: A rare but serious disorder that lowers quality of life and causes severe urine symptoms is called female urethral stricture disease, or USD. More successful surgical interventions are required because traditional treatments like internal urethrotomy and urethral dilation frequently have significant recurrence rates. In female patients with urethral stricture, the aim of this study was to assess the safety and efficacy of ventral-inlay buccal mucosal graft urethroplasty.

Methods: Twenty females with urethral stricture were included in prospective observational research. Individuals with neurogenic bladder or abnormal neurological examination results were not accepted. Cystoscopy was used to confirm the diagnosis. Following surgery, patients were monitored for 3, 6, and 12 months, during which time uroflowmetry, postvoid residual urine (PVRU), and AUA symptom scores were measured. Paired t-tests were used for statistical analysis.

Results: Significant surgical improvements in urinary symptoms and flow rates were shown in the study. After surgery, the average AUA symptom score dropped from 18 ± 3.5 to 4 ± 1.2 at 12 months (p < 0.001). The maximal urine flow rate (Qmax) increased from 8.5 ± 2.1 ml/s to 20 ± 3.0 ml/s (p < 0.001), and the mean PVRU dropped from 150 ± 45 ml to 20 ± 10 ml (p < 0.001). Recurrence was detected in 15% of patients, with few problems recorded.

Conclusion: Ventral-inlay buccal mucosal graft urethroplasty significantly improves urinary symptoms and flow rates in female patients with urethral stricture, demonstrating its effectiveness and safety with low recurrence and complication rates.

Recommendations: It is advised to do more studies with bigger sample sizes and longer follow-up times in order to confirm these results and create standardised treatment guidelines for female urethral stricture.

Correlation of Clinical Severity and Laboratory Parameters with Different Serotypes in Dengue Virus

2024-06-30T16:15:17+00:00

Background: Dengue is a common illness in specific areas, also the symptom of dengue coincides with many other illnesses. Thus, diagnosis of the disease becomes difficult, further adds to the existing complexity. This study is conducted to identify the diagnostic and prognostic marker of dengue, which indicates the severity of the disease.

Method: This study was conducted prospectively. The106 patients who visited the hospital with positive primary dengue infection test and those with positive secondary dengue infection test were included. The demography, clinical symptoms, laboratory investigation, comorbid conditions, the treatment given, and the outcome obtained were recorded. Serotypes were determined using RTPCR.

Results: DEN-V-3 was the common serotype observed in this study. There were coinfections reported in serotypes were more than 2. Patients with severe dengue had liver enzymes AST above 134U/L, ALT above 88 U/L, and ferritin above 3670ng/ ml. Mucoskeletal symptoms were most common after that gastrointestinal symptoms, respiratory symptoms and cutaneous were not reported significantly

Conclusion: DEN-V-3 was the common serotype reported for this cohort. Ferritin and liver enzymes can be used as prognostic marker of severity of dengue.

Recommendation: Liver enzymes and ferritin should be monitored regularly to determine the prognosis.

THE PREVALENCE OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS AT ADDINGTON HOSPITAL: A CROSS-SECTIONAL STUDY IN DURBAN, KWAZULU-NATAL.

2024-02-25T10:49:16+00:00

Background

Staphylococcus aureus (MRSA) is known to be a prominent public health issue that starts as a nosocomial infection that quickly escalates to catastrophic conditions such as pneumonia, necrotizing fasciitis, endocarditis, etc. The majority of Staphylococcus aureus infections among hospitalized patients are caused by methicillin-resistant Staph. aureus (HA-MRSA) which attributes 20–50% of Staph. aureus infections in South Africa.

The aim and objectives of the study

This study aims to evaluate the prevalence of Methicillin-Resistant Staphylococcus aureus (MRSA) at Addington Hospital and to monitor patterns of different classes of antibiotics tested on MRSA.

Methodology

This research study used a cross-sectional retrospective design with quantitative research analysis. Samples were tested for Microscopy, Culture, and Antibiotic Susceptibility in the microbiology laboratory from January 2021 to December 2021. The investigation focused on the sample population which tested positive for methicillin-resistant Staphylococcus aureus. It was recorded that a positive Staphylococcus aureus culture was used for quality control ensuring the accuracy of the results.

Results

Out of a total of 373 patients with Staphylococcus aureus isolates from different clinical specimens, 30(8.04%) were methicillin-resistant and 343 (91.96%) were methicillin-sensitive Staphylococcus aureus (MSSA). Antibiotic susceptibility tests showed that all patient samples were susceptible to vancomycin 373(100%).

Conclusion

The detection of 8.04% of MRSA in a hospital setting indicates that more work needs to be done to control MRSA prevalence.

PREVALENCE AND SENSITIVITY PATTERN OF ESBL PRODUCERS IN DIFFERENT CLINICAL ISOLATES FROM A TERTIARY HEALTHCARE CENTER OF EASTERN INDIA, A CROSS-SECTIONAL STUDY.

2023-09-29T07:13:40+00:00

Background

Antimicrobial-resistant organisms have led to increased mortality, morbidity, and economic burden throughout the globe. This study focused on measuring the prevalence of antimicrobial resistance bacteria mostly by extended-spectrum β-lactamase (ESBL) producers from several samples in a facility providing tertiary care in Eastern Odisha.

Methods

A cross-sectional study was conducted from February 2021 to January 2022. During that time a total of 2452 culture-positive specimens were processed from different samples. Identification of organisms and antibiotic susceptibility was done manually through Kirby Beuer’s disc diffusion method. Phenotypic detection of ESBL producers was performed by a Double disc synergy test.

Results

During the study, E. coli (852) was identified as the most prevalent organism followed by S. aureus (661) and K. pneumoniae (301). Among them, 1571 isolates were ESBL-producing and E. coli was the most prevalent one followed by S. aureus and K. pneumoniae which were 659, 479, and 172 in number respectively. Most of the ESBL producers were isolated from urine samples and the least number from stool samples. We found in this study that the highest population of P.mirabilis and K. oxytoca were resistant to the fluoroquinolones group of antibiotics, Pseudomonas and K. oxytoca are highly resistant to aminoglycosides group of antibiotics, P.mirabilis, Enterobacter, P. vulgaris and Enterococci were showing high resistance towards penicillin group of antibiotics, P.mirabilis was highly resistant towards β-lactamase inhibitor group of antibiotics.

Conclusion

As per the study findings, E. coli is the main producer of ESBLs among members of the Enterobacteriaceae family, and urine is the main source of ESBL-positive isolates. These findings are highly significant from a medical and scientific standpoint and may influence policymakers to better monitor and manage antibiotic resistance.

RELATIONSHIP OF WORKING SALARY, TEACHER RECOGNITION AND TEACHER COMMITMENT IN PRIVATE PRIMARY SCHOOL IN MUKUNGWE SUB-COUNTY, MASAKA DISTRICT. A CROSS-SECTIONAL STUDY.

2024-06-18T08:59:27+00:00

Background:

Private education in Uganda had a limited presence during the pre-independence era. Missionary schools played a significant role in providing education to the general population. The study aims to assess the relationship between working salary, teacher recognition, and teacher commitment in private primary schools in Mukungwe Sub-county, Masaka district.

Methodology:

A descriptive, cross-sectional, and correlational survey design. A qualitative approach was employed in examining the non-numerical findings of the study such as gender and attitudes of the respondents on the study variables were coded and summarized to produce descriptive findings. The quantitative approach was used to analyze and interpret numerical data for meaningful findings.

Results:

Among the respondents, 53% were male, while 47% were female. There was a strong positive correlation between working salary and teacher commitment (Pearson Correlation = 0.749, p = 0.001). This indicates that as working salary increases, teacher commitment also tends to increase.

Similarly, there is a strong positive correlation between recognition and teacher commitment (Pearson Correlation = 0.683, p = 0.000). This suggests that when teachers feel recognized for their efforts, their commitment to their work also increases. Financial Constraints hindered teacher recognition eg “We rarely recognize teachers due to constraints on our income. We only appreciate their efforts on parade where they are given a hand clap”

Conclusion:

There was a strong positive relationship between working salary and teacher commitment indicating that as working salary increases, teacher commitment also tends to increase. A strong positive relationship between recognition and teacher commitment suggests that when teachers feel recognized for their efforts, their commitment to their work also increases.

Recommendations.

Private primary schools should ensure regular and timely payment of salaries to teachers, as it positively impacts their perceptions of working conditions and enhances commitment.

RELATIONSHIP BETWEEN DEMOCRATIC AND INSTRUCTIONAL LEADERSHIP STYLES WITH TEACHERS JOB SATISFACTION IN SELECTED PUBLIC SECONDARY SCHOOLS IN KAGADI DISTRICT. A CROSS-SECTIONAL STUDY.

2024-06-18T06:36:55+00:00

Background:

The historical perspective of head teacher's leadership style and teacher job satisfaction in selected public secondary schools can be traced back to the early development of formal education systems. The study aims to assess the relationship between democratic and instructional leadership styles with teachers' job satisfaction.

Methodology:

A descriptive, correlational, and cross-sectional survey design was undertaken with a mixed approach with both quantitative and qualitative data in 8 secondary schools within Kagadi district. The target population comprised 146 participants which included 08 head teachers and 138 secondary school teachers. Means and standard deviations were also used to analyze data collected on the dependent variable and the dependent variable using the Likert 5-point scale of the responses.

Results:

The majority of the respondents were male 76%while females were 24%. respondents with 11 and above years of experience constituted the largest group at 39%, followed by those with 6-10 years of experience at 34%, and finally, respondents with 0-5 years of experience at 27%. There was a weak positive correlation between democratic leadership style and teacher job satisfaction (Pearson correlation = 0.311, p = 0.053). Although the correlation is not statistically significant at conventional levels (p < 0.05), there is still a trend indicating a positive relationship. There was a strong positive correlation between instructional leadership style and teacher job satisfaction (Pearson correlation = 0.671, p = 0.021).

Conclusion:

The strong positive correlation between instructional leadership style and teacher job satisfaction compared to Democratic leadership indicates that instructional leadership practices play a crucial role in shaping teachers' satisfaction levels.

Recommendations:

Management should promote a culture of transparency, fairness, and accountability in leadership practices, creating a supportive and inclusive environment for all staff members.

RELATIONSHIP BETWEEN SCHOOL PHYSICAL ENVIRONMENT AND CO-CURRICULAR ACTIVITIES IN PRIVATE PRIMARY SCHOOLS. A CROSS-SECTIONAL STUDY.

2024-06-18T07:16:43+00:00

Background

Co-curricular activities are seen as a way of enhancing students' academic, social, and personal development, as well as preparing them for future careers. The study aims to assess the relationship between the school's physical environment and co-curricular activities in private primary schools.

Methodology

The study adopted a descriptive, correlational, and cross-sectional survey design. The study was carried out in selected private primary schools in Fort Portal City. Fort Portal City is located in western Uganda, in the Kabarole District. The researcher ensured quantitative data was collected using questionnaires. Simple random sampling was used to select 196 respondents.

Results

The majority of the respondents were male 58.3% while females were 41.7%. The largest age group consisted of respondents below 20 years, mainly pupils, representing 66.1% of the total sample. The Pearson Correlation coefficient of 0.682** indicates a strong positive correlation between the school's physical environment and the pupil’s participation in co-curricular activities. A strong positive relationship (R = 0.714) between the school's physical environment and the pupil’s participation in co-curricular activities. The R Square value of 0.509 indicates that approximately 50.9% of the variance in pupil participation can be explained by the school's physical environment. The Unstandardized Coefficient for the school's physical environment is 3.214.

Conclusion

Further, findings showed a strong positive relationship between the school's physical environment and pupil’s participation in co-curricular activities within private primary schools in Fort Portal City.

Recommendations

Private schools should allocate resources to enhance the school's physical infrastructure, including sports facilities, recreational areas, and amenities, to create an attractive and functional environment that promotes student engagement in co-curricular activities.

A STUDENT SUPPORT GUIDING FRAMEWORK TOWARDS IMPROVING GRADUATION RATES FOR A NURSING COLLEGE IN SOUTH AFRICA: A CASE STUDY DESIGN.

2024-04-16T05:14:15+00:00

Background:

Student attrition poses a significant challenge to nursing education institutions, leading to health worker shortages in South Africa and globally. This occurs despite implementing student support interventions that appear not to be well-implemented, not escalated, and need organizational structures that enable it. Hence, the purpose of the study was to develop an intentional student support framework that could assist improve student outcomes.

Methods:

The process was informed by a prior mixed-method research approach that involved the participation of students and staff in the completion of questionnaires and interviews as stakeholders in a selected nursing college, employing a case study design.

Results:

The quantitative results showed poor pre-enrolment support, in particular participants from disadvantaged communities. Both quantitative and qualitative studies revealed good academic support. However, the qualitative studies highlighted organizational conditions, processes, and practices that hindered the provision of comprehensive support.

Conclusions:

Therefore, a well-coordinated, comprehensive, intentional, and policy-aligned student support guiding framework is presented in this article.

Recommendations:

The College should implement this comprehensive student support guiding framework across all its campuses to address the diverse needs of its student body and promote their success and well-being.

MORTALITY AND MORBIDITY PROFILE IN ELBW AND VLBW NEONATES IN A TERTIARY CARE SETUP: A RETROSPECTIVE OBSERVATIONAL STUDY.

2024-05-31T10:40:30+00:00

Background

Below 5 years of age globally half of the children are dying in the first month of life. The neonatal period accounts for 2.4 million/annum deaths globally. Low birth weight (< 2500 grams) is often associated with mortality and morbidity. The study analyzed the morbidity and mortality profiles of ELBW and VLBW neonates.

Method

The study was conducted as a retrospective observational study in the Department of Neonatology. Preterm babies with low birth weight were considered for this study. Maternal characteristics and neonatal characteristics were recorded. They were followed up for 28 days from the day of birth. All the complications developed, treatment, and outcomes were recorded during this period.

Results

In this study, 96 neonates with less than 1500 grams of birth weight were studied retrospectively over the last 2 years of data. The mortality rate of ELBW babies was 47.6%, that of VLBW babies excluding ELBW was 8%, and 2 babies were gone for LAMA. The death rate in babies with gestational age in weeks≤24, 25-26, 27-28, 29-32, 33-35, and >35 was 80%, 80%, 16.6%, 1.3%, 14.3%, and 75%, respectively. The most common cause of death in VLBW neonates is sepsis, with pulmonary hemorrhage being 25% each, followed by respiratory distress syndrome, severe intraventricular hemorrhage, and perinatal asphyxia being 18.75%, 18.75%, and 12.5%.

Conclusion

ELBW newborns have a higher probability of mortality and morbidity when associated with other complications such as pulmonary hemorrhage, RDS, and sepsis compared to LBW newborns.

Recommendation

The long-term follow-up done at the NICHD wherein the network is developed so that the tracking of the ELBW infants is assured decreases the mortality significantly. Such tracking networks and follow-up of the ELBW patients are required.

EVALUATING MEDICATION ADHERENCE THROUGH HOME MEDICATION REVIEWS IN THE PAEDIATRIC COMMUNITY: A CROSS-SECTIONAL STUDY.

2024-05-09T00:25:53+00:00

Background:

Medication adherence is vital for managing chronic conditions in pediatric populations, with community pharmacist-led home medication reviews showing promise in improving adherence and outcomes. However, they require careful consideration of pediatric-specific challenges and needs. The study aimed to evaluate medication adherence through home medication reviews in the pediatric community.

Methods:

A cross-sectional study was conducted over one year. One hundred participants aged 18 years and below, undergoing medication for any illness, were included. Data on socio-demographic characteristics, presenting symptoms, medical histories, diagnoses, treatments, and outcomes were collected using a custom-designed instrument. Statistical analysis was performed using Microsoft Excel 2019.

Results:

The study of 100 pediatric participants (52% males, 65% aged 16-18) found an 80% symptom improvement post-treatment and an 85% overall medication adherence rate. Home medication reviews increased adherence by 15%, with higher rates in chronic conditions like asthma (90%) compared to acute conditions (80%). Participants and caregivers reported improved medication understanding and reduced errors, with rural participants showing notable adherence improvements (70% to 85%).

Conclusion:

Home medication reviews significantly improved medication adherence in pediatric patients, increasing overall adherence rates by 15%. The intervention was particularly effective for chronic conditions like asthma. Participants showed symptom improvement, and both patients and caregivers responded positively. These findings highlight the value of pharmacist-led home medication reviews in enhancing adherence and health outcomes in pediatric care.

Recommendations:

Advocate for integrating community pharmacist-led home medication reviews into pediatric care, tailor interventions for socio-demographic factors, foster collaboration among healthcare providers, and conduct further research on their long-term effectiveness and cost-effectiveness.

ASSOCIATION OF MOTOR DEVELOPMENTAL DELAY IN CHILDREN WITH AUTISM: A RETROSPECTIVE COHORT STUDY FROM A TERTIARY CARE CENTRE.

2024-05-29T14:17:09+00:00

Purpose

For comparing children with autism spectrum disorder usually growing children's gross and fine motor profiles, this research was done. The study also evaluated whether the motor delay increased in severity with age.

Methods

This study compared children without autism spectrum disorders, the motor growth of those who usually develop, using data from children aged 12 to 60 months. The Schedule of Growing Skills II was utilized to evaluate their profile for growth. Utilizing statistical methods, the developmental profiles of the groups were examined.

Results

The study included a total of 50 children, comprising 29 children with autism spectrum disorder (ASD) and 21 typically developing (TD) children. Significant delays were observed in the ASD group, with 83.7% of these children exhibiting cognitive delays. Fine motor delays were present in 38.5% of children with ASD, and gross motor delays were noted in 6.7%. In contrast, none of the TD children exhibited such delays. The data further indicated that motor delays in children with ASD worsened with age, particularly in the older cohort (37-60 months), with 100% of gross motor delays and a higher percentage of fine motor delays in this age group. Statistical analysis using Fisher's exact test confirmed significant differences between the ASD and TD groups across all developmental domains assessed (p < 0.01). The findings highlight the necessity of early intervention to address motor delays in children with ASD, emphasizing the need for comprehensive developmental assessments.

Conclusions

Children suffering with ASD exhibit a discernible motor delay in contrast to children with normal development, and this delay only gets more severe as they grow older, making it imperative to assess their motor growth. Services for early intervention may be provided to maximize growth results in the event that motor delay is identified early.

FACTORS CONTRIBUTING TO INCREASED CASES OF EARLY WEANING AMONG MOTHERS OF CHILDREN BELOW 6 MONTHS AT KAYUNGA REGIONAL REFERRAL HOSPITAL, KAYUNGA DISTRICT. A CROSS-SECTIONAL STUDY.

2023-07-08T14:21:48+00:00

Introduction;

The specific objectives were to assess the individual, Health facility, and community-based factors contributing to increased cases of early weaning among mothers of children below 6 months of age in Kayunga National Referral Hospital

Methodology

The study was designed with a simple random sampling of the sample population. Data were collected from a sample size of 50 respondents using semi-structured questionnaires written in the English language with open-ended and closed-ended questions and the tools include sheets and pens entered in the computer program presented in tables and figures.

Results

Regarding Individual factors 86% were employed, 68% started using bottle feeding before 6 months, 64% used supplementary feeding for children below 6 months, and 54% returned to work within 6 months.

In regards to health facility-related factors, 56% took their children to nursing centers, 66% were educated on when and how to breastfeed, and 68% were educated on maternal nutrition during lactation. Regarding community-based factors, 76% of the mothers in their communities supported exclusive breastfeeding for 6 months, 62% of their children didn’t receive any herbal medication, and 84% were from monogamous families.

Conclusion

Despite the low individual, health facility, and community factors, contributing to increased cases of early weaning among mothers of children below 6 months of age at Kayunga Regional Referral Hospital, the researcher still recognizes that there is a need for mothers to carry out exclusive breastfeeding for the first 6 months of age for proper growth and development of the children.

Recommendations

The Ministry of Health should enforce the health team so that they can fully provide health services in terms of providing Nutritional Education to mothers on foods to eat during the lactation period and also on how and when to breastfeed.

Immunohistochemical expression of CD44 in Colorectal carcinoma in relation to histomorphologic parameters and clinico-pathological factors

2024-06-27T09:53:58+00:00

Background: Cancer stem cells (CSC) have proven to play a vital role in cell invasion, metastasis, and treatment resistance in colorectal carcinoma (CRC), which subsequently led to poor outcomes. Cluster of differentiation 44 (CD44) is usually expressed in stem cells in CRC’s and can be detected by immunohistochemistry (IHC).

Aims: The aim of this study is to evaluate the immunohistochemical expression of cancer stem cell markers CD44 in colorectal cancer and investigate their correlation with different clinicopathological characters of prognostic significance.

Methods: A cross-sectional study included 52 patients with primary CRC were analyzed for CD44 expression by IHC on paraffin embedded blocks. Data were collected, tabulated, and statistically analyzed by using SPSS Version 23.0.

Results: This survey found a male predominance over 45. 41 (78.8%) of CRC cases had membranous CD44 positivity in cancer cells and 31 (59.6%) in stromal cells. Signet ring cells have modest membranous CD 44 positivity. CD44 expression was unrelated to age, sex, or laterality. Regardless of physical appearance, tumour cells expressed CD44, especially annular tumours. Tumour budding was associated with higher tumour stages (T3, T4), greatest in T4, and tumour sizes over 5cm. It did not correspond with nodal stage or perineural and lymphovascular invasion. CD44 expression did not affect tumour budding grade. Regardless of morphological criteria (gross or microscopic), stromal CD44 expression was not correlated.

Conclusions: CRC prognosis is independently correlated with CD44 expression, a stem cell marker. They are linked to epithelial-mesenchymal transition (EMT) and tumour budding, with increased expression in high-burden instances.

Recommendation: Further research should be conducted on the role of CD44 expression in colorectal cancer, particularly focusing on post-neoadjuvant chemotherapy cases, to better understand its prognostic implications and potential as a therapeutic target.

THE EFFECT OF EXTERNAL RADIOTHERAPY TO THE LEFT VENTRICLE SYSTOLIC FUNCTION IN LOCALLY ADVANCED BREAST CANCER PATIENTS, ANDHRA PRADESH, INDIA: A COHORT STUDY.

2024-05-24T10:12:58+00:00

Introduction:

People having cancer on the left side are more prone to develop cardiac issues than patients with other-sided malignancies, and radiation therapy (RT) has certain risks. This study aims to offer a dosimetric analysis of how radiation therapy (RT) affects the heart and coronary arteries following breast conservation surgery and to ascertain whether these dosages are linked with a greater risk of ischemic heart disease (IHD).

Methods:

A random selection of 150 patients with early-stage T1/T2 + N0 breast carcinomas was made on both the left and right sides. In these individuals, the entire breast was treated with radiation, and the tumor beds were expanded and planned to use computed tomography. The dosages for the left ventricle (LV), right ventricular (RV), left anterior descending coronary artery (LAD), and left circumflex coronary artery (LCx) were noted.

Results:

The mean dose to the left anterior descending coronary artery (LAD) for left-sided breast cancer patients was significantly higher at 2402.480 ± 838.40 cGy compared to right-sided patients. The left ventricle (LV) in left-sided patients received an average dose of 397.56 ± 131.73 cGy, while the right ventricle in right-sided patients received 130.18 ± 24.92 cGy. High doses in cardiac substructures were noted for left-sided patients, with significantly elevated Dmean, Dmin, and Dmax values for the LCx, LAD, RV, and LV (P < 0.0001). This increased radiation exposure is associated with a higher risk of developing ischemic heart disease (IHD) in left-sided breast cancer patients.

Conclusion:

The most straightforward and effective way to lessen and prevent radiation-induced cardiac harm, particularly in cases of left-sided breast cancer, is to balance dosage limits between the mean heart dose and many high-dose zones of cardiac substructures.

Recommendation:

After a certain age, it is advising routine breast screening to lower breast cancer risk.

A STUDY ON THE EFFECTIVENESS OF TRANSVAGINAL SONOGRAPHY AND COLOR DOPPLER IN THE ASSESSMENT OF ENDOMETRIUM IN SUBFERTILE WOMEN COMING TO A TERTIARY CARE HOSPITAL.

2024-04-12T06:16:39+00:00

Background

Ultrasonography (USG) is a very important imaging modality for the diagnosis, treatment, and monitoring of subfertility. Grayscale USG provides structural information about the pelvic organs and color Doppler USG provides functional information along with its vascularity. Adequate blood flow via the uterine arteries and good endometrial perfusion plays a very important role in endometrial receptivity.

Objectives

The aim and objective of this study is to assess the mid-luteal phase endometrial spiral artery blood flow by TVS including Doppler, in women coming for the treatment of subfertility to a tertiary care hospital.

Results

Out of 50 patients, primary subfertility comprised 36 individuals while 14 were categorized under secondary subfertility. Most of the patients belonged to the age group of 20-30 years. Of the total number of females 56% conceived, among them 46.43% of patients conceived naturally, followed by IUI (32.14%) and then IVF (21.43%). In our study, 58% of patients presented with an endometrial thickness of over 7 mm, out of which 93.1% conceived successfully. The mean peak systolic velocity in conceived women was 13.18 ± 3.62 cm/s which was higher as compared to 11.55 ± 3.47 cm/s in non-conception menstrual cycles. Similarly, the EDV, Tmax, and Tmin were significantly higher as compared to the not-conceived group. 96.3% of the women who conceived had a lower pulsatility index (< 2.5). The best cut-off value of the resistive index was less than 0.9 for predicting conception status.

Conclusion

The combination of endometrial thickness and Doppler examination of endometrial and sub-endometrial blood flow can be used as a quick and efficient way to enhance the success of assisted reproductive techniques.

Recommendation

Due to rapid advancement in Doppler technology, it is highly recommended to perform transvaginal USG including Doppler for assessment of Doppler indices mid-luteal phase in subfertile women coming for treatment.

Evaluation of Gestational Diabetes Mellitus in a Tertiary Care Hospital

2024-06-30T16:00:04+00:00

Background: Gestational diabetes mellitus (GDM) is a prevalent pregnancy condition involving intolerance of glucose, leading to significant maternal and fetal health risks such as preeclampsia, Cesarean delivery, macrosomia, and neonatal hypoglycemia. The purpose of the study is to assess glycemic management and pregnancy outcomes in GDM-diagnosed pregnant women.

Methods: A prospective observational study was conducted involving 80 pregnant women, with 40 diagnosed with GDM and 40 serving as controls. Participants underwent glucose challenge tests (GCT) and oral glucose tolerance tests (OGTT) for screening. Women diagnosed with GDM were prescribed a diabetic diet based on BMI and, if necessary, insulin therapy. Data on mother and foetus outcomes were gathered and analysed using SPSS software. A p-value < 0.05 was deemed statistically relevant.

Results: The GDM group showed notably higher fasting (99.2 ± 11.3 mg/dl) and postprandial glucose levels (136.8 ± 14.7 mg/dl) compared to the control group (84.7 ± 8.9 mg/dl and 112.3 ± 10.2 mg/dl, respectively; p < 0.001). Thirty percent of the GDM group required insulin therapy. Cesarean section rates were greater in the GDM group (45% vs. 25%, p = 0.05). Adverse fetal outcomes, including macrosomia (20% vs. 5%, p = 0.04), neonatal hypoglycemia (15% vs. 2.5%, p = 0.04), and respiratory distress (10% vs. 0%, p = 0.05), were more frequent in the GDM group.

Conclusion: The study highlights the significant impact of GDM on mother and newborn health, with higher rates of Cesarean sections and adverse fetal outcomes in the GDM group. Effective glycemic control through dietary management and insulin therapy is crucial for improving pregnancy outcomes.

Recommendations: There is a need for stringent glucose monitoring and personalized treatment plans for pregnant women with GDM. Further research should focus on optimizing management strategies and exploring new interventions to reduce the risks associated with GDM.

EXAMINING THE EFFECTS OF COVID-19 ON OBSTETRIC CARE DELIVERY AND MATERNAL AND PERINATAL HEALTH: AN OBSERVATIONAL STUDY.

2024-05-29T15:41:39+00:00

Background

The global COVID-19 epidemic has presented hitherto unseen obstacles to healthcare systems across the globe, impacting a multitude of demographics, including expectant mothers. Modifications in obstetric care delivery, such as changes in antenatal practices and increased reliance on telemedicine, have been necessitated to mitigate infection risks. The study aims to assess the impact of COVID-19 on obstetric care delivery and maternal and perinatal outcomes by examining variations across different lockdown phases.

Methods

An observational investigation was conducted, involving 250 participants divided into groups based on delivery dates during distinct lockdown phases. Inclusion criteria encompassed pregnant individuals receiving care at the hospital, with confirmed COVID-19 infection during pregnancy. Data collection included demographic details, COVID-19 status, obstetric care, and outcome variables, analyzed using statistical methods.

Results

The mean ages ranged from 27.8 to 29.1 years across the three study groups. Significant associations were found between maternal COVID-19 status and antenatal visit frequency (χ² = 12.34, p < 0.001). Maternal outcomes varied across groups, with differences in preterm labor and preeclampsia incidences (χ² = 6.21, p = 0.031; χ² = 3.78, p = 0.052, respectively). Perinatal outcomes revealed lower mean birth weights and higher NICU admission rates among neonates born to COVID-19-positive mothers (t = -3.78, p = 0.001; χ² = 6.54, p = 0.011, respectively). Lockdown phases impacted maternal mortality rates and mode of delivery significantly (χ² = 5.67, p = 0.023; χ² = 7.89, p = 0.005, respectively).

Conclusion

The study highlights the substantial impact of COVID-19 on obstetric care and mother and newborn outcomes. Findings underscore the necessity of adaptive healthcare systems to ensure optimal care during pandemics.

Recommendations

Ongoing research is crucial for informing best practices and enhancing maternal and perinatal care resilience in future health crises.

Clinical Study on Fetal Outcomes of Jaundice During Pregnancy in a Tertiary Care Centre

2024-06-30T15:49:03+00:00

Background: Jaundice during pregnancy, arising from various etiologies, poses significant risks to mother and fetus health, containing preterm birth, intrauterine growth restriction, and fetal demise. The study aims to investigate the fetal outcomes of pregnant women presenting with jaundice or deranged liver function tests.

Methods: A prospective observational study involving 40 pregnant women with jaundice or abnormal liver function tests was conducted. Demographic, clinical, laboratory, and imaging data were collected, and patients were monitored through the antepartum, intrapartum, and postpartum periods. Outcomes assessed included gestational age at delivery, mode of delivery, and both fetal and maternal outcomes. Statistical analysis was used to identify significant associations.

Results: The mean age was 28.5 years, with a mean gestational age at presentation of 30.2 weeks. Common symptoms were jaundice, vomiting, pruritus, and dark urine. Elevated liver enzymes were noted in all patients. Fetal outcomes included 80% term deliveries, 87.5% live births, 7.5% intrauterine fetal demise, 5% stillbirths, 22.5% NICU admissions, and 5% early neonatal deaths. Maternal outcomes included fulminant liver failure (10%), disseminated intravascular coagulation (5%), eclampsia (5%), 12.5% ICU monitoring, and 2.5% maternal mortality. Significant associations were found between severe jaundice and preterm deliveries, abnormal liver function tests and NICU admissions, and a history of hepatic failure with adverse maternal outcomes.

Conclusion: Jaundice during pregnancy notably impacts both mother and foetus outcomes, leading to increased risks of preterm delivery, neonatal intensive care unit admissions, and severe maternal complications. Early detection, vigilant monitoring, and comprehensive management are crucial to mitigate adverse outcomes.

Recommendations: Healthcare providers should adopt a multidisciplinary approach to managing jaundice in pregnancy, ensuring timely interventions and close monitoring to improve mother and fetus health outcomes. Further research is needed to develop standardized protocols for managing this condition.

Examination of SFLT1/PLGF ratio in the second and third trimesters of pregnancy in predicting preeclampsia

2024-06-10T16:08:58+00:00

Background: Pre-eclampsia (PE) is a critical pregnancy complication leading to adverse perinatal outcomes like fetal growth restriction, stillbirth, oligohydramnios, eclampsia, and HELLP syndrome. An imbalance between pro-angiogenic (PlGF) and anti-angiogenic (sFLT-1) factors increases the sFLT-1/PlGF (sFlt1/PlGF) ratio, detectable about four weeks before the symptoms appear. The study was conducted to determine the predictive value of the sFlt1/PlGF ratio for the development of PE in high-risk pregnant women during the late 2^nd and 3^rd trimesters.

Methods: A Prospective, Monocentric, Observational study was conducted involving 50 high-risk pregnant females between 24 and 32 weeks of gestation. Participants were selected based on criteria such as age > 30 years, BMI > 30 kg/m², previous history of PE, PAPPA < 0.4 MoM, increased UtA PI at 11-13 weeks, twin pregnancy, IVF conception, and history of FGR. The sFlt1/PlGF ratio was determined, and participants were monitored for development of Pre Eclampsia . The study determined the specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of sFlt1/PlGF ratio for the development of Pre eclampsia.

Results: The sFlt1/PlGF ratio demonstrated a high NPV of 96.7%, indicating a reliable prediction for the absence of PE within a week. The PPV was 63.5%, suggesting a strong indication of PE development with a high ratio (>38). The sensitivity of the ratio was 92.3%, and the specificity was 81.08%, confirming its effectiveness in correctly identifying both the presence and absence of pre-eclampsia.

Conclusion: The sFlt1/PlGF ratio is a valuable predictive tool for identifying the possibility of development of PE in high-risk pregnancies, with high NPV, sensitivity, and specificity. It effectively aids in early identification and management, potentially improving maternal and fetal outcomes.

Recommendations: Clinicians should consider incorporating the sFlt1/PlGF ratio in the routine assessment of high-risk pregnant women to enhance early detection and intervention strategies for pre-eclampsia.

STUDY ON EVALUATION OF SFLT1/PLGF RATIO FOR PREDICTION OF PRE-ECLAMPSIA IN THE SECOND AND THIRD TRIMESTER OF PREGNANCY: AN OBSERVATIONAL STUDY.

2024-06-24T13:49:39+00:00

Background

Pre-eclampsia (PE) is a critical pregnancy complication leading to adverse perinatal outcomes like fetal growth restriction, stillbirth, oligohydramnios, eclampsia, and HELLP syndrome. An imbalance between pro-angiogenic (PlGF) and anti-angiogenic (sFLT-1) factors increases the sFLT-1/PlGF (sFlt1/PlGF) ratio, detectable about four weeks before the symptoms appear. The study was conducted to determine the predictive value of the sFlt1/PlGF ratio for the development of PE in high-risk pregnant women during the late 2nd and 3rd trimesters.

Methods

The study included 50 high-risk pregnant females between 24 and 32 weeks of gestation. Participants were selected based on criteria such as age > 30 years, BMI > 30 kg/m², previous history of PE, PAPPA < 0.4 MoM, increased UtA PI at 11-13 weeks, twin pregnancy, IVF conception, and history of FGR. The sFlt1/PlGF ratio was determined, and participants were monitored for the development of Pre-Eclampsia. The study determined the specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV).

Results

Among the participants, 70% were over 30 years of age, and 30% were under 30. The sFlt1/PlGF ratio demonstrated a high NPV of 96.7%, indicating a reliable prediction for the absence of PE within a week. The PPV was 63.5%, suggesting a strong indication of PE development with a high ratio (>38). The sensitivity of the ratio was 92.3%, and the specificity was 81.08%, confirming its effectiveness in correctly identifying both the presence and absence of pre-eclampsia.

Conclusion

The sFlt1/PlGF ratio is a valuable predictive tool for identifying the possibility of the development of PE in high-risk pregnancies, with high NPV, sensitivity, and specificity. It effectively aids in early identification and management, potentially improving maternal and fetal outcomes.

Recommendations

Clinicians should consider incorporating the sFlt1/PlGF ratio in the routine assessment of high-risk pregnant women to enhance early detection and intervention strategies for pre-eclampsia.

Prevalence And Risk Factors for Incisional Hernia Following Cesarean Section: A Cross-Sectional Study

2024-06-30T15:19:01+00:00

Background: Cesarean section (C-section) is a prevalent surgical procedure globally, essential for managing complicated deliveries. However, it carries risks, including the development of incisional hernias, which can significantly impact maternal health and healthcare costs. This study investigated the prevalence and risk factors associated with incisional hernia following cesarean sections.

Methods: A cross-sectional observational study was conducted. Eighty-six women who underwent C-sections were included. Data on demographics, medical history, surgical details, and postoperative outcomes were collected through structured questionnaires and medical record reviews. Participants were followed up at 6 weeks, 3-, 6-, and 12 months post-surgery for physical examinations. Statistical analysis was accomplished.

Results: The prevalence of incisional hernia was found to be 14.0%. Significant risk factors included higher BMI (OR: 1.15, p=0.035), hypertension (OR: 3.67, p=0.036), vertical incision type (OR: 4.82, p=0.037), postoperative wound infection (OR: 7.23, p=0.002), and low physical activity (OR: 3.21, p=0.046). These factors highlight the need for targeted interventions to reduce hernia incidence.

Conclusion: Incisional hernia is a common complication post-C-section, with significant risk factors identified as higher BMI, hypertension, vertical incisions, postoperative wound infections, and low physical activity.

Recommendations: To mitigate the risk of incisional hernia, it is recommended to manage patient weight and hypertension effectively, prefer Pfannenstiel incisions, ensure rigorous infection control, and promote appropriate postoperative physical activity.

PROSPECTIVE OBSERVATIONAL STUDY ON THE IMPACT OF ULTRASONOGRAPHY ON PREGNANCY OUTCOMES IN CASES OF THREATENED ABORTION, CHENNAI: A CROSS-SECTIONAL STUDY.

2024-06-04T20:03:05+00:00

Background

Threatened abortion, recognised by vaginal bleeding during the first 20 weeks of pregnancy, can result in unfavourable consequences such as intrauterine growth restriction, preterm birth, and miscarriage. Ultrasonography is essential for monitoring these pregnancies and predicting outcomes. The study aims to examine the predictive value of bleeding patterns and ultrasound findings on pregnancy results in females with threatened abortion.

Methods

The study comprised 100 pregnant women with threatened abortion. Bleeding patterns were categorized as light or heavy. Key ultrasound findings were recorded. Pregnancy outcomes, including loss before 20-weeks' gestation and late complications, were assessed. Statistical analyses, including chi-square tests and logistic regression, were employed to assess associations between variables and outcomes.

Results

The average age was 28.4 years (± 4.2), and the average BMI was 22.3 kg/m² (± 1.8). The average gestational age was 8 weeks (± 1). On average, participants had 1.5 previous pregnancies. Among them, 40% were primigravida and 60% were multigravida. Pregnancy loss before 20-weeks' gestation occurred in 25 participants (25%), while 35 participants (35%) experienced late pregnancy complications. Heavy bleeding was significantly associated with pregnancy loss (OR = 2.8, 95% CI [1.3, 6.0], p = 0.008). Subchorionic hematoma (OR = 2.1, 95% CI [1.0, 4.3], p = 0.045) and cervical length less than 2.5 cm (OR = 3.0, 95% CI [1.2, 7.2], p = 0.018) were also significant predictors of early pregnancy loss.

Conclusion

Heavy bleeding, subchorionic hematoma, and shortened cervical length are significant predictors of loss of pregnancy prior 20-weeks' gestation in women with threatened abortion. The findings underscore the importance of close monitoring and comprehensive care for at-risk pregnancies.

Recommendations

Further research is needed to develop targeted interventions for pregnancies with threatened abortion. Clinicians should use ultrasound findings and bleeding patterns to guide the management and counseling of affected patients.

Comparing Serum Cystatin C and Serum Creatinine as Early Markers for Acute Renal Dysfunction in Intensive Care Patients: A Cross-Sectional Analysis.

2024-06-30T15:59:06+00:00

Background: Acute renal dysfunction is a critical concern in intensive care units (ICUs), associated with increased morbidity and mortality. Early detection is essential, and serum biomarkers like cystatin C and serum creatinine have shown promise. This study aimed to assess their utility in identifying acute renal dysfunction.

Methods: A cross-sectional case-control study involving 960 ICU patients was conducted. Age and gender matching were ensured between control and case groups. Serum cystatin C and serum creatinine were evaluated and analyzed. Comparative and ROC curve analysis was performed to evaluate the biomarkers' relevance.

Results: The study found age and gender matching, validating the control-case group comparisons. Serum cystatin C consistently distinguished between groups, demonstrating its potential as an early marker. Comparative analysis and ROC curve analysis supported the relevance of these biomarkers. Cystatin C exhibited superior sensitivity and specificity.

Conclusion: Serum cystatin C and serum creatinine are valuable biomarkers for early detection of acute renal dysfunction in ICUs. Their consistent differentiation between control and case groups highlights their significance in critical care settings.

Recommendations: These biomarkers should be routinely considered for early assessment of acute renal dysfunction in ICUs. Further research is warranted to refine their clinical utility.

Evaluating the Impact of Coronary Artery Calcium on Cardiovascular Risk Stratification in an Indian Cohort

2024-06-30T14:21:01+00:00

Background: Coronary artery calcium (CAC) scoring has emerged as a significant marker for cardiovascular risk assessment, but its utility in an Indian cohort has not been extensively studied. This study aimed to evaluate the impact of CAC on cardiovascular risk stratification in an Indian cohort using WHO ISH and ACC/AHA risk calculators.

Methods: A cross-sectional observational study was conducted on 80 participants aged 30-75 years with at least one cardiovascular risk factor and no known atherosclerotic cardiovascular disease. Detailed history, clinical examinations, biochemical tests, and 64-slice coronary CT angiograms were performed. Two risk calculators (WHO ISH and ACC/AHA) were used to estimate 10-year cardiovascular risk. Participants were classified based on CAC scores, and statistical analysis was carried out to evaluate the association between CAC scores and CV risk factors.

Results: The study found that 25% of participants had no CAC, 50% had moderate CAD, and 25% had obstructive CAD. Higher CAC scores significantly correlated with age (r = 0.45, p < 0.001), BMI (r = 0.30, p = 0.005), hypertension (r = 0.40, p < 0.001), diabetes (r = 0.35, p = 0.002), and lipid profiles. Participants with higher CAC scores were more likely to be categorized as high risk for 10-year CV events. Among those with obstructive CAD, 75% were classified as high risk by WHO ISH and ACC/AHA calculators, compared to 0% in the low-risk category (p < 0.001 for both).

Conclusion: CAC scoring enhances cardiovascular risk stratification in an Indian cohort, identifying high-risk individuals more accurately than traditional risk calculators alone.

Recommendations: CAC scoring should be considered in routine cardiovascular risk assessment, particularly for individuals with moderate risk by traditional methods, to guide more aggressive preventive strategies.

Utilizing 3D Printing Technology for Enhanced Preoperative Planning in Orthopedic Surgery: A Narrative Review

2024-06-30T15:53:57+00:00

Background: In the field of orthopedic surgery, accuracy and careful preparation prior to surgery are essential for positive results. In this field, additive manufacturing, also referred to as 3D printing technology, has become a game-changing instrument. It enables the creation of patient-specific anatomical models, custom surgical tools, and personalized implants, enhancing the accuracy and efficiency of surgical procedures. While the potential benefits are significant, the integration of 3D printing into routine practice and its long-term implications are still under exploration.

Objective: This narrative review aims to systematically assess the current state of 3D printing technology in preoperative planning for orthopedic surgery, focusing on its applications, benefits, challenges, and the quality of the evidence supporting its use.

Summary: The review highlights the diverse applications of 3D printing across various orthopedic procedures, including joint replacement, spine, and trauma surgeries. Studies indicate that 3D printing contributes to improved surgical planning, reduced operative times, and potentially better patient outcomes. However, challenges related to cost, accessibility, and the need for specialized training are noted. The review also discusses the quality of current research, emphasizing the need for more high-quality, long-term studies to better understand the technology's impact.

Future Implications: As 3D printing technology continues to advance, it holds the promise of further revolutionizing orthopedic surgery. Future research should focus on long-term patient outcomes, cost-effectiveness, and the development of guidelines for its use. The potential for 3D bioprinting and the creation of biological implants also opens new avenues for personalized and regenerative medicine.

Clinical Policies: Clinicians and policymakers must weigh 3D printing's revolutionary promise against its existing limitations. Research, training, and infrastructure are needed to maximize its benefits. As data increases, clinical standards and policies will be needed to standardize 3D printing in orthopedic preoperative planning for safety, efficacy, and equitable access.

INDIVIDUAL FACTORS CONTRIBUTING TO LOWER BACK PAIN AMONG MALES AGED 20 TO 35 YEARS ATTENDING THE SPINAL CLINIC AT MULAGO NATIONAL REFERRAL HOSPITAL IN KAMPALA DISTRICT. A CROSS-SECTIONAL STUDY.

2024-05-14T15:10:51+00:00

Background

The gradual increase in cases of Back pain among the general population has been one of the neglected health concerns in developing countries. The study aims to assess the specific individual factors contributing to lower back pain among males aged 20 to 35 years.

Methodology

A cross-sectional survey involving the collection of quantitative data from 190 respondents including 14 Surgeons and other doctors, 40 nursing staff, 19 Administrative and support staff, and 108 patients.

Results

Prolonged sitting, poor posture, workplace ergonomics, stress, sleep quality, diet, and previous injuries or medical conditions were identified as significant contributors to LBP. Extended periods of sitting lead to an increase in LBP, with a mean score of 4.30. The standard deviation of 0.396 suggests agreement in opinions regarding the influence of poor posture on LBP. A relatively high standard deviation of 1.291 suggests variability in opinions regarding the relationship between stress and lower back pain. The overall mean score for all specific individual factors analyzed is 3.78, with a standard deviation of 0.489, indicating a high level of agreement among respondents regarding the impact of these factors on LBP. Most of the staff fall within the age range of 31 to 40 years, comprising 58% of the total surveyed population followed by staff aged 40 years and above, accounting for 25%. Potential age-related factors that may influence the occurrence of LBP. 53% are male, while 48% are female.

Conclusion

Poor posture, workplace ergonomics, stress, sleep quality, diet, and previous injuries or medical conditions were identified as the most significant contributors to LBP.

Recommendation

Developing patient education and self-management programs can empower individuals with low back pain to take an active role in managing their condition and preventing recurrences.

Functional Outcomes of Olecranon Process Fracture Treatment Using the Tension Band Wiring Technique

2024-06-27T10:03:36+00:00

Background

Olecranon fractures (OF) are a common elbow injury, often necessitating surgical intervention to restore function and anatomy. The tension band wiring (TBW) technique is frequently employed due to its biomechanical efficiency and cost-effectiveness. However, complications such as hardware irritation and infection remain concerns, highlighting the need for ongoing evaluation of its outcomes. This study retrospectively assessed the functional outcomes and complications of the TBW technique for treating olecranon process fractures.

Methods

Thirty individuals treated with TBW for isolated OF were included. Data on demographics, fracture classification, complications, and functional outcomes were collected. Functional outcomes were evaluated using the Mayo Elbow Performance Score (MEPS) and range of motion (ROM). Statistical analysis was performed using SPSS version 21.0.

Results

The average age was 42.5 years, with 60% male. The majority had Mayo Type IIB fractures (70%). Complications were noted in 20% of patients, primarily hardware irritation (13.3%) and infection (6.7%). The mean MEPS score improved significantly from 55.2 ± 10.5 at baseline to 88.5 ± 7.8 at the final follow-up (p < 0.001). Flexion-extension ROM increased

from 90° ± 15° to 135° ± 10° (p < 0.01), and pronation-supination ROM from 60° ± 10° to 85° ± 5° (p < 0.01). Eighty per cent of patients achieved excellent or good outcomes.

Conclusion

The TBW technique demonstrated favourable functional outcomes with significant MEPS scores and ROM improvements. Despite a 20% complication rate, the complications were manageable. These findings support the efficacy of TBW in olecranon fracture management.

Recommendations

Future studies should explore modifications to the TBW technique and alternative materials to reduce complications.

A Prospective Comparative Study Examines the Functional Outcome of Managing Intertrochanteric Fractures of the Femur Using Dynamic Hip Screw and Proximal Femoral Nail

2024-06-30T16:10:38+00:00

Overview: Low-energy wounds, such simple accidents, is usually the cause of intertrochanteric fractures, which are often experienced fractures of the hip, particularly in older individuals with osteoporotic bones. Intertrochanteric fractures have been treated with PFN and DHS.

Materials and Procedures: This current prospective comparative study was carried out over a 12-month period, at IGIMS Patna, Department of Orthopedics. Random treatments were administered for intertrochanteric fractures, utilizing either the proximal femoral nail (PFN) or Dynamic Hip Screws (DHS). Each and every one of the forty instances was included. Twenty patients were categorized into two categories, with twenty PFN in the second category and twenty Dynamic Hip Screws in the first. Following therapy, each patient was monitored for nine months.

Results: PFN categories in the current study showed a higher Harris Hip score (HHS). At each follow-up, their intercategory assessment of the Harris Hip score between the PFN and DHS categories showed notable variations. In addition, the PFN category had lower minimum blood loss, shorter surgical times, and smaller incisions than the DHS category; these differences were statistically significant. The mean hospital stay did not exhibit any noteworthy variations either.

Conclusion: PFN is a better fixing method for femur intertrochanteric fractures. The requirement will be met to the degree that it will increase the research's reliability and generalizability.

Outcomes of a Home-Based Unsupervised Rehabilitation Protocol Following Rotator Cuff Repair: A Cohort Study

2024-06-30T15:34:50+00:00

Background: Rotator cuff tears are a general cause of shoulder pain and dysfunction, often requiring surgical repair. Postoperative rehabilitation is crucial for optimal recovery, but traditional supervised physical therapy can be resource-intensive and costly. This study aimed to evaluate the outcomes of a home-based unsupervised rehabilitation protocol following rotator cuff repair performed through a mini-open incision.

Methods: A cohort study was carried out involving 50 individuals who underwent rotator cuff repair. Patients were taught a standardized home-based rehabilitation protocol and followed up at regular intervals. Pain levels (VAS score), functional status (DASH score), range of motion, cuff strength, and return-to-work rates were assessed over a 12-month period. Statistical analyses were performed to compare pre--operative and postoperative outcomes.

Results: Significant improvements were observed in pain levels, with the mean VAS score decreasing from 7.8 preoperatively to 2.3 at one year postoperatively (p < 0.001). The DASH score improved from a mean of 65.4 preoperatively to 20.7 postoperatively (p < 0.001). Forward flexion increased from 85.3 degrees to 165.7 degrees, and external rotation improved from 20.4 degrees to 55.6 degrees (both p < 0.001). Cuff strength increased from 48% to 92% of the opposite side (p < 0.001). Ninety percent of patients returned to full work duties within a mean of 10.2 weeks. The failure rate was low at 6%.

Conclusion: The home-based unsupervised rehabilitation protocol after rotator cuff repair significantly improved pain, functional status, range of motion, and cuff strength. Most patients returned to work promptly, and the low failure rate indicates this approach is effective and safe.

Recommendations: Home-based unsupervised rehabilitation should be considered a viable option for postoperative recovery following rotator cuff repair, providing a cost-effective and accessible alternative to supervised therapy. Further research with larger sample sizes and long-term follow-up is recommended to validate these findings.

MORINGA OLEIFERA LEAF POWDER INFLUENCED THE CHEMICAL PROFILE OF LEONOTIS LEONURUS ESSENTIAL OILS.

2024-06-13T19:50:57+00:00

Background:

Leonotis leonurus is used extensively in African herbal medicine to manage several diseases including diabetes mellitus, epilepsy, hypertension, and skin and respiratory infections. Although L. leonurusis a valuable medicinal plant in Africa, little has been done to improve the plant’s organoleptic and pharmacological properties.

The study evaluated the effects of Moringa (Moringa oleifera) leaf powder treatments on the chemical profiles of essential oils from L. leonurus.

Methodology:

All trials were conducted in experimental greenhouse tunnels. Six-week-old L. Leonurus seedlings were transplanted into individual pots (1 seedling per pot) containing 1kg of GromorTM potting mix (30 dm3) and subjected to varying quantities (0, 1.25, 2.5, 5, 7.5, and 10g) of Moringa leaf powder (MLP) biweekly for eight weeks. Additionally, each seedling received 100 mL of 50 % Hoagland’s solution once every 4 weeks and was watered regularly throughout the trial. At the end of the trial, the plant’s shoots were harvested and essential oils were extracted from them by steam distillation. The oils’ chemical profiles were then determined by Gas Chromatography-Mass Spectroscopy.

Results:

MLP applications caused each treatment to have a distinct chemical profile. Notable variations in oil yield, number, and concentration of compounds per each sample evaluated were observed. Caryophyllene and humulene were among the bioactive compounds whose concentration increased by 4- to 10-fold in treatments, compared to the control. Caryophyllene, β-copaene, humulene, and phytol were among the most dominant compounds in the oil samples.

Conclusions:

MLP induced qualitative and quantitative changes in L. leonurus essential oils. The powder could therefore be potentially used to improve the quality and yield of medicinally valuable crucial oils from the plant.

Recommendations:

Future research could focus on maximizing the use of MLP in natural situations. Such field trials should also investigate the powder's possible use in conjunction with other organic fertilizers.

A NARRATIVE REVIEW ON DEFINING AGING: A MULTIDISCIPLINARY REVIEW OF BIOLOGICAL, PSYCHOLOGICAL, SOCIOLOGICAL, AND CLINICAL PERSPECTIVES WITH A FOCUS ON SUCCESSFUL AGING.

2024-06-05T09:46:29+00:00

Aging is a complex, multifaceted process affecting every living organism, characterized by progressive physiological changes, functional decline, and increased susceptibility to diseases and death. As the global population continues to age, understanding and defining aging becomes increasingly important for healthcare, policy-making, and social support systems. The review aims to explore and synthesize various definitions of aging, including biological, psychological, sociological, and clinical perspectives, and to examine the concept of successful aging. The review identifies distinct definitions of aging across different disciplines, highlighting the multifaceted nature of the idea. Biological aging involves cellular senescence, genetic theories, and damage accumulation. Psychological aging encompasses cognitive changes and emotional regulation, while sociological aging focuses on social roles and cultural attitudes. Clinical aging addresses the decline in physical and mental health and the emergence of geriatric syndromes. The maintenance of physical health, mental well-being, social engagement, and productive activities defines successful aging. Factors influencing successful aging include genetics, lifestyle choices, social support, and access to healthcare. Understanding the various definitions of aging is crucial for advancing research, developing effective interventions, and shaping policies that support healthy aging. Future research should explore the interplay between genetic, environmental, and social determinants of aging, and promote societal attitudes that value and support older adults. Insights from this review can inform the design of clinical programs and policies aimed at enhancing the quality of life for older adults. Emphasizing preventive measures, health promotion, and social support can help mitigate the negative impacts of aging and promote successful aging across populations.

INFLUENCE OF TRAINING AND DEVELOPMENT PRACTICES ON THE PERFORMANCE OF NON-GOVERNMENT ORGANIZATIONS. A CROSS-SECTIONAL STUDY OF TASO MBARARA.

2024-06-24T07:53:22+00:00

Background.

Human Resource Management practices are functions and practices of human resources such as recruitment and selection, skills monitoring and training, and ongoing performance management of businesses to ensure improved Organizational performance. The study aims to determine the influence of training and development practice on organizational performance.

Methodology.

A sectional study used both quantitative and qualitative research approaches. Using a simple random sampling technique 132 respondents were selected from TASO Mbarara comprising human resource managers from Ankole Cluster, MEAL officers, MEAL managers, HR department staff, and top management. Pearson correlation, multiple regression analysis, and t-test statistics were used to establish relationships between independent and dependent variables.

Results.

The majority of 80 (69%) respondents in the study were males whereas 36 (31%) were females A Pearson correlation coefficient of 0.726 showed a positive and significant relationship between Training and Development Practices. The findings were important at a 0.000 level given that Training and Development Practices is statistically significant at a 95% confidence level since a sign value of 0.000 is less than 0.05. The coefficient of determination (Adjusted R Square) is 0.280. This implies that Training and Development Practices account for 28% of the variations in the Organisational Performance of TASO Mbarara A simple linear regression analysis using the standardized coefficients for Training and Development Practices indicated a beta standardized coefficient value of 0.726, with p-value = 0.000 Meaning that Training and Development Practices has a positive and significant effect on Organizational performance of TASO Mbarara.

Conclusion.

Training and development practices are part of the significant practices that contribute to the better organizational performance of TASO Mbarara.

Recommendations.

TASO needs to conduct compliance training for all staff to ensure understanding and adherence to HR policies and improved performance.

COMPARING THE EFFECTIVENESS OF ORAL ISOTRETINOIN AND CYPROTERONE COMPOUND IN ACNE TREATMENT AMONG ADULT FEMALES WITH CUTANEOUS HYPERANDROGENISM: A PROSPECTIVE STUDY.

2024-07-09T17:35:32+00:00

Background:

Acne is a complex illness caused by androgenic stimulation of the sebaceous glands. As a result, combined oral contraceptives (COCs) including anti-androgenic progestogens are good candidates for acne treatment. The purpose of this study is to compare the effectiveness of oral isotretinoin and cyproterone compound in the treatment of nodulocystic acne, in adult females with signs of cutaneous hyperandrogenism.

Materials and Methods:

Thirty female patients with SAHA syndrome were randomly assigned into two groups of fifteen each. Group A got cyproterone compound (35 μg ethinyl estradiol and 2mg cyproterone acetate) starting day 5 of the menstrual cycle. Group B got isotretinoin at a dose of 0.5mg/kg daily. All recruited patients got topical benzoyl peroxide 3.5% gel regularly. SPSS was used to do statistical analysis. P-values < 0.05 were considered significant.

Results:

Despite a consistent reduction in ASI score in both groups, according to both physician (P = 0.63) and patient (P = 0.25) assessment, the cyproterone compound was not statistically more successful than traditional treatment of nodulocystic acne at the end of the trial. Patients in both groups reported minor and acceptable side effects, except in two cases.

Conclusion:

This study found that cyproterone compound is not more effective than isotretinoin in the treatment of nodulocystic acne in patients with SAHA syndrome or cutaneous hyperandrogenism. Indeed, additional research is needed to assess the efficacy of cyproterone molecules (independent of testosterone level) and isotretinoin in people with just nodulocystic acne.

Recommendation:

Oral isotretinoin is recommended for treating nodulocystic acne in patients with cutaneous hyperandrogenism due to its comparable efficacy to cyproterone compound and established effectiveness in reducing acne lesions. Further research should compare these treatments regardless of androgen levels in nodulocystic acne patients.

TO STUDY IODINE VERSUS TALC PLEURODESIS IN RECURRENT SUSPICIOUS MALIGNANT PLEURAL EFFUSION AND RECURRENT PNEUMOTHORAX: A COHORT STUDY.

2024-06-19T09:37:33+00:00

Background

Malignant pleural effusion (MPE) significantly diminishes the quality of life in individuals with advanced lung cancer and other malignancies. Effective management is crucial for symptom relief and improved outcomes. This study compares the safety, efficacy, and success rates of talc versus povidone-iodine pleurodesis in patients with recurrent MPE and spontaneous pneumothorax.

Methods

The study involved 66 MPE patients who underwent medical thoracoscopy followed by either talc (Group A) or povidone-iodine (Group B) pleurodesis. Data on demographics, clinical presentation, radiological findings, pleural fluid analysis, thoracoscopic findings, complications, and pleurodesis outcomes were collected. Statistical analysis compared the efficacy and safety of both methods.

Results

The study comprised 66 participants, with an average age of 57.86 ± 9.92 years. Pleurodesis was successful in 90.90% of the talc group (n=30) and 100% of the povidone-iodine group (n=33). Complications associated with talc included ARDS (4.5%, n=1) and empyema (4.5%, n=1), whereas povidone-iodine was associated with higher incidences of pain (63.63%, n=14) but no cases of ARDS or empyema. The mean duration of intercostal tube drainage was 4.8 ± 2.1 days for talc and 4.2 ± 1.8 days for povidone-iodine. The mean hospital stay was 8.4 ± 1.8 days for talc and 9.2 ± 2.2 days for povidone-iodine. Povidone-iodine pleurodesis had a slightly higher success rate and fewer severe complications compared to talc pleurodesis.

Conclusion

Both talc and povidone-iodine pleurodesis are effective for managing MPE, with povidone-iodine showing a higher success rate and fewer severe complications. These findings suggest that povidone-iodine may be a safer alternative to talc for pleurodesis in MPE patients.

Recommendations

Further research is recommended to optimize pleurodesis techniques and agents, considering patient-specific factors to improve outcomes and minimize complications. Clinicians should weigh the benefits and risks of each pleurodesis agent to make informed treatment decisions.

A CLINICO-EPIDEMIOLOGICAL STUDY OF ADULT ACNE WITH SPECIAL REFERENCE TO ITS ETIOLOGICAL FACTORS AND COMPLICATIONS- AN OBSERVATIONAL STUDY IN EASTERN PART OF INDIA

2024-06-29T09:02:23+00:00

Background

Acne is affecting an increasing number of adults so no longer be considered as a disease of adolescence. Limited data are available on the clinical characteristics, etiological factors, and complications of adult acne in the Indian population.

Aim

To study the prevalence, clinical pattern, contributing etiological and aggravating factors, and complications of adult acne.

Methods

Patients older than 25 years presenting with acne were included in this prospective study. A detailed history and clinical examination with stress on aggravating and etiological factors were carried out. Hormonal studies were done in females with signs of hyperandrogenism. Complications like scarring and psychological stress were assessed by using a qualitative scarring grading system and PHQ-4 respectively.

Results

A total of 200 patients were included in the study (mean age 31.88 ±1.325 years), comprising 80% females and 20% males. The prevalence of adult acne among the study population was 0.63%. Persistent acne was observed in 64% and late onset in 36%. The majority of the patients had inflammatory papules and it was of grade II in severity (56.5%). The predominant site of involvement was the cheek (70.56%) in the majority, followed by the mandible (12.29%). The most common etiological factor was topical steroid use seen in 43% of patients. Hyperandrogenism was observed in 19.38% but hyperandrogenemia in only 3.75% of females. Scarring was recorded in 82% and psychological stress in 53% of patients.

Conclusion

Adult acne is more common in females, with both external and internal factors playing significant roles. It is primarily facial and inflammatory, often leading to scarring and psychological comorbidities, significantly impairing quality of life. Early and adequate treatment is crucial.

Recommendations

Early and adequate treatment of adult acne is crucial to prevent significant scarring and psychological comorbidities. Large-scale studies are recommended to validate these findings and optimize management strategies.

IMPACT OF HYPERKERATOTIC PALMOPLANTAR DERMATOSES ON DERMATOLOGY LIFE QUALITY INDEX, IN A TERTIARY CARE CENTRE IN EASTERN INDIA: A CROSS-SECTIONAL STUDY.

2024-05-08T18:10:33+00:00

Background:

Palmoplantar dermatoses viz., palmoplantar psoriasis (PPP), hyperkeratotic hand foot eczema (HHFE), and palmoplantar keratoderma (PPK) are the common concern in dermatology as being chronic nature of the dermatoses. Furthermore, they are recalcitrant to treatment and cause significant impairment in quality of life. Early diagnosis and prompt treatment help in improving the quality of life of a patient.

Aim: To study the impact of hyperkeratotic palmoplantar dermatoses on quality of life.

Materials and methods:

A cross-sectional study was conducted. Patients of either sex, over 16 years of age presenting with hyperkeratotic lesions on palms and soles who were clinically diagnosed as palmoplantar psoriasis, hyperkeratotic hand foot eczema, palmoplantar keratoderma those were not under any topical or systemic medication within past 1 month were enrolled in the study. Quality of life was assessed by the Dermatology Life Quality Index (DLQI) questionnaire.

Results:

One hundred fifty-one patients were enrolled, of which 83 (55%) were males and 68 (45%) were females. palmoplantar psoriasis was the most common dermatosis with 74 (49%) patients, followed by hyperkeratotic hand foot eczema with 45(30%) patients and palmoplantar keratoderma with 32(21%) patients. Farmers and housewives were the most affected occupational group. The mean DLQI was maximum in hyperkeratotic hand foot eczema (13.31) followed by PPP (12.08) and PPK (9.15) being the lowest. The most common symptoms affected were feeling and work-related disability.

Conclusion:

Chronic palmoplantar dermatoses have significant impairment in quality of life.

Recommendations:

Early diagnosis and treatment of hyperkeratotic palmoplantar dermatoses, like PPP, HHFE, and PPK, are essential for improving quality of life. Using the Dermatology Life Quality Index routinely helps create personalized treatment plans and enhances patient outcomes.

MICROMORPHOLOGY, AND PRELIMINARY PHYTOCHEMICAL SCREENING OF SPIROSTACYS AFRICANA L. LEAF AND BARK.

2024-06-06T17:56:50+00:00

Background:

Spirostachys africana is indigenous to Southern Africa and is often widely used in African traditional medicine. The utilization of this species has been investigated for its medicinal properties. However, the current investigation aimed to analyze the micromorphology of S. africana leaves and at the same time screen for the presence of secondary metabolites in the leaf and latex extracts.

Methods:

Stereomicroscopy and scanning electron microscopy were used to study morphological characters of both the abaxial and adaxial surfaces of S. africana leaves. Phytochemistry screening was performed using a standard protocol involving chemical reagents and a series of reactions to determine the presence of the phytochemical compound classes.

Results:

It was found that S. africana leaves possess both non-glandular and glandular trichomes on the adaxial surface, and no trichomes on the abaxial surface of the leaves. The phytochemical analysis revealed that the latex crude extract contains six phytochemical classes (alkaloids, steroids, flavonoids, coumarins, saponins, terpenoids) while the leaf crude extract contains seven phytochemical classes (alkaloids, phenols, flavonoids, coumarins, saponins, terpenoids, tannins).

Conclusion:

The micromorphological analysis of Spirostachys Africana leaf and bark provided valuable insights into their structural characteristics, revealing unique features such as thick cuticles, trichomes, and distinctive epidermal cells that are likely to play crucial roles in the plant's defense mechanisms and ecological adaptations. Preliminary phytochemical screening further identified the presence of key bioactive compounds. These findings not only corroborate the traditional uses of S. africana in herbal medicine but also highlight its potential for pharmacological applications.

Recommendations:

The identification of the bioactive compounds lays a foundational framework for future studies aimed at exploring the therapeutic potential and bioactivity of S. africana, thereby contributing to the broader understanding of its medicinal properties and promoting the sustainable use of this Indigenous species.

EPIDEMIOLOGY OF DEPRESSION IN DIABETES PATIENTS: A CROSS-SECTIONAL STUDY CONDUCTED AT A TERTIARY CARE INSTITUTION.

2024-05-29T16:45:17+00:00

Background

Food habits and sedentary lifestyles have a substantial impact on mental and physiological health. The rise in the number of patients suffering from diabetes mellitus is exponential. Diabetes and depression both spread widely, and the association between diabetes and depression has been reported in previous studies. This study aims to determine the prevalence of depression among patients with diabetes and to investigate the association between diabetes-related factors, sociodemographic factors, and the occurrence of depression.

Method

This observational study was conducted prospectively at Narayana Medical College, Nellore. 109 patients who visited the outpatient department of the medical college were considered for this study. The sociodemographic profile of the patients was determined by interviewing them. The occurrence of depression was correlated with diabetes-related factors and sociodemographic factors.

Results

The study included both men and women, however over 60% were men. Study participants were mostly 50–60 years old. More than 70% of study participants reported Beck Depression Inventory scores over 16, suggesting depression and development. In the 50–60 age range, 42 of 43 patients experienced depression. Depression was correlated with age (p=0.032), gender (p=0.046), marital status (p=0.038), BMI (p=0.042), fasting blood sugar levels (p=0.029), HbA1c levels (p=0.039), and diabetes duration (p=0.037).

Conclusion

In this study, it was found that over 70% of the diabetics participating in this had depression. Most of the patients participating in this study were males belonging to the age group of 50 to 60 years. Diabetes and depression were found to be associated in the population participating in this study.

Recommendation

More such studies are required with large cohorts and inclusive of various geographical locations are required.

PREVALENCE AND PATTERN OF MALOCCLUSION AMONG PATIENTS IN SATNA MADHYA PRADESH: A CROSS-SECTIONAL STUDY BASED ON DEWEY’S MODIFICATION

2024-06-25T13:39:22+00:00

Aim

This study aimed to evaluate the prevalence and distribution of malocclusion among the patients reporting to the dental outpatient department (OPD) of the affiliated hospital of a Medical College in M.P.

Materials and methods

This cross-sectional study included 383 individuals aged 14–30 years who satisfied the inclusion criteria. Inclusion criteria consisted of the presence of all permanent teeth with or without third molars. The occlusal relationships were recorded in the centric occlusion position (COP). The occlusion traits were assessed as normal occlusion or malocclusion using the first permanent molars as described by E.H. Angle and deviation from the line of occlusion. The mean and proportions of the data were calculated using descriptive statistics.

Results

The prevalence of malocclusion in individuals aged 14–30 years was 60.84% (116 males and 117 females) Angle’s Class I malocclusion (41.77%) was more common among the individuals than Angle’s Class II malocclusion (15.40%) and Angle’s Class III malocclusion (3.67%). The distribution of Class II Division 1 was 11.75%, whereas Class II Division 2 was 3.65%. Dewey’s Class I type 1 was identified as the most common malocclusion. The prevalence of normal occlusion (as described by Angle) was 39.16% (116 males and 117 females)

Conclusion

Angle’s Class I malocclusion was the most prevalent in participants followed by normal occlusion as described by Angle. Dewey’s Class I type 1 was observed to be the most common malocclusion and Dewey’s Class III type 3 was the least observed type of malocclusion.

Recommendations

To develop a systematic and well-organized dental health care program in a community, basic information such as epidemiological studies on orthodontic malocclusion is required. This study is therefore useful for future studies on the prevalence of malocclusions in the Vindhya region of Madhya Pradesh (M.P.)

BITE MARKS – A BALANCED PERSPECTIVE

2024-03-05T09:57:07+00:00

The article compliments the recently published manuscript titled “Bite Marks – A Vital Investigation in the Field of Forensic Medicine”. It highlights the importance of bite mark analysis in forensic dentistry for solving crimes. Forensic odonatologists handle dental evidence, which is vital for law enforcement. Although bite marks have historically been used in criminal cases, doubts about their accuracy remain, highlighting the necessity for more uniform methods. Computer-assisted techniques have improved precision, yet obstacles persist in guaranteeing scientific validity and reliability. The President's Council of Advisors on Science and Technology stresses the significance of fundamental validity and standardized procedures. Historical cases show the importance of improving analysis techniques. Ultimately, bite mark evidence is essential in court but should be corroborated by other evidence to ensure accuracy and credibility, emphasizing the importance of cooperation for dependability and validity.

Clinico-Hematological Profile of Anemia in Infants and Children

2024-06-24T13:44:59+00:00

Introduction: Anemia is characterized by decreased hemoglobin levels it is widely prevalent around the world. It is reported amongst women within 13-50 years of age group and among the pediatric population. It has severe health consequences and it affects the social and economic growth of the country as well.

Material and Methods: This is an outpatient as well as inpatient department based Prospective Observational study among 100 patients with suspected anemias who are infants or children (up to the age of 14) attending the OPD and Emergency of Department of Paediatrics at Patna Medical College and Hospital, Patna.

Results: In our study, 44% of the study participants were having IDA followed by ACD (17%). Dyserythropoiesis and Pure Red Cell Aplasia consist of 1% of the study population. In the infant and younger age group, IDA were most prominent type of anemia. However, in older age group 10-14 years, Aplastic anemia were the prominent type of anemia.

Conclusions: Among 100 pediatric patients studied, Anemia was prevalent in children below 5 years. Children with a male preponderance aplastic anemia was most common among 10-14 years age group. For optimal treatment of anemia multiple facets should be addressed. An integrated approach can help in dealing with this disease.

PREVALENCE, ASSOCIATED FACTORS, DRIVERS AND BARRIERS OF SATISFACTION WITH HIV COUNSELLING AND TESTING SERVICES AMONG ADOLESCENT GIRLS AND YOUNG WOMEN ATTENDING MILDMAY HOSPITAL: A MIXED-METHODS CROSS-SECTIONAL STUDY.

2024-05-21T09:21:25+00:00

Background:

Uganda faces high HIV/AIDS rates among adolescent girls and young women (AGYW). This study sought to determine the prevalence of satisfaction with HIV counseling and testing services among AGYW. It aimed to identify factors associated with their satisfaction and explored drivers and barriers to their satisfaction with HCT provided at the adolescent and pediatric clinic in Mildmay Hospital.

Methodology:

A mixed methods cross-sectional study was conducted, 385 AGYW aged 15-24 were obtained through systematic random sampling. Quantitative data on patient satisfaction was collected through exit interviews using a patient satisfaction questionnaire. Modified position regression was conducted to determine factors associated with satisfaction with HCT using STATA version 15 software. Qualitative data was obtained through ten in-depth interviews. Data analysis for this was done by transcribing, coding, and extracting themes manually.

Results:

The prevalence of satisfaction with HCT services was 86%. AGYW with the following characteristics had higher odds of being satisfied: primary as the highest level of education APR: 1.17, 95 CI(0.70-1.97), age (23-25), APR: 1.18, 95 CI (0.82-1.70), single APR: 0.93 95 CI (0.69-1.26) and students APR: 1.17, 95 CI(0.80-1.70). Drivers of satisfaction included a friendly and supportive environment, positive interactions with healthcare professionals, and efficient service delivery. Barriers on the other hand included long waiting times and accessibility challenges.

Conclusion:

High satisfaction with HCT services was found among AGYW. Paying attention to the barriers to satisfaction as mentioned by respondents can significantly enhance satisfaction as well as the quality of HCT services.

Recommendation:

The hospital should work towards reducing waiting times, staff communication skills, and providing transportation assistance to AGYW to ensure that they can access the facility whenever they need to. This will help maintain and enhance satisfaction.

FACTORS CONTRIBUTING TO IMPROPER BIOMEDICAL WASTE MANAGEMENT AMONG HEALTH WORKERS IN OLI HEALTH CENTRE IV, ARUA DISTRICT. A CROSS SECTIONAL STUDY.

2023-07-07T13:17:54+00:00

Introduction

The purpose of this study was to determine factors contributing to improper Biomedical Waste management among Health workers in Oli Health Centre IV, Arua District

The specific objectives of the study were to determine; the individual factors and health facility factors contributing to improper Biomedical waste management among health workers.

Methodology

The study employed a retrospective study design; a purposive sampling technique was used. Data was collected using a questionnaire on a sample of 50 respondents. Data was analyzed manually by use of tally sheets and entered in the Excel computer program to generate tables graphs and pie charts

Results

Most of the respondents (60%) who work in Oli Health Centre iv were Nurses, most of the respondents (44%) were married, most of the respondents (60%) were females, most of the respondents (60%) did not receive training on biomedical waste management, most of the respondents (70%) segregated waste, majority of the respondents (96%) do use protective gears, majority of the respondents (64%) agreed that biomedical waste isn’t an extra burden on their work, majority of the respondents (100%) agreed that different wastes are generated by the facility.

Conclusion

The overall results on individual factors about Biomedical waste management were pleasing in that most of the health workers always segregated waste at the point of generation, and knew the color-coded bins. about health facility related factors biomedical waste management was not so pleasing because few health workers knew about Biomedical waste management plans.

Recommendations

The health facility should provide more training sessions to Health Workers who are directly involved in medical waste management, and should also disseminate regulatory information which will help health workers to understand the issues and perform their jobs properly in compliance with those regulations.

FACTORS CONTRIBUTING TO DRUG ABUSE AMONG YOUTHS OF NAKASEKE TOWN COUNCIL, NAKASEKE DISTRICT, A CROSS-SECTIONAL SURVEY.

2023-07-07T13:10:22+00:00

Background

(WHO, 2017) defines drug abuse as the harmful or hazardous use of psychoactive substances including alcohol and illicit drugs. It eventually leads to dependence, a cluster of behavioral, cognitive, and physiological phenomena after repeated substance use despite the harmful consequences.

Objectives

The study aimed to determine how peer group formation among youths, parental supervision, and drug control laws and policies contribute to drug abuse among youths in Nakaseke town council.

Research methods

The researcher used a descriptive cross-sectional study design. The targeted population was the youths in Nakaseke town council. The sample size was 100 determined by Kish and Leslie’s method. Data was collected using questionnaires and interviews.

Results

It was revealed that the majority of respondents have peer groups, while 38% of the respondents misuse drugs. Alcohol is the most abused drug followed by Tobacco, marijuana, and others (which included codeine, morphine, tramadol, & NSAIDs). The study findings showed that most people misuse drugs due to peer pressure 34%, depression 21.1%, media influence 18.4%, curiosity 10.5%, and others (such as excitement, passing time, etc.). Many of the respondents knew individuals counseled for getting involved with drugs, 30% knew those who were imprisoned, 22% were not aware of any punishment given to the victims of drug abuse, and 10% of the respondents mentioned that some would undergo mob justice when they are caught.

Conclusion

The study concluded that in contrast to peer group formation among youths and drug control laws and policies, parental supervision does not have a significant impact on drug abuse.

Recommendations

Youth-based & non-governmental organizations, county & national governments, as well as other relevant stakeholders, should devote maximum attention and resources towards factors against drug abuse effectively. Town council-level strategies also influence the relationship of the other factors with drug abuse.

THE EFFECTS OF SOCIO-CULTURAL INTERVENTION ON PERCEIVED SOBRIETY IN SELECTED REFERRAL HOSPITALS AND REHABILITATION CENTRES IN KAMPALA AND WAKISO DISTRICTS, UGANDA. A CROSS-SECTIONAL STUDY.

2024-05-02T07:47:47+00:00

Background

Alcohol presents a serious challenge worldwide; it is increasingly associated with negative consequences in developing countries including Uganda which bear the heaviest burden of diseases and injuries attributed to alcohol. Alcohol abuse is alarming despite the availability of treatment facilities in Uganda. The study objective was to analyze the effect of recovery interventions on perceived sobriety in Butabika National Referral Hospital and Serenity Rehabilitation Centre in the Wakiso and Kampala districts, Uganda. The post-positivist paradigm guided the study.

Methods

The research adopted a cross-sectional research design with a mixed-method approach known as simultaneous triangulation design. Using purposive sampling and simple random sampling, Data was collected, and questionnaires and interview guides were used. 338 subjects participated in the study. Quantitative data was analyzed using SPSS, and Pearson’s product-moment correlation coefficient was employed in hypothesis testing. Primary data was collected using self – self-administered questionnaires and Focused group discussions to obtain in-depth results.

Results

Sociocultural intervention and perceived sobriety have r=0.544, with a probability value p=0.000 < a=0.01 suggesting a significant correlation. The null hypothesis was rejected; which implies that sociocultural intervention significantly positively correlates with perceived sobriety at a one percent level of significance. “Culturally, alcohol is taken when twins were born and at the initiation “wall” ceremony, a day for receiving the twins into the family, the birth of a new baby, marriage introduction, paying dowry and wedding ceremonies”.

Conclusion

The more socio-cultural intervention is utilized in treatment facilities, the more sobriety is realized. Therefore, having workable socio-cultural intervention would help to reduce perceived sobriety.

Recommendation

The Ministry of Health through the mental health desk office encourages mental health practitioners to empower therapists in the treatment facilities to give more attention to using sociocultural intervention to address beliefs about excessive use of alcohol.