Therapeutic Plasma Exchange in Guillain Barre Syndrome: An experience of Bangabanhu Sheikh Mujib Medical University, Bangladesh

Background: Therapeutic plasma exchange (TPE) has been used as one of the treatment modalities of neurological diseases. Intravenous Immunoglobulin (IVIG) and Therapeutic Plasma Exchange (TPE)are treatment options in Guillain Barre syndrome (GBS). In developing countries IVIG is not easily available and it is also expensive, TPE is preferred for treatment of GBS as it is affordable. Study on TPE for GBS are scarce here. Most of the study regarding TPE in GBS has been conducted in high –income countries as it is expensive treatment modality. Reports on TPE in GBS is very scared from Bangladesh. Materials and Methods: A retrospective analysis of TPE with a standard hemolysis equipment for the treatment of Guillain Barre syndrome (GBS) was conducted A 50 patients of GBS who received TPE conducted between January 2017 to December 2018 in the department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh were analyzed. All patients had underdone at least 2 cycles of plasma exchange. Volume exchanged in each cycle was one plasma volume. Results: Out of 50 cases there were 43 (86%) male and 7 (14%) female. Age range of patients was from 11 – 50 years. Approximately 40% improved clinically of first cycle of PE & 85% after second cycle, 95% after third cycle and 95-100% after 5 cycle. 1(2%) patient died, and 49(98%) patients survived and recovered. Conclusion: The treatment is cost affection in Compassion to IVIG. TPE is and affection, safe and affordable treatment modality for GBS.

A Surgical Approach to Giant Cell Tumor of Lower End of Tibia with Curettage and Reconstruction by Bone Grafting Harvested from Left Iliac Crest and K-wire Fixation: A Case Report

Introduction: Giant cell tumor (GCT) is a distinctive lesion characterized by the proliferation of multinucleate giant cells in a stroma of mononuclear cells; it is generally seen in skeletally mature individuals. GCT is usually found in the long bones around the knee or in the distal radius but distal end of tibia, proximal humerus, vertebrae of young adults are unusual location. We report a case of GCT of the distal end of tibia, with a secondary aneurysmal bone cyst, in a 26-year-old female. Based on our review of the medical literature, it appears that the occurrence of a GCT along with a secondary aneurysmal bone cyst (ABC) in distal end of tibia is less typical with challenging task for full tumor resection and restoration of ankle function to normal. Case Summary: 26 year old female presented with pain&swelling over left ankle since last six month. Biopsy was suggestive of GCT with ABC of lower third tibia. We managed this case with intralesional curettage using phenol and burr and bone graft harvested from left iliac crest for reconstruction of defect along with kwire fixation to achieve optimum anatomical restoration. Conclusion: In cases of GCT, the management depends upon the various factors such as site, age, involvement of the bone, extent of bone involvement and whether there is articular involvement or not. Here Intra-articular GCT is managed with extended intralesional curettage with phenol. Bone graft plays a role of agent for reconstruction of the defect and kwire for anatomical reduction.

Variation between Initial and Final Diagnosis as A Predictor of Adverse Obstetric Outcome among Post-Natal Women at Bungoma Hospitals, Kenya

Despite diagnosis being an important part of clinical or medical consultations, the diagnosis might fail leading to adverse effects. This is a global problem, where developed and developing countries go through. In sub-Saharan Africa, variations between initial diagnosis and final diagnosis lead to diagnostic errors with high maternal mortalities. In Kenya, a lot of measures have been put in place but still, variation in diagnosis appear to have become rampant. Bungoma county is one of the counties with a high mortality ratio, especially for pregnant women attributed to the variation between initial and final diagnosis. Therefore, it was crucial to investigate the variation between initial and final diagnosis in relation to obstetric outcomes at hospitals in Bungoma County. The cross-sectional research design was used (Bungoma and Webuye hospitals). Systematic sampling was used to obtain 384 respondents after proportionate allocation to each hospital, and purposive sampling to select 8 health care workers as key informants. Data was collected using a structured questionnaire and an interview guide. The pre-test was done with validity established through crosschecking and reliability calculated using the Cronbach method (0.89). Using a statistical package for social sciences version 25, descriptive and inferential statistics was run where chi-square and odds ratio was used to determine the influence between variables, significance and prediction. The study revealed a variation between initial diagnosis and the final diagnosis was 20.8% while diagnostic errors were significant predictors of obstetric outcomes among post-natal mothers at level five with a p-value of 0.045 at a significance of 5%(P=0.045). Demographic characteristics showed no relationship with obstetric outcomes (P=0.54>0.05). Matched diagnostic had no variations (N=327, M=1.00, SD=0.000); while unmatched diagnostic had variations (N=327, M=1.82, SD=.384). There was a relationship between diagnostic errors and obstetric outcome (ꭓ2 (1) = 251.86, p< .001). An association between diagnostic error with unsafe obstetric outcomes was significant at the odds ratio of 2.03(OR 2.03, 95% CI 1.31–2.16). The study demonstrates that a correct diagnosis is a viable strategy in preventing unsafe obstetric outcomes and by extension minimizing morbidity and mortality among pregnant women. The study concluded that there was a variation between initial diagnosis and final diagnosis which had an adverse obstetric outcome. it was recommended to build capacities for the health workers in order to address increased diagnostic errors.

Normal Chest X-Ray in Patients with Pulmonary Embolism May Involve Increased Risk of Massive Pulmonary Embolism

Purpose: Chest radiography is normal in approximately 20-40% of acute pulmonary embolism (PE) patients without cardiopulmonary disease. The aim of this study was to determine whether there is any difference between the patients with normal chest X-ray and those with pathological findings in terms of clinical severity and prognosis. Methods: 178 of PE patients were included in the study. 110 patients had no parenchymal pathology, whereas group 1 (n = 110); group 2 (n = 68) had various pathological parenchymal findings in 68 patients. Clinical and radiological parameters were compared between these groups. Following the diagnosis of PE, the cases were recorded in the fifth year. Results: In 178 participants; those with normal chest X-ray (group 1), with parenchymal pathological findings on the chest X-ray (group 2); echocardiographic systolic pulmonary artery pressure (sPAP) (p = 0.68), gender (p = 0.9) and thrombus type (p = 0.41) were similar. The patients in group 1 were not different in terms of central thrombus detected in computed tomography pulmonary angiogram compared to the patients in group 2; however, the chest radiograph of the patients in group 1 had no parenchymal pathology. Central thrombus group 1, group 2, respectively; 97 (89.0%), 53 (77.9%), p = 0.07. There was no significant difference between the two groups in terms of mortality which was followed up in fifth year (p > 0.05). Conclusions: Normal chest X-ray in PE can determine mortality and may involve increased risk of massive PE.

Coronavirus in HIP Fractures CHIP 2: Is Vitamin D Deficiency Associated with Increased Mortality from COVID-19 Infections in A Hip Fracture Population?

Purpose: There is controversy as to whether vitamin D deficiency is associated with increased mortality from coronavirus infection. The aim of the study was to assess the relationship between vitamin D levels and 30-day mortality in hip fracture patients co-infected with COVID-19. Methods: This was a national observational audit conducted between 23 March 2020 (start of UK lockdown) and 31st December 2020. The cohort consisted of patients aged >60 years presenting with a hip fracture. Patients were included if they had a vitamin D level done during the admission episode, diagnosis of COVID-19 infection via a viral reverse transcriptase PCR swab, and a hip fracture. There were 517 patients included in the study from 43 different hospital trusts. The primary outcome measure was 30-day mortality. Secondary outcomes were the percentage of patients who had vitamin D deficiency, the percentage of patients who were prescribed Vitamin D, and the impact of vitamin D prescribing on mortality Results: Vitamin D deficiency was not associated with a higher 30-day mortality. Low serum vitamin D was observed in 56% of the patients on admission. Vitamin D was prescribed prior to admission in 28% and during admission in a further 49%. Pre-hospital vitamin D therapy reduced the chance of vitamin D deficiency. Starting vitamin D before or on admission did not affect the mortality rates. Conclusion: Vitamin D deficiency was common, but not associated with a higher 30-day mortality in the hip fracture population co-infected with COVID-19.

Epidemiology and Vaccine Efficacy of Delta Variant

Several variants of concern (VOCs) of SARS-CoV-2 have emerged after its first outbreak in 2020. These VOCs possess mutations in the spike protein that confers enhanced rate of infection and transmission of these VOCs. Among these VOCs, the delta/B.1.617.2 variant was identified in late 2020 in India and soon spread to several countries around the globe. Currently, it is the most widely sequenced variant among new infected individuals with SARS-CoV-2 infection. This variant is also found to be associated with COVID-19 infection in vaccinated individuals, but the severity of disease and rate of hospitalization are low among these individuals as compared to unvaccinated individuals. With the emergence of new variants of SARS-CoV-2 due to continuous mutations, it is suggested that vaccination plays a significant role in preventing the transmission of disease and disease severity.

On the Delta Plus Variant of SARS-CoV-2

The unprecedented consequences brought by the COVID pandemic are still going on, the virus hasn’t been tamed yet. It is evolving through mutations to consistently being a risk to public health. Recently, the Delta variant has been declared as the variant of concern by the World Health Organization (WHO). In this article, a subvariant of Delta known as Delta Plus has been presented to provide a relevant foundation for future research works. The evolution, pathogenesis, associated symptoms, suggested prevention and treatments, vaccine efficacy, and current trends of transmission of Delta Plus variant of SARS-CoV-2 are reviewed and discussed.

Diabetes Self-Efficacy and Associated Factors among People Living with Diabetes in Ibadan, Southwestern Nigeria

With the increasing prevalence of diabetes mellitus (DM) globally, including in Nigeria, self-care practices are universally recognized as imperative to keeping the illness under control and preventing complications. It is important to determine how competent patients feel about managing their diabetes; as well as their psychosocial adjustment. Self-efficacy measures these important aspects of diabetes care and act as a guide to health professionals on how best to tailor diabetes education and support. There is a dearth of studies on self-efficacy and associated influences, among people living with diabetes in Nigeria. Hence, this study was carried out to fill the lacunae. This descriptive study was carried out at the Out-patient Clinic of the University College Hospital (UCH), Ibadan, among 235 people receiving treatment for diabetes. A total sampling of all available patients who provided consent at the time of data collection was done. The instrument for data collection was a questionnaire consisting of a section on sociodemographic and clinical characteristics including fasting blood glucose; followed by a section on diabetes self-efficacy. Diabetes self-efficacy was measured using the validated and adapted Michigan Diabetes Empowerment scale (DES). Ethical approval was obtained from the University of Ibadan/University College Hospital Institutional Review Board (UI/UCH IRB). Data were entered into the Statistical Package for Social Sciences, version 20. Data were analysed using frequencies, percentages, mean, independent t-test and Pearson’s correlation at α 0.05. Participants were predominantly women (60.9%) and had a mean age of 59.3 ± 14.0 years. More than half of the participants (55%) had a high self-efficacy level. Educational level and having a family member who is a nurse or a doctor were significantly associated with high self-efficacy. Fasting blood glucose level was negatively correlated with self-efficacy and the domain of managing the psychological aspect of diabetes. A good percentage of people living with diabetes had high self-efficacy, which was influenced by educational level and having a health professional as a relative. Those with high self-efficacy had better glucose control. It is recommended that individually-tailored diabetes education be provided for people with poorly controlled glucose level.

Multi-Modal Oral Implantology. The Screw-Blade Single-Implant for the Replacement of the Upper Molar: A Case Report

Intense forces are naturally downloading on molar roots. Due to inflammation, the post-extraction sockets of the upper molars are often poor of bone on one side. A single implant supporting a prosthetic crown can easily go subject to displacing forces that reabsorbed and recently healed bone can hardly bear. By utilizing a couple of prosthetic roots, i.e.: one screw implant in the side in which bone is richer and one blade implant in the side in which the bony wall has gone subject to reabsorption, it is possible to build a better supported prosthetic crown. The clinical cases performed by the Authors confirm the validity of this implant architecture. Aim of the work is to describe a post-extraction multi-modal implantological technique useful for replacing the roots of upper molars with poor bone support on one side. Materials and Methods: Combination of submerged screw implant and submerged blade implant or emergent screw implant and emergent blade implant welded intraorally. Discussion: The combination of a palatal screw implant and a buccal blade implant, or vice versa, allowed to solve clinical cases and to make reliable prosthetic crowns. Conclusions: The presence of variable residual anatomies in the molar area of the upper jaw recommends the use of morphologically different implant shapes, suitable for the construction of a biomechanically functional prosthetic abutment. Specifically in the presence of bone resorption, the combination of a screw implant and a blade implant allowed us to obtain a reliable abutment. Given the small number of cases performed, further research will confirm the positive results of this technique.

Another Perspective of the Miller Forensic Assessment of Symptoms Test – Part II: A Quantitative Review

Reference [1] presented pooled data for the specificity of the M-FAST cut-off, but ignored or excluded data based on poor justifications and used questionable analytic methods. The analyses here corrected the problems associated with [1]. No moderator substantively influenced sensitivity values. Therefore, sensitivity values were pooled across all studies (k = 25) to provide an overall estimate. Overall, the average sensitivity of the M-FAST cut-off was estimated to be 0.87, 95% CI [0.80, 0.91], and 80% of true sensitivity values were estimated to range from 0.63 to 0.96. Thus, there could be methodological scenarios when the M-FAST cut-off may not operate efficiently. Average specificity values for the M-FAST cut-off were moderated by one variable: the comparison group. On average, specificity values for clinical comparison (k = 15) groups (i.e., 0.80, 95% CI [0.73, 0.85]) were lower than specificity values for non-clinical comparison (k = 11) groups (i.e., 0.96, 95% CI [0.89, 0.99]). Unlike the CIs, the estimated distributions of true specificity values for the two subgroups overlapped, which suggests there could be scenarios when these subgroups share the same true specificity value. The M-FAST was designed to be a screener to detect potential feigning of psychiatric symptoms. An examinee is never to be designating as feigning or malingering psychiatric symptoms based on only a positive M-FAST result. As a screening instrument, the results here show that the M-FAST cut-off is operating adequately overall and negate the conclusions of [1].