Prevalence of Anti-leptospiral IgM and Detection of Pathogenic Leptospira Species DNA in Neonates Presenting With Clinical Sepsis in Southwestern Uganda

BackgroundLeptospirosis is an emerging neglected zoonotic disease that presents with nonspecific signs/symptoms and it can be mistaken for other diseases. Due to limited diagnostic capacity and unawareness, data on human leptospirosis particularly in neonates is scarce in many sub-Saharan countries. It has been underreported hindering preventive and control measures in place. The study aimed at determining prevalence of leptospirosis as a cause of febrile illness in neonates using a commercially available IgM ELISA and a quantitative real-time PCR (qPCR). MethodsThis was a descriptive cross-sectional study that included 103 neonatal sepsis cases whose parents/legal guardians gave informed consent. Data on demographic and clinical characteristics was collected using structured data collection form. EDTA whole blood sample was collected from the neonates by trained study nurses. From the samples, IgM ELISA was done using automated analyzers, DNA extracted and qPCR was performed using primers for LipL32, specific for the pathogenic leptospires. ResultsThe prevalence of anti-leptospiral IgM among the neonates as determined by ELISA was 4.3%, where all of them presented with lethargy and poor feeding. No pathogenic Leptospira species DNA was amplified by qPCR.ConclusionsEvidence of leptospirosis was demonstrated in neonatal sepsis cases in this study. The findings suggest considerations of leptospirosis in the differential diagnosis of neonates with sepsis. More data is needed on the real epidemiology, clinical features and burden of leptospirosis in neonates. There is need to include intermediate pathogenic species of Leptospira in the diagnostic qPCR assays.

Off-Label Use of Medicines in Children Attending a Secondary Healthcare Facility in Federal Capital Territory

Before a new drug is approved for marketing in any country, it must have undergone three phases of clinical trials designed to assess its efficacy and safety when used according to an approved recommendation. After a drug has been tested and approved by the regulatory authorities, the drug is usually given a ‘label’ or ‘license’ which is a report describing the drug intended use and dosage. This study aimed at evaluating the use of medicines outside the terms stated in the label. The study was conducted using a data collection form to obtain information from patients’ case file. Data were analysed using Statistical Package for Social Sciences. The case notes of 449 patients were included in the study. The ages of the patients ranged from 4 days to 16 years. Females constituted 51.7% (232) and males 48.3% (217). A total of 1866 drugs were administered to patients, of which 469 (25.13%) were off-label prescriptions. The highest category of off-label drug was indication (45%). This study has revealed a considerable prevalence of off-label use of medicines, there is however need for proper pharmaceutical care to be emplaced in healthcare facilities so as to minimize off-label drug use and prevent adverse effect of drugs as a result of inappropriate use of medicines.

Practices of Niruha Vasti in Low back pain from an Academic Hospital of Kerala - An observational study

Introduction: Niruha Vasti plays a major role when compared to Anuvasana, because of its variety of drug combinations and utility in a wide range of clinical conditions. Many formulations of Vasti are, in practice which came from the clinical experiences of eminent physicians and from researches. There is a deficit of baseline data regarding the current practices of Niruha Vasti in LBP and the preparation of which may help to prioritize the topics for further research. Materials and Methods: The study design was prospective cross-sectional observational study and sample included all the patients admitted in VPSV Ayurveda College Hospital, Kottakkal during January-December 2018, presented with LBP and posted for Niruha Vasti. Study tool used was a Data collection form which was prepared from available literatures. Data was verified, analyzed and presented with the help of tables and charts. Statistical analysis was done by Microsoft office 2016 and IBM SPSS Statistics version 16. Observation and Results: Total 141 patients were observed and among them 474 Vasti done in 174 schedules and 16 different types of Vasti were used. Vaitarana Vasti, Madhutailika Vasti, Kshira Vasti, Ruksha Vasti, Erandamuladi Vasti and Grdhrasihara Vasti are the major Vasti prescribed in LBP patients. Conclusion: There are certain characteristic patterns in the practice of Niruha Vasti administered in cases of Low Back Pain.

Complications in Patients with Cardiac Penetrating Trauma

Background: Cardiac penetrating trauma is a medical emergency that mostly affects young people. Based on the type of injury and associated complications, it can present as a surgical challenge and can lead to mortality. Objective: The aim of this study is to evaluate the complications of penetrating heart trauma among patients referred to Shahid Madani Hospital. Methods: In this retrospective descriptive study, the data of penetrating cardiac trauma patients referred to Shahid Madani hospital, Karaj, Tehran, from 2016-2019, were investigated. Information, including age, sex, cause of trauma, traumatized area and complications, was extracted and recorded in a data collection form. The data were evaluated statistically using SPSS v18. Results: A total of 44 patients were included in the study, where the mean age of the patients was 25 years. 73.3% of these patients were men and 26.7% were women. Knife stab wounds were the most prevalent cause of the trauma, present in 93.3% of patients. 73.3% of the patients had cardiac tamponade and 20% had a pneumothorax. The right ventricle was the most common site of the injury in 46.7% of the patients. A mortality rate of 3.4% was reported in this study. Conclusion: The results of this study showed that the highest penetrating heart rate trauma occurred among young people, and the most common cause of the trauma was a knife stab. The most common area of the injury was the right ventricular, and cardiac tamponade was the most common complication.

Malarial Epidemiology among Patients in Al-Medina Al-Munawara, KSA

Worldwide, malaria is the most important disease caused by parasites and responsible for a yearly estimation of 225 million clinical cases. The risk of the disease covers almost half of the world’s population and the annual death has been estimated as 800.000. Children under five years of age are mainly affected. Pregnant women and adults with immunosuppression become victims of cerebral manifestations or anaemia and frequently die. Almost 40% of the world's population is at risk to acquire the infection. Human malaria is caused by four Plasmodium species among which the most prevalent is Plasmodium falciparum. Because of the higher global prevalence, morbidity and mortality rate of P. falciparum, most research efforts on malaria pathogenesis have been focused on this species. Recent studies have reported the clinical outcomes that originate from regions where P. falciparum and P. vivax are equally prevalent. This in turn could make the clinical tools inappropriate for use in managing vivax mono infections. Thus, the present study was aimed to identify the epidemiology and clinical features of the malarial cases of the Referral laboratory, Al Madinah, Saudi Arabia. A retrospective case series study was conducted among the patients reported from January 2016 to December 2016 using a specially designed data collection form. Out of the 182 confirmed cases, 143 were non-saudi and 39 were Saudi cases. Most of the cases reported in the month of September due to seasonal change. Gender distribution showed a higher dominance of male patients compared to females. No cases were reported to be caused due to P.malariae. The predominant species was found to be P.Vivax (87%) while P.falciparum with only 13% incidence. Further investigations in large sample sizes are recommended to explore the other aspects in reducing the malaria burden.

The Relationship between the Fear, the Perceived Risk of COVID-19 and Compliance with Standard Precautions of Nurses

Aim: it was aimed to examine the correlation between the fear of COVID-19 and the perceived risk of COVID-19 and compliance with standard precautions of nurses working in pandemic clinics. Materials and Methods: The study conducted in a cross-sectional research design. The sample consists of 194 participants who worked in COVID-19 clinics between November 2020 - January 2021 in an Education and Research Hospital in Ankara, and met the inclusion criteria. Data collection form consisted of the Introductory Information Form (18 questions), the The Fear of COVID-19 Scale (7 items), the Perceived COVID-19 Risk Scale (8 items) and the Standard Precautions Scale (20 items). The data were collected by considering the pandemic conditions, using an online questionnaire. Mann Whitney U Test and Kruskal Wallis Variance Analysis were used to compare continuous data. Spearman Correlation Analysis was used to determine the correlation between the scales’ scores. Results: The mean age of the participants was 29.01 ± 6.73. Participants’ mean scores were on the The Fear of COVID-19 Scale, Perceived COVID-19 Risk Scale, and Standard Precautions Scale were 19.83 ± 6.36, 29.89 ± 5, and 14.05 ± 2.81, respectively. It was determined that there was a moderate and positive significant correlation between the The Fear of COVID-19 Scale mean scores of the participants and the Perceived COVID-19 Risk Scale (r = 0.619; p = 0.001). There was no statistically significant correlation between the mean scores of the Compliance with Standard Precautions Scale and the mean scores of the The Fear of COVID-19 Scale and Perceived COVID-19 Risk Scale (p>0.05). Conclusion: In line with the results obtained in the study, it was determined that the nurses’ fear of COVID-19 and the perceived risk of COVID-19 were above average. However, it was revealed that fear of COVID-19 and perceived risk were not related to Compliance with Standard Precautions.

Assessment of Anxiety due to COVID-19 among the Surgery Staff of the René ESSOMBA Theater "BORE" at the Yaoundé Central Hospital

Background: The COVID-19 pandemic has had a negative impact on healthcare systems worldwide, including surgical disciplines. To date, only a few studies have assessed the effects of the ongoing pandemic on the mental state of those potentially exposed through their daily activities, such as operating theatre staff. The present study aimed to determine the prevalence of anxiety among the operating theatre staff "BORE" during the COVID-19 pandemic. Methods: From 13 January to 19 February 2021, we conducted a cross-sectional study using a pre-designed online form. This form was disseminated to participants via social networks. The data collection form was divided into three parts: one part was for socio-demographic information, the second part was for professional information, and the third part was for assessing the anxiety score by the Hamilton Anxiety Scale (HAM-A). Results: A total of 42 questionnaires were fully completed and retained for analysis. The sex ratio was 1.67, with 16 men and 26 women. COVID-19 anxiety with mild severity (HS ˂ 17) was found in 22 (55.4%) of the participants, and 33.3% had moderate to severe depression, while 11.3% had severe anxiety. Conclusion: About 4/5 of the participants in our survey suffered from anxiety due to the COVID-19 pandemic. This study highlights the need for psychological assistance for health care workers, especially the operating theatre staff of the Yaounde Central Hospital.

First Census of Patients with Hereditary Angioedema in the Canary Islands

Hereditary angioedema (HAE) is a rare genetic condition whose main symptoms are recurrent swelling in the skin, mucosa, and internal organs. Recent studies suggested that the regulation of the inflammatory response and the complement cascade are two of the pathways significantly enriched in the Canary Islands, Spain. Here, we describe the first HAE patient series in this region. Forty-one patients (33 F, 8 M) and nine healthy relatives belonging to twenty-nine families were recruited for this study, obtaining their clinical and demographic features using a data collection form, as well as blood samples for biochemical analysis. The mean age of patients was 36.8 years (ranging from 4 to 72 years). Positive family history of HAE was reported in 13 patients (32.5%), and a mean diagnosis delay of 7.9 (±12.5) years was estimated, ranging from months to 50 years. Cutaneous edema was the most common symptom (53.6%), while airway symptoms was present in 11 patients. Prophylactic treatment was indicated for 23 patients, while 14 also require on-demand rescue treatment. We estimate a minimum prevalence of 1.25:100,000 for HAE due to C1-INH deficiency or dysfunction in the Canary Islands, which is higher than the estimates for mainland Spanish populations. HAE continues to be a disease poorly recognized by health care professionals due to its confusing symptoms, leading to longer diagnosis delay. Altogether, the evidence reinforces the need for a rapid and accurate diagnosis and precision medicine-based studies to improve the patient’s quality of life.

Primary postpartum haemorrhage at the Libreville University Hospital Centre: Epidemiological profile of women

In Gabon, the proportion of maternal deaths directly related to Primary PostPartum Haemorrhage (PPPH) is 15 to 25%, despite the different means that the World Health Organization has made available to the providers of Emergency Obstetrical and Neonatal Care (EmONC). The objective of this study was to determine the prevalence and epidemiological characteristics of Primary PostPartum Haemorrhage to improve its management and reduce the rate of maternal deaths. An analytical retrospective study involved 42,728 records, whose data were collected using a chart collection form on the basis of information contained in partograms and other patient records. Sociodemographic variables were expressed using percentage. The relationship between the etiologies of PPPH and certain characteristics of the women was established using the ORs with their 95% confidence intervals. The difference was significant if p < 0.05. The prevalence of PPPH was 1.6%. Delivery haemorrhages accounted for 65.5% of PPPH. The main factors associated with delivery haemorrhages were pauci parity and multiparity (p = 0.003 and 0.051), post-term (p = 0.042), and birth weight >4,000 g (p = 0.006). Those associated with genital tract injuries were young maternal age (p = 0.008) and multiparity (p = 0.028). The most common etiology was haemorrhage from delivery. Multiparity remains the most common risk factor and the young age of the patients. It is important to improve management through better assessment of blood loss in the primary postpartum period as well as capacity building of health providers on EmONC.

Orofacial Granulomatosis Associated with Crohn’s Disease: a Multicentre Case Series

Background Orofacial granulomatosis [OFG] is a rare syndrome that may be associated with Crohn’s disease [CD]. We aimed to characterise this relationship and the management options in the biologic era. Methods This multicentre case series was supported by the European Crohn’s and Colitis Organisation [ECCO], and performed as part of the Collaborative Network of Exceptionally Rare case reports [CONFER] project. Clinical data were recorded in a standardised collection form. Results This report includes 28 patients with OFG associated with CD: 14 males (mean age of 32 years, ±12.4 standard deviation [SD]) and 14 females [40.3 years, ±21.0 SD]. Non-oral upper gastrointestinal tract involvement was seen in six cases and perianal disease in 11. The diagnosis of OFG was made before CD diagnosis in two patients, concurrently in eight, and after CD diagnosis in 18. The distribution of OFG involved the lips in 16 cases and buccal mucosa in 18. Pain was present in 25 cases, with impaired swallowing or speaking in six. Remission was achieved in 23 patients, notably with the use of anti-tumour necrosis factors [TNFs] in nine patients, vedolizumab in one, ustekinumab in one, and thalidomide in two. A further five cases were resistant to therapies including anti-TNFs. Conclusions OFG associated with CD may occur before, concurrently with, or after the diagnosis of CD. Perianal and upper gastrointestinal [UGI] disease are common associations and there is a significant symptom burden in many. Remission can be obtained with a variety of immunosuppressive treatments, including several biologics approved for CD.