Articles

Background: We report our experience with management and treatment of pregnant women who were admitted at our institution for snake envenomation. Methosd: We reviewed the charts and recorded the management, treatment, and outcome of 51 pregnant women admitted to our high-risk obstetric service with a diagnosis of snakebite. Results: One patient experienced spontaneous abortion, 2 had intrauterine fetal death due to placental abruption, 2 delivered malformed babies, 1 had premature birth of twins with low birthweight. There were no maternal deaths. Conclusion: Snake-venom poisoning in pregnancy is a complex medical emergency that involves complications at the site of the bite and may also involve dysfunction of multiple organ systems in both mother and fetus.

Aims: Histological diagnostic criteria are used for the assessment of the degree of dysplasia and hence the risk of cancer progression for premalignant lesions. Clonal changes in the form of hyperorthokeratosis and hyperchromasia that are sharply demarcated from adjacent areas are not currently part of the criterion for dysplasia diagnosis. The objective of this study was to determine whether such clonal change should be regarded as a diagnostic feature for dysplasia. The following histological conditions were used to define such change: (1) hyperorthokeratosis; (2) hyperchromatism but no other features of dysplasia; (3) sharp margin demarcation from adjacent area by both the hyperorthokeratosis and hyperchromasia (clonal change), and (4) no prominent rete ridges, marked acanthosis or heavy inflammation. Lesions fitting these criteria were termed orthokeratotic lesions with no dysplasia. Methods: Patients from a population-based longitudinal study with more than 10 years of follow up were analyzed. Of the 214 patients with primary oral premalignant lesions, 194 had mild or moderate dysplasia (dysplasia group) and 20 fit the criteria for orthokeratotic lesions without dysplasia (orthokeratotic with no dysplasia group). The two groups were compared for their cancer risks using clinical (site and toluidine blue), histological (nuclear phenotype score), and molecular criteria (loss of heterozygosity) and by outcome (progression). Results and conclusions: The lesions from orthokeratotic with no dysplasia group showed a similar cancer risk (clinical, histological and molecular risk) and time to progression as the dysplastic lesions. We recommend that the clonal change should be included as a criterion for dysplasia diagnosis

Background: Pre-eclampsia is a frequent and serious pregnancy complication contributing for the increasing maternal morbi-mortality rates. This study was designed to evaluate the effect of calcium supplementation during pregnancy, on the incidence of pre-eclampsia and eclampsia among primigravid women. Method: In a hospital-based, opened, randomized and controlled clinical trial carried out in the city of Yaounde, 70 women were randomized to either 1.5 g daily calcium supplements (n = 35) or vitamins at the same time (n = 35) from 20 weeks gestation till delivery. Were included all singleton healthy, primigravid women who offered their signed inform consent and were excluded, all women with any chronic condition. Primary outcomes were pre-eclampsia and eclampsia. Results: No significant difference was observed between the two study groups with respect to the baseline characteristics obtained at enrollment. We recorded a sevenfold decrease in the incidence of preeclampsia in the calcium group (RR = 0.26, CI 0.06 – 0.44, p = 0.024). The onset of pre-eclampsia was delayed 3 weeks in the calcium group. Meanwhile the mean diastolic blood pressure at delivery was of no significant difference (p = 0.126), the mean systolic blood pressure at delivery however, presented a significant difference between both groups (p = 0.009). Conclusion: A 1.5 g daily calcium supplementation of healthy normotensive primigravid women during pregnancy seems to be effective in reducing the incidence of pre-eclampsia. 

Deliveries prior to 28 weeks’ gestation (extreme preterm birth) pose a global health concern, according to the World Health Organization (WHO). Extreme preterm birth is associated with several complications in the newborn and management in neonatal intensive care unit would incur high expenses. In parallel, advancements in in vitro fertilization will give an opportunity for women to conceive in cases of ovarian failure. At the same time, health providers also encourage patients to receive more than one embryo simultaneously during an embryo transfer. Here we report a case of a patient in coma condition of triplet pregnancy, post ovum donation with three-embryo transfer. Following stabilization, cranial computed tomography (CCT) was performed. The result showed bleeding in the brainstem and into intraventricular spaces at 25+4 gestation weeks. Furthermore, ICH during pregnancy is considered as a rare case in obstetrical field, especially involving the brainstem. This could lead to life-threatening conditions and serious disability in the future. On the fifth day of hospitalization, she suffered from pneumonia and pulmonary edema. On the eight day (26+5 gestations weeks), an emergency caesarean section was performed due to fully dilated of the cervix with breech presentation of all fetuses. Mother and the children survived with some non-life-threatening disabilities. This is the very first case reported of intracerebral hemorrhage in the brainstem in triplet pregnancy after receiving ovum donation. Heterologous conception could be an iceberg phenomenon of gestational complications among the population. Reproductive tourism could still become greater in the future. 

Background: Leiomyoma itself is not a rare disease, but it is rarely found intravascularly. Case presentation: A 54-year old female sought medical help after noticing her leg being swelling. A diagnosis of deep vein thrombosis (DVT) was made and antithrombotic treatment was given after her initial imaging exam. Several days later, a contrast CT and sequential pathology revealed the real diagnosis was intravascular leiomyoma. The patient was discharged after a successful surgery. Conclusion: Intravascular leiomyoma should not be confused with DVT.

Drug addiction is one of the burning problems in the modern society. Annually there is a steady increase in the level of drug abuse. United Nations Office on Drugs and Crime publishes “World Drugs Report 2018”, where it was reported that about 275 million people (almost 5.6% of the world population) aged 15-64 used drugs at least once in their lives, and opium production increased by 65% in 2016-2017 [1-3]. Therefore, the question of studying the influence of drugs on the structural organization of organs remains open and relevant [4,5].

Medical postgraduate trainees are given increasing levels of responsibility during training in the apprenticeship-model of training [1-3]. Responsibility is said to be a key driver of deep learning and understanding [4-7]. Trainees with greater levels of responsibility for decision making have higher levels of motivation to learn compared with trainees who self-assess as having less autonomy [5]. The Royal College of Pathologists (RCPath) indicate that ‘graded responsibility’ is part of training histopathologists and provided a framework for implementation with increasingly complex specimens suitable for reporting by more senior trainees [8,9]. 

Objective: To evaluate the impact of adding two different doses of dexmedetomidine to local anesthetic mixture on the quality of single injection peribulbar block in vitreoretinal operations Design: A prospective, double-blinded and randomized study. Setting: carried out in operating room of our university hospital. Patients: The study included 120 patients with viteroretinal diseases who were scheduled for vitreoretinal operations during the period from April 2016 to March 2017. Interventions: 120 patients were randomly allocated to three groups of 40 patients each. Group I (the control group) received 5-7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase, group II received5- 7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase +15 µgdexmedetomidine, and group III received5- 7 ml mixture of lidocaine 2% and Levobupivacaine 0.5% with 120 IU of hyaluronidase + 30 µg dexmedetomidine Measurements: The primary outcome was to evaluate the impact of adding two different doses of dexmedetomidine on the onset of globe anesthesia and akinesia. Secondary outcomes were the duration of globe anesthesia and akinesia, overall patient satisfaction and surgeon satisfaction. Results: The onset of globe anesthesia was significantly shorter in group II and III in comparison with group I. Adding dexmedetomidine to the local anesthetic mixture prolonged the duration of globe analgesia, and this difference was statistically significant in group II and III in comparison with the group I. Conclusion: Adding dexmedetomidine to a mixture of lidocaine 2% and levobupivacaine/hyaluronidase mixture in single injection peribulbar block shortened sensory and motor block onset, extended the analgesia period and the motor block duration with high patient and surgeon satisfaction.

We wish to present our case of the rare Meckel-Gruber syndrome, diagnosed prenatally at 18 weeks’ gestation. Informed consent was obtained from both parents for publishing this case and including photos.

An investigation into the pathological lesions of Cypermethrin on the testes, accessory sexual and pituitary glands of Yankasa rams was carried out. Sixteen Yankasa rams aged 18 - 30 months and weighing between 21.5 - 46.5kg were used. The 16 rams were divided equally into two groups (A and B) A served as the treatment group while B served as the control. Group (A) were given Cypermethrin (3%) at the dose rate of 3mg/kg (0.1ml/kg) body weight, topically. Group (B) rams were given distilled water at the same dose rate and route. These treatments were repeated every two weeks for a period of 12 weeks. The rams were sacrificed at the end of 12 weeks and the following organs (testes, pituitary, vesicular and prostate glands), were collected and weighed, gross pathological lesions were observed and photographs were taken. The samples were kept for histopathology. Results showed that there were no gross pathological lesions found on the testes, pituitary, prostate glands and the seminal vesicles of both groups. The mean weight of the pituitary gland, the prostate glands and the seminal vesicles of the treated and control groups were statistically not significant (P>0.05). No histologic lesions were found on them. The mean testicular weights of the treated (143.81±7.71g) and the control (130.43±0.63g) were significantly different (P<0.05). There was a reduced number of spermatozoa in the lumen of the seminiferous tubules of the treated group. It was concluded that Cypermethrin reduced spermatozoa in the lumen of the seminiferous tubules.