Correlation between interdialytic weight gain, left ventricular hypertrophy and FGF- 23 in prevalent hemodialysis patients
Published on: 28th July, 2020
OCLC Number/Unique Identifier: 8648999984
Background:Patients with end-stage renal disease are suspected to have significant volume shifts and thereby cardiovascular strain as a result to interdialytic weight gain, chronic fluid overload and fluid removal during dialysis. In long-term hemodialysis patients, higher IDWG (interdialytic weight gain) could be associated with poor survival. Patients with the lowest interdialytic weight gain have the greatest survival. Certain laboratory and imaging modalities could help to assess and monitor the appropriate fluid balance for hemodialysis patients.
FGF -23 might be associated with cardiovascular morbidity in ESRD patients.
Objective: To evaluate correlation between hypervolemia and left ventricular hypertrophy and FGF-23 in hemodialysis patients.
Patients and Methods: This cross sectional study was conducted on 60 prevalent hemodialysis patients. Patients were divided into two groups according to interdialytic weight gain (IDWG): Group I (low IDWG): Patients with absolute weight gain < 3 kg. Group II (high IDWG): patients with weight gain ≥ 3 kg. FGF 23, routine laboratory tests and echocardiography were done for both groups.
Results: high IDWG group has higher systolic blood pressure and LVMI than low IDWG group. In all patients group, FGF-23 had a positive correlation with (weight gain, Na, PO4, PTH, systolic, diastolic blood pressure, LV wall septal and posterior wall thickness and left ventricular mass index) and had a negative correlation with Hb level.
Conclusion: FGF-23 could be a marker of volume overload and LVH in ESRD patients, which affect morbidity and mortality in these patients.
FGF- 23 might be a marker of anemia in ESRD as it has a negative correlation with HB.
SGLT2 Inhibitors and nephroprotection in diabetic kidney disease: From mechanisms of action to the latest evidence in the literature
Published on: 21st August, 2020
OCLC Number/Unique Identifier: 8651234199
Type 2 Diabetes Mellitus constitutes a major problem in public health worldwide. The disease poses a high risk of severe microvascular and macrovascular complications. Diabetic kidney disease is the most common cause of end-stage chronic kidney disease and contributes to the increasing morbidity and mortality associated to diabetes. Sodium-glucose contransporter-2 inhibitors (SGLT2 inhibitors) are the latest oral diabetic medications, which exhibit a great nephroprotective potential, not only by improving glycemic control, but also by glucose-independent mechanisms, such as decreasing blood pressure and other direct renal effects. We conduct a literature review based on the most recent scientific evidence with the goal to elucidate the postulated mechanisms of action of SGLT2 inhibitors in diabetic kidney disease, which are the base of the beneficial clinical effects that are seen in the condition.
Prognostic factors for chronic kidney disease and end-stage renal disease in patients with lupus nephritis: A retrospective cohort study
Published on: 27th April, 2021
OCLC Number/Unique Identifier: 9022387289
Background: Lupus Nephritis (LN) occurs in approximately half of all patients with Systemic Lupus Erythematosus (SLE) and it is the most common cause of morbidity and mortality in patients with SLE. Factors associated with poor renal outcome vary among studies, and researches coming from Brazil are scarce.
Objectives: To identify the prognostic factors associated to the development of Chronic Kidney Disease (CKD) and End Stage Renal Disease (ESRD) in LN patients followed in a tertiary hospital.
Design and Settings: We conducted a retrospective cohort study set in a tertiary hospital in Fortaleza, Ceará, Brazil. Methods: We compiled a total of 214 LN patients diagnosed between 1983 and 2015. Data was collected from medical records and further analyzed using logistic regression.
Results: LN prevalence was 53.9%. The cohort had a mean follow-up of 11.2 years (SD ± 7.2 years). At the end of follow-up, 93 of 197 patients (47.2%) had CKD, and 49 of 191 (25.6%) were on regular dialysis. The main factors associated for developing CKD after logistic regression analysis were the following predictors: hypertension (HR 2.80; 95% CI 1.30-6.01; p = 0.008), time between diagnosis of SLE and diagnosis of LN (HR 0.98; 95% CI 0.97-0.99; p = 0.009) and discontinuation of medications (HR 2.41; 95% CI 1.08-5.37; p = 0.03).
Conclusion: Hypertension, discontinuation of medications, and time between diagnosis of SLE and diagnosis of LN are independent variables associated with the development of CKD and ESDR in our study.
Factors associated with mortality after decompressive craniectomy in large basal ganglia bleeds
Published on: 11th May, 2021
OCLC Number/Unique Identifier: 9272362372
Aim: To assess the efficacy of decompressive craniectomy in patients with large basal ganglia (BG) bleed. To establish predictive criteria of mortality after surgery in patients with BG bleed.
Materials: This prospective study includes all patients of large spontaneous BG bleed operated by decompressive craniectomy without hematoma evacuation from October 2012 to September 2015. Data was collected on patient age, gender, distribution of bleed, affected hemisphere dominancy, preexisting medical conditions, admission Glasgow Coma Score (GCS), midline shift on CT or MRI Brain, hematoma volume and anisocoria, duration (hours) between the onset of stroke and operation, post-operative complications, and the duration of hospital stay. This data was correlated with one month mortality of the patients.
Results: Total number of patients were 27. Mean age was 51 years and mean GCS was 7.55(range 5-11). The mean volume of the bleed was 68.51 ml. Mortality was noted in 17 out of 27 patients (63%) in 30 days. Thirteen of the 16 patients with intraventricular extension of BG bleed had mortality. The factors that showed statistically significant correlation with one month mortality were age, GCS at admission, volume of the bleed and the intraventricular extension.
Conclusion: Large BG bleed was associated with high mortality and morbidity. Age of 50 years or more and GCS ≤ 8 at presentation were poor prognostic factors for decompressive craniectomy in patients with BG bleed. Patients with large BG bleed of volume > 60 ml and intraventricular extension had poor prognosis.
An algorithm to safely manage oral food challenge in an office-based setting for children with multiple food allergies
Published on: 11th August, 2021
OCLC Number/Unique Identifier: 9231823989
Background: In France, from 30% to 35% of children suffer from multiple food allergies (MFA). The gold standard to diagnosis a food allergy is the oral food challenge (OFC) which is conducted in a hospital setting due to risk of anaphylaxis. The aim of this study was to evaluate an algorithm to predict OFCs at low risk of anaphylaxis that could safely be performed in an office-based setting. Methods: Children with MFA and at least one open OFC reactive or non-reactive to other allergens were included. The algorithm was based on multiple clinical and biological parameters related to food allergens, and designed mainly to predict “low-risk” OFCs i.e., practicable in an office-based setting. The algorithm was secondarily tested in a validation cohort. Results: Ninety-one children (median age 9 years) were included; 94% had at least one allergic comorbidity with an average of three OFCs per child. Of the 261 OFCs analyzed, most (192/261, 74%) were non-reactive. The algorithm failed to correctly predict 32 OFCs with a potentially detrimental consequence but among these only three children had severe symptoms. One hundred eighty-four of the 212 “low-risk” OFCs, (88%) were correctly predicted with a high positive predictive value (87%) and low negative predictive value (44%). These results were confirmed with a validation cohort giving a specificity of 98% and negative predictive value of 100%. Conclusion: This study suggests that the algorithm we present here can predict “low-risk” OFCs in children with MFA which could be safely conducted in an office-based setting. Our results must be confirmed with an algorithm-based machine-learning approach.
Depression and anxiety in patients with suspected renal artery stenosis
Published on: 6th September, 2021
OCLC Number/Unique Identifier: 9244771644
Objective: To investigate the occurrence of depressive and anxiety disorders in patients remitted for endovascular treatment of renal artery stenosis (RAS), and whether symptoms of depression and anxiety can be reduced after the treatment of RAS with percutaneous transluminal renal angioplasty (PTRA).Methods Patients: Selected for renal angiography with pressure measurement in the renal arteries due to suspected RAS were invited to participate in the study. 37 patients agreed to answer a questionnaire. Eighteen patients also agreed to a clinical psychiatric examination including the International Neuropsychiatric Interview (M.I.N.I. 6.0) to be diagnosed according to the DSM-IV. Results: Twenty-one of the 37 patients completing the questionnaire were found to have a pressure gradient of ≥ 10 mmHg at angiography, indicating significant stenosis. Ten of the 18 examined patients met the criteria for current DSM-IV anxiety diagnosis and two patients had a current depression. Three of the 18 examined patients had previously made a suicide attempt. Conclusion: The results of this study suggest that patients with suspected RAS have a high psychiatric comorbidity, as 56% of the patients undergoing psychiatric examination met the DSM-IV criteria for a current anxiety disorder.
Descriptive study to assess the knowledge on risk factors of Coronary Artery Disease (CAD)
Published on: 30th September, 2021
OCLC Number/Unique Identifier: 9278266118
CAD is the most common type of CVD which is characterized by deposits of lipids within the intima of the coronary artery. CAD is the leading cause of mortality and morbidity in many countries worldwide. The investigators adopted a quantitative approach to assess the knowledge on risk factors of CAD among patients in selected OPDs of M.O.S.C Medical College Hospital, Kolenchery. A descriptive design with non-probability convenience sampling technique was used. 120 clients who have given consent and shown willingness to participate were enrolled in the study. Data was collected by using demographic proforma, and structured knowledge questionnaireThe data was analyzed using descriptive and inferential statistics. The collected data was organized tabulated and analyzed by descriptive [mean, median, mode and standard deviation] and inferential statistics [chi-square test].The data revealed that the level of knowledge on risk factors of cad among subjects attending selected OPDs, out of 120 samples 30 (25%) have good knowledge, 85 (71%) have average knowledge and only 5 (4%) have poor knowledge. There was significant association between knowledge level and education whereas there was no significant association between age, sex, religion, income, marital status, occupation and food habit.
Metabolic profiling and antibacterial activity of Eryngium pristis Cham. & Schltdl. - prospecting for its use in the treatment of bacterial infections
Published on: 3rd November, 2021
OCLC Number/Unique Identifier: 9331573236
Morbidity and mortality of the infected patients by multidrug-resistant bacteria have increased, emphasizing the urgency of fight for the discovery of new innovative antibiotics. In this sense, natural products emerge as valuable sources of bioactive compounds. Among the biodiversity, Eryngium pristis Cham. & Schltdl. (Apiaceae Lindl.) is traditionally used to treat thrush and ulcers of throat and mouth, as diuretic and emmenagogue, but scarcely known as an antimicrobial agent. With this context in mind, the goals of this study were to investigate the metabolic profile and the antibacterial activity of ethanolic extract (EE-Ep) and hexane (HF-Ep), dichloromethane (DF-Ep), ethyl acetate (EAF-Ep) and butanol (BF-Ep) fractions from E. pristis leaves. Gas Chromatography-Mass Spectrometry (GC-MS) was performed to stablish the metabolic profile and revealed the presence of 12 and 14 compounds in EAF-Ep and HF-Ep, respectively. β-selinene, spathulenol, globulol, 2-methoxy-4-vinylphenol, α-amyrin, β-amyrin, and lupeol derivative were some of phytochemicals identified. The antibacterial activity was determined by Minimal Inhibitory Concentration (MIC) using the broth micro-dilution against eight ATCC® and five methicillin-resistant Staphylococcus aureus (MRSA) clinical strains. HF-Ep was the most effective (MIC ≤ 5,000 µg/µL), being active against the largest part of tested Gram-positive and Gram-negative bacterial strains, including MRSA, with exception of Escherichia coli (ATCC 25922) and Pseudomonas aeruginosa (ATCC 9027) and (ATCC 27853). These results suggest that E. pristis is a natural source of bioactive compounds for the search of new antibiotics which can be an interesting therapeutic approach to recover patients mainly infected by MRSA strains.
RV Function by cardiac magnetic resonance and its relationship to RV longitudinal strain and neutrophil/lymphocyte ratio in patients with acute inferior ST-segment elevation myocardial infarction undergoing primary percutaneous intervention
Published on: 23rd November, 2021
OCLC Number/Unique Identifier: 9359437609
Background: Although acute inferior myocardial infarction (MI) is usually regarded as being lower risk compared with acute anterior MI, right ventricular (RV) myocardial involvement (RVMI) may show an increased risk of cardiovascular (CV) morbidity and mortality in patients with inferior MI. CMR is ideal for assessing the RV because it allows comprehensive evaluation of cardiovascular morphology and physiology without most limitations that hinder alternative imaging modalities. Objectives: To evaluate the sensitivity of strain and strain rate of the RV using 2D speckle tracking echo and the neutrophil/ lymphocyte ratio (NLR) compared to cardiac MRI (CMR) as the gold standard among patients with inferior STEMI undergoing primary percutaneous coronary intervention (PCI). Methodology: 40 Patients with inferior MI who had primary PCI were included in the study; they were divided into two groups according to the RVEF using CMR. NLR was done in comparison to RVEF.Results: out of the 40 patients, 18 (45%) patients had RV dysfunction. 2D echocardiography was done for all patients, where fractional area change (FAC) in the RV dysfunction group appeared to be significantly reduced compared to the group without RV dysfunction (p value = 0.03). In addition, RV longitudinal strain (LS) by speckle tracking echo was reduced with an average of 19.5 ± 3.9% in the RV dysfunction group.Both CMR- derived RV SV, and EF were lower among the RV dysfunction group, (26.8 ± 15.8) ml and (35.4 ± 6.9)% respectively, with large RV systolic volume, with a highly statistically significant difference in comparison to the other group (p value = 0.000). Complications, heart block was significantly higher in patients with RV dysfunction (p value = 0.008) as it occurred in 5 (27.8%) patients.N/L ratio for predicting RV dysfunction by CMR had a cut-off value of > 7.7 with low sensitivity (38.8%) and high specificity (77.3 %). In contrast, LS for predicting RV dysfunction by CMR had high sensitivity (83.3%) and high specificity (63.6%) with p value = 0.005.Conclusion: Our results showed that RV dysfunction in inferior MI is better detected using cardiac magnetic resonance imaging. In inferior STEMI patients who underwent primary PCI, NLR has low sensitivity but high specificity for predicting RVD when measured by cardiac MRI.
Severe preeclampsia at the University Hospital Center of Mother and Child (UHCMC) in N’djamena: Epidemiology and prognosis
Published on: 28th January, 2022
OCLC Number/Unique Identifier: 9406521355
Introduction: Preeclampsia constitutes a public health problem in our region. According to the WHO, it is the third cause of maternal mortality after severe hemorrhages, infections and is responsible for morbidity and high fetal mortality. The aim of this study was to improve on the management of severe preeclampsia at the University Hospital Center of Mother and Child (UHCMC) in N’Djamena.Patients and method: It was a prospective and descriptive survey of 3 years duration, from January 01st, 2017 to December 31st, 2019. Included in our study were, all patients admitted for severe preeclampsia and agreed to participate in the study. Epidemiological, clinical, therapeutic and prognostic studies were conducted. The data collected was analyzed using SPSS 18.0 software.Results: During the study period, 13599 pregnant and parturients were admitted to the Gynecology-Obstetrics department of the UHCMC, among whom 406 cases of severe preeclampsia, with a frequency of 2.9%. The patients were young (23.2 years), married (96.3%), primipara (61.3%), referred (64.3%) without antenatal care in 47.9% of cases. Functional signs were dominated by headaches with 34.0% of cases. The proteinuria was ≥ 3 crosses in 83.7% of cases. Patients had received magnesium sulfate in 98.3%, the delivery mode was cesarean in 64.0% of cases. Principal morbidity was eclampsia (40.8%) and fetal was prematurity (36.4%). Maternal lethality was 11.1% and fetal mortality was 19.9% cases.Conclusion: Severe preeclampsia is frequent in the UHCMC in N’Djamena. It is responsible for high maternal and fetal mortality. The practice of quality antenatal care, could prevent the occurrence of complications and improve the maternal-fetal prognosis.
To compare serum Vitamin D status in pre-eclamptic and non-preeclamptic pregnant women in labour: A tertiary care centre study of Northern India
Published on: 28th January, 2022
OCLC Number/Unique Identifier: 9406533422
Background: Pre-eclampsia and eclampsia have remained a major global public health threat in contributing significantly to maternal and perinatal morbidity and mortality. Based on the inverse relationship between serum 1,25(OH)2D3 levels and plasma renin activity found previously, it is speculated that 1,25(OH)2D3 might be a negative endocrine regulator of renin production in vivo. During pregnancy, vitamin D may play a role in implantation and placental function potentially due to angiogenic, immunomodulatory, and antiinflammatory effects. Vitamin Ddeficiency can affect the health of both mother and fetus by increasing the production of inflammatory cytokines and stimulating the activity of T-regulating cells. Vitamin D is emerging as a promising agent for pre-eclampsia prevention. Aims and objectives: The objective of this study is to compare the vitamin D levels in pre-eclamptic and healthy non-pre-eclamptic pregnant women in labor and find out the relationship between vitamin D levels and pre-eclampsia. Methodology: The present cross-sectional study was carried out on pregnant women with pre-eclampsia in labor. For each case with pre-eclampsia, one uncomplicated, normotensive pregnant woman in labor was taken as control. On admission to the labor room detailed history, physical examination followed by thorough obstetrics and systemic examination was done. Required investigations were done including vitamin D and calcium levels. Maternal and fetal condition was monitored during labor/cesarean section, mode of delivery, maternal and fetal outcomes were recorded. After delivery, 2cc of cord blood was collected in a serum tube and sent for vitamin D levels. Data was collected and analyzed statistically using Epi-info version 7.1.Results: It was observed that the patients in both groups were comparable with respect to demographic and obstetrics characteristics except for significantly high BP in group I. Vitamin Ddeficiency (i.e. < 20 ng/ml) was significantly more in group I as compared to group II and the difference was highly significant (p < 0.0001). Similarly, the mean maternal calcium levels were significantly lower in group I in comparison to group II (p < 0.0001) i.e. the mean maternal calcium level in group I and group II were 8.03 ± 0.94 and 9.19 ± 0.67 respectively. It was also observed that the level of 25-OH-D in neonates of preeclamptic women was significantly lower than for those of the normal pregnant women (p < 0.0001). Conclusion: Vitamin D deficiency is highly prevalent in all parts of the world. Pregnant women and neonates are highly vulnerable to vitamin D deficiency. Preeclampsia is indeed associated with lower vitamin D levels and the pathophysiology of pre-eclampsia involves vitamin D and calcium metabolism through their role in immunomodulation, angiogenesis and anti-inflammatory effects. From the present study, it was observed that vitamin D and calcium levels were significantly lowered in women with pre-eclampsia as compared to those of the normotensive pregnant women. So early detection of vitamin D and calcium deficiencies may be helpful in preventing occurrence of PET and its complications.
An update in the utilization of N-acetyl cysteine & vitamin c for tackling the oxidative stress in acute kidney injury secondary to robust sepsis - A systematic review
Published on: 1st February, 2022
OCLC Number/Unique Identifier: 9414669659
The commonest etiology of acute kidney injury (AKI) is Sepsis that results in an escalation of morbidity and mortality in the hospital intensive care units. Existentially, the therapy of septic AKI rather than being definitive or curative is just supportive, without tackling the pathophysiology. Usually, Sepsis gets correlated with systemic inflammation, along with the escalated generation of Reactive oxygen species (ROS), in particular superoxide. Simultaneously liberation of nitric oxide (NO) subsequently reacts with the superoxide, thus, resulting in the generation of reactive nitrogen species (RNS), that is mostly peroxynitrite. This sepsis stimulated generation of ROS in addition to RNS might cause a reduction in the bioavailability of NO that modulates microcirculation aberrations, localized tissue hypoxia as well as mitochondrial impairment, thus starting a vicious cycle of cellular damage which results in AKI. Here we conducted a systematic review utilizing search engine PubMed, Google scholar; Web of science; Embase; Cochrane review library utilizing the MeSH terms like septic AKI; ROS; inducible nitric oxide synthase (iNOS); nicotinamide adenine nucleotide phosphate(NADPH)oxidase complex; Oxidative stress; Renal medullary hypoxia; Hypoxia inducible factor1; hypoxia responsive enhancer A; mitochondrial impairment; Intrarenal oxygenation; urinary oxygenation; erythropoietin gene; RRT; NAC; Vitamin C from 1950 to 2021 till date. We found a total of 6500 articles out of which we selected 110 articles for this review. No meta-analysis was done. Thus here we detail the different sources of ROS, at the tie of sepsis, besides their pathophysiological crosstalk with the immune system, microcirculation as well as mitochondria that can result in the generation of AKI. Furthermore, we detail the therapeutic utility of N-acetylcysteine (NAC), besides the reasons for its success in ovine as well as porcine models of AKI. Moreover, we discuss preclinical along with clinical for evaluation of Vitamin C’s antioxidant effects as well as pleiotropic effects as a stress hormone that might aid in abrogation of septic AKI.
Lifestyle modification practice and associated factors among diagnosed hypertensive patients in selected Hospitals in West Arsi Zone, Oromia Regional State, Ethiopia
Published on: 1st February, 2022
Background: Globally 1.13 billion people were living with hypertension, Out of this two-thirds of them were living in low and middle-income countries. In Ethiopia, Non-Communicable Disease deaths are estimated at around 42%. However, it remains widely undetected and poorly controlled. To resolve these, lifestyle modification approaches that are often overlooked are the cornerstone of the prevention and management of hypertension. Objective: To assess lifestyle modification practice and associated factors among hypertensive patients in selected hospitals in West Arsi Zone, Oromia Regional, Ethiopia December 7 to 21, 2019. Method: Hospital-based cross-sectional study was conducted in the selected public hospital among 299 hypertensive patients. Systemic random sampling methods were used to select the study participants. Data were collected by face-to-face interviews using a structured questionnaire by trained data collectors. Data were analyzed using descriptive statistics and multivariate logistic regression method to identify predictors of the outcome (p < 0.05). Results: Of the total participants, only 25.2% (95% CI: 18.8-32.9) of the patients were practiced recommended lifestyle modifications. Patients Age older than 65 years (AOR = 2.9, 95% CI: 1.17 - 7.0), the patients with 2-5 years’ time since diagnosed hypertension (AOR = 0.26, 95% CI: 0.07 - 0.9), multiple co-morbidity (AOR = 2.7, 95% CI: 1.25 - 5.8,) and their knowledge on hypertension management (AOR = 14.6, 95% CI: 4.6 - 45.9) have an independently associated with recommended lifestyle modification. Conclusion: Lifestyle modification practices among hypertensive patients were low in this study. Age, comorbidity, time since diagnoses of hypertension, and knowledge of lifestyle were identified as predictors of the outcome.
Journey with a 21 weeks primi with acute massive pulmonary thromboembolism secondary to possible “Latent Lupus”: an audacious ride
Published on: 9th March, 2022
OCLC Number/Unique Identifier: 9445952693
In pregnancy, the incidence of pulmonary embolism (PE) is increased fivefold when compared to nonpregnant women of the same age, and PE is one of the leading causes of death during pregnancy.However, the diagnosis of PE among pregnant women is complicated by concerns regarding radiation exposure. Systemic lupus erythematosus (SLE) is an autoimmune disorder with a wide array of presentations and a predilection to affect women of certain ethnic backgrounds. The hallmark of the disease is multisystem involvement, dispersed in time and severity. Usual pulmonary involvement includes pleuritis, pleural effusions, pneumonitis, shrinking lung syndrome, pulmonary hypertension, and alveolar hemorrhage. Pulmonary embolism (PE) is a relatively unusual presentation of SLE. We report the case of a 20-year-old primi at 21 weeks gestation with an acute PE with central chest pain and shortness of breath. The absence of overt signs and symptoms and traditional risk factors prompted a fragmentary workup. This led to the detection of antibodies sensitive for SLE, in the absence of overt signs and symptoms. We revive the concept of latent lupus, a condition construed as early lupus. We firmly suspect direct causation between SLE and PE. Further studies are needed to establish pathogenesis to facilitate early diagnosis and prevent morbidity and mortality from PE. Due to persistent hypotension, thrombolytic therapy with streptokinase was administered and the clinical and hemodynamic response was excellent, with no maternal or fetal hemorrhagic complications. The clinical presentation of pulmonary embolism is sometimes camouflaged by the physiological changes that occur in pregnancy and diagnosis is often delayed by a reluctance to expose the fetus to ionizing radiation.
Spinal cord involvement in tuberculous meningitis: a case report and brief review of literature
Published on: 15th March, 2022
Introduction: Tuberculosis (TB) continues to pose a significant public health problem worldwide. Tuberculous meningitis (TBM) is the most devastating form of extrapulmonary TB however other forms of central nervous system (CNS) disease include tuberculoma and spinal arachnoiditis. TBM carries high mortality even for a patient who is already receiving treatment. The difficulty in diagnosis often leads to a delay in treatment and subsequent mortality. The emergence of Xpert ultra has improved the rapid detection of MTB and rifampicin resistance in CSF and is the preferred diagnostic tool in TBM.Case: In this case report we present a 33 years patient of concern who presented with progressive lower limb weakness associated with pain and paresthesia for 4 months, admitted via the Orthopedic unit with a diagnosis of spinal mass (meningioma, neurofibroma, or nerve sheath tumor) for which biopsy was done and revealed a chronic inflammatory process, necrotic bone lesions with no granulomas and no malignancy, he was later diagnosed with tuberculous meningitis and promptly started anti-tuberculous therapy with a dramatic recovery and improvement in neurological function.Conclusion: Tuberculous meningitis conditions have high morbidity and mortality yet diagnosis and start of treatment continue to experience an important delay. Clinicians should keep in mind the limitations of clinical presentation due to pleiotropy and current diagnostics and should employ a combination of diagnostic modalities in addition to a high index of suspicion to prevent morbidity in patients with TBM.
Prevalence and pattern of congenital heart disease among children with Down syndrome seen in a Federal Medical Centre in the Niger Delta Region, Nigeria
Published on: 11th April, 2022
Background: Down syndrome (DS), or Trisomy 21, is the most common genetic disorder in the world and congenital heart disease (CHD) contributes significantly to morbidity and mortality in this population. Early diagnosis and prompt cardiac intervention improve their quality of life. This study was done to determine the prevalence and pattern of congenital heart disease among children with Down syndrome seen at the Paediatric Cardiology Unit of Federal Medical Centre (FMC), Bayelsa State.Method: A prospective study of children with Down syndrome referred for cardiac evaluation and echocardiography at the Paediatric Cardiology Unit of FMC, Bayelsa State over four years from 1st January 2016 to 30th December 2019. Data on socio-demographic information, echocardiographic diagnosis, and outcome were retrieved from the study proforma and analyzed.Results: A total of 24 children with Down syndrome were seen over the study period. Their age ranged from 0 to 16years. The majority, 20 (83.3%) of the children with Down syndrome were aged 5 years and below. There were 13 males and 11 females with a male to female ratio of 1.2:1. A total of 23 (95.8%) of the children with Down syndrome had CHD. The most common CHD was AVSD (including complete, partial, isolated, or in association with other defects) in 66.6% followed by TOF in 8.3%. Multiple CHDs were seen in 43.5% of the children. Only one child (4.2%) had a structurally normal heart on echocardiography. All the children with Down syndrome had pericardial effusion of varying severity while 33% had pulmonary artery hypertension (PAH). The fatality rate among the children seen with Down syndrome over the study period was 34.8% and only one child (4.2%) had open-heart surgery with the total repair of cardiac defect during the study period. Conclusion: Morbidity and mortality are high among children with Down syndrome due to the high prevalence of CHD. Early referral, diagnosis, and prompt intervention are encouraged.
A witnessed intra-operative blood transfusion-related air embolism under epidural anaesthesia for vesicovaginal fistula repair
Published on: 21st June, 2022
OCLC Number/Unique Identifier: 9554643394
The transfusion is a normal life-saving procedure conducted commonly by the nurses at the prescription of the attending physician or the emergency physicians. It is generally a safe procedure if guidelines for processing and administering are carefully followed. Blood transfusion is an independent risk factor for morbidity and mortality and major complications arising from transfusion are generally rare. We present a case of a mild case of iatrogenic air embolism exacerbated by pressure infusion for a patient who had undergone an exploratory laparotomy for an iatrogenic fistula repair under epidural anesthesia.
Can infants develop meningitis in the absence of bacteremia in the first ninety days of life? A retrospective chart review
Published on: 4th July, 2022
OCLC Number/Unique Identifier: 9554569888
The overall incidence of meningitis in infants 0-90 days is low; however, it remains a serious cause of morbidity and mortality among affected patients. It is standard of care to perform lumbar punctures as part of the work-up of fever in the first four weeks of life and sick-looking babies up to the age of 90 days. This particular procedure is often refused by parents, and physicians are left to predict the possibility of meningitis based on blood culture results.The aim of this study is to determine whether it would be safe to rule out meningitis based on a negative blood culture in this age group.
Heart failure with preserved ejection fraction: A mini review
Published on: 22nd July, 2022
Over the past 20 years, there has been a surge of clinical investigations and useful trials on heart failure (HF) with preserved ejection fraction (HFpEF). HFpEF represents the largest phenotype of HF, a public health concern for its link with high mortality and rates of morbidity.
The “sweet” relations between diabetes and platelets
Published on: 28th July, 2022
Atherosclerosis is the most important factor that leads to the high risk of atherothrombotic cases in patients with diabetes mellitus (DM). High morbidity and mortality in these patients are firstly caused by cardiovascular disease, mostly coronary artery disease (CAD) along with acute coronary syndrome (ACS) [1].
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