Successful Treatment of Generalized Pustular Psoriasis during Pregnancy by Cyclosporin and Etanercept: Own Experience and Review of Literature
Published on: 27th February, 2024
Psoriasis is a common inflammatory skin disease affecting about 2% of the population. Generalized pustular psoriasis (GPP) is a rare variant of this disease, and it can be life-threatening for a pregnant woman and fetus.Medication during pregnancy can be challenging since many drugs can cause marked adverse effects for a fetus or newborn baby. Because controlled studies are difficult to perform, the knowledge grows slowly, e.g., from case reports. Here we describe a review of past and present treatments for GPP patients with a special reference to pregnancy and our experience on two GPP cases treated with cyclosporin and etanercept during pregnancy with successful outcomes of infants.
Surgical and Delivery Outcomes of Coexisting Uterine Fibroids with Pregnancies in Nigeria
Published on: 19th March, 2024
Background: Coexisting uterine fibroid with pregnancy is associated with increased pregnancy complications. This study evaluates the prevalence of coexisting uterine fibroids, and surgical and delivery outcomes among pregnant women who had cesarean sections.Methods: This comparative observational study was conducted among pregnant women who had cesarean sections at the labor ward operating room of Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. One hundred and five pregnant women aged 20 years - 40 years were recruited and grouped based on the intraoperative presence of grossly visible uterine fibroids (n = 23) and no uterine fibroids (n = 82). Surgical and delivery outcomes were measured. Data were analyzed using IBM SPSS version 26 and the means between the two groups were compared using an independent sample t-test with significance set at p < .05.Results: The prevalence of uterine fibroids found during cesarean sections in this study was 21.9%. The mean age of the participants was comparable (M = 30.25 SD = 5.232). There were statistically significant differences in mean pre-operative packed cell volume (t(df) = 2.077 (65.31) p = .042, estimated blood loss (t(df) = 2.045 (36.664) p =.010, post-op packed cell volume (t(df) = 1.054 (24.035) p = .049, and duration of hospital stay (t(df) = -.235(65.846) p = .019. The study showed that there was a difference in mean surgery time = 7.996 95% CI: -.879 to 16.871 but this was not found to be statistically significant. Conclusion: Uterine fibroid coexisting with pregnancy has a significant effect on the surgery time, estimated blood loss, and length of hospital stay. Therefore, adequate complication readiness and proper follow-up of the patient will be crucial to avert likely complications during and after surgery in women with coexisting uterine fibroid in pregnancy.
Diagnosing Peripartum Cardiomyopathy in a Resource-Limited Setting, a Clinical Perspective: Case Report
Published on: 29th March, 2024
Peripartum cardiomyopathy is a rare case of heart failure with reduced ejection fraction and is considered a diagnosis of exclusion. The symptoms of heart failure in patients with peripartum cardiomyopathy can mimic the physiologic conditions of normal pregnancy. In an acute decompensated state, PPCM can present with acute severe upper abdominal or epigastric pain. We are presenting a 24-year-old female with no personal or family history of heart disease and no identifiable risk factor for PPCM. Based on her initial presentation in the emergency department, a diagnosis of acute severe pancreatitis was sought, and she was referred to the Intensive Care Unit. After further evaluation of the serological tests and imaging, she was eventually diagnosed as a case of PPCM. We emphasize the rare nature of the disease with a diverse presentation which poses a diagnostic challenge, especially in a resource-limited setting where advanced diagnostic tools may be restricted and socioeconomic condition poses a barrier to further patient evaluation. This case exemplifies the infrequent occurrence and atypical manifestation, presenting a learning opportunity for future clinicians.
A Qualitative Study of Caregivers of Children Living with HIV/AIDS in Ghana: Diagnosis History, Health-seeking Behaviour, and Care Expectations
Published on: 5th April, 2024
Caregivers of Children Living with HIV/AIDS experience severe burdens in Africa amidst unmet needs while seeking care from hospitals. This study aimed to explore the diagnosis history, health-seeking behaviour, and care provided by hospitals and whether the services meet caregivers’ expectations. We used a qualitative approach and conducted individual in-depth interviews among purposively sampled caregivers of children living with HIV/AIDS from three hospitals. We achieved data sufficiency after interviewing nine participants. Audio-recorded interviews were transcribed verbatim and thematically analyzed manually through Collaizi’s steps. Four themes developed including; history of pregnancy and poor HIV testing, effective care for caregivers and CLWH, attitude of healthcare providers, and unmet expectations of care. Healthcare providers showed positive attitudes towards caregivers and provided services (counselling, dispensing Anti-retrovirals, health monitoring, and coordination of clinical care). Expectations bordered on financial support (for food, education, health care), and treatment for opportunistic infections. Findings indicate gaps in HIV voluntary testing for pregnant women, enrollment in Prevention of Mother to Child Transmission (PMTCT), and unmet needs. It is imperative to improve coverage of testing for pregnant women and efforts made to meet their needs. Financial support, provision of food security, and assistance for caregivers are essential for care.
COVID-19 Pneumonia in Pregnancy: A Retrospective Study on Maternal and Neonatal Outcomes
Published on: 8th April, 2024
Objective: To identify risk factors among pregnant with COVID-19 for adverse outcomes related to disease severity, maternal mortality, and morbidity.Materials and methods: In this retrospective study, 45 pregnant patients with COVID-19 pneumonia were confirmed by RT-PCR. The inclusion criteria were pregnant patients diagnosed with COVID-19 confirmed by RT-PCR and hospitalized in the gynecology-obstetrics and intensive care unit. Exclusion criteria were non-pregnant patients and pneumonia cases with unconfirmed COVID-19 causes. The study used SPSS software to analyze the data. Results: Our study recorded 45 cases of SARS-CoV-2 infection in pregnant women over 2.5 years. The age group most affected was 20-35 years, with 75% of cases. 57% of patients had no known comorbidities. 88.8% of patients were symptomatic at diagnosis. Almost 30% of patients required admission to the ICU, with 60% requiring oxygen supplementation. The study recorded 36 live births (80%), of which 26 cases (72.2%) required no further care and had a favorable outcome.Conclusion: Pregnant women with medical conditions are at higher risk of severe COVID-19, which can cause respiratory distress syndrome and impact delivery and neonatal outcomes. Preventive measures are important.
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