African Health Sciences

Editor’s choice: Infectious disease are still dominating the African scene

James K Tumwine — 2024-10-06

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Burden of virologic failure, and its determinants among HIV positive children in East Africa: a systematic review and meta-analysis

Bogale Chekole Temere — 2024-10-06

Background: There are many studies regarding the prevalence of Virologic failure and its associated factors in East Africa, but they are inconclusive. In this study, the prevalence of Virologic failure and its associated factors in east Africa were determined.

Methods: Published articles that were conducted in English language were prepared based on preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. Web of Science, PubMed, and Google Scholar were explored to find out the articles. STATA Version 14 software was used for computing the pooled estimates of both the prevalence of virologic failure and associated factors. The pooled estimates were computed using both random and fixed effect models. Results were presented by using the randomand fixed effect models. . The pooled estimates were presented with 95% CI. Publication bias was assessed by looking the symmetry in the funnel plot.

Result: The pooled prevalence of virologic failure was, 25.90 (19.49, 32.32, p ≤ 0:001) in the random effect model. Four factors, poor adherence (2.91 (Pooled odds ratio(POR): 2.91, 95%CI: 1.93, 4.40), being male (1.17 (POR: 1.17, 95%CI: 1.08, 1.27)), wasting as an under nutrition (3.1 (POR:3.1, 95%CI: 1.63, 5.95), and Nevirapine(NVP) based regimen (2.76 (POR: 2.76 (1.65,95%CI: 4.62)) were found to be independent predictors of virologic failure.

Conclusion: The prevalence of virologic failure in East Africa is remarkably high. Four factors were found to be the determining factors Different strategies must be designed to address (poor adherence, being male, wasting as an under nutrition, and NVP based regimen).

Keywords: HIV; virologic failure; adherence; viral load suppression.

Experiences of community engagement for SARS-COV-2 and COVID-19 community surveillance in a rural and urban population in South Western Uganda

Dominic Bukenya — 2024-10-06

Background: We describe lessons learnt from community engagement activities for the successful implementation of a COVID-19 community surveillance study in Kalungu district, south-western Uganda.

Methods: One rural and one urban site were selected for COVID-19/SARS-CoV-2 community surveillance in selected households and three public health facilities. COVID-19 pandemic and national COVID-19 protection measures were described and explained in meetings with: district, sub-county/town, village council officials, religious leaders, health workers and Community Advisory Board members. The community surveillance study was introduced to the meeting attendees and minutes captured in English/Luganda (subsequently translated to English). All minutes were manually coded and analysed thematically.

Results: The minutes revealed that community members were generally supportive of the COVID-19 surveillance study. Members requested wider communities’ sensitisation about COVID-19 and the survey beyond the selected households. Misinformation and mistrust of Government statements were widespread. People in the community did not understand the `random sample’ selection for the study. Providing appropriate medical care, face masks and honouring appointments for study participants and ensuring that COVID-19 prevention measures were followed during the study improved participation.

Conclusion: Successful COVID-19 community surveillance required continuous, active community engagement between the research team, and community stakeholders while maximising previous gains and exploiting existing resources.

Keywords: SARS-COV-2; COVID-19; community engagement; surveillance; acceptability; East Africa.

Diversity and antibiotic sensitivity of uropathogens from a regional hospital in Rwanda

Charles O Odongo — 2024-10-06

Background: Urinary tract infections are a common cause for antibiotic consumption. Empirical treatment is common for community-acquired infections owing to predictability of pathogens.

Objectives: Describe sensitivity profiles of uropathogens at a regional hospital in Rwanda.

Methods: Hospital-based cross-sectional study in which clean-catch urine samples were analyzed. A two-stage process involving dipstick urinalysis and urine culture was used to identify true infections. The Kirby-Bauer disc diffusion method was used for antibiotic sensitivity analysis as per EUCAST guidelines.

Results: Of 198 samples studied, 107 met criterion for UTI with 94 yielding significant growth. Klebsiella pneumoniae (35%), and Escherichia coli (32%) were the most common organisms isolated. Others included Staphylococcal species, Proteus spp, Enterobacter spp and Salmonella. Very high resistance frequencies (above 70%) were observed against amoxycillin, cotrimoxazole, trimethoprim, aztreonam and fosfomycin. Resistance to fluoroquinolones, aminoglycosides and cephalosporins varied between 40-60%. High levels of cross resistance were observed for drugs of the same class. Resistance to the potentiated penicillins, meropenem, cefoxitin and nitrofurantoin were less than 30%. Piperacillintazo bactum performed best with 91% sensitivity against all organisms tested.

Conclusion: High levels of resistance were observed for most antibiotics studied. For empirical treatment of community-acquired UTI in our setting, nitrofurantoin remains effective while ciprofloxacin is not.

Keywords: Diversity and antibiotic sensitivity; uropathogens; Rwanda.

A systematic review and meta-analysis on the prevalence of extended-spectrum beta-Lactamase-Producing Klebsiella Pneumonia in Nigeria

Christian Kelechi Ezeh — 2024-10-06

Background: Rapid emergence and proliferation of extended spectrum beta-lactamase producing Klebsiella pneumoniae (ESBL-KP) constitute a serious health problem globally.

Objectives: The aim of this study was to evaluate the pooled prevalence of ESBL-KP and ESBL genes in Nigeria.

Methods: A quantitative method (Meta-analysis) design was used to summarize pooled results of primary studies. Different databases [Google Scholar, PubMed, and African Journal Online (AJOL)] were searched for relevant studies. Meta-analysis was done using random-effects model. I2 and Egger test was used to ascertain heterogeneity and publication bias evaluation.

Results: Eighteen observational studies were selected and the pooled prevalence of ESBL-KP in Nigeria was 47.3% [95% confidence interval (CI) 37 – 58%]. Among the genes encoding ESBL, OXA had the highest pooled prevalence in the selected studies [57% (95% CI 32, 76)], followed by TEM [55% (95% CI 36, 70)], CTX-M [54% (95% CI 38, 70)], and 41% (95% CI 27, 57). Heterogeneity tests (I2) was observed to be between 69.22 and 95.63 % for ESBL-KP and ESBL genes in the studies. Egger tests showed no publication bias (0.09 – 0.99).

Conclusions: This meta-analysis demonstrated that the prevalence of ESBL-KP is increasing in Nigeria. Hence, antimicrobial stewardship and infection control measures for the prevention and spread of these strains be implemented.

Keywords: Extended spectrum beta-latamase; Klebsiella Pneumonia; meta-analysis; Nigeria.

High false hepatitis C antibody positivity rate in a regionally-inclusive population of non-renumerated blood donors in Uganda

P Ocama — 2024-10-06

Background: Successful elimination of hepatitis as a public health threat by 2030 will partly rely on the availability and accessibility of affordable accurate disease testing platforms. In the past, testing of hepatitis C virus (HCV) in low resource settings of sub-Saharan Africa (SSA) has relied on anti-HCV testing using rapid diagnostic tests, chemiluminescent microparticle immunoassay (CMIA) and Enzyme-linked Immunosorbent Assays (ELISA) whose diagnostic accuracy has been sub-optimal. We determined the false positivity rate of a CMIA platform that is routinely used to screen donor blood for anti-HCV in Uganda.

Methods: 1,216 CMIA-screened anti-HCV-positive blood donor samples at four regional Ugandan blood banks, were subjected to a third generation ELISA and subsequently to nucleic acid testing (NAT).

Results: Of the above 1,216 samples, 1,122 (92.2%) were negative on ELISA and thus deemed false positives. Active infection (NAT positive) was detected in 98 (8.0%). Presumed resolved infection was recorded among 3 (3.2%) of participants that remained positive on the ELISA platform but negative on NAT.

Conclusion: The Architect CMIA assay exhibited very low specificity for anti-HCV testing. In this context, this finding may suggest need to employ testing protocols that include NAT or a combination of tests with higher validity.

Keywords: High false hepatitis C; antibody positivity rate; non-renumerated blood donors; Uganda.

Prevalence and pattern of antibiotic use and resistance among Iraqi patients: a cross-sectional study

Hashim Talib Hashim — 2024-10-06

Background: According to The Centers for Disease Control and Prevention (CDC) 2019, around 32,000 deaths in addition 2.8 million infections occur annually in the US because of antibiotic-resistant bacteria.

Objectives: To determine the prevalence and study pattern of antibiotic use and resistance among Iraqi patients.

Methodology: We carried out a cross-sectional study from January 2021 to October 2022 including data of 850 patients at different private and general hospitals, primary health centers, and private clinics. The data was collected during the patient’s admission or visiting time using medical records and mini-interviews.

Results: Escherichia coli and Staphylococcus aureus were the most detected pathogens in our sample in 14.5% and 11.29% of the patients respectively. Most patients (87.18%) had taken over-the-counter antibiotics previously. Around 55% of the antibiotics that were tested were resisted among our patients who were included in 2021. This percentage has increased to about 75% of the included patients in 2022. Amoxicillin was the most resistant antibiotic (77%) in our sample while meropenem was the least resistant among the tested antibiotic (5%).

Conclusion: Antibiotic resistance is a major public health concern that is often caused by the overuse and misuse of antibiotics, as well as poor infection control practices.

Keywords: Antibiotic; resistance; Iraq.

Can flow cytometry be an alternative method for the detection of antimicrobial resistance?

Ozel Yuruker — 2024-10-06

Background: The inappropriate use of antibiotics may cause antibiotic resistance, cause side effects, and eventually cause an increase in healthcare costs. This study aimed to determine a flow cytometry-based test to detect ESBL E. coli and MDR p. aeruginosa in a short time.

Methods: The study included 25 E.coli isolates and 25 P.aeruginosa isolates identified by Phoenix TM 100 automated system [Becton Dickinson, USA]. In the flow cytometric method, the percentages of death cells exposed to cephalosporin including ceftazidime [CAZ] or cefotaxime [CTX] and clavulanic acid [CLA] combination, were compared with death cells exposed only to a cephalosporin [CAZ or CTX]. CLA index values [CAZ-CLA and CTX-CLA indices] were obtained for CTX and CAZ. Index values that were higher than 1.5 just for one cephalosporin were accepted as positive.

Results: Cell viability was performed after 1-hour exposure to the drugs. When PI staining was applied to ESBL-treated and MDR-treated bacteria, 65% and 85% had nonviable membranes, indicating the method efficiently identified only cells with damaged membranes.

Conclusion: Flow cytometry is a rapid and reliable method for the detection of ESBL and MDR in clinical microbiology laboratories

Keywords: Antibiotic resistance; ESBL; flow cytometry; MDR.

The predictive value of PCT, SP-D and 8-iso-PGF2 α for the development of severe pneumonia in children

Guiying Zhang — 2024-10-06

Background: To investigate the predictive value of predictive value of procalcitonin (PCT), 8-iso-prostaglandin F2α (8-iso-PG-F2α) and pulmonary surfactant-associated protein D (SP-D) for the development of severe pneumonia in children.

Methodology: Children with severe pneumonia were selected as the pneumonia group, and children with non-pulmonary respiratory diseases were selected as the control group. PCT, 8-iso-PGF2α, and SP-D were compared between the pneumonia group and the control group at admission; PCT, 8-iso-PGF2α, SP-D, and Acute Physiology and Chronic Health Evaluation (APACHE-II), Pediatric Critical Illness Score (PCIS) and Clinical Pulmonary Infection Score (CPIS) scores were compared between children with severe pneumonia with different pathogen infection types and different prognostic outcomes; and the correlation between APACHE-II, CPIS, and PCIS scores and PCT, 8-iso-PGF2α, and SP-D levels was analysed in children with severe pneumonia.

Results: PCT, 8-iso-PGF2α and SP-D in pneumonia group were higher than those in control group. PCT, 8-iso-PGF2α, SP-D, APACHE-II, CPIS, and PCIS were lower in good prognosis children than in poor prognosis children. APACHE-II, CPIS, and PCIS scores were positively correlated with PCT, 8-iso-PGF2α, and SP-D levels in children with severe pneumonia (P < 0.05).

Conclusion: PCT, SP-D and 8-iso-PGF2α levels relate to pathogen type, illness severity and prognosis in children with severe pneumonia. They can aiding early evaluation.

Keywords: severe pneumonia in children; procalcitonin; 8-isoprostane F2α; pulmonary surfactant-associated protein D; disease assessment.

Molecular identification of Mycobacterium bovis in patients with tuberculosis attending a tertiary care hospital in South India

Imola Jamir — 2024-10-06

Background: Mycobacterium (M.) bovis is a member of Mycobacterium tuberculosis complex (MTBC). Clinical infection caused by M. bovis is indistinguishable from other MTBC and could pose a potential challenge for control of TB epidemic due to its zoonotic nature. Availability of reliable molecular diagnostic methods such as Genotype MTBC based on line probe assay (LPA) paves way for reliable differentiation of M. bovis from other MTBC.

Objective: To determine the proportion of Mycobacterium bovis among the Mycobacterium tuberculosis complex isolates from patients with tuberculosis.

Methods: In our study, we analysed MGIT positive cultures and performed Line probe assay (LPA) for identification of MTBC isolates. Total of 206 patient samples were taken, 104 pulmonary and 102 from extrapulmonary sites.

Results: M.tuberculosis/ M.canettii was isolated in all pulmonary specimens (100%). Among 102 extrapulmonary samples, 99 % was identified as M.tuberculosis/ M.canettii, and 1 % as M. bovis BCG.

Conclusion: Our study suggests that zoonotic TB by M. bovis may not be as prevalent in India and hence may not constitute a significant risk to public health in India.

Keywords: TB; M. bovis; line probe assay.

Neonatal tetanus in South Sudan: a case series

Justin B Tongun — 2024-10-06

Introduction: Neonatal tetanus is a life-threatening disease of public health importance; it is yet to be eliminated and is still occurring in South Sudan. It is caused by a neurotoxin from a bacterium Clostridium tetani whose spores exist in the environment. Compared to high-income countries, most low-income countries lack intensive care units, and magnesium sulfate shown to improve neonatal tetanus outcomes.

Objectives: We aimed to determine the outcome of neonatal tetanus in Al Sabah Children’s Hospital, Juba, South Sudan.

Methods: We conducted a case series study in Al Sabah Children’s Hospital in Juba, South Sudan. It described three neonates who presented within the first seven days of life with a history of excessive crying, inability to breastfeed, and tetanic muscle spasms when stimulated. They had signs of respiratory distress, fever, and labile heart rates. We made a diagnosis of neonatal tetanus with autonomic dysfunction, and started them on phenobarbitone because diazepam was not available, oxygen, and antibiotics. However, tetanus immune globulin and anti-tetanus serum were not available.

Results: Unfortunately, all three neonates died within 24 hours of admission.

Conclusion: Our primary focus as a nation is to improve access to quality health services and the prevention of neonatal tetanus through encouraging appropriate antenatal care, facility delivery, clean delivery and healthy umblical cord care practices, and tetanus vaccinations in teenage girls and young adults. When prevention fails, there is a need for neonatal intensive care with recommended medicines to significantly decrease mortality in this preventable tragic illness.

Keywords: Neonatal tetanus; low-income countries; neonates; Al sabah children hospital; South Sudan.

Factors associated with acute kidney injury and outcomes in patients with malaria in a district hospital in Rwanda

Larrisa Umuhire — 2024-10-06

Introduction: Acute kidney injury (AKI) remains one of the complications of severe malaria. Evidence on associated factors and outcomes for patients with complicated malaria and AKI is limited in Rwanda.

Aim: To assess the factors associated with acute kidney injury and outcomes in patients with malaria in a district hospital in Rwanda.

Method: A retrospective study design was applied. A census sampling strategy was used to select 122 files of patients admitted as severe malaria patients in 2016- 2017. A developed clinical audit form was used to collect data from patients’ files. Both descriptive and inferential statistics were used to analyze data.

Results: Among the confirmed severe malaria files, 44% of participants were over 50 years and 52.5% were males. The majority, (91.5%) had community-based health insurance and 16.3% had acute kidney injury. The significant associated clinical factors were dehydration (p=.01), high-grade fever (p=.002), profuse sweating (p=.034), vomiting (p=.043), and diarrhea (p=.025). Of the 20 patients who developed AKI, 55% completely recovered, 15% died and 30% of cases were transferred to the highest facilities for hemodialysis.

Conclusion: The existence of AKI among severe malaria patients was evident with some recovering and others dying. There is a need for educating healthcare professionals, mostly at district hospitals about the diagnosis and management of AKI as a result of complicated malaria.

Keywords: Acute kidney injury; severe malaria; complications of malaria.

The relationship between gender and cultural beliefs of malaria into typhoid progression among rural rice farmers in Central Kenya

Dawit Woldu — 2024-10-06

Background: Women have an increased risk of contracting malaria in Kenya and the developing world because of gender roles and the cultural belief systems about disease progression and treatment. Cultural belief systems about illness progression have important implications for gender-based health intervention.

Objectives: The main objective of this research is to explore how rice farming Kikuyu ethnic group in the Mwea division of central Kenya cultural beliefs about malaria into typhoid progression. It also aims to examine the association between gender and malaria into typhoid progression cultural belief system.

Design: The study employs cross-sectional study design (N=250). Variables related to demographic and cultural beliefs on malaria into typhoid progression were collected using a structured questionnaire.

Results: More than 62% of women and 47% of men interviewed adhere to malaria into typhoid progression belief system. Multivariable logistic analysis shows women are more than twice as likely than men to believe in malaria into typhoid progression (aOR 2.15; 95% CI 1.21, 3.79, p < 0.009).

Conclusion: The study demonstrates the underlying cultural factors related to the gender disparity in the appropriate knowledge on cultural belief system of malaria into typhoid progression which could influence the overall women’s health outcomes in developing countries.

Keywords: Malaria; Typhoid; illness progression; cultural beliefs; gender disparity in Health.

Spatio-temporal characterization of malaria prevalence in a peri-urban resource limited setting of Western Kenya Highlands

Beatrice Aleyo Muzame — 2024-10-06

Background: Malaria is the main killer disease in sub-Sahara Africa.

Objective: The study identified malaria prevalence patterns in relation to space and time trends in a peri-urban resource limited setting of Western Kenya highlands aimed at strengthening implementation of malaria control strategies.

Method: A longitudinal study was carried out in Mbale town and its environs, Vihiga County, from December 2019 to November 2020. Among patients who presented themselves at Mbale Provincial Rural Training health center for different medical issues, 768 malaria confirmed patients were recruited and signed consent before the study commenced. Data was collected using questionnaire and microscopy which was presented through graphs, frequency, means and analyzed using linear regression. P-value ≤ 0.05 was considered statistically significant.

Results: Plasmodium falciparum malaria constituted 98.7%,while P. malariae, P. vivax, and P. ovale constituted 1.3%. Linear regression analysis showed effect of age, gender and location on malaria prevalence as (R2 = 0.7, [F (3,764) = 1.854], p < 0136). Malaria prevalence varied in different months due to changes in amount of rainfall and temperatures received.

Conclusion: Spatio-temporal characterization and many mosquito breeding grounds influenced malaria prevalence in the study area. Malaria control strategies should be strengthened in relation to space and time-trend.

Keywords: Plasmodium species; space; time trend; malaria prevalence; socio-economic factors; demographic factors.

Unmasking aflatoxin hazards in maize for human consumption: investigating maize contamination in Mwanza Markets, Tanzania

Betrand Msemwa — 2024-10-06

Background: Aflatoxin arises from toxigenic Aspergillus species, which infect maize because of improper storage, insufficient drying, extended storage periods, and suboptimal farming practices. This study investigated the aflatoxin contamination in maize for human consumption within specific markets of Mwanza, Tanzania.

Methodology: A cross-sectional study was conducted from June to August 2021. Maize samples were analyzed using ELISA followed by descriptive statistical data analysis.

Results: A total of 90 maize merchants from 8 local markets were involved. Their mean age was 34.7 (± 6.7) years, majority were male (51 out of 90, 56.7%). Among the vendors, the majority were not aware of aflatoxin (62 out of 90, 68.9%), stored maize in polypropylene woven bags (62 out of 90, 68.98%) and dried the maize before storage (86 out of 90, 95.6%). Out of the 90 samples, 10 (11.1%) had aflatoxin contamination above 1µg/kg, ranging from 1.01µg/kg to 33.4µg/kg with 3 (3.3%) being contaminated above the acceptable standard (≥10µg/kg).

Conclusion: The levels of aflatoxin contamination in maize for human consumption exceed the established safety thresholds. Governments in lower and middle-income nations should intensify enforcement of regulations aimed at enhancing community awareness regarding aflatoxin risks and minimizing contaminations.

Keywords: Maize vendors; maize contamination; polypropylene woven bags; Aflatoxin.

Are TP53 Arg72Pro and MDM2 T309G polymorphisms associated with bladder cancer risk? A meta-analysis

Rym-Khadidja Abderrahmane — 2024-10-06

Background: We still do not know the exact cause of bladder cancer (BC).

Objectives: Evaluation of the effect of TP53 Arg72Pro and MDM2 T309G polymorphisms with the risk of Bladder cancer.

Methods: A literature search was conducted followed by a meta-analysis. Then, sensitivity and subgroup analyses were performed. 14 relevant studies were included in the quantitative analysis.

Results: No statistically significant associations were found. The results of the subgroup analysis revealed a significant association in the Turkish population for T309G: G vs. T (P-value= 0.015; OR 95%CI= 1.51 [1.084; 2.125]), GG vs.TT (P-value= 0.009; OR 95% CI= 2.60 [1.262; 5.370]). Sensitivity analysis revealed a significant association between the Arg72Pro: C vs G (OR= 1.22, 95% CI [1.05; 1.40]), CC vs. GG (OR= 1.54; 95% CI [1.13; 2.09]), CC+CG vs. GG (OR= 1.24; 95% CI [1.01; 1.53]), CC vs. CG+GG (OR= 1.33; 95% CI [1.01; 1.74]), and T309G: G vs. T (OR= 1.30; 95% CI [1.07; 1.57]), GG vs. GT+TT (OR= 1.53; 95% CI [1. 10; 2.11]), GG vs. GT (OR=1.44; 95% CI [1.02; 2.02]), GG vs. TT (OR= 1.88; 95% CI [1.25; 2.82]) with BC occurrence.

Conclusion: The T309G polymorphism was found to be a predisposing allele for BC in Turkish population.

Keywords: Bladder cancer (BC), polymorphism, Meta-analysis, T309G, Arg72Pro, TP53, MDM2.

In-vitro scientific validation of anti-inflammatory activity of Punica granatum L. on Leukemia monocytic cell line

Sharmistha Dutta — 2024-10-06

Background: The induction of the inflammatory cascade results in the production of a number of inflammatory mediators, including prostaglandin E2 (PGE2), nitric oxide (NO), and proinflammatory cytokines like TNF-, IL-, and IL-6. This study examined the cytotoxicity and anti-inflammatory properties of a methanolic crude extract of Punica granatum L. peel (PPM) on monocytic leukaemia cell line (THP-1).

Materials and methods: The PPM along with Quercetin as reference was used to assess the cytotoxic effect on THP-1 cells and describe its effect on pro-inflammatory cytokines such as COX-2, TNF-α, IL-6 against cancer cell line by flow cytometry.

Results: The percentage of viable cells significantly decreased which correlates to non-toxicity whereas quercetin was found to be highly toxic, the IC50 could not be calculated because of drug precipitation. There was a significant decrease in the expressions of inflammatory cytokines upon pre-treatment of the cells with PPM prior to LPS stimulation.

Conclusion: Our findings indicate that no cytotoxicity was observed after the treatment of THP-1 cells with PPM (25-400 µg/ml), but at higher concentration (400µg/ml), the cell viability decreased to 84% and attenuated the expression level of inflammatory cytokines. The inhibitory effect of the extract on pro-inflammatory factors production may provide a theoretical source on upcoming treatment of inflammation.

Keywords: Punica granatum L; Monocytic leukaemia cell line; cytotoxicity; anti-inflammation.

JAK2 mutational status and the contribution of TERT and JAK2 polymorphisms to the occurrence of myeloproliferative neoplasms in Eastern Morocco

Karam Yahya Belmokhtar — 2024-10-06

Background: The JAK2 V617F somatic mutation is a hallmark of myeloproliferative neoplasms (MPN) and is present in some patients with splanchnic venous thrombosis (SVT).

Objectives: We investigated for the first time in Eastern Morocco the JAK2 mutational status and germline risk factors, such as the TERT and JAK2 polymorphisms, in MPN and SVT patients.

Methods: This study included 38 patients with MPN, 24 patients presenting with SVT and 60 healthy donors from the BRO Biobank. JAK2 mutations were analyzed using qPCR and Sanger sequencing. Predisposing polymorphisms to MPN were eval uated using Sanger sequencing.

Results: JAK2 V617F mutation was positive in 64.5% of patients with MPN and 20.8% of patients with SVT. The JAK2 V617F allelic burden ranged from 2% to 97.53%. We found a strong association between the JAK2 rs56241661 polymorphism of the JAK2 46/1 haplotype and the development of MPN. However, no association was detected between the TERT rs2736100 polymorpism and MPN.

Conclusion: The JAK2 mutational status and its allelic burden in Eastern Morocco are consistent with previous studies. The JAK2 46/1 haplotype was strongly associated with MPN. However, unlike other previously studied populations, the TERT polymorphism rs2736100 has no effect on the occurrence of MPN in our population.

Keywords: Myeloproliferative neoplasms; JAK2 V617F; TERT and JAK2 polymorphisms; genetic predisposition; Morocco.

Late diagnosis among patients with prostate cancer at the Uganda Cancer Institute: a retrospective cohort study

Nelson Bunani — 2024-10-06

Background: Late diagnosis of prostate cancer is associated with high mortality, morbidity and low quality of life. We aimed to assess the time of diagnosis among prostate cancer patients in Uganda and investigate the factors associated with early or delayed diagnosis.

Methods: A retrospective cohort analysis of 280 records of patients with histologically confirmed diagnosis of prostate cancer from January 2016 to December 2017. Delayed diagnosis was defined as the diagnosis done at stage III or IV. Stage I and II were classified as early. We used modified Poisson regression to assess factors associated with early or delayed diagnosis.

Results: The median from symptom recognition to diagnosis was 12 months (Interquartile Range, IQR: 5-24), with 76% of patients receiving their diagnosis more than 4 months after experiencing symptoms. Notably, 35.7% of patients were diagnosed at stage III, and 46.1% at stage IV. Upon diagnosis, all patients exhibited elevated prostate-specific antgen (PSA) levels with median PSA of 100.2 ng/ml (IQR: 36.02-350) in blood.

Conclusion: Taking a biopsy after 4 months of initial symptoms was partially responsible for the delay in diagnosis. Communities should be educated about prostate cancer symptoms and advised to seek health care early. Health care workers should be sensitized to suspect prostate cancer among patients to allow timely referral.

Keywords: Diagnosis; prostate cancer; Uganda; timing; late diagnosis.

Prognostic impact of diagnostic and therapeutic time delays in breast cancer: an exploratory data analysis for patients at Parirenyatwa Hospital, Zimbabwe

Bester Saruchera — 2024-10-06

Objective: This paper seeks to investigate factors related to time delays for diagnosis and treatment in breast cancer patients at Parirenyatwa Hospital in Zimbabwe and subsequently evaluate the effects of presentation and diagnosis delays on cancer stage.

Methods: The study was done for 379 patients with histologically diagnosed invasive breast cancer, from 2015 through to 2029. The study sought to identify factors associated with the time delays ( months)using parametric and non-parametric methods, depending on whether underlying assumptions of such tests are met. A multiple logistic regression model was also used to analyse the association between factors, primary delay, secondary delay variables and cancer stage.

Results: The median of the primary, secondary and treatment delay were found to be 7.6, 1 and 0.4 months respectively. Rural residence, Karnofsky Performance Score below 70%, hypertension comorbidity, tumor size (>5cm) and well differentiated tumors (grade 1) were significant factors for delayed presentation. Longer primary delay times and post-menopausal status were associated with secondary delay. Advanced cancer stage at diagnosis and those on medical aid were more likely to have a delay in treatment onset.

Conclusion: Primary and secondary delay were predictive of advanced disease using logistic regression.

Keywords: Breast cancer; primary delay; secondary delay; treatment delay; Zimbabwe.

Biological role of Semaphorin 6D in the proliferation, migration and invasion of gastric cancer

Huan Zhou — 2024-10-06

Background: To analyse how Semaphorin 6D (SEMA6D) expression and extracellular signal-regulated kinase (ERK), phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/AKT/mTOR) signal pathways are activated and how they influence gastric cancer proliferation, migration, and invasion.

Methodology: SEMA6D expression was knocked down in human gastric cancer cells using RNA interference technology. In vitro assays were used to analyse how SEMA6D knockdown affects clone formation, migration, and invasion. ERK and PI3K/ AKT/mTOR signaling pathway related proteins were detected by immunoblotting.

Results: In the si-NC group, Sema6D protein levels were higher than those in the si-1 and si-2 groups after knockdown of Sema6D, while in the si-1 group, Sema6D protein levels were higher than those in the si-2 group (P<0.05). P-PI3K, ERK/p-ERK, AKT/p-AKT, and mTOR/p-mTOR levels in the si-NC group were significantly higher than those in the si-1 and si-2 groups after knockdown of Sema6D (P < 0.05). It was found that scratch healing rate of SGC-7901 cells in si-NC group was higher than that in si-1 and si-2 groups, and the difference was statistically significant (P < 0.05).

Conclusion: SEMA6D expression level can affect the biological behavior of gastric cancer cells.

Keywords: Gastric cancer; extracellular signal-regulated kinase; semaphorin 6D; ERK and PI3K/AKT/mTOR; cell proliferation.

Correlation between abdominal visceral fat and the risk of endometrial cancer in patients with polycystic ovary syndrome

Jiyan Zhang — 2024-10-06

Objective: To explore the correlation between abdominal fat and the occurrence risk of endometrial cancer (EC) in patients with polycystic ovary syndrome (PCOS).

Methods: The clinical information of 120 PCOS patients receiving treatment in our hospital from March 2019 to April 2022 were included in this study. Patients were divided into two groups, endometrial cancer (EC, n=35) and normal group (NM, n=85). Statistical analysis included t-test, c2-test, and Pearson's correlation coefficient. We analysed the data using logistic regression. The predictive accuracy and discriminative ability of the prediction model were assessed by the area under the receiver operating characteristic (ROC) curve (AUC) and calibration curves.

Results: The incidence rate of EC in women with PCOS is 10.91% (12/110). Significant differences were found in waist circumference, hypertension, diabetes, hyperlipidemia, body mass index (BMI), waist-hip ratio (WHR), insulin resistance index (HOMA-IR), visceral fat area (VFA) oestrogen receptor, progesterone receptor, human epidermal growth factor receptor-2 (HER2), estradiol (E2), and luteinizing hormone (LH) between the two groups (P<0.05). No statistical difference was found in age, hip circumference, menopause, use of intrauterine device, progesterone (P) and follicle-stimulating hormone (FSH) between the groups (P>0.05). Multivariate logistic regression analysis showed that BMI, HOMA-IR, VFA and HER2 were independent influencing factors of EC in PCOS patients (P<0.05). The AUC of BMI, HOMA-IR, VFA, HER2 were 0.878 (95%CI: 0.810~0.946), 0.831 (95%CI: 0.751~0.911), 0.816 (95%CI: 0.704~0.929) and 0.737 (95%CI: 0.634,0.840), respectively. The model had more diagnostic effectiveness (AUC=0.973).

Conclusions: In PCOS disease, high-level BMI, HOMA-IR, VFA, and positive HER2 show an increased risk in the incidence of EC. These findings suggest that BMI, HOMA-IR, VFA, and HER2 are potential markers for Risk assessment of EC. HER2: Human epidermal growth factor receptor-2, E2: estradiol, P: progesterone, LH: Luteinizing hormone, FSH: Follicle-stimulating hormone.

Keywords: Polycystic ovary syndrome; Abdominal visceral fat; Endometrial cancer; Occurrence risk.

Diagnostic value of FNA, ultrasound elastography and CEUS in thyroid carcinoma

Lei Zhao — 2024-10-06

Background: To investigate the role of fine needle aspiration cytology (FNA), sonoelastography and contrast-enhanced ultrasound (CEUS) in the diagnosis of thyroid carcinoma.

Methodology: A total of 150 patients with suspected thyroid cancer admitted to our hospital from January 2019 to December 2021 were selected and divided into group A, group B and group C according to random number table, with 50 cases in each group. FNA was used in group A, ultrasound elastography was used in group B, and CEUS was used in group C. Pathological diagnosis was performed in all patients, and the diagnostic sensitivity, specificity, and accuracy were compared among the three groups.

Results: The diagnostic sensitivity, specificity and accuracy of FNA in group A were 90.91%, 70.59% and 84.00%, respectively; the diagnostic sensitivity, specificity and accuracy of ultrasound elastography in group B were 94.12%, 81.25% and 90.00%, respectively; the diagnostic sensitivity, specificity and accuracy of CEUS in group C were 88.57%, 73.33% and 84.00%, respectively; the three groups were compared (P > 0.05).

Conclusion: All three diagnostic techniques had a relatively high sensitivity and accuracy in the diagnosis of thyroid carcinoma. Ultrasound elastography had the highest sensitivity and specificity among the three techniques, while FNA and CEUS had similar diagnostic performance.

Keywords: Fine needle aspiration cytology; ultrasound elastography; contrast-enhanced ultrasound; thyroid cancer; diagnostic efficacy.

MiRNA-153 attenuates progression of non-small cell lung cancer through targeting positive regulatory/SET domain 2

Ji Chen — 2024-10-06

Background: To explore whether micro ribonucleic acid (miR)-153 regulates positive regulatory/SET domain 2 (PRDM2) in a targeted manner and affects the proliferation and apoptosis of non-small cell lung cancer (NSCLC) A549 cells.

Methodology: The expressions of miR-153 and PRDM2 in NSCLC tissues and A549 cells were detected by quantitative real-time polymerase chain reaction (qRT-PCR). TargetScan was utilized to predict miR-153 target genes. Methyl thiazolyl tetrazolium (MTT) and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assays were carried out to study the cell proliferation and apoptosis. Western blotting was performed to examine the changes in the proteins in the Janus kinase-signal transducer and activator of transcription (JAK/STAT) signaling pathway following the miR-153 overexpression.

Results: The expression of miR-153 was decreased and that of PRDM2 was increased in NSCLC tissues and cells. Target genes regulated by miR-153 participated in self-vascular development, miRNA metabolic process and the Wnt signaling pathway. The overexpression of miR-153 led to an obvious reduction in the proliferation ability of A549 cells, a notable increase in apoptotic cells, and significant decreases in phosphorylated (p)-JAK2 and p-STAT3 proteins. Dual-luciferase reporter gene assay revealed that miR-153 could directly modulate the expression level of PRDM2.

Conclusion: MiR-153 directly targets PRDM2 and affects A549 cell proliferation and apoptosis through the JAK/STAT pathway.

Keywords: Non-small cell lung cancer; miR-153; positive regulatory/SET domain 2; Janus kinase-signal transducer and activator of transcription (JAK/STAT) signaling pathway.

The importance of blood parameters in the detection of intestinal metaplasia and early diagnosis of gastric cancer

Ayşe Kefeli — 2024-10-06

Background: We aimed to determine whether complete blood count(CBC) parameters, such as the white blood count(WBC), hemoglobin(Hb), platelet(PLT), red cell distribution width(RDW), mean platelet volume(MPV), platelet distribution width(PDW), neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR), and monocyte-to-lymphocyte ratio(MLR), have a predictive value in the detection of gastric cancer(GC) and intestinal metaplasia(IM).

Methods: While proven GC, IM, and healthy control(HC) patients were included, patients with the comorbid disease were excluded, and univariate analyses compared three groups. The receiver operating characteristic(ROC) curve analysis was run for CBC parameters. The area under the curve(AUC) was evaluated, and a cut-off value was determined. The sensitivity and specificity of each parameter were considered.

Results: The GC, IM, and HC groups consisted of 72(33%), 73(34%), and 72(33%) patients, respectively. RDW, PLT, NLR, PLR, and MLR were significant between GC and IM. The highest AUC (0.727) was obtained for the PLT yielding a 56.9% sensitivity and 79.4% specificity at a cut-off value of 151.8. The AUC of RDW was found as 0.691 and 0.626 for pairwise comparisons of GC-HC and IM-HC, respectively. At a cut-off value of 13.4, PLR yielded 70.8% sensitivity and 61.1% specificity in the detection of GC, while 64.4% sensitivity and 51.1% specificity for IM.

Conclusion: CBC parameters, such as RDW, PLT, NLR, PLR, and MLR, have value in detecting GC. RDW also has diagnostic value in helping to detect IM. PLR can help to distinguish patients with GC from those with IM. These inexpensive, easily accessible parameters may help in the timely diagnosis of GC and IM.

Keywords: Gastric cancer; intestinal Metaplasia; Monocyte to lymphocyte ratio; red cell distribution; hemoglobin; platelet; neutrophil-lymphocyte ratio; platelet-lymphocyte ratio; inflammation.

The utility of Insulin Like Growth Factor Binding Proteins (IGFBPs-1, 2, 3) with genes expression in resistance to Imatinib and Nilotinib in chronic myeloid leukemia: a pilot study from Delta Egypt

Nadia El Menshawy — 2024-10-06

Introduction: Resistance to tyrosine kinase inhibitors (TKIs) is an obstacle facing CML patients in spite of the high cure rate. In this context, a study association between IGFBP (1, 2, 3) genes expression and their proteins in CML with the response to TKI has been implicated.

Patients and methods: 115 newly diagnosed CML in chronic phase (CP) followed up over 12 months under TKI. 116 apparently healthy individuals were used as a control. RT-qPCR amplification was used for detecting IGFBPs genes expression, and ELISA technique was used for measuring serum IGFBPs.

Results: IGFBP-1 and IGFBP-3 genes expression, as well as their serum levels, were significantly higher in CML patients, whereas IGFBP-2 gene expression was not. Interestingly, IGFBP-1 gene expression and IGFBP-1 serum levels were significantly higher in resistant patients compared to responder patients. However, the expression of IGFBP-2, 3 genes and their serum were insignificant.

Conclusion: IGFBP-1 gene expression and its serum were significantly correlated with resistance. It is currently recommended that IGF-receptor inhibitors be developed and utilized. We are hoping to optimize the cure rate for CML treated with TKIs.

Keywords: IGFBP-1-3; Gene expression; CML; Imatinib; Nilotinib.

Self-Reported Late Effects in Childhood Cancer Survivors in Kenya

Jesse Lemmen — 2024-10-06

Background: The number of children surviving cancer in low and middle-income countries is expected to grow in the coming years. Knowledge about late effects and follow-up preferences in Kenya is lacking.
Objectives: This study assessed self-reported late effects in Kenyan childhood cancer survivors and explored their preferences for survivorship care.
Methods: Childhood cancer survivors, having successfully completed treatment for at least one year, were interviewed using semi-structured questionnaires during clinic or home visits between 2021-2022. Medical records were reviewed for patient and treatment characteristics.
Results: Twenty-six survivors of hematological malignancies (n=19, 73%), solid tumors (n=6, 23%), unknown tumor type (n=1, 4%), were interviewed. Most survivors (n=19, 73%) solely received chemotherapy and one survivor (4%) was irradiated. Median time since treatment completion was seven years. Fifteen survivors (58%) were previously lost to follow-up. Many survivors (n=19; 73%) self-reported late effects, predominantly pain and fatigue. Survivors (n=11, 42%) were limited in daily life activities: physical work (n=10, 38%), personal care (n=6, 23%), social activities (n=6, 23%). Eight survivors (31%) recalled being informed about late effects. Some survivors experienced a negative attitude toward cancer in regional hospitals. Follow-up duration was longer among informed patients (p=0.043). Survivors recommended education and survivor meetings and preferred their follow-up to be done at the referral center.
Conclusions: Kenyan childhood cancer survivors self-report late effects, comparable in frequency, nature and severity to other survivors worldwide. Survivors and healthcare providers require education about the lifelong impact of childhood cancer and should have access to survivorship expertise to continue follow-up.

Keywords: Pediatrics; survivorship; neoplasms; aftercare.

Attitudes of medical students towards abortion and their willingness to perform abortion: meta-analysis

Jian-xin Hu — 2024-10-06

Background and Objectives: This study evaluates the opinion of medical students about abortion and their willingness to perform the abortion.

Methods: After a systematic review, meta-analyses of proportions were performed to achieve percent estimates of medical students’ opinions about abortion and willingness to perform the abortion.

Results: 15 studies appraising 6341 medical students were included. Most medical students opined that abortion should be provided if the mother's life is threatened (89%), in case of rape (84%), if the mother's mental health is affected (79%), if the fetus is seriously defective (73%); and on mother’s request (37%). Medical students informed that they would perform abortion if the mother's life is threatened (87%); in case of rape (77%); if the fetus is seriously defective (78%); if the mother's mental health is threatened (65%); in case of teenage pregnancy (51%); on mother’s request (25%); and if court rules (19%). Religiosity was associated with significantly lower proabortion (favoring legalization of abortion) attitudes of medical students (OR: 0.10 [95% CI: 0.04, 0.24]; p<0.00001) but longer duration of medical education was associated with higher proabortion attitudes (OR: 1.75 [95% CI: 1.42, 2.14]; p<0.00001).

Conclusion: Attitudes of medical students towards abortion are generally ambivalent where the majority opine that abortion should be performed under certain circumstances.

Keywords: Abortion; medical students; attitudes; opinion.

Relationship between sleep quality during pregnancy and postpartum anxiety: a prospective birth cohort study

Niloofar Alizadeh — 2024-10-06

The present study aimed to determine the relationship between sleep quality during pregnancy and postpartum anxiety.
A total of 237 pregnant women participated in this birth cohort study, using the sequential sampling method. The data collection tools included a demographic information form, Pittsburgh Sleep Quality Inventory, and Spielberger State-Trait Anxiety Inventory. The PSQI was completed by the participants at 28 and 40 weeks of gestation, and the STAI was completed in two stages, that is, once in the third trimester and once at eight weeks postpartum.
The mean global PSQI score of the participants was 8.11 (SD=5.41) in this study. Overall, 138 (58.2%) women had poor sleep quality. The mean score for overt anxiety was 36.58 (SD=9.37), and the mean score for latent anxiety was 37.56 (SD=9.44). There was a significant positive correlation between the total score of sleep quality during pregnancy and the scores of overt anxieties (r=0.314, P<0.001) and latent anxiety (r=0.344, P<0.001) after delivery.
The results of the present study indicated a significant relationship between sleep quality during pregnancy and postpartum anxiety. Therefore, it is recommended to evaluate the quality of sleep of pregnant women and design appropriate interventions during pregnancy to reduce postpartum anxiety.

Keywords: Sleep; pregnant woman; postpartum period.

Women’s fertility and vitamin D: Could hypovitaminosis D biomarkers correlate with the disease, and explain the unexplained female factor infertility?

Albahlol Ibrahim A — 2024-10-06

Objective: Vitamin D (Vit D) deficiency correlates women reproductive pathophysiology. We analyzed Vit D deficiency biomarkers in infertile women.

Patients & method: This case-control study enrolled 80 infertile women polycystic ovary syndrome (PCOS), and other etiologies; anovulation and unexplained and 25 controls. Serum calcidiol and calcitriol were determined by ELISA and their direct ratio was calculated.

Results: 72% of controls and 92.5% of patients had Vit D deficiency/insufficiency (calcidiol mean ± SDM of 33.50±22.10 vs 20.26±5.226 ng/mL and an AUC of 0.808±0.048). Calcitriol had an AUC of 0.909±0.031 that more effectively distin guished patients and etiologies (53.49±23.30 pg/mL) from controls (114.0±43.20 pg/mL; P<0.001). 4 other etiology cases and 17 controls had calcitriol levels ≥100 pg/mL. 64% of controls (4.090±0.020) and 16.25% of patients [2.634±0.855, P<0.04; 5 PCOS (3 primary/2 secondary), 3 secondary unexplained, and 5 others (one primary tubal, one primary/one secondary peritoneal, one primary/one cervical and one primary tubal had a normal ratio ≥3.333 at an AUC of 0.740±0.065. All biomarkers revealed patient levels ~50% lower than controls; lowest in PCOS and unexplained etiologies.

Conclusion: Vit D levels are significantly reduced in infertile women; lowest in PCOS and unexplained etiology, for all biomarkers, where calcitriol was the optimal predictor of both infertility and etiology.

Keywords: Female infertility, Polycystic ovary syndrome; unexplained infertility; Vitamin D; 25-Hydroxy-cholecalceferol, 1; 25-Dihydroxyl-cholecalceferol.

Guidelines to manage women with infertility: an e-Delphi study

Armah Deborah — 2024-10-06

Introduction: The psychosocial health problems associated with infertility is compounded in African women when prevailing cultural expectations emphasize the value of parenthood. Despite the social stigma these women endure, they are still mostly managed from a biomedical approach, especially in Ghana, the context of the study.

Objective: This study explored the views of a panel of experts to reach consensus on holistic guidelines to manage women with infertility in Ghana.

Methods: An e-Delphi technique was employed to retrieve information using a panel of 20 experts. Data collection was conducted in two rounds, and each participating expert was emailed the preliminary guidelines to rate based on certain criteria. Data analysis was done in accordance with the expert participants’ rating of and comments on the guidelines.

Results: The final guidelines for holistic healthcare to manage women with infertility include the following interventions: Holistic healthcare assessment, psychological interventions, health education, spiritual support, relevant support from significant others; all within a therapeutic relationship.

Conclusion: When healthcare providers use the final set of guidelines to manage women diagnosed with infertility, these women will receive holistic healthcare to attain optimal health and improved chances of conceiving.

Keywords: Holistic approach; e-Delphi technique; psychosocial interventions; infertility.

Fast-track surgery applied in gynecological oncological surgical treatment: a prospective randomized trial

Xunwei Shi — 2024-10-06

Background: The study aimed to compare the fast-track and traditional gynaecological oncological surgeries from postoperative recovery.

Methods: A total of 107 patients undergoing gynaecological oncological surgery were randomly assigned to the FTS group (n=50) and the traditional group (n=57).

Results: No significant differences in LOS (Length of hospitalization post-operation) were observed. A less total cost of hospitalization and a lower C-Reactive protein (CRP) level were found (P < 0.05). Also, the trial revealed a significantly lower number of the overall complications in the FTS Group (P < 0.05).

Conclusions: FTS applied in gynaecological oncological surgeries is beneficial to patients in terms of the postoperative recovery.

Keywords: fast track surgery; gynaecological surgery; oncological surgery; post-operative length of hospitalization; randomised controlled study.

Spatial analysis and associated factors of underweight, overweight and obesity among non-pregnant women of reproductive age in Zambia

Samson Shumba — 2024-10-06

Introduction: Malnutrition in women in reproductive age (WRA) is associated with distinct types of public health problems such as preterm birth, low birth weight, malnourished children, poor psychological health and high mortality. The study aimed at investigating the risk factors associated with underweight, overweight and obesity among WRA and map their spatial distribution.

Methods: The study used the 2013/2014 Zambia Demographic Health Survey (ZDHS) data and survey proportional odds model was fitted to the data. Spatial effects were modeled using Quantum Geographic Information System (QGIS) version 2.18.1 to develop univariate choropleth maps.

Results: 14,377 WRA were enrolled into the study. Overweight was more prevalent (15.87%) compared to underweight (10.22%) and obesity (6.47%). The findings revealed that a higher wealth index, age, having a car, using contraceptives, being married or divorced similarly increased the odds of being at or beyond a particular category of nutrition status. The spatial analysis also suggested Lusaka and Copperbelt were more prone to overweight and obesity, whereas Western had increased prevalence of underweight.

Conclusion: Appropriate nutritional and economic programs are highly recommended in specific provinces of Zambia. Programs to curb overweight and obesity should be directed more to Lusaka and Copperbelt while underweight programs to Western province.

Keywords: Underweight; overweight; obesity

Burden of childhood diarrhea and cholera outbreaks in the Lake Tana Basin (Ethiopia): Review

Bayeh Abera — 2024-10-06

Objectives: Diarrhoea is one of the leading causes of childhood morbidity and mortality, while cholera outbreaks are a major public health emergency insub-Saharan African countries. This study was aimed at investigating the link between climate changes and cholera outbreaks, and the burden of childhood diarrhoea in the Lake Tana Basin (Ethiopia).

Methods: Research articles published in English were searched from Google scholar, PubMed, and Web of science and these were supplemented by a four-year secondary data of childhood diarrhoea and cholera outbreaks extracted from health management information system (HMIS) in 61 districts.

Results: The mean prevalence of diarrhoea per 1000 children was 420 (95% CI:311.7; 528.6). The prevalence of childhood diarrhoea showed spatial and temporal variation hereby 16.4% (10/61) districts exhibited high prevalence (>201/1000 children). The prevalence of diarrhoea was significantly higher in boys compared to girls (p = 0.001), while the incidence of cholera was significantly higher in females compared to males (p < 0.001). Heavy precipitation and El-Niño events were linked to the episodes of cholera outbreaks.

Conclusions: Health interventions should consider spatial and temporal variations of diarrhoea. The cholera outbreak preparedness needs to be aware during the events of climate changes in the hotspot areas.

Keywords: Cholera; diarrhoea; climate change; Lake Tana Basin; Ethiopia.

Association between stunting and fecal calprotectin levels in breastfed infants living in a rural area of the Democratic Republic of the Congo: a cross sectional study

Joe Bwija Kasengi — 2024-10-06

Background: Stunting is a major public health problem in low- and middle-income countries as in Democratic Republic of the Congo (DRC). Many factors, such as environmental enteric dysfunction (EED), are incriminated in the pathogenesis of stunting. EED, characterized by intestinal inflammation, can be evaluated by a non-invasive marker, the fecal calprotectin (FC). The aim of this study was to determine the concentration of FC, to compare the FC of exclusively breastfed infants with that of mixed-fed infants, and to assess the association between the stunting and the FC in infants aged 4 to 7 months.

Methods: Socio-demographic, nutritional, and clinical data were collected in infants aged 4 to 7 months attending child welfare clinic activities from eight targeted rural health areas of South-Kivu province, eastern DRC. A single assay of calprotectin was performed in stool samples by Bühlmann Quantum Blue® Calprotectin Extended device.

Results: A total of 240 infants (median age: 6 months, interquartile range: 5-6 months) were enrolled in this study. Among them, 41 (17.1%) were stunted. The median FC was 87 µg/g of stool. Exclusive breastfed infants had significantly higher FC compared to mixed-fed infants (median FC: 108 µg/g versus 79 µg/g, p=0.031). In addition, stunted infants had higher FC levels (107 µg/g) compared to infants with normal length for age (82 µg/g) but without reaching the statistical significance level (p= 0.41).

Conclusion: This study shows higher FC levels in exclusively breastfed and in stunted infants living in rural areas of South Kivu. Further studies are needed to assess the prevalence of EED and its association with stunting in the DRC.

Keywords: Stunting; fecal calprotectin; infants; breastfeeding.

Complementary feeding and food handling practices among caregivers in a semi-urban setting in Northern Uganda

Elizabeth Atim — 2024-10-06

Background: Complementary feeding practices influence the nutritional status and health of children, especially in developing countries where sub-optimal infant feeding practices are the major cause of childhood undernutrition, morbidity, and mortality. This study sought to characterize the adequacy of complimentary feeding and food handling practices among caregivers of children aged 6-23 months in a semi-urban setting.

Methods: Exploratory cross-sectional study was conducted in Adyel division, Lira district in Northern Uganda among 127 child-caregiver pairs randomly selected from three villages. Caregivers were interviewed about their child-feeding practices, com plementary foods used, and common practices in handling and preparation of foods used as complementary feeds.

Results: Overall, children’s feeding patterns met the recommended dietary intake when assessed using the child feeding index (CFI) whereby children aged 6-8, 9-11, and 12-23 months scored 8.03, 9.17, and 7.59, respectively. However, most children were complemented with foods from the household meals and dietary diversity was limited by frequent use of food leftover from the previous meals.

Conclusions: Inappropriate meal patterns and food handling practices identified are likely to compromise child nutrition and health. Nutrition education is needed to improve the caregivers’ child-feeding and food handling practices within their socio-economic and cultural context.

Keywords: Complementary feeding practices; food handling; diet quality; food safety; children; Uganda.

Epidemiology of congenital malformations in Tunisian liveborns: a retrospective study

Kaouther Nasri — 2024-10-06

Objective: To identify the various congenital malformations in liveborns in the neonatology service within the center of maternity and neonatology of Tunis (CMNT).

Methods: This is a retrospective study of liveborns with congenital malformations hospitalized during one year from 1rst January to 31 December 2016.

Results: The profile of malformations was dominated by polymalformations (22.29%), followed by chromosomal aberrations (21.14%), cardiovascular malformations (16.00%), and system nervous malformations (11.43%). Comparisons of liveborns and parental characteristics between all congenital malformations subtypes have shown significant differences in liveborns sex, consanguinity, and maternal age. Comparisons between malformed newborns and malformed fetuses have shown significant differences in consanguinity, rhesus type, maternal origin and parity.

Conclusion: It seems important to set a careful surveillance of pregnancies at risk of developing congenital anomalies, systematic supplementation of vitamins and folic acid, and a national registry of congenital malformations.

Keywords: Congenital malformations; liveborns; risk factors; prevention; Tunisia.

Canine pillar bone bearing traction method of skull external fixator combined with nickel-titanium memory alloy spring for unilateral cleft lip and palate with severe facial skeletal hypoplasia

Xin Wang — 2024-10-06

Background: For unilateral cleft lip and palate severe midfacial skeletal dysplasia, external skull fixator combined with nickel titanium memory alloy spring was used to treat canine pillar bone bearing traction.

Methodology: Patients (n = 200) with unilateral cleft lip and palate and severe midfacial skeletal hypoplasia who were treated in our hospital within three years were divided into control group (treated with trans suture traction osteogenesis) while the observation group was treated with skull external fixator combined with nickel titanium memory alloy spring supporting force traction of canine bone.

Results: After applying significantly different traction forces to the maxillary tissues on both sides of the patient, the patient was treated with appropriate traction correction, orthodontic treatment and moderate traction on the facial arch to effectively reduce the recurrence of the disease after surgery. Compared with the control group, the curative effect in all aspects was better and the asymmetry rate was lower.

Conclusion: Canine strut bone traction method of external skull fixation combined with nickel-titanium memory alloy spring was applied for severe facial skeletal dysplasia caused by unilateral cleft lip and palate. For this purpose, reasonable and scientific treatment methods were provided for early correction and treatment of the disease.

Keywords: External fixator of skull; nickel titanium memory alloy spring; bone bearing traction of canine pillar; unilateral cleft lip and palate; severe midfacial skeletal dysplasia; clinical research.

Assessment of foot care practice among adults with diabetes mellitus in Ogbomoso, Nigeria

Adeola Idowu — 2024-10-06

Background: The prevalence of diabetes mellitus (DM) has steadily increased as also the number of people bearing its complications. One of such complications is diabetic foot disease. Foot care is an integral part of diabetes self-care and preventive strategy for reduction of diabetic foot disease and ultimate amputation.

Aim: To assess foot care practices among adults with diabetes mellitus accessing care at the Out-patient Clinic of the Bowen University Teaching Hospital, Ogbomoso, Nigeria.

Methods: This was a cross-sectional study comprising of 384 adults aged 18 years and above with diabetes mellitus of at least 6 months duration. A systematic sampling technique was used to recruit the participants for this study. Nottingham Assessment of Functional Foot Care (NAFFC) was used to assess the foot care practices of the participants. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 23.

Results: Of the 384 participants recruited for the study, 321 (83.6%) had good foot care practice and 63 (16.4%) had poor foot care practice. Gender, level of education and medication use had significant association with foot care practice.

Conclusion: Foot care practice was good in majority of the participants in this study. As such, clinicians need to be consistent in providing self-foot care practice education to prevent diabetic foot diseases.

Keywords: Foot care practice; diabetic foot disease.

Prevalence and factors associated with depression and suicidal ideation among people with diabetes mellitus and hypertension in Uganda

Rahel Nkola — 2024-10-06

Background: Depression and suicide ideation are more common among patients with chronic physical illness including diabetes mellitus (DM) and hypertension (HTN). Depression is often undetected, underdiagnosed, and undertreated during routine care and may complicate into suicidal ideation in this population. This study aimed to determine the prevalence of depression and suicidal ideation, and associated factors among people living with DM and /or HTN in Uganda.

Methods: We enrolled 512 participants and assessed depression using PHQ-9 , and suicidal ideation using item 9 of PHQ-9. We run logistic regression models to determine the factors associated with depression and suicidal ideation among those with DM only, HTN only or both.

Results: The overall prevalence of depression and suicidal ideation was 22.07% and 10%, respectively. Among participants with both DM&HTN the prevalence of depression was 26.3% while 30.4% had comorbid suicidal ideation. Fear of complications (AOR = 7.21; 95% CI =2.68-19.39; p = 0.01) was significantly associated with depression. Adherence on antidiabetic medications (AOR = 0.10; 95% CI = 0.02-0.72; p = 0.02) was protective against depression.

Conclusion: The prevalence of depression and suicidal ideation among patients with DM and/or HTN in Uganda is high.

Keywords: Depression; suicidal ideation; diabetes mellitus; hypertension; Uganda, sub-Saharan Africa.

Application effect of task-oriented multi-dimensional nursing intervention in patients with coronary atherosclerotic heart disease and concurrent hypertension

Weihe Li — 2024-10-06

Background: The purpose of this study was to explore the application effect of task-oriented multi-dimensional nursing intervention
in patients with coronary atherosclerotic heart disease (CAD) and concurrent hypertension.

Methodology: The clinical data of 196 patients with CAD and concurrent hypertension in our hospital between January 2019 and January 2022 were retrospectively analysed. The patients receiving task-oriented multi-dimensional nursing were set as study group (n=98), while those given routine nursing as control group (n=98). The two groups were compared in the Hamilton Anxiety Scale (HAMA) scores, left ventricular end-diastolic diameter (LVEDD), 36-Item Short Form Health Survey (SF-36) scores, left ventricular ejection fraction (LVEF), Hamilton Depression Scale (HAMD) scores, systolic blood pressure (SBP), treatment compliance and incidence rates of adverse events.

Results: After intervention, study group showed lower HAMA and HAMD scores, SBP and LVEDD, but higher SF-36 scores and LVEF than control group (P<0.05). The treatment compliance rate was higher in control group than that in study group (92.86% vs. 80.61%), while an opposite result was detected in the total incidence rate 5.10% vs. 13.27%, P<0.05).

Conclusion: Multidimensional nursing benefits CAD patients with hypertension, improving emotions, compliance, and quality of life, reducing adverse events, and promoting recovery. Recommended for clinical use.

Keywords: Coronary atherosclerotic heart disease; task-oriented theory; multi-dimensional nursing care; clinical nursing.

A Review of emergency medical services for stroke

Yanxia Wu — 2024-10-06

In the past decade, Emergency Medical Services have been associated with innovations in technology; the 911 telephone system and two-way radio have developed the notification, scheduling, and response processes. The recent twenty years have witnessed the unparalleled innovation changes of the computer framework. These new frameworks in mobile, social, cloud computing or big data concentrations essentially affect the entire society. In the last ten years, major innovation and strategic improvements have occurred, which will affect the concepts and communication methods of Emergency Medical Service in the future. Emergency Medical Service can treat various diseases in the correct way. For example, Emergency Medical Service personnel's early recognition of stroke performance is an important ideal consideration for patients with stroke patients. Pre-stroke screening tools that have been preliminarily evaluated for sensitivity and specificity are necessary to improve detection rates for the pre-court stroke by Emergency Medical Service experts. This is an excellent time for Emergency Medical Service to play a key role in achieving and transcending vision. The motivation behind this article is to provide extensive investigations and unique opportunities for Emergency Medical Service personnel groups to solve how to improve.

Keywords: Emergency medical service; stroke; management; strategies; technologies.

Comparison of eptinezumab 300 mg with 100 mg for the treatment of migraine: a meta-analysis of randomized controlled studies

Wang Jing — 2024-10-06

Introduction: The efficacy and safety of eptinezumab 300 mg versus 100 mg for migraine remains debatable. We conduct this meta-analysis to compare eptinezumab 300 mg with 100 mg on the treatment of migraine.

Methods: We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through April 2021 for randomized controlled trials (RCTs) assessing the effect of eptinezumab 300 mg versus 100 mg on treatment efficacy and safety in migraine patients. This meta-analysis was performed using the random-effect model.

Results: Four RCTs were included in the meta-analysis. Overall, compared with eptinezumab 100 mg in migraine patients, eptinezumab 300 mg was associated with substantially improved 75% responder rate (OR=1.34; 95% CI=1.06 to 1.69; P=0.01), but
demonstrated similar monthly migraine days (MD=-0.09; 95% CI=-0.20 to 0.01; P=0.08), 100% responder rate (OR=1.38; 95% CI=0.94 to 2.02; P=0.10), 50% responder rate (OR=1.20; 95% CI=0.97 to 1.48; P=0.10), migraine 1 day after dosing (OR=0.92; 95% CI=0.72 to 1.18; P=0.52), adverse events (OR=1.13; 95% CI=0.77 to 1.65; P=0.53), nasopharyngitis (OR=1.26; 95% CI=0.74 to 2.14; P=0.40), upper respiratory tract infection (OR=1.25; 95% CI=0.83 to 1.88; P=0.29), sinusitis (OR=1.78; 95% CI=0.95 to 3.33; P=0.07) or nausea (OR=1.26; 95% CI=0.68 to 2.32; P=0.46).

Conclusions: Eptinezumab 300 mg may have better efficacy for migraine patients than eptinezumab 100 mg.

Keywords: Eptinezumab; migraine; randomized controlled trials.

Challenges of minimally- invasive orthopaedic surgery practice in Nigeria - a national survey of residents’ perceptive

Kelechi Imediegwu — 2024-10-06

Background: Minimally invasive orthopaedic surgery (MIOS) practice globally has been on a gradual increase, however the current state in Nigeria is not same.

Objectives: To determine the challenges of minimally invasive orthopaedic surgery (MIOS) practice in Nigeria and proffer realistic suggestions to improve the current state in Nigeria.

Methodology: A descriptive cross-sectional online survey conducted among senior orthopaedic surgery residents across all specialist hospitals in Nigeria. Data was analysed with the SPSS software version 20. Significance was set at p<0.05. Mean and S.D scores were calculated for responses with Likert scales of 1-5 (5- strongly agree).

Results: 48 residents completed and submitted the questionnaire, response rate of about 70.6%.
The results showed that the most significant factors affecting minimally invasive orthopaedic surgery practice in Nigeria were lack of funds (72.9% of respondents), unavailability of equipment and implants (60.4%), limited number of trainers and fellows skilled in minimal access surgery (54.2%). The narrowest Standard deviation reflecting closest precisions in perspectives of the challenges was a S.D of 0.794, Mean 4.02, which stated that there are very few courses on training of MIOS procedures.

Conclusion: Funds, training, equipment availability were the major challenges of minimally invasive orthopaedic surgery practice in Nigeria.

Keywords: Minimally- invasive orthopaedic surgery; residents’ perceptive; Nigeria.

A unique approach for investigating skin lesions and their relationship with TCM syndrome differentiation in alopecia areata

Xianzhe Zhang — 2024-10-06

Background: Alopecia areata is also known as ‘oil wind’ in Chinese medicine. Alopecia areata is a debilitating autoimmune skin
disease characterized by patches of non-scarring hair loss and inflammation that damages the scalp and body hair in a variable,
often relapsing or permanent fashion. It is not quite obvious how the various Traditional Chinese Medicine (TCM) syndromes differentiate between the skin lesions under dermatoscopy caused by alopecia areata.

Objective: This study aimed to provide a rational basis for TCM syndrome differentiation of alopecia areata and investigate the role of skin lesions in various TCM syndromes of alopecia areata under dermatoscopy.

Methods: The dermatologist used a dermatoscope to take four images of the patient's skin lesion area and the skin lesion junction. Two of the images were captured with polarized light, while the other two were taken with non-polarized light. Patients with alopecia areata who had TCM syndrome differentiation were identified and examined using dermatoscopy. The occurrence of the yellow dot, white dot, exclamation mark hair and vascular sign, was determined and then statistically analyzed.

Results: The positive rates of vascular signs relate to alopecia areata, exclamation mark hair relates to Qi-blood deficiency and white dot corresponded to liver and kidney deficiency. All the positive rates were statistically significant (P < 0.05). Compared to vascular sign, white dot sign, and Qi-blood deficiency syndrome groups, the positive rate of yellow dot syndrome was not significant (P>0.05)

Conclusion: The findings suggest that particular skin lesions contribute to differentiating different TCM syndromes associated with alopecia areata. Skin lesions examined under dermatoscopy can assist in diagnosing the TCM syndromes associated with alopecia areata.

Keywords: Dermatoscopic signs; Alopecia areata; TCM syndromes; Qi and blood deficiency; Liver and kidney deficiency.

Frequency of red blood cell allo-immunization in transfused patients with sickle cell disease in Africa: a systematic review with meta-analysis

Theresa Ukamaka Nwagha — 2024-10-06

Background and Objectives: Blood transfusion is an effective and proven treatment for some severe complications of sickle cell disease. Recurrent transfusions have put patients with sickle cell disease at risk of developing antibodies against the various antigens they were exposed to. This study aims to investigate the frequency of red blood cell alloimmunization in patients with sickle disease in Africa.

Materials and Methods: This is a systematic review of peer-reviewed and published literature. The review was conducted consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist.
Data sources for the review include MEDLINE, PubMed, AJOL, CINAHL, Psych-Info and Academic Search Complete. Included in this review are articles that reported the frequency/prevalence of red blood cell alloimmunization in sickle cell disease patients in Africa. Eligible studies were subjected to independent full-text screening and data extraction. Risk of bias assessment was conducted with the aid of the mixed method appraisal tool. We employed a random-effects model of meta-analysis to estimate the pooled prevalence. We computed Cochrane’s Q statistics and I2 and prediction interval to quantify heterogeneity in effect size.

Results: The prevalence estimates range from 2.6% to 29%. Pooled prevalence was estimated to be 12.1% (95% CI 8.1 to 17.7), with significant heterogeneity (I2= 91.83; PI = 2 to 54%).

Conclusion: The frequency of red cell alloantibody varies considerably in Africa.

Keywords: Systematic review; red blood cell; alloimmunization; sickle cell disease; Africa.

Prevalence and factors influencing substance abuse among secondary school students in Mbeya City, Tanzania

Abnery Gift — 2024-10-06

Background: Substance abuse among students has far-reaching social, religious, economic, health and demographic consequences, such as unplanned pregnancies, school dropouts, abortions, maternal and newborn mortality, infection risks and other psychological problems. Our study investigated the prevalence of substance abuse among secondary school students in Mbeya City, Tanzania.

Methods: This school-based cross-sectional study was conducted from January to May 2021 among secondary students from Mbeya City, Tanzania. Students completed a self-administered substance use questionnaire. Data were analysed using descriptive statistics.

Results: A total of 343 students were requested to participate in the study. However, 300 agreed to indicate 87% response rate. 9.7% (n=59) reported substance use, primarily cannabis, 75% (n=225) and alcohol, 68% (n=204). Friends influenced substance use among 82.7% of users. Reported immediate effects included misbehaviour, 73.7% (n=221) and unprotected sex, 72.3% (n=217). Long-term harms were predominantly brain damage (86.7%). Community education (78%) and media campaigns (76.7%) were suggested to curb use.

Conclusion: Substance abuse among a sizable minority of Mbeya City secondary school students is driven by peer influence and has detrimental impacts reported by students themselves. Comprehensive education and preventive strategies engaging families, schools and communities are recommended to address this critical youth issue.

Keywords: Substance abuse; cannabis; alcohol; secondary school students; Tanzania.

Study on the relationship between NF-kB pathway and skeletal muscle dopamine receptors in muscle-attenuated mice

Hui Tian — 2024-10-06

Background: To investigate the relationship between the NF-kB signaling pathway and muscle-attenuated skeletal muscle dopamine
receptor (DR) in mice.

Methodology: 40 specific pathogens free (SPF) C57BL/6 mice aged 6 to 7 months were randomly divided into a model group and control group by random number table method, with 20 mice in each group. Muscle-attenuated mice were established in model group, and the expression of NF-kB protein was detected by Western-blot, and the expressions of IL-β1, TNF-a, DRD1, and DRD2 were detected by enzyme linked immunosorbent assay (ELISA). Meanwhile, the muscle fiber cross-sectional area was determined.

Results: The relative expression of NF-kB protein, IL-,1 and TNF-a in model group were significantly higher than those in control group (P < 0.05). The levels of DRD1 and DRD2 in skeletal muscle in model group were significantly lower than those in control group (P < 0.05). The cross-sectional are the model group was significantly lower than in the control group (P < 0.05). The relative expression of NF-kB protein was negatively correlated with DRD1, DRD2 and muscle fiber cross-sectional area. DRD1 and DRD2 were positively correlated with muscle fiber cross-sectional area.

Conclusion: In muscle-atrophied mice, NF-kB protein, an indicator of the NF-kB signaling pathway, was negatively correlated with DR, and both had an important role in muscle atrophy.

Keywords: Nuclear factor kB signaling pathway; Muscle attenuation; Mice; Skeletal muscle; Dopamine receptor.

Added prognostic value of fat attenuation index and CT-derived fractional flow reserve over plaque burden in suspected CAD patients without standard modifiable risk factors

Yang Yu — 2024-10-06

Background: In this study, we aimed to investigate the added prognostic value of fat attenuation index (FAI) and CT-derived
fractional flow (CT-FFR) over plaque burden in suspected coronary artery disease (CAD) patients without standard modifiable
risk factors (SMuRFs).

Methodology: A total of 260 consecutive suspected CAD subjects without SMuRFs who underwent first coronary computed tomography angiography (CCTA) were retrospectively collected. We calculated FAI, CT-FFR, and segment involvement score (SIS) from CCTA images. Cox regression models were used to assess the incremental prognostic value of FAI and CT-FFR.

Results: During a median follow-up of 25.00 months, major adverse cardiovascular events (MACE) were observed in 40 (15.4%) patients. FAI ≥ −70.1, CT-FFR ≤ 0.80, and SIS ≥ 4.5 were associated with the increased rate of MACE (P < 0.0001). FAI did not provide incremental prognostic value over SIS (P = 0.169). Likewise, CT-FFR did not enhance risk prediction (P = 0.159). Combining FAI and CT-FFR added incremental prediction value and improved risk discrimination (P = 0.032; Absolute integrate discrimination improvement (IDI) = 0.070, P < 0.001).

Conclusion: In suspected CAD patients without SMuRFs, neither FAI nor CT-FFR independently added incremental prognostic value over plaque burden. Combining FAI and CT-FFR had added prognostic value and improved cardiovascular risk stratification.

Keywords: Coronary artery disease; CT-derived fractional flow reserve; fat attenuation index; plaque burden; standard cardiovascular
risk factor; prognosis.

Strengthening the traditional medicine regulation, education and practice in Nigeria

Pal Sanjoy Kumar — 2024-10-06

Background: Despite tremendous advances in medical sciences still a large section of the population in rural areas is heavily dependent on indigenous and Traditional Medicine (TM) for treatment. Moreover, there has been a resurgence of interest in the use of Complementary and Alternative Medicine (CAM), globally.

Objective: To review the overall regulator structure for the control of TM and the course curriculum for TM education in Nigeria.

Method: Information on CAM and TM was collected via online search.

Results: Responding to this unprecedented situation government of many countries have taken proactive steps to streamline and regulate the practitioners of CAM and TM in their countries as mandated by WHO. In many African countries because of the availability of research and training programs many traditional herbal medicines are now being sold over the counter. However, the situation is different in Nigeria, even though TM is very popular across the country, structured institutionalized teaching and research activity on TM are inadequate.

Conclusion: Health is a key component in determining the Human Development Index (HDI) of a country. CAM and TM practitioner may play an important role in improving the HDI score of the country. Government-sponsored education & training program for TM practitioners is crucial.

The practice and effect of multi-disciplinary cooperative mobile devices in improving the satisfaction of inpatients on drug education

Shuangai Zhu — 2024-10-06

Objective: To explore the effect of multi-disciplinary cooperative mobile device-assisted drug education on the satisfaction of inpatients drug education.

Methods: Mobile nursing vehicle, IPAD, and mobile phone were used to scan QR code to play drug propaganda videos and distribute drug propaganda materials. Doctors, nurses and pharmacists cooperated to complete drug education for inpatients. The satisfaction on drug education of inpatients was collected through a third-party satisfaction survey.

Results: Before implementation, the four satisfactions of communicating about the drug, understanding the purpose of the drug, informing the role of the drug and informing the side effect of the drug were 83.9%, 80.4%, 83.8% and 83.9%, respectively, and after the implementation increased to 88.2%, 86.4%, 89.6% and 87.3% (P<0.05). The effective rate of drug education among inpatients increased from 95% before the implementation to 99.4%, and the medication compliance of inpatients increased from 93.1% before the implementation to 98.75%.

Conclusion: Multi-subject cooperative mobile device-assisted drug education can improve the satisfaction of inpatients drug education, the efficiency of drug education and drug compliance.

Keywords: Multidisciplinary collaboration; mobile devices; drug education; patient satisfaction.

Dissemination of medical research findings among medical researchers in a tertiary institution in Uganda

Nelson Twinamasiko — 2024-10-06

Background: Dissemination of research findings is a key obligation for researchers. It increases access to evidence and the ability to use and apply the evidence. Repackaging of research findings to inform policy and practice is not yet embraced in many low-and-middle income countries that have under-resourced health care systems.

Objective: To determine the methods of communication of research findings by researchers at the Makerere University College of Health Sciences as well as the facilitators and barriers faced while disseminating the findings.

Methods: This was a concurrent nested mixed-methods study among researchers. Key informant interviews and self-administered questionnaires were used. The collected Qualitative data was examined through thematic analysis. Quantitative data were analysed with STATA version 15.0, analysing categorical variables using frequencies and percentages.

Results: Of 176 researchers involved in the quantitative survey, more than half (60%, n=106) were males and 40.9%(n=84/176) were lecturers. The most used dissemination method was journal publications (71.6%, n=126) followed by presentations in conferences/workshops (62.5%, n=110). Twelve researchers participated as key informant interviewees. Themes that emerged included: benefits, facilitators and challenges faced in research communication.

Conclusions: Research findings are commonly disseminated through journals and conference presentations. However, researchers face challenges like financial constraints, time limitations, and misrepresentation of findings.

Keywords: Dissemination of medical research; Journal Publication; Community engagement.

The Onerous task of managing paroxysmal nocturnal hemoglobinuria in a Low resource setting: a case report. A hematologist’s experience

Musa Kasadhakawo Waiswa — 2024-10-06

Introduction: Paroxysmal nocturnal hemoglobinuria (PNH) is a form of red cell membrane defect characterized by increased sensitivity to complement-mediated cell lysis, resulting in intravascular hemolytic anemia, passage of hemoglobin-containing urine, a high risk of venous thrombosis and progression to pancytopenia.
The diagnosis of PNH is based on the flow cytometric (FCM) detection of peripheral blood cell clones. Such clones lack expression of the surface molecules linked to the glycosylphosphatidylinositol (GPI) anchors. The underlying defect is a somatic mutation of the short arm of the phosphatidylinositol glycan class A gene (PIG-A).

Case report: We report a case of a 34-year-old male, with recurrent hemolytic anemia and dural venous sinus thrombosis found to have PNH by flow cytometry. He is currently on anticoagulation, iron and folate supplements, intermittent steroids for hemolytic episodes as we await complement inhibitors.

Conclusion: As part of the diagnostic workup for patients presenting with recurrent hemolytic anemia and thrombosis in unusual sites, clinicians should include PNH on the list of differential diagnoses. Effort should be taken to characterize the red urine reported on the urine dipstick as blood/hemoglobin by microscopy to differentiate hematuria and hemoglobinuria and order for flow cytometry as this has implications on patient management.

Keywords: Thrombosis; hemolysis; complement; paroxysmal nocturia; hemoglobinuria.