Case Files Research Articles

Clinical Profile of Patients Presenting With Eclampsia at a Semi-urban Tertiary Care Center.

Introduction Pregnancies complicated by hypertensive disorders contribute to enormous burden on economy and health-care facilities.Eclampsia is one of the clinical markers of near-miss mortality. To achieve optimal outcomes, efforts should be directed at both periphery and tertiary care levels. This study aimed to compare the feto-maternal outcome in patients presenting with eclampsia and a matched control population. Methodology A comparative observational study was conducted among 70 cases and 70 controls. Detailed historyand general and obstetrical examinations were carried out. Data was extracted from case files, labor room, and ICU records. Maternal and fetal outcomes were noted from January 2023 to January 2024. Statistical software STATA 14.2 (StataCorp LLC, College Station, Texas, USA) was used for data analysis. Observational descriptive statistics and chi-square and Fisher extract tests were applied. Results In our study, the incidence of eclampsia was 0.7% (70 per 1000 live births). The maternal mortality rate was 102.8/100000 live births and the perinatal mortality rate was 10.2/ 1000 live births in our study. The study observed a relatively young aged population and a significant bulk of cases belonged to late gestation or post-partum. Events like HELLP syndrome, abruption, liver, and renal failure were found to be frequently linked to eclampsia. Neonatal asphyxia (P-0.005), NICU requirement 41.43% vs 29% (P<0.01) preterm delivery 45.7% vs 14% (P=<0.001), and low birth weight were more commonly observed among the cases than the controls. Conclusions Eclampsia was found to be a significant contributor to elevated rates of morbidity and mortality in mothers and newborns. Poor antenatal care, severe anemia, and late referrals were some of the modifiable risk factors. Health care and economic burden on society is immense due to the significant utilization of intensive care and high dependency units.

In Search of Living Law: How Should We Design for (Digital) Legal Interaction?

In his work on human-centric design, urban theorist Christopher Alexander elaborated design patterns as a way to conceptualise and practice urban design together with its users. Alexander aspired to design “living places”, physical spaces created by the social interactions that take place there. In this article, I use this lens to uncover the “living places” of law, and what might be the “living law” that legal design patterns could capture? I explore law as a product of design, and design as an activity, an activity that produces the many material manifestations of law. These manifestations may be digital or analog, such as case files on paper or interactive online forms, courthouse architecture or institutional webpages, courtroom furniture or dispute resolution platforms. Although often overlooked in legal scholarship, such material manifestations shape legal interaction, privileging certain forms and actors over others. They reflect values and ideologies as well as legal concepts and doctrines. By thinking about law through legal design patterns, living law becomes defined through interaction. I explore this connection between spatial and material arrangements and legal interaction they manifest and enable. This analysis makes it possible to compare law’s old material manifestations with its new places and things that rely on digital technologies. This shift of focus to legal interaction enables us to ask what legal interaction is, how it should be designed, and by whom, reconceptualising the dynamics of law, technology, and design. Ultimately, legal design patterns may provide us with conceptual and methodological tools for designing user-centric justice.

Clinicopathological Profiles of and Patterns of Recurrence in Triple-Negative Breast Cancer Patients at a Cancer Care Center in Southern India.

Triple-negative breast cancer (TNBC) is characterized by the absence of expression of the estrogen receptor and the progesterone receptor by immunohistochemistry and human epidermal growth factor receptor overexpression absence either by immunohistochemistry or absence of amplification by fluorescence in-situ hybridization. TNBCs tend to have rapid growth when compared to other subtypes of breast cancer. TNBC is associated with higher histologic grade and more advanced disease at presentation. TNBC shows aggressive behavior and a high chance of recurrence. The aim was to analyze the clinicopathological profiles of and recurrence patterns in TNBC patients at our institute where most patients are from rural areas. This retrospective study was done at a tertiary cancer care center in Southern India where most patients come from rural backgrounds. Institutional Ethics Committee approval was obtained before the study. Case files of all breast cancer patients registered and treated at our center from 2014 to 2019 were retrieved from the medical record department and reviewed. Data from patients diagnosed with triple-negative breast cancer were identified and analyzed. Among the 841 breast cancer patients registered in our study, 150 (17.8%) were diagnosed with TNBC. The median age of diagnosis was 47 years. The majority of the patients, 89 (59.3%) presented with T2 tumors, and lymph node involvement was observed in 88 (58.6%) cases. Patient distribution based on cancer stage revealed that 77 (51.3%) had early-stage breast cancer (EBC), 70 (46.6%) had locally advanced breast cancer (LABC), and only three patients were categorized as having metastatic breast cancer (MBC). Modified radical mastectomy (MRM) was the preferred surgical approach in 144 (96%) cases, while only four patients underwent breast-conserving surgery (BCS). Adjuvant chemotherapy was administered to 119 (79.3%) patients, with 30 (20%) receiving both neoadjuvant and adjuvant chemotherapy (NACT/ACT). Among those who underwent NACT/ACT, a pathological complete response was observed in five (16.6%) patients out of 30 patients. The median duration of follow-up was 32.8 months. Among all patients, 36 (24%) experienced recurrence, with seven (19.4%) having local recurrence, 24 (66.6%) developing distant metastases, two patients experiencing both local and distant recurrence, and three patients developing contralateral breast cancer. Additionally, three patients experienced a second primary cancer. The most common sites of metastases were the lungs (14), followed by the bone (seven), the liver (four), and the brain (four). Recurrence rates were notably high within the first one to three years post-diagnosis. The median disease-free survival (DFS) of TNBC patients was estimated to be 65.6 months with no statistically significant difference (p=0.174) between EBC and LABC patients. TNBC is known for its heterogeneity. While it is often regarded as being more responsive to chemotherapy compared to other subtypes of breast cancer, TNBCs tend to behave aggressively, basically due to the underlying aggressive tumor biology. Though there are many treatment options for different subtypes of breast cancer, therapeutic modalities are limited for TNBCs. Aggressive tumor biology with limited treatment options denotes a gap in the development of novel strategies to improve outcomes in this subset of breast cancer patients.

Pregnancy-Related-Acute Kidney Injury in Jigawa, Nigeria

Introduction: Pregnancy-related acute kidney injury (PR-AKI) is a significant cause of maternal morbidity and mortality. Objective: This study aimed to determine the causes and outcomes of PR-AKI management. Methods: This was a two-year retrospective review of patients managed for PR-AKI between 1 October 2021 and 31 September 2023 in the Department of Obstetrics and Gynaecology of Rasheed Shekoni Federal University Teaching Hospital Dutse. Patients’ data were obtained from their case files. Results: One hundred and three women were diagnosed with PR-AKI out of 1,647 admissions during the review period. The mean age of the patients was 27 7.5 years, with an age range of 15 to 48 years. The mean parity was 4.513.2 and most (47.6%) patients were grand-multipara. The majority (70.7%) booked for antenatal care in primary healthcare centres, and only 2(3.1%) booked in tertiary hospitals. The commonest cause of PRAKI was obstetric haemorrhage (48.5%), with postpartum haemorrhage and antepartum haemorrhage accounting for 72% and 28%, respectively. Seventy-five (72.8%) patients received a blood transfusion, while 28 (27.2%) had haemodialysis. Thirty-five (33.9%) deaths were recorded. Conclusion: This study revealed that PRAKI was common, and obstetric haemorrhage, hypertensive disorders and sepsis were the leading causes.

ROLE AND ETHICS OF HAKAM IN RESOLVING MATRIMONIAL DISPUTES

Conflicts and disagreements are part and parcel of married life. As revealed in the Qur’an the best way to resolve conflict in family is by the efforts of the spouses themselves. In the event of failure to restore harmony between the spouses, Islam laid out other remedies from outside the conjugal home where competent third parties are available to assist in resolving the conflict. In Malaysia, provisions relating to third party intervention can be found, for instance, under sections 47 and 48 of Part V on the Dissolution of Marriage of the Islamic Family Law (Selangor) Enactment 2003. The sections respectively provide clauses for conciliatory committee and arbitration. The courts, under s. 48 will appoint two hakam (arbitrators) to act for the husband and the wife. In agreement with the Islamic law of Tahkim, it is recommended that where possible, for a hakam to be from among the family of the spouses. This paper seeks to examine first, the role of Hakam in a Tahkim process and, second, the ethics of Hakam. To achieve this, apart from field research, the Hakam Rules 2014 of Selangor was referred to to examine detailed aspects on the qualifications, role and ethics of Hakam. A minor fieldwork was conducted at Shah Alam Syariah Subordinate Court. 20 case files involving settlement reached through tahkim sessions were examined. Separate interviews with Syariah Court Judge as well as ‘court-annexed’ hakam were also carried out. The findings suggest that besides emphasizing on the principal requirements, it is equally important to pay greater attention to promoting additional qualification and nurturing relevant skills in the light of the hakam duties as third party in resolving family disputes. Furthermore, maintaining the characteristic as hakam by following the code of ethics is another key to the successfulness of majlis tahkim.

Patterns of Spine Cases in a New Neurosurgery Centre in Southeast Nigeria

Background: The Imo State Specialist Hospital (IMSSH) commenced neurosurgical services in April 2021 and spine procedures in August 2021. The activities of the hospital with respect to surgical management of spine pathologies were audited. Aims: Our aims were to look at the pattern of spinal pathologies surgically managed in the hospital including their age and sex distribution, the pathologies and procedures performed as well as immediate post operative outcomes. Methods: The case files of all spine patients who had surgical procedures at IMSSH from August 2021 to April 2023 (21 months) were retrospectively reviewed. Results: Seventy-two spine patients had surgical procedures during the study period (an average of 3 – 4 spine procedures per month). The mean age of patients was 55.4±16.1 years with a male-to-female ratio of 7: 5. The mean age for male patients was 53.86±17.83 years while that of female patients was 57.5±13.2years. The peak age range at presentation was in the 7th (n=23, 31.9%) decade. The highest frequency of procedures was performed in the lumbar/ lumbosacral spine (56.9%), followed by cervical spine (29.1%), and thoracic/thoracolumbar spine (13.8%). Degenerative spine diseases (69.4%) accounted for the highest number of spine cases, followed by spinal trauma (20.8%) and Spinal tumours (6.9%). Mortality in the immediate post-operative period was 6.9% (n=5). Conclusion: The study showed a male preponderance for spinal surgeries among our spine patients, with most cases being of degenerative spine pathology. We hope this would be helpful in formulating policies for the growth of this new Neurosurgical Centre.

Special criminal investigation (in absentia): problematic issues of a defence counsel's participation

Based on the analysis of the criminal procedure legislation and generalisation of theoretical developments, the article identifies some peculiarities of legal regulation of the institute of special criminal proceedings (in absentia). The author identifies the categories of cases (types of criminal offences) and procedural grounds which are sufficient to initiate a pre-trial investigation in the form of special criminal proceedings. The need to exclude certain articles from the list of those listed in part 2 of Article 297-1 of the CPC of Ukraine in order to bring them in line with the provisions of the Criminal Code of Ukraine is emphasised. The peculiarities of defence counsel’s participation in special pre-trial investigation and court proceedings are analysed. It is determined that a defence counsel in such cases benefits from all the rights guaranteed to a suspect or an accused person in criminal proceedings. In view of this, and in the context of ensuring such fundamental principles of criminal proceedings as the right to defence, adversarial proceedings, observance of human rights and freedoms, access to justice, etc., the author emphasises the need to amend the current criminal procedure legislation to ensure that the defence counsel can appeal against the investigating judge's decision to conduct a special pre-trial investigation The problematic issues of defence counsel's participation are characterised, and the inadmissibility of his/her formal participation in criminal proceedings is emphasised. It is determined that the active actions to be taken by the defence counsel involved include familiarisation with the case file, choosing the defence position, participation in the trial and examination of evidence, participation in the debates, etc. The author emphasises the need for further research on the development of the practice of active participation of defence counsel in special criminal proceedings.

Who is involved in child protection investigations? The relationship between gender, ethnicity/migration background, and contacts between parents and caseworkers during investigations and assessments

Involvement of parents in child protection investigations and assessments is important and associated with the quality of care in the system. However, it seems that not all parents are involved to the same extent. Mothers seem to be more involved compared to fathers and parents of minoritized ethnic groups or with migration backgrounds seem less likely to be involved compared to parents of advantaged ethnic populations. In this study, we operationalized involvement by analyzing the number of contacts parents had with child protection agencies. We investigated whether gender and ethnicity or migration background impacted contacts in child protection investigations and assessments in England, the Netherlands, and Germany. We conducted a quantitative case file study and analyzed case files representing investigations and assessments regarding suspected child abuse and neglect (1,954 parents involved in 1,207 child protection cases). Using linear multilevel regression analyses, we investigated whether parent gender and family ethnicity/migration background were associated with the number of contacts that parents had. In all countries, we found that fathers had fewer contacts compared to mothers. In the Netherlands only, we found that parents in migrant families had fewer contacts. We discuss strategies to enhance the involvement of fathers and parents with migration backgrounds.

Insufficient criminal justice system response to the severity of domestic violence during the pandemic in Indonesia

Domestic violence increased dramatically in Indonesia during the COVID-19 pandemic compared to the previous pandemic. This article analyses how Indonesia's criminal justice system responded to domestic violence during the pandemic. This article used secondary data gathered from various online resources and legal publications. This article demonstrated that during the pandemic, victims of domestic violence in Indonesia were unable to access justice due to two significant barriers. Before filing a formal complaint with the appropriate official, victims would prefer to discuss the matter with their relatives. Furthermore, the victims could not report their cases to the responsible official due to mobility constraints. This case demonstrates that in patriarchal societies, the criminal justice system could not handle domestic violence cases more effectively. As a result, the technical operation of the criminal justice system necessitates the development of a novel method of case filing. This article proposes that the Indonesian criminal justice system establish a complaint system based on social media to provide victims of domestic violence with prompt justice. Furthermore, the legal advocacy role of the community in assisting domestic violence victims is critical.

An Analysis of Reunifications Between Adopted Adults and Their Birth Relatives

ABSTRACT The life-long nature of adoption and recognition of the often-fragile nature of post-reunion relationships, means adoption agencies have a duty of care and moral onus to facilitate comprehensive support services that can be readily accessed. The Health and Social Care (HSC) Trust Post-Adoption Service was established in 1989, in response to the legislative changes brought about by The Adoption (Northern Ireland) Order 1987. This study employed retrospective file analysis and a purposive sample of 15 Case Files, drawn from a 10-year period (2009–2018), to explore reunifications between adopted adults and their birth relatives, from the time of initial involvement and over the longer term. The use of an Advisory Panel of professional experts, a Pilot Study and a specifically created Data Collection Form, enhanced overall rigour and robustness. Thematic analysis of the data identified common themes of curiosity; identity related; meeting the birth mother; and death of adoptive parents/loss; leading to meta-themes of identity and loss. Key findings include the diversity amongst service users accessing the service in terms of their gender, age and life stage; their motivations; the time-restricted nature of current involvement; protracted timescales from initial contact to search is not uncommon; that post-reunion social work involvement saw a marked drop from pre-contact levels, particularly for birth relatives. The study makes a compelling case for a well-resourced service that offers additional pre- and post-reunion support and argues for a more proactive professional approach, with further expansion of existing support provision.

Enhancing the Quality of Judicial Service Delivery through E-Filing System: The Case of Rukwa District Courts in Tanzania.

E-filing system is advocated for improving the quality of judicial service delivery worldwide; andthis has proved successful in developed countries. In 2016, the Tanzania judicial organ piloted e- filing system and later in 2018, a countrywide rollout proceeded. Despite the adoption of the e- fil ing system, anomalies in the procedures for case filing are common especially in Rukwa Region. Previous studies have not given enough consideration to the aspects and dimensions of quality judicial service delivery through e-filing system such as duration, accessibility and convenience in district courts. This knowledge gap made it difficult for scholars and policy implementers to comprehend the current situation in district courts where reforms in judicial service delivery are ongoing. This study aimed to examine the contribution of e-filing system in the quality of judicial service delivery in Rukwa District courts. This work applied a mixed approach with a case study design using both primary and secondary data. Primary data were collected from 78 respondents through survey method, while seven (7) key informants were involved in interviews and supplemented by non-participant observation method. On the other hand, secondary data were collected through a documentary review. The statistical package for social sciences (SPSS) was used to generate frequencies, percentages followed by correlation analysis. Findings revealed that e-filing system had a potential to improve the quality of judicial service delivery through time saving, increased accessibility and enhanced convenience of specific judicial services such as the case filing. However, the potential of the e-filing system was challenged by disruptions in internet connectivity, limited interoperability and inadequate ICT facilities mainly desktops. The study recommends fostering reliable internet connectivity, enabling the system to operate off-line, to integrate the system with more technological innovations, and optimizing ICT facilities such as laptops or desktops to meet the needs.

Affects of Objectivity: Decision-Making Practices in the Dutch Asylum Procedure

This article explores the pursuit of objectivity in the Dutch asylum procedure, where asymmetrical forms of intimacy and techniques of suspicion are used to gather sensitive information from asylum applicants and evaluate their case files. Firstly, I examine the procedural design and how objectivity is pursued in producing distance, detachment, and the rotation of several Immigration and Naturalization Department (IND) officers in and out of applications. Secondly, I focus on the authority granted to a specific kind of trained IND subjectivity, well-versed in a critical and intuitive reading of the ever-suspected asylum applicant. By analysing the entanglement of objectivity and subjectivity, this study contributes to existing scholarship on the interplay between emotions and legal judgment, as well as to scholarship on borders and bureaucratic practices within contexts of heightened control and securitization. By doing so I challenge the notion of ‘emotion management’ as a means to enhance objectivity, arguing that pursuing objectivity in these state practices is not merely managed affective work; more crucially, it privileges affects of suspicion.

Sick Leave and Absence Rate of Hospital Workers During the Sixth to Eighth Wave of COVID-19 in Japan

Abstract Background There are several reports of breakthrough infections of severe acute respiratory syndrome coronavirus 2 in vaccinated individuals and reinfections in previously infected individuals. Although the coronavirus disease (COVID-19) pandemic has increased the incidence of infections at healthcare facilities, the association between the increase in community spread and absence rate of hospital workers due to COVID-19 infection-related sick leave has not yet been fully elucidated. Method We reviewed the case files of patients with COVID-19 diagnosed at the Jikei University Katsushika Medical Center, Tokyo, Japan, between January 1, 2022, and February 28, 2023. The obtained data was used to determine the number of COVID-19 admissions and absence rate of hospital workers due to COVID-19 infection-related sick leave during the sixth to eighth wave of the COVID-19 pandemic. Results Of 1899 patients with confirmed COVID-19, 397 (20.9%) were hospital workers. Of the 397 patients, 71, 156, and 119 contracted the infection during the sixth (January–March 2022), seventh (July–September 2022), and eighth wave (November 2022–February 2023), respectively. The absence rate of hospital workers due to COVID-19 was 6.3%, excluding leaves of absence due to close contact in the seventh wave, which had the highest number of infections. Conclusions Given the difficulty of maintaining a usual work schedule during the COVID-19 outbreak, it may be necessary to re-evaluate the backgrounds of healthcare workers at high risk of contracting COVID-19 and to make aggressive adjustments to their work schedules by distributing assignments and restricting leave.

Jurisprudential Discernment and Protection Path of Personal Biological Information in the Context of Metaverse

摘要：随着大数据时代的降临，算法技术的正当性问题引发人们关注。区别于算法正义和数据正义，认知正义以认知主体为视角并具有法律意义，要求认知主体的认知水平与认知客体的可信度相匹配。实践中存在对大数据挖掘所获证据的证明力进行天然推定，证明标准难以对法官心证形成控制的现状。这是由于大数据挖掘基于相关关系的思维冲击了人们的认知惯性，将解释权交给了算法，降低了认知水平，算法黑箱的不透明性和难以检验性导致认知客体本不应当赋予过高的可信度，算法歧视导致难以对二者匹配的过程进行矫正。需要将内心确信符合信念标准、偏见性算法信息应仅发挥补强性作用、将大数据挖掘所获信息在辩护人阅卷中进行披露、破除相互印证的因果逻辑桎梏，从而回归于认知正义，走向法治而非“算法治”。 Abstract: With the emergence of the big data era, questions about the legitimacy of algorithmic technologies have arisen. Distinguished from algorithmic justice and data justice, cognitive justice takes the perspective of the cognitive subject and has legal significance, requiring the cognitive level of the cognitive subject to match the credibility of the cognitive object. In practice, there is a natural presumption of the probative power of evidence obtained by big data mining, and the standard of proof is difficult to control the judge’s mental evidence. This is due to the big data mining based on the correlation of thinking impacts the cognitive inertia of people, the interpretation of the right to the algorithm, reducing the level of cognition, the opacity of the black box of the algorithm and difficult to test leads to the cognitive object should not have been given too much credibility, the algorithmic discrimination leads to the difficulty of the process of correcting the matching of the two. There is a need to return to cognitive justice, towards the rule of law rather than the “rule of law”, by bringing inner certainty in line with the standard of conviction, biased algorithmic information should play only a reinforcing role, disclosure of the information obtained from big data mining in the reading of the defense case file and breaking the shackles of the causal logic of mutual corroboration.

A Study of Cognitive Justice Issues in Big Data Mining Behaviour

随着大数据时代的降临，算法技术的正当性问题引发人们关注。区别于算法正义和数据正义，认知正义以认知主体为视角并具有法律意义，要求认知主体的认知水平与认知客体的可信度相匹配。实践中存在对大数据挖掘所获证据的证明力进行天然推定，证明标准难以对法官心证形成控制的现状。这是由于大数据挖掘基于相关关系的思维冲击了人们的认知惯性，将解释权交给了算法，降低了认知水平，算法黑箱的不透明性和难以检验性导致认知客体本不应当赋予过高的可信度，算法歧视导致难以对二者匹配的过程进行矫正。需要将内心确信符合信念标准、偏见性算法信息应仅发挥补强性作用、将大数据挖掘所获信息在辩护人阅卷中进行披露、破除相互印证的因果逻辑桎梏，从而回归于认知正义，走向法治而非“算法治”。 Abstract: With the emergence of the big data era, questions about the legitimacy of algorithmic technologies have arisen. Distinguished from algorithmic justice and data justice, cognitive justice takes the perspective of the cognitive subject and has legal significance, requiring the cognitive level of the cognitive subject to match the credibility of the cognitive object. In practice, there is a natural presumption of the probative power of evidence obtained by big data mining, and the standard of proof is difficult to control the judge’s mental evidence. This is due to the big data mining based on the correlation of thinking impacts the cognitive inertia of people, the interpretation of the right to the algorithm, reducing the level of cognition, the opacity of the black box of the algorithm and difficult to test leads to the cognitive object should not have been given too much credibility, the algorithmic discrimination leads to the difficulty of the process of correcting the matching of the two. There is a need to return to cognitive justice, towards the rule of law rather than the “rule of law”, by bringing inner certainty in line with the standard of conviction, biased algorithmic information should play only a reinforcing role, disclosure of the information obtained from big data mining in the reading of the defense case file and breaking the shackles of the causal logic of mutual corroboration.

Association between patient tumour characteristics and five-year survival in Nigerian patients with breast cancer.

e13504 Background: Breast cancer is a heterogeneous disease. The sociodemographic features and biological profile of breast cancer differ globally, especially in women of African descent. In Nigeria, limited studies explore the impact of these breast cancer-related factors on survival. This study evaluated the association between patients' tumour characteristics and survival in breast cancer patients in three regional tertiary cancer treatment centres across Nigeria. Methods: Data were extracted from patients' case files with a histopathologic diagnosis of breast cancer from January 1, 2005 - January 1, 2019. Patients' sociodemographic and clinical features were presented, and survival probabilities were reported; the Log-rank test was used to determine the association between time to death and categorical variables. Results: The study included 1020 patients across the three centres. Five-year survival probability was 0.65; 95% C.I: 0.60- 0.69. Most patients were between ages 30 and 49, and 49% presented with left-sided breast cancer. Patients aged&gt;70 had significantly better survival. Only 40% had Immunohistochemistry (IHC) done, out of which HR+ breast cancer accounted for 43% while triple-negative breast cancer was 30%. Patients who received Herceptin and had molecular subtyping (immunohistochemistry) done had a higher survival probability. Conclusions: Most breast cancer patients in Nigeria present at earlier ages with advanced disease. Regardless of patient tumour characteristics, 5-year survival rates are lower than global rates. Only a few patients have access to optimal breast cancer management, molecular subtyping and targeted treatment inclusive. There is an urgent need to fund the National Cancer Control program to aid in implementing its strategic framework for breast cancer screening and management to improve access to cancer care in Nigeria.

Tuberculosis and HIV/AIDS coinfection in patients attending Directly Observed Treatment Short-course (DOTS) centers in Anambra State, Nigeria: A retrospective study.

This study retrospectively assessed the prevalence of TB and human immunodeficiency virus (HIV)/AIDScoinfection among patients that attended the Directly Observed Treatment Short-course (DOTS) centers in Anambra State, Southeast, Nigeria, between 2013 and 2017. The study adopted a descriptive and retrospective epidemiological survey design. A total of 1443 case files of patients aged 15-60 who were treated in DOTS centers selected from Anambra State's 21 Local Government Areas between 2013 and 2017 were investigated. The uniform data form, a standardized instrument used in Anambra State's health facilities for data collection, was used to collect data from case files of all those identified as coinfected with TB and HIV/AIDS. The mean prevalence rate of TB and HIV/AIDS coinfection in the state during the 5-year period (2013-2017) was 20.00%. The highest annual prevalence of TB and HIV/AIDS coinfection was recorded in 2014 (23.84%). The state's prevalence of TB and HIV/AIDS coinfection increased dramatically from 13.17% in 2013to 23.84% in 2014, followed by a slight downward trend to 22.80% in 2015, 20.17% in 2016, and 20.03% in 2017. In terms of gender, age, marital status, and occupation, females (59.5%), those aged 15 to 25 years (30.7%), married people (43.90%), and traders/business owners (50.7%), respectively, had the highest rates of tuberculosis and HIV/AIDS coinfection during the study period. The findings of this study show that young people, females, married people, and traders/business owners appear to be the most vulnerable groups affected by TB and HIV/AIDS coinfection, accounting for the majority of the disease burden in the state. To address the high prevalence of TB and HIV/AIDS coinfection in the Anambra State, novel intervention and control programs should be developed and implemented, and existing intervention frameworks should be strengthened.

Clinical features and prognostic analysis of 247 patients with ovarian clear cell carcinoma (OCCC) and an exploration of the treatment of recurrent OCCC: A single-center study in China.

e17548 Background: Ovarian clear cell carcinoma (OCCC) is relatively resistant to chemotherapy and has a worse prognosis than other ovary cancer. In this study, we reviewed the case files of OCCC in a single center to find its clinical characteristics and explore the treatment of recurrent cases, and the efficacy of immunotherapy. Methods: From August 2007 to August 2023 247 patients with OCCC were retrospectively involved. Univariate and multivariate Cox regression analyses were used to identify independent clinicopathological factors. The relapse OCCC were divided into four groups based on the different treatment who underwent chemotherapy or chemotherapy combined with surgery, bevacizumab, immune checkpoint inhibitors treatment. Kaplan–Meier curves were utilized to compare OS and DFS/PFS between the groups. Results: (1) 247 patients with OCCC were included, CA125 abnormality (&gt; 35 U/ml) 65.2%, ascites cytology positive 10.1%, and the overall satisfactory reduction of tumor was 92.7%, CR and PR were 93.1 and 6.9%, respectively. 16.2% patients received more than 6 cycles of postoperative chemotherapy.(2)Univariate Cox regression analysis identified ascites (HR=4.012, 95% CI: 1.846 - 8.720, P&lt;0.001), initial treatment effect (HR=2.714, 95% CI: 1.132 - 6.506, P=0.025), and chemotherapy cycles (HR=2.564, 95% CI: 1.402 - 4.689, P=0.002) were identified as independent prognostic factors for OS.(3)The patients who received chemotherapy cycles exceeding 6 cycles had worse prognosis(HR=3.01, 95%CI: 1.70-5.33, P&lt;0.001), the result is the first proposal in our study.(4) Kaplan-Meier survival analysis showed that the OS of the chemotherapy combined with surgery relapse OCCC group was significantly better than the other three groups (HR=0.2732, 95%CI: 10.133-0.559, P=0.001). Subgroup analysis showed that relapse patients with satisfactory tumor reduction had more significant survival benefits(HR=3.86, 95%CI: 0.79-18.93, P=0.096).(5)The PFS of the chemotherapy combined with surgery group was also better than the other three groups (median PFS 25 months vs 8.5 months in chemotherapy vs12 months in chemotherapy combined immunotherapy vs 12 months in chemotherapy combined with bevacizumab). (6)4 patients who tested positive for PD-L1 received immune maintenance therapy after chemotherapy for 6-24months. There has been no recurrence since follow-up. Conclusions: Ascites, initial treatment effect and chemotherapy cycles were identified as independent prognostic factors for OCCC OS, chemotherapy combined with surgery for recurrent OCCC was significantly improving patient prognosis. For patients who achieve CR after initial treatment, if PD-L1 expression is positive, maintenance immunotherapy can be considered, but further studies with large samples are needed.

DETERMINANTS OF MORTALITY AND COMPLICATIONS IN HYPERTENSIVE DISORDERS OF PREGNANCY : A SINGLE CENTER EXPERIENCE

Our retrospective cohort study set out to identify the determinants of adverse maternal and perinatal outcome in patients admitted to intensive care (ICU) with severe features of Hypertensive Disorders of Pregnancy(HDP).Case files of patients with severe pre-eclampsia and eclampsia (including HELLP syndrome) were analyzed.The prevalence of HDP was 6.01% and eclampsia 0.99%. Parity did not affect the severity of disease nor survival. The incidence of chronic hypertension was 15.38% and 12.5% in survivors and non-survivors respectively. There was a high number of patients who did not receive any antenatal care prior to admission in both the groups [69% and 87%]. Severe anemia was significantly higherin non-survivors (42%) than in survivors (13%). Symptoms such as blurred vision, respiratory distress, oliguria, altered sensorium and absent fetal movements were prognostic markers. Multiple seizures and a time lapse between the onset of symptoms and administration of magnesium sulfate produced an increased mortality. The stillbirth rate, as expected, was high is those who demised (62.5%).We conclude that complications due to hypertension in pregnancy should be considered as a failure to provide quality antenatal care and represent a missed opportunity to detect and treat raised blood pressure.

LEGAL REFORM ON THE CONCEPT OF RESTORATIVE JUSTICE IN THE CRIMINAL JUSTICE SYSTEM

Restorative justice is an alternative to solving criminal cases, which in the resolution mechanism involves the perpetrator, victim, perpetrator’s family, victim’s family, community leaders, or stakeholders to jointly find a fair solution and emphasize returning to the situation as before. The implementation of the concept of restorative justice is needed in an effort to reform the law of the criminal justice system. This study aims to understand, explain, analyze, and make a comparison with the implementation of the concept of restorative justice as an effort to reform criminal law. The method used in this study is normative legal research. There are efforts to reform the law or legal findings in a criminal justice system regarding the resolution of criminal cases. The concept of restorative justice can be adopted and simultaneously applied. In addition to minimizing the accumulation of case files, restorative justice prioritizes the rights of perpetrators and victims and the restoration of the situation.