Clinical Profile Research Articles

Griscelli syndrome: a diagnostic challenge of a rare disease: a case report

Introduction: Griscelli syndrome (GS) is a rare autosomal recessive genetic disorder that primarily manifests as hair and skin hypopigmentation, with three types differentiated by their specific genetic defects as well as by their clinical features. Clinically, GS type 1 is characterized by early neurological alterations, while GS type 2 is characterized by immunodeficiency and could present with neurological symptoms, and type 3 is characterized by a chromosomal anomaly without a specific clinical profile besides hypopigmentation. This article details the challenges faced in the diagnosis of a patient with GS who presents with neurological symptoms followed by immunological deficits. Case presentation: A 7-month-old female presented with complaints of developmental delay following an otitis media infection. Upon examination, she exhibited signs of psychomotor developmental regression and had pale bronze skin and silvery-gray hair, as well as hepatosplenomegaly. The examination of her hair shaft revealed a pattern consistent with GS. During her hospitalization, the patient developed an intermittent fever and signs of hemophagocytic lymphohistiocytosis (HLH). She subsequently developed recurrent seizures treated with phenytoin and Aciclovir. Shortly she succumbed to respiratory distress syndrome and multisystem failure. Discussion: The presence of HLH confirms the type of GS. However, in some cases, the HLH criteria could not be fulfilled, presenting a diagnostic challenge. Conclusion: The genetic examination is the only way to differentiate GS type 1 from type 2. However, when it is not available, the presence of specific symptoms and features may assist in the classification. Furthermore, treatments should be administered when GS type 2 is suspected since they have the potential to improve life quality through treating HLH, delaying and altering the neurological symptoms.

Clinical profile of obese patients treated in Oran, a city in Western Algeria.

Clinical profile of obese patients treated in Oran, a city in Western Algeria.

Personality in Alcohol and Opioid Use Disorder: A Multiphasic Personality Questionnaire Study

Background This study explored the relationship between personality attributes and substance use disorder (SUD). Research has identified specific personality dimensions, such as neuroticism, psychoticism, antisocial personality traits, paranoia, and anxiety, as contributing factors on the way to the initiation, continuation, and relapse of SUD. Purpose To explore this connection, we examined the personality profiles of subjects with alcohol use disorder (AUD) and opioid use disorder (OUD). Methods A total of 928 subjects, 320 with AUD, 490 with OUD and 118 healthy controls (HC), in the age range of 16–65 years were recruited in the study. The Clinical Profile Sheet and the Multiphasic Personality Questionnaire (MPQ) were administered to HC and patients who fulfil the diagnostic criteria for substance dependence as defined by ICD-10 (WHO-1992). Results We found significant differences in personality profiles between individuals with OUD and AUD. Patients with AUD scored higher than OUD on the MPQ subscales for depression, mania, paranoia, and antisocial personality traits. All subscales of the MPQ showed elevated scores in subjects with SUD compared to HC. Conclusion Elevated scores on the MPQ subscales suggest that personality factors may contribute to the pattern of substance use and misuse in this cohort.

Intensive Group Behavioral Treatment for Older Youth with Selective Mutism: An Open Trial

Selective mutism (SM) is an anxiety disorder characterized by an inability to speak in social situations despite comfortably speaking in familiar situations (APA, 2022). To date, research has demonstrated the effectiveness of cognitive-behavioral therapy (CBT) models, including both weekly CBT and intensive group behavioral treatment for younger children with SM (Haggerty et al., 2022; Cornacchio et al., 2019; Oerbeck et al., 2018; Cohan et al., 2006). However, no research has examined treatment options for older youth with SM. The present study sought to examine effectiveness of an intensive group behavioral treatment (IGBT) for older youth with SM by examining pre-treatment to follow-up differences on primary (SM symptoms) and secondary outcomes (self-efficacy and social skills). Sixteen youth, ages 10-17, with a primary diagnosis of SM engaged in a five-day IGBT. Results indicated statistically significant reductions in parent- and self-reported SM symptoms from pre-treatment to follow-up (two months and five months into the following school year), as well as statistically significant improvements in self-reported self-efficacy and social skills from pre-treatment to follow-up. These findings provide empirical support for the preliminary effectiveness of IGBT for older youth with SM and reveal information about the unique clinical profile of this subset of the population.

Current trends in vestibular schwannoma management at a referral center in Indonesia: A cross-sectional study with retrospective data collection

Background. Vestibular schwannoma (VS) is the most common benign brain tumor of the cerebellopontine angle. Due to its location, this pathology can create both focal and general deficits. The registry system for VS in Indonesia is developing, including in the author’s institution, which eventually shows a changing trend in managing VS. Methods. We retrospectively collected data from all patients diagnosed with vestibular schwannoma, based on histological or radiological results. Treatments included craniotomy and/or Gamma Knife Radiosurgery (GKRS) from 2018 to 2023. Results. Data from 88 patients were analyzed. The number of treated patients has increased annually. VS predominantly affects females (64%). The proportion between GKRS and craniotomy procedures also shifted throughout the year. Common symptoms included hearing loss (63.6%), disequilibrium (50%), and headaches (39.7%). The most common tumor size was medium (15-30 mm; n=37; 42%). Tumors that fell into the intrameatal and small (<15 mm) categories were all treated with GKRS, whereas the other groups were divided into GKRS and craniotomy. GKRS demonstrated high efficacy in tumor control and favorable hearing and facial nerve preservation, whereas craniotomy remained crucial for larger tumors. Conclusion. The number of VS diagnosed each year has increased in our center, accompanied by a noticeable shift in preference from GKRS to craniotomy, which is influenced by the integration of intraoperative monitoring. Treatment preference was further determined based on the clinical profile and tumor size. In the future, there is a need to develop a national registry to better reflect the true incidence of VS within the Indonesian population.

Evaluation of prevalence, predisposing factors, inter-species differences in clinical profile and outcome of Campylobacter blood-stream infections: A 7-year experience from north India

Purpose: A comprehensive study evaluating prevalence, risk factors and outcome of Campylobacter bloodstream infection (CBSI) in Indian population is lacking. Methods: A retrospective analysis of blood culture specimens positive for Campylobacter species over a 7-year period (September 2013 to August 2020) was conducted. Campylobacter species were identified using MALDI-TOF MS and patients’ details were retrieved from hospital records. Results: 39 episodes from 38 patients were reported (0.15% of all BSI), with one case of recurrence. The median age was 10 years. 54.5% patients presented with gastrointestinal symptoms. Steroid-dependent nephrotic syndrome predisposed paediatric patients (27.3%) and liver cirrhosis predisposed adult patients (81.8%) to CBSI. Conclusion: C. jejuni was the most prevalent species (59%) followed by C. coli (25.6%) and C. fetus (15.4%). C. fetus infection was seen in immunocompetent patients (p=0.01) and was associated with longer hospital stay (p=0.01). Overall outcome of CBSI was good.

Clinical Profile and Outcome of Twin Babies Delivered at a Tertiary Care Center in Eastern Nepal

Introduction: Twin pregnancies are often associated with higher risks of complications for both the mother and the neonates, particularly in resource-limited settings. This study was conducted at a tertiary care center in Eastern Nepal to assess the clinical profile and outcomes of twin pregnancies. Methods: A descriptive cross-sectional study was carried out in the department of Pediatric and neonatology at Nobel Medical College Teaching Hospital, Biratnagar, Nepal over the period of 6 month (December 2023 to May 2024). Total of 32 twin pregnancies of gestational age of ≥28 weeks, where both twins were alive at delivery were included. Data were collected on maternal and neonatal characteristics, including birth weight, gestational age, Apgar scores, and clinical outcomes. Statistical analyses were performed to compare the outcomes between the first and second twins. Results: In the present, study total of 32 eligible twin were analyzed. The majority of twins were (53.1%) delivered between 32 to <37 weeks of gestation rest 46.87% delivering between 28 to <32 weeks. The average Apgar scores were 6.5 at 1 minute and 8.6 at 5 minutes. The most common clinical feature seen in twin neonates was lethargy which was seen in 32 neonates (50%). NICU admission was required for 70.3% of the neonates. There were no significant differences between groups twin 1 and twin 2 in most health indicators, such as clinical symptoms, hemoglobin, PCV, serum calcium level, jaundice, TTTS, chest X-ray findings, NICU admissions, or overall outcomes (P > 0.05). However, twin 1 had a higher rate of neonatal sepsis (P = 0.048). notable difference was observed in the incidence of neonatal sepsis between the first and second twins, with the first twin being more affected. Neonatal mortality rate in twin in the present study was 7.8%. Conclusion: Twin pregnancies have high incidence of preterm delivery and low birth weight. Requirement of NICU care is more in case of first twin.

High Blood Ammonia Level Is a Predictor of Medium and Large Size Esophageal Varices In Cirrhotic Patients

Background: The development of esophageal varices (EV) and rupture of them are the most serious complications of portal hypertension. Upper gastrointestinal endoscopy is the gold standard for diagnosis of EV but it is a costly and troublesome invasive procedure. To find a non-invasive method for detection of size of EV and to predict the bleeding risk is appealing and would decrease the indications cost and discomfort of upper GI endoscopy. The aim of the study is to evaluate high blood ammonia level is a predictor of medium and large size of esophageal varices in Cirrhotic patients. Methods: This was an observational Cross-sectional study conducted on 40 cirrhotic patients in Department of Gastroenterology, BSMMU using a pre-designed data collection sheet. Information about clinical profile, laboratory parameters- blood ammonia, serum bilirubin, serum albumin, prothrombin time, and ultrasonography of abdomen, endoscopy upper GIT was collected and recorded. The collected data was analyzed by computer with the help of SPSS version 22. Statistical analysis was done by using appropriate statistical tool like Chi-square test, Student’s t- test. P value < 0.05 was considered as significant. Diagnostic efficacy of blood ammonia was calculated by using a value. Results: A total of 40 patients with cirrhosis. Mean age of cirrhotic patients were 47.47±12.98 years. Mean blood ammonia of small size EV of cirrhotic patients was 73.70±32.11 (μmol/L) and medium and large size EV was 118.3±38.37 (μmol/L) (P< .001). At the level of 78.5 (μmol/L), sensitivity and specificity of blood ammonia was 95% and 65% respectively in detection of size of EV. Conclusion: Blood ammonia estimation could be a good tool for identifying individuals with medium and large size esophageal who will need to undergo endoscopy more frequently. Bangladesh J Medicine 2024; 35: 167-172

Clinical Profile and Outcomes of Late Preterm Neonates in Relation to Gestational Age and Maternal Psychosocial Factors in a Tertiary Care Centre

The relationship between maternal psychosocial factors and outcomes among LPN remains unexplored. Objectives: To determine the morbidity profile of LPN with respect to gestational age and study its association with maternal psychosocial, lifestyle and demographic factors. Methodology: Cross-sectional study on LPNs in a tertiary care centre over one year. Results: Total sample: 263. LPN incidence: 94/1000 live births; Maternal age 20-30 years (p=0.03), high screen time (p=0.02), Caesarean section (p=0.02), moderate Maternal Stress (MS) (p=0.014) was associated with (a/w) births at 35 0/6 to 6/7 weeks of gestation (WOG).Low Birth Weight (LBW) LPN: 66.5% incidence, highest at 35 0/6 to 6/7 WOG; a/w maternal age 20-30 (p=0.002), nulliparity (p=0.02), moderate to severe MS (p=0.012), and Pregnancy Induced Hypertension (PIH) (p=0.04).Small for Gestational Age (SGA): 35%, peaking at 35 0/6 to 6/7 WOG; a/w nulliparity and severe MS. Sepsis 12.2%, highest at 34-35 0/6 to 6/7 WOG (p=0.001); a/w lower-middle socioeconomic status (p=0.05) and multiparity (p=0.02). Respiratory Distress Syndrome (RDS) 5.3%, peaked at 34 0/6 to 6/7 WOG (p=0.044); a/w poor socioeconomic status (p= 0.00). Transient tachypnoea of Newborn (TTN) 49.4%, a/w nulliparity (p=0.02). Neonatal hyperbilirubinemia (NNH) 57.8%, peaking at 34-35 0/6 to 6/7 WOG (p=0.01); a/w nulliparity (p=0.03). Perinatal asphyxia (PA) 6.5%, highest at 35 WOG. Conclusion: NNH and TTN were common in LPN. 35 WOG related to various risk factors and morbidities. LPN born to mothers with moderate MS, PIH, nulliparity, and age 20-30 were LBW. Mother’s screen time > 4 hours/day a/w LPNs born at 35 WOG.

Clinical, demographic characteristics and antimicrobial resistance profile of Staphylococcus aureus isolated in clinical samples from pediatric patients in a tertiary hospital in Rio de Janeiro: 7-year longitudinal study.

In the pediatric population, Staphylococcus aureus infections are responsible for increased morbidity and mortality, length of hospitalization and the cost of inpatient treatment. The aim of this study is to describe the antimicrobial resistance profile of S. aureus isolated in clinical specimens from pediatric patients admitted to a tertiary hospital in Rio de Janeiro, Brazil. Culture reports and medical records of hospitalized patients under 18 years of age with S. aureus infections between January 2015 and December 2022 were retrospectively analyzed. Information was collected on recent antibiotic use, previous hospital admission, inpatient unit, clinical specimen, time of infection (community or nosocomial), classification according to susceptibility to methicillin (methicillin sensitive - MSSA or methicillin resistant - MRSA) and sensitivity to other antimicrobials. We analyzed the distribution of the sensitivity profile of S. aureus infections over the 7 years evaluated in the study. Were included 255 unique clinical episodes, among which the frequencies of MSSA and MRSA were 164 (64%) and 91 (36%), respectively. Over the 7 years evaluated, there was stability in the prevalence percentage, with a predominance of MSSA in the range of 60 to 73.3%, except in 2020, when there was a drop in the prevalence of MSSA (from 73.3% in 2019 to 52.5%) with an increase in MRSA (from 26.7% in 2019 to 47.5%). Ninety-seven (38%) infections were community-acquired and 158 (62%) were healthcare-associated. The main clinical specimens collected were blood cultures (35.2%) and wound secretions (17%). The MRSA isolates presented percentages of sensitivity to trimethoprim-sulfamethoxazole from 90.4 to 100%, and to clindamycin from 77 to 89.8% in MRSA healthcare associated and MRSA community respectively. There was a constant predominance in the prevalence of MSSA with percentage values ​​maintained from 2015 to 2022, except in 2020, in which there was a specific drop in the prevalence of MSSA with an increase in MRSA. MSSA infections are still predominant in the pediatric population, but MRSA rates also present significant values, including in community infections, and should be considered in initial empiric therapy.

Unusual familial cystic kidney disease: combining fine radiologic and genetic evaluation to solve the case

BackgroundAutosomal dominant polycystic kidney disease (ADPKD) is the most prevalent hereditary kidney disease, characterized by enlarged kidneys with numerous cysts, high blood pressure, and a variety of extrarenal complications. This disease is a significant cause of renal failure and requires accurate differentiation from other cystic kidney diseases, especially when family history does not clearly indicate ADPKD. This is crucial due to differences in prognosis, treatment, and familial implications. Advanced molecular genetics and imaging techniques are employed to diagnose and assess the prognosis of patients and their families.Case presentationThe case study revolves around three patients from the same family—two sisters and one daughter—referred to a nephrology department for ADPKD management. The initial proband, a 42-year-old woman, experienced abdominal discomfort leading to an ultrasound that suggested ADPKD. However, MRI findings indicated standard-sized kidneys with bilateral parapelvic cysts, and no genetic markers for ADPKD were found. Her sister, presenting with controlled hypertension and similar ultrasound findings, also had her initial ADPKD diagnosis refuted by MRI and genetic testing, which revealed no significant mutations. The daughter, however, exhibited a different scenario with enlarged kidneys and multiple cysts characteristic of early-stage ADPKD. Genetic testing confirmed a deleterious PKD1 mutation, suggesting a de novo mutation, as her father showed no signs of the disease.ConclusionThis study highlights the complexity and necessity of thorough diagnostic processes in suspected ADPKD cases to prevent misdiagnosis. The initial symptoms and imaging might misleadingly suggest ADPKD, as seen in the cases of the two older patients. Still, further detailed imaging and genetic analyses revealed no ADPKD, preventing inappropriate treatment and stress. In contrast, the younger patient's distinctive clinical and genetic profile confirmed ADPKD, illustrating the variability within even closely related individuals. Such detailed assessments are crucial in guiding correct treatment decisions and providing accurate familial counseling, emphasizing the importance of considering a broader spectrum of renal cystic disorders before confirming a diagnosis of ADPKD.

Clinical profile of newborns admitted in Special Newborn Care Unit of a tertiary teaching hospital of Arunachal Pradesh: A Retrospective Cross Sectional Study

Introduction: The neonatal period presents the greatest daily risk of death compared to any other stage of childhood. Objective: To study the clinical profile of neonates admitted in Special Newborn Care Unit (SNCU) in a tertiary teaching hospital of a tribal area. Materials and Methods: A retrospective case record analysis of all admissions between January 2017 to December 2022 was done based on medical record data. The neonates with complete record were included in the study. Results: Total of 1476 newborns were admitted from the year 2017 to 2022 in SNCU of TRIHMS, out of which, 860 (58.3%) patients were male and 612 (41.5%) were females. 84.4% admissions were inborn and 15.6% were outborn patients. Major causes of admission were neonatal jaundice (22.4%) followed by prematurity (15.4%), neonatal sepsis (15.1%) and birth asphyxia (11.4%). The outcome rates for survival, referral, deaths and LAMA were 79.3%, 9.7%, 5.8% and 5.1% respectively. The leading causes of mortality were birth asphyxia (22.3%), prematurity (21.2%) and sepsis (11.8%). Conclusion: In our SNCU, common causes of deaths are birth asphyxia, prematurity, sepsis respiratory distress syndrome and congenital heart disease. Enhancing antennal care, improving access to healthcare facilities, ensuring timely referral of high risk cases, building capacity and providing intensive interventional management can significantly reduce neonatal mortality and its associated complications. Surveillance and training interventions for managing these causes should be established and reinforced. Keywords: Neonates, morbidity, mortality, preterm, sepsis.

Identification of CDH4 Gene Copy Number Alteration and Its Association with Clinical Profile of Colorectal Cancer Patient

Background: The genes cadherin 4 (CDH4), Kirsten rat sarcoma viral oncogene homolog (KRAS), V-Raf murine sarcoma viral oncogene homolog B (BRAF), and microsatellite instability (MSI) each play a role in the development of colorectal cancer (CRC). CDH4 gene is located in chromosome 20q13.33 and its amplification or gain is the earliest mutational event found in the majority of CRC and colon polyps. This study aimed to identify copy number alteration in the CDH4 gene and its association with the clinical profile of CRC patients, including gender, age, tumor location and differentiation, frequency of BRAF and KRAS mutations, and MSI status. Methods: The DNA was extracted from 50 tumors and adjacent normal tissues based on the manufacturer’s instructions. Detection of MSI status was carried out by pentaplex polymerase chain reaction (PCR) and PCR products were size separated by capillary electrophoresis (CE) using an ABI 310 Genetic Analyzer. Both KRAS and BRAF mutations were identified by PCR and sequencing while CDH4 copy measurement was measured using TaqManTM Copy Number Assay. Results: Our findings showed 22 (44%) samples with no changes in the copy number of CDH4 gene. Interestingly, 21 (42%) cases had an amplification of the CDH4 gene or CDH4 gene gain, and seven (14%) cases decreased in CDH4 gene expression or CDH4 gene loss. We found an association between changes in the CDH4 gene and gender (p=0.001). However, there was no association between changes in the CDH4 gene and age (p=0.979), tumor location (p=0.145) and differentiation (p=0.648), the frequency of BRAF (p=0.171) and KRAS mutations (p=0.184) and MSI status (p=0.923). Conclusions: Copy number alteration in CDH4 gene in CRC patients and this alteration is significantly associated with gender. Further studies with a larger number of samples are essential to confirm this result and to identify the cause of CDH4 copy number alteration and its biological significance.

Epidemiological and Clinical Characteristics of Multiple Sclerosis in the Iraqi Population: A Study of 600 Cases

Background: These are two diseases of the central nervous system which are associated with demyelization of nerves and which has caused neurological disease and disability all over the world. Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO) are chronic diseases exhibiting features of an autoimmune affection mainly affecting the central nervous system. To date, no study or report has looked at the epidemiology and clinical profile of these disorders in Middle Eastern countries, Iraq included, even though there is bibliographic evidence of the existence of these conditions in Western peoples. This project aims at encompassing this gap by carrying out a descriptive epidemiological analysis study of multiple sclerosis (MS)and neuromyelitis optica (NMO) in the Iraqi population. In this case, the research is going to be aimed at the demographic characteristics of patients, their clinical presentation and outcomes of their treatment. Methodology: A post hoc comparative cross-sectional examination of the medical records of 600 patients in Iraq was performed as part of the present investigation. For this study, data was gathered and analyzed. An additional 150 individuals with neuromyelitis optica and 450 patients with multiple sclerosis were recalled from the sample. The information was collected from Baghdad Teaching hospital in Medical City complex. The records of the patients were combed through for the previous 10 years in a row in order to determine the demographic and clinical features of the patients, as well as information on the relapses, treatment, and rehabilitation processes. In order to examine the prevalence and incidence of the two illnesses, the research used comparisons based on frequency and percentage analysis, as well as the t-test and the Chi square statistic. Results Although there were some similarities between NMO and MS, the relapse rate was notably higher in NMO patients (3. 4, compared with 2. 8 in patients with MS), and severe relapses were more frequent in the NMO group (38. ∗%, compared with 29. ∗% in the MS group; p = 0. 041). This means that NMO is much more aggressive than MS. Moreover, the NMO patients experienced more severe and longer lasting relapses than the Ms patients (median relapse duration 4. 1 weeks, p = 0. 008 compared to the 3. 2 weeks of Ms patients; 34. 7% degree of impairment in NMO patients, p = 0. 007 compared to the 21. 8% degree of impairment in Ms patients). The first notitur is that more patients with NMO received immunosuppressants (86. 7% versus 46. 7% of patients with multiple sclerosis who received immunosuppressive drugs; p = 0. 001) Thus, it is necessary to use other approaches with this group of patients. Despite this, the results showed that there was no significant difference between the two groups in relation to the time it took to resume work and/or a normal lifestyle. Thus, out of the sample, 28% showed complete recovery with the remainder 56%. Regarding the recoveries made, majority stated they had full recovery at 92 percent, 8 percent had partial recovery. Conclusion: The current study focuses on this problem in the Iraqi population and also acknowledge that NMO seems to be worse and more progressive than MS. It also puts much stress on the early diagnose of such cases as well as the use of treatment techniques that are both wide and intense especially with those who have other related complications of NMO. Each of the result supports the argument of the need to establish new treatment procedures that are relative to the area with the intention of enhancing the living standards of the patients. These results are a significant addendum to the overall shortage of knowledge of multiple sclerosis and neuromuscular disorder in the regarding of patients who belong to the developing world. In addition, they form a basis for future research that will help in the discovery of methods that can be utilised in enhancing disease treatment in the developing countries.

Clinical Presentation and Treatment Outcomes of Adult-Onset Coats Disease

Purpose: To study the clinical profile, treatment, and outcomes of patients 35 years or older diagnosed with Coats disease. Methods: A cross-sectional observational hospital-based study was performed. Results: The study included 74 eyes diagnosed with adult-onset Coats disease. The mean age at presentation was 50 years (range, 35-75). Most patients were men (72.5%) and had a unilateral presentation (92.8%). The most common stage at presentation was 2A (extrafoveal exudation) (39.2%) followed by 2B (foveal exudation (33.7%). Optical coherence tomography was performed in 40 eyes; 32 eyes (80.0%) had intraretinal fluid (IRF), 31 eyes (77.5%) had hard exudates, and 22 eyes (55.0%) had a disorganized retinal inner layer. Fluorescein angiography was performed in 35 eyes and showed an irregular foveal avascular zone in 28 eyes (80.0%). Multiple leaking microaneurysms were seen in 32 eyes (91.4%), with extensive vascular abnormalities involving the macula (86%) and extramacular zones (91%). Treatment modalities comprised laser photoablation (43.4%), cryotherapy with or without laser application (5.7%), and intravitreal injections (49%), alone or in combination. At a mean follow-up of 28 months (range, 3-293), 23 eyes (39.6%) had anatomic resolution of subretinal fluid and/or IRF. No statistical improvement was found in the mean best-corrected visual acuity (VA) between preoperatively and postoperatively ( P > .05). Conclusions: Patients with adult-onset Coats disease have a unilateral presentation with a less severe stage than patients with childhood-onset disease. Despite the good anatomic responses after treatment, the final VA remained unchanged.

Clinical profile of patients with surgical brain abscesses and etiology in a reference hospital.

The annual incidence of brain abscesses is 1-2% in developed countries and up to 8% in developing countries. Our aim was to describe the profile and etiological agents of patients with surgical brain infections according to their nosological diagnosis on admission, and to analyze whether the initial diagnosis influenced the neurological deficit at discharge. This was an observational study with convenience sampling. All surgical cases operated between January 2017 and February 2022 with a final diagnosis of an infectious process were included. Three groups were analyzed according to admission diagnosis: a) infection, b) neoplasia, and c) miscellaneous. The time before admission, final histological diagnosis, etiological agent, length of hospital stay, and secondary neurological deficits were investigated. Descriptive and comparative statistics were used. 24 cases, including 18 (75%) men and 6 (25%) women, of ages 19 to 61 years (average 43.7 years) were studied. Nosological diagnoses on admission were infection in 9 (37.5%) patients, cerebral neoplasia in 9 (37.5%) patients, and miscellaneous diagnoses in 6 (25%) patients. Among the miscellaneous, neoplastic, and infectious groups, 33.3%, 33.3%, and 22.2% of patients were discharged with some neurological deficits with overall neurological morbidity and mortality of 29.6% and 8%, respectively. The etiological agents were Mycobacterium tuberculosis (16.6%), Streptococcus sp. (13%), Morganella morganii (8.7%), Nocardia sp. (4.3%), Cryptococcus sp. (4.3%), and Klebsiella sp. (4.3%). Nosological diagnosis on admission did not influence the percentage of patients with neurological deficits in our study. Mycobacterium was the most frequent etiological agent.

Profile of women with retained placenta at a tertiary care hospital

Abstract The placenta is said to be retained when it is not expelled from the uterus even 30 min after the delivery of the baby. The occurrence of retained placenta following vaginal birth is estimated to be 1%–3% of deliveries. It can lead to severe bleeding, infection, and other adverse outcomes, making it a significant concern in obstetric care. Hence, the present study was carried out to study the profile of women with retained placenta. This was a descriptive study among 97 women with retained placenta. The incidence of retained placenta was 97 (1.8%). The most common characteristic feature was postdated pregnancy in 29.8%. Eighty women responded to medical management alone, whereas 17 women required manual removal. The most common complication was postpartum hemorrhage in 33.3%. We conclude that a retained placenta can be a source of significant hemorrhagic and surgical morbidity to the mother. In considering ways to lessen morbidity, the clinician should have a knowledge of the clinical profile of retained placenta.

Clinical profile and management of patients with acute myocardial infarction admitted to cardiac care units: The EYESHOT-2 registry

BackgroundThe clinical governance of patients with acute myocardial infarction (AMI) has markedly changed in the last few years. We sought to assess the contemporary in-hospital management patterns of patients with AMI at a country level. MethodsEYESHOT (EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units)-2 was a nationwide, prospective registry aimed to evaluate the current management of patients admitted to intensive cardiac care units (CCUs) for an AMI in Italy. ResultsOver a 4-week period (February 1st-29th, 2024), 183 CCUs enrolled 2806 consecutive patients: 52.6 % with non-ST elevation myocardial infarction (NSTEMI) and 47.4 % with ST-elevation myocardial infarction (STEMI). The median time from hospital admission to angiography in NSTEMI was 22.3 h (IQR 10.9–46.1), while for STEMI was 1.1 h (IQR 0.5–2.2) with significant difference between hospitals with and without catheterization laboratories. In both NSTEMI and STEMI patients, percutaneous coronary intervention (PCI) was the preferred management strategy (73.3 % and 94.2 %, respectively). An optimal secondary prevention therapy, including dual antiplatelet therapy, inhibition of the renin-angiotensin system, a beta-blocker and a high-intensity statin was prescribed at discharge in more than 75 % of patients with AMI. In-hospital major bleedings occurred in 2.0 % and 2.3 % (p = 0.58), while death in 1.8 % and 2.8 % (p = 0.09) of NSTEMI and STEMI patients, respectively. ConclusionsThe EYESHOT-2 registry shows the current management strategies and outcome of AMI patients admitted to Italian CCUs and provides insights to improve the clinical care of such patients.Clinical Trial Registration. URL: http://www.clinicaltrials.gov. Unique identifier: NCT06316128.

Clinical profile and outcome of kidney transplantation at Muhimbili National Hospital, Tanzania

BackgroundKidney transplantation is the definitive treatment option for chronic kidney failure, offering improved quality of life and extended survival. Access to kidney transplantation is limited in the Sub-Saharan Africa (SSA) region, with only a few countries with established services. Tanzania started its program five years ago, for the sustainability of the program it is important to understand the outcome. Therefore, this study was conducted to determine the clinical outcomes and survival rates of kidney transplant recipients at Muhimbili National Hospital in Tanzania, in the absence of a national transplant registry, since the inception of the program.MethodsThis was a retrospective study conducted among kidney transplant recipients from live donors at Muhimbili National Hospital (MNH) between November 2017 and February 2022. Analyses were performed to assess baseline characteristics, post-transplant complications, and patient and graft survival.ResultsIn our study of 68 kidney transplant recipients, the majority of recipients were male (63.2%) with a mean age of 45.8 years and under medical insurance (88.2%). The predominant cause of CKD was hypertension (58.2%) with recipients undergoing dialysis for a mean duration of 14.4 months, and basiliximab being the most commonly used induction medication (57.3%). The majority of donors were males (64.7%) and had first-degree relationships with recipients (76.5%). Haploid HLA mismatch was observed in 36.8% of cases. One-year patient and graft survival rates were 91.2% and 96.7%, respectively, with infection being the primary cause of death (n = 5), and more than half of deceased patients died with a functioning graft (n = 4).ConclusionOur study underscores favorable one-year patient and graft outcomes among kidney transplant recipients at Muhimbili National Hospital, Tanzania. However, challenges persist, notably with infections posing ongoing difficulties for this cohort.

Infective endocarditis in children with heart diseases at Jakaya Kikwete Cardiac Institute, Tanzania: a cross-sectional study

BackgroundInfective endocarditis (IE) in children with pre-existing heart conditions is a life-threatening disease entity associated with significant morbidity and mortality. In our cardiac setting, the management outcomes of children with IE are not well documented. We therefore aimed to document the clinical profile and treatment outcomes of children with IE attended at the Jakaya Kikwete Cardiac Institute (JKCI).MethodsThis was a hospital-based cross-sectional study with longitudinal follow-up conducted among children with IE diagnosed by Modified Duke’s Criteria at the JKCI from November 2021 to November 2023. A structured questionnaire was used to collect patients’ socio-demographic and clinical data.ResultsDuring the study period, 1,546 children were admitted to the JKCI. A total of 30 children with IE were enrolled, of these half (n = 16, 53%) were aged 10 to 18 years, with a median of 10 yrs (Inter quartile range, IQR: 6.5–12.2 yrs). Twelve children (40%) and nearly half (n = 14, 47%) had fever and used antibiotic therapy respectively. Majority of participants had anaemia (n = 26, 87%) and heart failure (n = 21, 70%). Nine children (30%) had positive blood cultures and S. aureus was the most frequently isolated organism (n = 7). Ten patients (33%) developed acute kidney injury (AKI), and eleven (37%) children died during the hospital stay.ConclusionIn our setting, in-hospital mortality due to IE among children with heart diseases is high. Heart failure and anaemia were the common presentations of IE. Furthermore, AKI was observed to be the leading in-hospital non-cardiac complication.