Common Aetiological Factor Research Articles

Hyponatraemia in stroke patients: A single-centre prospective cohort study.

Cerebral salt wasting syndrome (CSWS) and syndrome of inappropriate anti diuretic hormone secretion (SIADH) are the most common aetiological factors for developing hyponatremia following stroke. The differentiation of these two entities is crucial as the treatment options are completely different. The aim of this study is to determine the incidence of aetiologies of hyponatremia and compare demographic, clinical, imaging and laboratory parameters in each groupTwo hundred and forty-six patients with confirmed strokes were prospectively observed throughout the hospital stay in a tertiary referral center in Sri Lanka to identify the possible predictors of CSWS. Hyponatremia was defined as a serum Na+ level less than 131mmo/l. Serum osmolality, urine osmolality, urinary Na+, serum cortisol and thyroid function tests were performed on all the hyponatremic patients. The CSWS and SIADH were differentiated based on physical examination findings and laboratory parameters.The incidence of hyponatremia in our study population was 19.1% (95% Confidence interval, 14.39-24.58). The majority of patients (24, 51%) were attributed to CSWS. SIADH group comprised of 17 (36.2%) patients and 6 (12.7%) patients had other undetermined causes.The incidence of CSWS is higher than the incidence of SIADH among stroke patients in our setting.

Utility of expression of 4-hydroxynonenal tested by immunohistochemistry for cervical cancer.

Cervical cancer (CC) is a leading cause of mortality in women around the world, with the highest incidence rate still being in developing countries. The most common aetiological factor is infection with high-risk human papilloma virus viral strains. Oxidative stress through generation of reactive oxygen species leads to lipid peroxidation and DNA damage. Studies show that reactive lipid electrophiles such as 4-hydroxynonenal (4-HNE) produced in the process play an important role in cancer signalling pathways and are a good biomarker for oxidative stress. We aim to investigate the prognostic role of 4-HNE as a biomarker for oxidative stress in patients in early and advanced stages of CC measured by immunohistochemistry. This is a retrospective study of 69 patients treated at our Department of Oncogynaecology. Paraffin embedded tumour tissues were immunohistochemically tested for the levels of expression of 4-HNE. The results for H-score, Allred score, and combined score were investigated for association with tumour size, lymph node status, andInternational Federation of Gynaecology and Obstetrics stage. 4-hydroxynonenal showed higher expression in more advanced stages of CC and in cases with involved lymph nodes. Tumour size was not associated with the levels of 4-HNE. To best of our knowledge, this is the first study to use immunohistochemistry to examine the expression of 4-HNE as a prognostic factor in CC. The 3 score systems showed similar results. The pattern of 4-HNE histological appearance is dependent on the histological origin of cancer and is not universal.

Correlation Between Portal Vein Diameter and Clinical Prognostic Scores in Patients with Liver Cirrhosis: A Cross-sectional Study

Introduction: Patients with liver cirrhosis develop portal hypertension, which leads to complications like splenomegaly, ascites, and oesophageal varices. Hepatic Venous Pressure Gradient (HVPG) measurement, the best available method to measure portal hypertension, is invasive and difficult to perform. Some studies suggest that an increased Portal Vein Diameter (PVD) on ultrasonography indicates portal hypertension and correlates with oesophageal varices. Studies correlating PVD with other complications of portal hypertension, like ascites and spleen size, are scarce. Aim: To correlate ultrasonographically measured PVD with clinical prognostic models: Child-Turcotte-Pugh (CTP) score and Model for End-stage Liver Disease (MELD), as well as with platelet count, in patients with liver cirrhosis. Materials and Methods: This was a cross-sectional study conducted in the Department of General Medicine in collaboration with the Department of Radiodiagnosis at Government Medical Collge, Chandigarh, India, from February 2021 to September 2021 over an eight-month period in a tertiary healthcare centre in North India. A total of 97 patients with cirrhosis, identified based on clinical features supported by laboratory tests and ultrasonography, were included in the study. A 6 mL of blood sample was collected from each patient for haemogram, biochemical tests (liver function tests and renal function tests), and coagulogram. Ultrasonography assessment of PVD, spleen size, and ascites was performed in a supine position using a right subcostal approach, after overnight fasting. The collected data were analysed using relevant statistical tests. Results: The mean age of the study population was 47.39 ± 12.64 years, with 73 (75.3%) males and 24 (24.7%) females. The most common aetiological factor for liver cirrhosis was alcohol, present in 52 (53.6%) patients. The mean PVD was found to be 12.31±2.71 mm. The correlation coefficient of PVD with spleen size was 0.3 with a p-value of 0.004, suggesting a positive correlation. The correlation coefficient of parameters like thrombocytopenia, CTP score, and MELD score was -0.2 (p-value=0.066), 0.1 (p-value=0.463), and 0.0 (p-value=0.725), respectively. Conclusion: Sonographically measured PVD cannot be used as a substitute for the clinical grading and staging of cirrhosis. Only a weak positive correlation was found between PVD and spleen size.

Quality of life after endoscopic procedures for chronic pancreatitis: A multicentre study.

Chronic Pancreatitis (CP) causes morphological changes in the pancreatic tissue, leading to complications and pain, which may require endoscopic interventions. Our aim was to determine the frequency of endoscopic procedures (EP) in CP patients and to analyse pain and quality of life (QoL) in these patients after their EP. This study included 1327 CP patients from the Scandinavian Baltic Pancreatic Club (SBPC) database including four countries and eight centres. We analysed patients undergoing EPs and gathered information on the EP, pancreatic function, pain, disease and duration. The EORTC C-30 QoL questionnaire was gathered prospectively and multivariable analysis was conducted on independent parameters between the groups. The reference population had no interventions (n=870). 260 CP patients (22%) underwent EPs, median one year (range 0-39years) after CP diagnosis. 68% were males. The median age was 59 (20-90) years. Most common aetiological factors were alcohol in 65% and smoking in 71%. Extracorporeal shock wave lithotripsy (ESWL) was used in 6% of the CP population and in 21% of the EP group. Biliary duct stenting was performed on 37% and pancreatic stenting was performed on 56% of the patients. There was no difference in pain patterns between patients who had pancreatic stenting and the reference population. The EP group had slightly better QoL (p=0.047), functioning and fewer symptoms than the reference population, in the multivariable analysis there was no interaction effect analysis between the groups. The pancreatic stent group had better QoL and the same amount of pain than the reference group. The patients who needed later surgery (23%) had more pain (p=0.043) and fatigue (p=0.021). One in five of the CP patients underwent EP. These patients scored higher on QoL responses and had better symptom scores. CP patients who had pancreatic stenting performed had the same pain patterns as the reference population. Randomised prospective trials are needed to determine the effect of endoscopy procedures on CP patients.

Global epidemiology of geriatric burns, capacities of care, and injury outcomes: Perspectives from the World Health Organization global burn registry

BackgroundAn increasing aging population alongside a potentially increasing injury risk emphasizes a critical need for evidence-based burn care regarding preventive and therapeutic strategies tailored to the unique needs of older adults. However, we note a critical gap in understanding geriatric burn trends on a global scale and the care capacity across settings. Thus, this study sought to ascertain the global trend of geriatric burns with a focus on patient demographics, injury characteristics, capacities of care, and injury outcomes. MethodsA retrospective design focusing on older adults aged ≥ 60 years with burns recorded in the World Health Organization Global Burn Registry as of 31st May 2023 was employed. Descriptive statistics were employed to analyze the data. ResultsOf the 9277 records obtained from the Global Burn Registry, 849 participants (9.2%) were aged ≥ 60 years with the majority of these reported from the Eastern Mediterranean (EMRO) and Southeast Asia (SEARO) regions. More females than males were involved in burn injuries with the most common aetiological factor being flame. Most burns occurred in the home/ domestic setting with a seasonal variation (more injuries occurred in December and January). In terms of burn care capacity, the data suggest the availability of specialized services in most settings albeit the AFRO and SEARO regions still lacked the resources to offer specialized burn care. While most injured older adults were discharged home with no physical impairment (395, 46.5%), a substantial number died (250, 29.4%) during hospitalization, particularly in the African (AFRO) region and 111 (11.1%) left the facility against medical advice with the majority from the SEARO region (88). ConclusionBurn injuries in older adults remain a public health issue. On the preventive aspect, the results demonstrate a need to intensify safety in the home or domestic setting, and during festive seasons. Therapeutically, the findings underscore a need to consider the inclusion of more specialist geriatric and palliative care services in the burn management process. Additionally, we identified a need to strengthen burn care capacity in the AFRO and SEARO regions.

The utility of the bedside index of severity in acute pancreatitis at prognosticating adverse outcomes.

Identification of at-risk patients with acute pancreatitis (AP) early on in the course of hospital admission remains a challenge. Early identification of these patients can facilitate early referral to tertiary hospitals with skilled multidisciplinary teams (MDTs) and high-dependency health care facilities. This study retrospectively reviewed the ability of the bedside index of severity in acute pancreatitis (BISAP) score and other biochemical markers to predict organ failure and mortality in acute pancreatitis. All patients presenting to Grey's Hospital with AP between 2012 and 2020 were included in the study. The BISAP score and other biomarkers were evaluated at presentation in predicting organ failure (≥ 48 hours duration) and mortality. A total of 235 patients were included in the study. A total of 144 (61%) were male and 91 (39%) were female. Alcohol (81%) and gallstones (69%) were the commonest aetiological factors amongst males and females respectively. A total of 42 (29%) males and 10 (11%) females developed organ failure during their hospital stay. The mortality rate was 11.8% for males, 6.59% for females, with an overall mortality of 9.8%. A BISAP score of 2 had a sensitivity of 87.98% and specificity of 59.62% at predicting organ failure (positive predictive value [PPV] = 88.46%, negative predictive value [NPV] = 58.49%, 95% confidence interval [CI], p = 0.001). A BISAP score of 3 and above had a sensitivity of 98.11% and specificity of 69.57% at predicting mortality (PPV = 96.74%, NPV = 80%, 95% CI, p = 0.001). A multivariate analysis of biomarkers bicarbonate, base excess, lactate, urea and creatinine either failed to reach statistical significance or had specificity that is too low to prognosticate organ failure and mortality. The BISAP score has limitations at predicting organ failure, but it is a reliable tool for predicting mortality in AP. Due to its simplicity of use, it should be used in resource-constrained settings to triage at-risk patients in smaller hospitals, for early referral to tertiary hospitals.

Oral Squamous Cell Carcinoma Metastasising to Unusual Sites: A Case Series of Four Cases

Oral cancer ranks as the sixth most common malignancy worldwide, with Squamous Cell Carcinoma (SCC) being the predominant type observed in the head and neck region. Incidence and mortality rates of SCC have significantly increased over the past few decades. Smoking and tobacco chewing are the most common aetiological factors, predominantly affecting elderly males. Distant metastasis at the time of diagnosis is a rare occurrence, typically disseminating through blood vessels or lymphatics. The lungs are the most frequent site for distant metastasis, followed by bone, mediastinal nodes, and occasionally the liver. However, in our cases, we observed metastasis to uncommon sites, excluding the liver. Accurate diagnosis necessitates the correlation with clinical history, radiological, histopathological, and immunohistochemical findings. Despite employing various surgical and radiotherapeutic modalities, distant metastasis diminishes the chances of survival, successful treatment, and worsens the prognosis. This article presents four cases of oral SCC that exhibited metastasis to unusual sites. Two cases had a primary tumour in the left lateral border of the tongue, with distant metastasis to the breast and skin (chest wall), while the other two cases had a primary tumour in the left buccal mucosa and left mandibular region, with distant metastasis to the kidney and liver.

Clinical Presentation and Management of Peripheral-induced Oromandibular Dystonia in Nigeria: A Case Report and Literature Update

Oromandibular dystonia (OMD) is a rare focal neurological disorder associated with impaired masticatory function, dysphagia, dysphonia, and involuntary abnormal movements of the mandible of varying severity. The peripheral-induced variant among other factors is a common aetiological factor of secondary dystonias, associated with constellations of clinical features and presents with differing responses to various treatment therapies. To report a case of oromandibular dystonia and to add to the body of literature. The case report is of a 33-year-old male who presented with complaints pain on speaking and from the temporomandibular joint area for 8 months which adversely affected patient’s work, social life and psychological well-being. Examination revealed retraction and repetitive but uncoordinated pattern of labial, cheek and masticatory muscular movement on mouth opening and closing. Diagnosis of oromandibular dystonia was made on clinical grounds. Patient was managed with a combination of medications by the oral physician, and physical therapy, which led to a significant improvement in the control of muscle contractions within 5 weeks. OMD though a rare neuromuscular condition can present to the dentist, and effective assessment, diagnosis and collaboration with relevant specialities are key to improved outcome.

MDCT Imaging Features of Acute and Chronic Pancreatitis with its Complications: A Pictorial Review

The incidence of Acute Pancreatitis (AP) was 30.0 per 100,000 population overall. The two most common aetiological factors of AP are gallstones and alcohol abuse, while other causes such as metabolic, iatrogenic, vascular, infections, and toxic factors are less important and less common. Two laboratory tests, serum amylase and lipase levels, which have relatively good sensitivity and specificity, complement imaging in the diagnosis and treatment of some cases of AP. Imaging helps confirm the clinical diagnosis, determine the cause, grade the extent of AP, and assess its severity, in addition to clinical symptoms and laboratory studies. Chronic Pancreatitis (CP) is characterised by continuous inflammatory and fibrotic changes in the pancreas, eventually resulting in exocrine and endocrine dysfunction. Alcoholism is a factor in 70-90% of CP cases. Other causes include chronic ulcerative colitis, Sjogren’s syndrome, primary sclerosing cholangitis, etc. Early diagnosis of CP is challenging, as biochemical studies do not provide definitive diagnosis in the early stages. Imaging, mainly Contrast Enhanced Computed Tomography (CECT) and Magnetic Resonance Imaging (MRI), aids in the definitive diagnosis. The present pictorial article aimed to provide an image-rich overview of the morphological features associated with the early-stage and late-stage local consequences of acute and chronic pancreatitis.

Traumatic dental injuries in adults attending a London-based trauma clinic in the UK: a seven-year survey

Introduction This survey reports the incidence of traumatic dental injuries in an adult population attending an adult dental trauma clinic in a London teaching hospital.Materials and methods Retrospective data were collected from patients attending an adult dental trauma clinic between 2012 and 2018.Results In total, 1,769 patients attended, with more men seen (1,030; 58.2%) compared to women (739; 41.8%) and this was statistically significant (p <0.05). The most common aetiological factor was an accidental fall (728; 41.15%), followed by assaults (413; 23.35%), bicycle accidents (253; 14.3%), sports injuries (132; 7.46%) and road traffic accidents (84; 4.75%). Lateral luxation (833) was the most common traumatic injury and this was followed by avulsions (362; 17%). Enamel-dentine fractures were the most common type of fracture injury (1,273; 64%).Discussion This retrospective survey attempts to report on the incidence of traumatic dental injuries in a London-based cohort of patients attending a specialised dental trauma clinic. In line with other reports, there were more men than women affected, which is probably attributed to behavioural activities.Conclusion(s) Accidental falls are the most common cause of a traumatic dental injury, lateral luxation was the most common type of displacement injury and enamel-dentine fractures were the most common type of fracture injury.

Sociodemographic and medical characteristics of liver cirrhosis deaths in a Ghanaian tertiary hospital.

Cirrhosis is common in Ghana because of its high risk factors prevalence. However, information on cirrhosis in Ghana is lacking. This study aimed to study the clinical, and laboratory characteristics of cirrhotic patients in a tertiary hospital in Ghana. This was a retrospective study of sociodemographic characteristics, symptoms and signs, biochemical and fibrotic indices, treatments, and complications data of 247 patients with cirrhosis who died on admission. This study was carried out at the Gastroenterology Unit of the Korle-Bu Teaching Hospital, Ghana. Two-thirds (68.0%) of the patients were within 30 to 60 years, with more than half (73.7%) being males. The most common aetiological factors among the patients were Hepatitis B virus infection (53.8%), alcohol use (31.6%) and Hepatitis C virus infection (4.9%). More than half (55.0%) of the patients reported late for admission, and 67.2% died within the first two weeks of admission. The most common clinical feature was abdominal distension (61.1% of patients), and the least was upper-abdominal mass (14.2%). The levels of most liver test parameters were elevated, fibrotic indices were high, and haemoglobin and albumin levels were reduced. More than half (53.8%) of the patients were in Child Pugh class B. The most common complication was hepatic encephalopathy; the least was hepato-renal syndrome. Definite treatment for complications of cirrhosis was lacking. Deaths from cirrhosis at the hospital were mostly of young males with chronic hepatitis B infection. Implementation of hepatitis B prevention and treatment guidelines can help reduce cirrhosis deaths. None declared.

A cross-sectional survey on knowledge and attitudes of Greek dentists regarding molar incisor hypomineralisation diagnosis and treatment

BackgroundMolar Incisor Hypomineralisation (MIH) remains a challenge for clinicians underlining the gap in the literature regarding the condition. The study aimed to record knowledge and attitudes of Greek dentists regarding diagnosis and treatment of MIH and correlate findings with non-dental characteristics.MethodsIt is a cross-sectional study based on a questionnaire consisting of 37 multiple-choice questions. Data regarding diagnosis, aetiopathogenesis, and clinical management of MIH were collected from active members of three Greek Dental Associations. Chi-square and student’s t-test were used to correlate responses with practitioners’ characteristics and odds ratios calculated to evaluate differences on treatment of MIH-affected teeth (p < 0.05).ResultsFrom the 360 participants (response rate = 94%), 185 were general dental practitioners (GDPs) and 175 dental specialists (59 paediatric dentists (PDs), 38 orthodontists and 78 of other specialties).MIH was commonly encountered as a clinical problem, with GDPs reporting genetics and fluoride intake as common aetiological factors at significantly higher percentages as compared to PDs (p < 0.05). Permanent molars and incisors (44%) were the teeth most commonly affected, with yellow/brown demarcated opacities (68%) the most common clinical feature with PDs reporting them in a significantly higher percentage (p < 0.05). Dentists with specialisation, dentists that treat > 10 children per week and children with MIH-affected teeth had a 2–5.5 times greater probability to report difficulty achieving sufficient anaesthesia and hypersensitivity problems (p < 0.001). Agreement between GDPs’ and dental specialists’ views was found on less invasive treatment of anterior lesions. Non-PDs reported bulk-fill restorations and onlays as the ideal treatment of severely-affected posterior teeth, as compared to PDs that preferred preformed metal crowns (p < 0.05). Multivariate logistic regression analysis revealed that the age of the clinician, years of experience and number of children treated per week were the factors significantly associated with the decision for the treatment of only severely-affected posterior MIH teeth.ConclusionsMost participants had encountered MIH-affected teeth in their clinical practice and were able to recognize main aetiological factors and clinical findings related to the condition. Nevertheless, their knowledge regarding treatment is limited.

Renal Amyloidosis: A Clinicopathological Study From a Tertiary Care Hospital in Pakistan.

IntroductionSystemic amyloidosis can affect any organ in the body, but the kidney is the most commonly involved site. It is characterized by the extracellular deposition of insoluble fibrillar proteins. Amyloid deposits can be identified histologically by Congo red stain, which gives apple-green birefringence under polarized light. Typing of renal amyloidosis is done by direct immunofluorescence on frozen tissue. The most common types of amyloidosis seen in renal tissue are amyloid light chain (AL) primary amyloidosis and amyloid A (AA) secondary amyloidosis. Although primary amyloidosis is considered the most common type in western countries, however, in the subcontinent region, secondary amyloidosis is more common.The spectrum of signs and symptoms in renal amyloidosis is variable including isolated proteinuria, nephrotic syndrome, hypertension, hypotension, and renal insufficiency. The present study aims to evaluate the incidence and aetiology of various types of renal amyloidosis, determine their distribution within the kidney, and study various clinicopathological features.ObjectiveThe present study aims to evaluate the aetiology and clinicopathological profile of renal amyloidosis, determine its various types, and their distribution within the kidney.Materials and methodsThis retrospective cross-sectional study was conducted from 1st January 2013 to 31st December 2020 at the Department of Histopathology, Shifa International Hospital (SIH), Islamabad. All renal biopsies diagnosed as renal amyloidosis were included in the study. Data were analysed using SPSS version 23 (IBM Corp., Armonk, NY). Frequency and percentages were calculated for qualitative variables, and mean and standard deviation were calculated for quantitative variables.ResultsA total of 131 cases were diagnosed with renal amyloidosis during the study period of eight years (from 1st January 2013 to 31st December 2020) at SIH. The age range varied from 17 to 82 years. The mean age of the patients was 45 ± 16.33 years. Out of 131 patients, 82 (62.6%) were males and 49 (37.4%) were females. Amongst them, 72 (54%) cases were diagnosed with secondary AA amyloidosis and 16 (12%) cases were diagnosed with primary AL amyloidosis. The rest of the cases 43 (34%) were of indeterminate type. The associated conditions in secondary amyloidosis were tuberculosis in 41 (57%), rheumatoid arthritis in 16 (22%), ankylosing spondylitis in five (7%), lymphoma in three (4%), diabetes in two (3%), and chronic osteomyelitis, chronic heart disease, hepatitis, and vasculitis in one case each (1.7%). Out of 16 cases reported with AL amyloidosis, 10 cases (62.5%) had a history of multiple myeloma. The most common clinical presentation was nephrotic syndrome followed by subnephrotic proteinuria, renal failure, and hypertension.ConclusionThe findings of the present study show underlying etiological factors and clinicopathological characteristics of renal amyloidosis. AA amyloidosis is the most common type of renal amyloidosis in our study and tuberculosis is the most common aetiological factor. AL amyloidosis is less frequent in our population.

Chronic subdural haematoma- A dilemma of most common aetiological factor

Background: Chronic subdural haematoma (CSDH) is common of all intracranial haemorrhages specially in old age. Mortality is still 13% after invention of simplest and latest technique including operation. Incidence of CSDHs in over 65 years is 58.1 per 100,000 per year but only 3.4 per 100,000 per year in those under 65 years of age. So, age has a great role inducing CSDH, there is also chance of intracranial haemorrhage on anti-platelet &amp; anticoagulant drugs, platelet &amp; coagulation dysfunction. Major trauma to head produces acute haematoma but minor trauma should take into cognizance for CSDH. The purpose of this study was to take details history, analysis of patients to find out aetiological factors of chronic subdural haematoma and to take precautions regarding them specially most one to avoid preventable morbidity and mortality. Materials and Method: This prospective study was carried out in Combined Military Hospital (CMH), Dhaka from March 2018 to March 2019. All of our patients above 20 years of age; were admitted and diagnosed clinically and confirmed by CT scan head as CSDHs. Total number of patients were 50; randomly allocated and sampling was done as per inclusion and exclusion criteria. Elaboration of details history, through examination including neurological examination, meticulous investigations including CT scan of head was done. Statistical analyses were performed by using the Statistical Package for Social Sciences version 26 for Windows (SPSS). Results: In our study 50 cases were finally selected as CSDHs and diagnosed clinically then confirmed radiologically. The most of the patients 39 (78%), 51-80 years age group, male were 41(82%) and female were 9(18%) in number. In this study, it was observed that unknown aetiology 7(14%), on anti-platelet drug 10(20%), on anti-coagulant drug 6(12%) and 27(54%) subjects had trivial head trauma. Explored aetiology; trivial head trauma, on anti-coagulant and anti-platelet medication were 43(86%) in number. Conclusion: Diagnosis of CSDH is relatively easier than to find out aetilogy. We should cautious about the causative factors specially most common like trivial head trauma in old age &amp; keen observe them and avoid coagulopathic medication if not essential.

Use of antihypertensive medication before diagnosis of atrial fibrillation in Finland – results from the nationwide FinACAF -study

Abstract Background and aims Long-standing arterial hypertension increases the risk of cardiovascular morbidity including atrial fibrillation (AF), coronary heart disease and renal failure. Arterial hypertension is the most common aetiologic factor associated with the development of AF and is also the most prevalent co-morbid cardiovascular disease in patients with AF. Coexisting arterial hypertension together with AF increases further the risk of stroke, heart failure and overall mortality. The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) -study is a nationwide retrospective register-based AF study that combines data from several Finnish health care registers. In this sub-study, we characterized the use of antihypertensive medications in patients with new-onset AF. Methods This sub-study included all adult new-onset AF patients of the FinACAF study from January 2007 to December 2018. Patients were excluded if they were under 18 years of age, had any oral anticoagulant purchase in the year prior to AF diagnosis, or had diagnosis of AF or warfarin purchases between the years 2004–2006. Appropriate data such as anonymized study ID's, ICD-10 diagnoses, and drug purchases (dates, ATC-codes, amounts) were obtained from the National Prescription Register as well as the Finnish Hospital and Primary care registers. The antihypertensive medication purchases from the year preceding the AF diagnosis were analysed and identified by appropriate ATC-codes. Purchases one-month prior to the new-onset AF diagnosis were excluded from in order to avoid confounding by any medication changes due to AF diagnosis. Results Of 229,282 patients with new-onset AF 164,527 (71.8%) had purchased antihypertensive medication during the year prior to the AF diagnosis. The most common antihypertensive drugs used were beta blockers (n=108,510; 47.3%), ACE-inhibitors or angiotensin receptor blockers (n=104,840; 45.7%), diuretics (n=79,270; 34.6%) and selective calcium channel blockers (n=61,610; 26.9%). Diltiazem was purchased by 2,001 patients (0.9%) and verapamil by 1,508 patients (0.7%). At the beginning of the study period, beta-blockers were the most widely used antihypertensive agents, but between 2007 and 2018, RAAS-inhibitors (ACE inhibitors and ARB blockers) became the most widely used group of antihypertensive drugs (Figure 1). Conclusion Most Finnish new-onset AF patients had at least one pre-existing antihypertensive medication in use before the diagnosis of AF. Beta blockers were the most common antihypertensives until the latest years when RAAS-inhibitors became the most prescribed antihypertensive agents, whereas the use of diltiazem and verapamil was marginal in the treatment of hypertension before the AF diagnosis. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Helsinki and Uusimaa Hospital District research fundThe Finnish Foundation for Cardiovascular Research Figure 1. Annual use of antihypertensive medication among Finnish new-onset AF patients prior to diagnosis. Annual number of new-onset AF patients plotted for reference.

Fractures of the Mandible: Epidemiological Study of 519 Nigerian Cases.

Background:Epidemiological studies despite their limitations provide information that is useful for the formulation of effective and efficient injury prevention strategies.Aim:The aim is to carry out epidemiology study of mandibular fracture in a Nigerian population.Setting:Department of Oral and Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria.Materials and Methods:A retrospective observational study was carried out at the Ahmadu Bello University Teaching Hospital, Shika-Zaria. Data retrieved from patients’ case notes and operating records were subjected to statistical analysis involving frequencies (count, percent), measures of central tendency (mean), and measures of dispersion (standard deviation) using Statistical Package for Social Sciences (SPSS) version 16 (SPSS Inc., Chicago, IL). Mandibular fracture was classified based on sites, and patients’ socioeconomic status was classified based on United Kingdom National Statistics Socio-economic Classification (NS-SEC, 2010).Results:There were 466 (89.9%) males and 53 (10.1%) females. Based on Socio-economic Classification (NS-SEC, 2010), there was a preponderance of analytical class 6 (n = 217; 54.9%) and 8 (n = 127; 32.2%). Road traffic–related accident (n = 385; 74.2%) was the most common aetiological factor, and a total of 215 (41.4%) patients had a record of loss of consciousness. The mandibular body (n = 225; 32.0%) followed by the parasymphyseal (n = 187; 26.6%) regions were the most fractured sites. Closed-reduction technique was the predominant treatment modality.Conclusions:A road traffic accident was the most common aetiological factor for mandibular fracture, and the mandibular body had the highest frequency of fractures. Measures aimed at injury prevention should be continually reviewed and updated to limit the morbidity and economic burden on individuals.

Characteristics of patients with acute heart failure in North Central Nigeria

Objectives: Heart failure (HF) is an important cause of hospital admission in Nigeria. HF is increasingly prevalent because the population is aging and HF epidemiology is changing. We aimed at profiling the socio-demographic, clinical and echocardiographic (Echo) characteristics of patients admitted for acute HF. This is one of the largest cohorts of HF patients profiled in Nigeria so far.&#x0D; Methods: Cross sectional design. Socio-demographic, clinical and Echo data were collected from 455 patients admitted for AHF at University of Ilorin Teaching Hospital, North central, Nigeria.&#x0D; Results: Mean age of patients was 58.9± 15.7years, (men were older than women, P= 0.006). 265(58.2%) were males, most patients were aged &gt;60 years, 4.8% had pre-existing Type2 Diabetes mellitus. 53.2% of patients presented in New York Heart Association Stages III and IV. Median duration of admission was 11days (IQR, 6-17), intrahospital mortality- 11.6%. Hypertension was the commonest aetiological factor (62.4%), followed by dilated cardiomyopathy 17.6%, rheumatic heart disease (6.6%), Peripartum cardiomyopathy (5.3%), and others.&#x0D; Conclusion: AHF patients in our study are older than those in previous studies in Nigeria and sub-Saharan Africa. Hypertension is main driver of AHF, and patients largely present with clinically advanced disease necessitating stronger public health education about risk factors and early presentation.&#x0D;

English

BACKGROUND Cirrhosis is a progressive clinical condition associated with considerable mortality and morbidity. It leads to a wide spectrum of characteristic clinical manifestations, mainly attributable to hepatic insufficiency and portal hypertension.1 In cirrhosis, primary diagnostic test for evaluation of upper-gastro-intestinal bleeding (UGIB) is endoscopy.2 The present study attempts to find out different clinical patterns of the chronic liver disease (CLD) with portal hypertension along with the endoscopic profile of the patients. METHODS It was a cross sectional study conducted in Down Town Hospital, Guwahati, Assam. RESULTS A cross sectional study was conducted at Downtown Hospital, Guwahati, Assam on patients diagnosed with chronic liver disease from 01 January 2017 to 31 January 2018. Male predominance was observed in this study with 84 % males and 16 % females. Male to female ratio was 5.25 : 1. Maximum patients (58 %) were observed in the age group of 40 to 60 years followed by 30 % in the age group of 60 to 80 years. The average age was 53.6 years. Most common aetiological factor was alcohol (66 %) followed by non-alcoholic steatohepatitis (NASH) (16 %). Other aetiologies were hepatitis-B, hepatitis-C and cryptogenic. 88 % cases were recorded in model for end stage liver disease (MELD) score range of 10 to 29. Ascites was noted in 88 % cases, of which 20 % had grade-1 and grade-2, 48 % had grade-3. Splenomegaly was noted in 70 % cases. Child-Pugh class-C consisted of 26 % cases (13) with grade-III varices followed by 18 % cases (9) with grade-II varices while Child-Pugh Class-B had 24 % cases (12) and 8 % cases (4) with grade-III and grade-II varices respectively. Child-Pugh class-A had all the cases with grade-I varices. CONCLUSIONS Alcoholism was the leading cause for cirrhosis followed by hepatitis-B, hepatitis-C, NASH and cryptogenic. Class-C had maximum number of cases with grade-III varices followed by class-B. MELD score ranged between 10 - 29 in majority. Severe anaemia was noted in 10 % cases. Thrombocytopenia a non-invasive indicator of oesophageal varices was noted in 70 % with different grades of oesophageal varices. KEYWORDS Endoscopy, Portal Hypertension, Chronic Liver Disease

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BACKGROUND Cytopenia is the most common condition in paediatric population which requires detailed haematological evaluation. The objective of this study was to understand the, aetiological factors of the three types of cytopenia (single cytopenia, bicytopenia, pancytopenia) in children. METHODS This study is a descriptive &amp; retrospective 5 year study conducted in the Haematology wing of a paediatric tertiary health care centre in South India. Data of all cases who underwent detailed haematological evaluation like Complete blood count, peripheral smear and bone marrow examination for cytopenias during the study period were included in the study. RESULTS The study sample was 365. The total number of patients with single cytopenia (isolated anaemia / leukopenia / thrombocytopenia) was 240 (65.7 %), bicytopenia were 90 (24.6 %) and pancytopenia was 35 (9.58 %). There was slight female predominance (M: F = 1: 1.05). Bicytopenia and pancytopenia were commonly observed between 1 - 5 years of age, while single cytopenias were more common in 5 - 10-year age group. The analysis of symptoms and signs in all cytopenia groups showed petechiae / purpura as the most common presentation in single cytopenia. The analysis of clinical symptoms showed significant correlation (P value &lt; 0.05). Single cytopenia was the most common observed type of cytopenia with Immune thrombocytopenic purpura as the commonest aetiologic factor. In the present study most common causes of bicytopenia were reactive conditions like ITP with and without anaemia, infections etc. Acute Lymphoblastic Leukaemia (ALL) was the most common aetiologic factor for pancytopenia (ANOVA test and Bonferroni test P value &lt; 0.05). Isolated thrombocytopenia was the most common peripheral smear picture observed, followed by hypochromic microcytic picture and combination of hypochromic microcytic anaemia (HMA) with thrombocytopenia. CONCLUSIONS Children with cytopenias commonly have benign conditions than malignant conditions. Cytopenias due to primary haematological malignancies are more common than secondaries. KEYWORDS Bicytopenia, Cytopenia, Children, Aetiology, Paediatric Pancytopenia

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BACKGROUND Cirrhosis is a chronic disease of liver marked by degeneration of cells, inflammation and fibrous thickening of the tissue. It is a common cause of morbidity and mortality. Globally, the incidence of liver cirrhosis is on the rise. Therefore, the exact knowledge of aetiology, mode of clinical presentation, and pattern of development of complications of cirrhosis will help in optimal and costeffective control measures of this disease. We undertook this study to evaluate the cause and mode of presentation of patients with liver cirrhosis presenting in a tertiary care hospital of North India. We also wanted to determine biochemical changes in liver cirrhosis. METHODS This observational prospective study was conducted in the Department of Medicine over a period of one year, it included 122 cirrhotic patients of both sexes between 18 and 75 years irrespective of aetiology who fulfilled inclusion criteria. After detailed medical history and thorough physical examination, relevant laboratory investigations, ultrasound of abdomen, and upper GI endoscopy was done. Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease ( MELD) score was calculated. The recorded data was analysed statistically. RESULTS Out of 122 patients, 85.2 % were males and 14.8 % were females. Maximum number of patients 33.60 % were in 41 - 50 years of age. Alcohol was found to be the most common aetiological factor in 80.3 % patients. The most common presenting symptom was abdominal distension in 89.9 % patients. Various complications such as spontaneous bacterial peritonitis was present in 13.9 %, anaemia in 93.4 %, thrombocytopenia 75.4 %, deranged international normalized ratio (INR) 78.6 %, deranged renal function 45.9 %, hyponatremia in 35.2 % patients. Maximum number of patients 72.9 % were in CTP class C. 68 % patientshad MELD score &gt; 14. CONCLUSIONS Males are mainly affected by liver cirrhosis due to excessive alcohol consumption therefore proper preventive measures have to be taken. The raised total leucocyte count (TLC), serum bilirubin, serum creatinine, decreased serum albumin, serum sodium and coagulopathy were found to be poor prognostic markers. KEYWORDS Cirrhosis, Aetiology, Complications, Prognosis