Teaching Hospital Center Research Articles

Role of Hepatic and Renal Biomarkers in Diagnosing Preeclampsia

Objective: The study aims to gain insight into the importance of hepatic and renal biochemical parameters AST, ALT, bilirubin, urea, creatinine, urinary protein to creatinine ratio, and novel marker cystatin C in the domain of preeclamptic patients. Methodology: This prospective cohort study was conducted in Central Park Medical College and Teaching Hospital Lahore from Sep 2023 to Apr 2024 on 300 subjects. Inclusion criteria were pregnant women over 18 years of age, gestational age of 20 weeks, and singleton pregnancy. Women with preexisting hypertension, kidney disease, or other diseases causing liver dysfunction were excluded. Blood and urine samples were collected to measure AST, ALT, bilirubin, urea, creatinine, urinary protein to creatinine ratio, and novel marker cystatin C and data was analysed using an independent t test and Chi-square test by SPSS version 26. Results: ALT, AST, and bilirubin levels were higher (45±12 p<0.001, mean±SD 55±15 U/L, mean±SD: 1.5±0.4 mg/dL) in preeclamptic women. Creatinine, urine protein to creatinine ratio, and cystatin C (mean±SD: 1.0±0.2 mg/dl, mean±SD: 300±100 mg/g, p 1.2±0.3ng/mL) were raised in preeclamptic women as compared to the control group. Conclusions: Serum creatinine, urine protein/creatinine ratio, and cystatin C and creatinine were found in women with preeclampsia compared to women without preeclampsia.

Analysis of the mean electrical axis of the heart from standard electrographic leads in normal adult males

Background: Electrocardiogram has been widely applied as a diagnostic tool for cardiovascular disease. The concept of the cardiac vector is crucial for the clinical application in ECG interpretation. Methods: A prospective cross-sectional study was conducted among 116 male subjects, aged 18-25 years, comprising students and staff of Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal, over the period from June to September 2023. Electrocardiograms (ECGs) were recorded using a standard ECG machine with conventional limb leads. The mean electrical axis of the heart for each individual was determined by plotting the net voltage of the QRS complex in Lead-I and Lead-III. The study aimed to analyze the correlation between the cardiac vector and physical measurements, such as height, weight, Body Surface Area (BSA), and Body Mass Index (BMI). Data analysis was performed using SPSS version 27.0. Results: The normal mean electrical axis of the healthy male subjects was observed as 57.88±24.55°. There was significant positive correlation of cardiac vector with height (p< 0.05), whereas negative correlation was observed with weight and BMI (p< 0.01). However, there was no significant correlation with BSA. In our study we observed the maximum left axis cardiac vector as -10° and right axis as 90° among 116 male subjects. Conclusion: We established a cardiac vector with values differing from those reported in other studies, using standard bipolar limb leads in normal, healthy male subjects. It is also examined that greater BMI has shifted the electrical activity of the ventricles to the left.

Incidence of Maxillary Sinus Disorders in Dental Patients Undergoing Cone-Beam Computed Tomography: A Retrospective Cross-Sectional Study.

Background Cone-beam computed tomography (CBCT) was quickly adopted in dentistry settings due to its compact size, low cost, and minimal ionizing radiation dose when compared to medical computed tomography. CBCT generates three-dimensional (3D) images that are useful in a variety of oral and maxillofacial circumstances, including diagnosis and assessment of disease severity, treatment planning and delivery, and follow-up. A significant advantage of CBCT lies in its capability to recognize incidental findings. In the realm of dental CBCT imaging, incidental findings often involve the maxillary sinuses, temporomandibular joints, or other craniofacial structures. Objective To demonstrate the incidental findings of maxillary sinus disorders in dental patients undergoing CBCTfor numerous indications. Methods A retrospective cross-sectional study was carried out using data extracted from the Picture Archiving and Communication System (PACS)of Pure Smile Dental Center and Dental College Teaching Hospitals in the Jazan regionfrom September to December 2022. The study sample included a total of 70 patients who underwent orthodontics CBCT, most of whom were female(76%). Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 27 (IBM Corp., Armonk, USA), along with descriptive statistics. Furthermore, chi-square tests and cross-tabulation were done to assess the relation between the study variables. A p-value <0.01 and <0.05was considered statistically significant. Results The most common dental CBCT findings were root invasion (18.6%), followed by gingivitis (7.14%), and dental caries (4.29%). Of the 70 patients, 42 (60%) had maxillary sinus findings, including opacification (50%), sinusitis (40%), mucosal thickening (34.3%), and polyps (7.1%). Female patients had more frequency of incidental findings related to males (41.43% and 18.57%, respectively). Conclusion A high percentage of dental patients exhibited incidental maxillary sinus findings in CBCT scans, confirming the utility of CBCT as a precise imaging method for detecting paranasal sinus disorders. A holistic documentation of incidental findings is crucial for improving patient outcomes and treatment plans.

Fast-Food Outlets in Hospitals Affiliated With U.S. Medical Schools.

Objectives: To determine the current prevalence and type of fast-food outlets at medical-school-affiliated hospitals and compare them to previous findings to assess progress in improving the hospital food environment. Method: We invited medical students at 192 medical and osteopathic schools to complete Sogolytics surveys reporting on fast-food restaurants that are affiliated with their main teaching hospital or medical centers. Results: Of 192 medical and osteopathic schools, 255 individual completed surveys were received from 146 schools. 101 schools (69.2%) reportedly hosted at least one fast-food restaurant associated with the hospitals at which students rotate, these include 15.1% schools that gave a mixed response to the question if fast-food restaurants are present in any affiliated hospitals. 45 schools (30.8%) reported no fast-food restaurants in any affiliated hospitals. The five most common fast-food restaurants reported were Starbucks (27.9%), Subway (18.8%), Chick-fil-A (9.2%), Au Bon Pain (8.8%), and McDonald's (5.4%). Regarding the statement, "It is acceptable for fast-food restaurants to be in hospitals," 27.8% of students strongly disagreed, 29.0% somewhat disagreed, 16.9% neither agreed nor disagreed, 21.2% somewhat agreed, and only 5.1% strongly agreed. Conclusions: The majority of the teaching hospitals affiliated with the schools have at least one fast-food restaurant onsite.

Association Between Red Cell Distribution Width and Liver Injury after Cardiac and Aortic Aneurysm Surgery with Cardiopulmonary Bypass

This study aimed to investigate the association between preoperative red blood cell distribution width (RDW) levels and liver injury (LI) after cardiac surgery, to highlight RDW's usefulness in the early identification and intervention for patients at high risk of LI. A retrospective observational study. A university-affiliated teaching hospital and tertiary referral center. Adult patients who underwent cardiac and aortic aneurysm surgery at Changhai Hospital in 2021. Postoperative LI was defined by increased liver enzyme levels and/or hyperbilirubinemia, noted from the time of surgery to discharge. Logistic regression analyses were conducted to examine the RDW-LI relationship, with stratified analyses based on age, gender, and anemia. Survival within 30 days was assessed using the Kaplan-Meier method, with survival curve differences analyzed via the log-rank test. The study included 3 sets of sensitivity analyses. Postoperative LI was observed in 75 patients (10%). Multivariate regression analysis showed a significant association between high RDW levels and postoperative LI (adjusted odds ratio, 3.25; p = 0.033; 95% confidence intefal, 1.10-9.63), even after adjusting for all covariates. This association remained consistent across 3 sets of sensitivity analyses. Subgroup analysis showed men had a higher correlation with LI (p for interaction = 0.041). Kaplan-Meier analysis indicated a significantly lower survival rate in the LI group (76%) compared with the non-LI group (99.6%; p < 0.001). Preoperative RDW levels are significantly associated with postoperative LI. RDW could serve as a significant useful marker for early detection and intervention in patients at high risk of LI, thereby potentially improving patient outcomes.

High prevalence of late presentation with advanced HIV disease and its predictors among newly diagnosed patients in Kumasi, Ghana

BackgroundLate presentation with advanced HIV disease (LP-AHD) remains a significant challenge to Human Immunodeficiency Virus (HIV) care, contributing to increased morbidity, mortality, and healthcare costs. Despite global efforts to enhance early diagnosis, a considerable proportion of individuals with HIV infection are unaware of being infected and therefore present late for HIV care. For the first time in Ghana, this study assessed the prevalence of LP-AHD and associated factors among people diagnosed with HIV (PDWH).MethodThis bi-center retrospective cross-sectional study included 315 PDWH at the Aniniwah Medical Centre and Komfo Anokye Teaching Hospital, both in Kumasi, Ghana. A well-structured questionnaire was used to collect data on sociodemographic, clinical, lifestyle and psychosocial factors from the study participants. Statistical analyses were done in SPSS version 26.0 and GraphPad Prism version 8.0 at significant p-value of < 0.05 and 95% confidence interval. Predictors of LP-AHD were assessed using binary logistic regression models.ResultsThis study observed that, 90 out of the 315 study PDWH (28.6%) reported late with advanced HIV disease (AHD). Participants within the age group of 36–45 years (adjusted Odds Ratio [aOR]: 0.32, 95% CI: 0.14–0.69; p = 0.004) showed a significantly decreased likelihood of LP-AHD. However, participants who perceived cost of HIV care to be high (aOR: 7.04, 95% CI: 1.31–37.91; p = 0.023), who were diagnosed based on clinical suspicion (aOR: 13.86, 95 CI: 1.83–104.80; p = 0.011), and missed opportunities for early diagnosis by clinicians (aOR: 2.47, 95% CI: 1.30–4.74; p = 0.006) were significantly associated with increased likelihood of LP-AHD.ConclusionThe prevalence of LP-AHD among PDWH in Ghana is high. Efforts to improve early initiation of HIV/AIDS care should focus on factors such as the high perceived costs of HIV care, diagnosis based on clinical suspicion, and missed opportunities for early diagnosis by physicians.

Prevalence and Predictors of Occlusive Myocardial Infarction in Patients Presenting With Non-ST-Elevation Acute Coronary Syndrome in Duhok, Iraq: A Cross-Sectional Study.

Background and aim Myocardial infarction is a major global health issue and the leading cause of death. Non-ST segment elevation acute coronary syndrome (NSTE-ACS) could behave like ST-segment elevation ACS in terms of causing total or near total occlusion of the coronary artery and leading to occlusive myocardial infarction (OMI). This study aims to assess OMI prevalence and associated factors in NSTE-ACS patients in Duhok, Iraq, to improve diagnosis and treatment outcomes. Materials and methods This prospective cross-sectional study, conducted at Azadi Heart Center and Zakho Teaching Hospital from March 2023 to March 2024, included 189 NSTE-ACS patients undergoing coronary angiography. Data collection encompassed demographics, clinical profiles, electrocardiographic (ECG) patterns, cardiac biomarkers, and angiographic outcomes. Patients were categorized into those with and without occlusive myocardial infarction (OMI). Results A total of 189 NSTE-ACS patients with a mean age of 58.65 (±10.38 SD) years were enrolled in the study. The overall OMI rate was 29.63%. OMI patients were older and had a higher prevalence of hypertension, dyslipidemia, and a family history of ischemic heart disease (IHD). Significant ECG changes associated with OMI included biphasic T-wave inversion and ST depression in specific leads. Marked elevation in troponin levels was also noted in OMI patients. The left anterior descending (LAD) artery was the most common culprit artery. Conclusions About one-quarter of our study cohort exhibited OMI. The condition was linked to clinical, ECG, and elevated troponin levels. The study underscores the importance of promptly recognizing occlusive myocardial infarction (OMI) in NSTE-ACS patients for better outcomes. Regular audits are imperative to augment awareness among healthcare professionals at cardiac centers regarding updated protocols and guidelines.

Clinical-etiological profile of neonatal seizures and their outcomes in children&amp;#039;s central teaching hospital

Clinical-etiological profile of neonatal seizures and their outcomes in children&amp;#039;s central teaching hospital

Aminoglycoside Susceptibility among Extensive Drug Resistant Pseudomonas aeruginosa from Hospitalized Patients in Al-Diwaniyah, Iraq

Abstract Background: Pseudomonas aeruginosa is one of the most prevalent Gram-negative microbes associated with serious and fatal nosocomial infections. It is routine to use aminoglycosides as a treatment for P. aeruginosa infections. Objectives: The dissemination of aminoglycoside resistance offers a major challenge to the treatment of life-threatening infections caused by these bacteria. Aim of Study: Determination of aminoglycoside-modifying enzymes and 16S ribosomal RNA methylases in extensive-drug resistant (XDR) P. aeruginosa isolates. Materials and Methods: From November 2021 to August 2022, a total of 200 samples were collected in this cross-sectional study including burns (n = 80, 40%), wounds (n = 66, 33%), and diabetic foot ulcers (n = 54, 27%) from admitted patients to Al-Diwaniyah Burn Center and Al-Diwaniyah Teaching Hospital. The identification and antibiotic susceptibility profile of P. aeruginosa were done by vitek2 compact system. The isolates were subjected to polymerase chain reaction assays with specific primers for ant(4’)-IIa, ant(4’)-IIb, acc(6’)-Ia, aph(3’)-IIb, rmtA, and rmtD. Results: The recovery rate of P. aeruginosa isolates was (n = 50, 25.0%) from the clinical samples. Antibiotic-susceptibility patterns demonstrated that 18% of the isolates were multi-drug resistant and 22 (44%) were XDR. The XDR isolates were resistant to all 14 antibiotics related to the seven antibiotic classes tested in this study. The prevalence of aminoglycoside resistance genes among XDR isolates is ant(4’)-IIa (22.7%), (4’)-IIb (27.3%), acc(6’)-Ia (18.18%), aph(3’)-IIb (100%), rmtA (36.36%), rmtD (36.36%), mexZ and parR (100%). Conclusion: Increased resistance to aminoglycosides in Al-Diwaniyah Hospitals serves to highlight how critical this issue is when treating multidrug-resistant P. aeruginosa infections that are life-threatening. All the resistance isolates harbored aph(3’)-IIb gene.

Comparison of sodium and potassium values in arterial and venous blood samples

Abstract Background: In routine practice, electrolytes are measured in serum using an electrolyte analyzer, which takes approximately 30 min. In contrast, electrolyte measurements from arterial blood using an arterial blood gas (ABG) analyzer can be completed within 5–10 min. However, limited information compares electrolyte values between venous and arterial samples. This study aims to determine if sodium (Na) and potassium (K) test results from arterial blood and venous serum samples can be used interchangeably. Materials and Methods: An observational cross-sectional study was conducted over 2 months (July and August 2019) at a tertiary care teaching hospital and research center. Data were collected from 50 intensive care unit patients, including their ABG analysis and serum electrolyte reports. The ABG samples, collected in heparinized syringes, were processed immediately using GEM Premier 3500 Blood gas analyzer. Serum electrolytes were measured with the Roche 9180 analyzer after centrifugation. Data analyses were performed using IBM Statistical Package for the Social Sciences version 21, and Bland–Altman plots were used to compare the results. Results: The mean sodium levels in venous samples and arterial blood were statistically insignificant (P &lt; 0.17). In contrast, a significant difference was observed in potassium measurements between the two sample types (P = 0.000, null hypothesis rejected). The mean difference in sodium (Na+) results was 2.01 mEq/L, with a limit of agreement ranging from −17.98 to 22 mEq/L. The bias in arterial potassium was 0.99 mEq/L, with a 95% limit of agreement from 0.01 to 1.97 mEq/L. Conclusions: While sodium results from arterial and venous samples were similar, potassium results differed significantly. Therefore, potassium measurements from ABG and serum electrolyte analyzers should not be used interchangeably and must be interpreted cautiously.

Evaluation of Myostatin and Some Biochemical Variables in Both Type 2 Diabetic and Diabetic Nephropathy Patients

Background: The kidneys are essential organs that keep blood pH stable and eliminate excess water, salts, and aid in the body's waste removal. Aim of the study: The study aims to investigate the importance of myostatin in the development of diabetic nephropathy patients. In addition, the level of urea, creatinine, sodium, potassium, and phosphorus. Materials and methods: A Case-Control study lasted from- November 2023 to January 2024, at Al-Amal Kidney Dialysis Center and Azadi Teaching Hospital in Kirkuk Governorate. The 135 blood samples, their ages (25-70), were divided into three groups. The first group G1 (n:50) patients with T2DM. The second group G2 (n:55) with diabetic nephropathy. The third group G3 for control. Serum samples were utilized to measure MSTN by ELISA, blood urea, serum creatinine, S.PO4, S. Na+, S. K+, and S. Ca++ by spectrophotometer. Results: Significant variations (P&lt;0.05) in MSTN were seen between study groups (8.43±4.69, 10.99±7.05, 5.63±3.38) ng/ml. Additionally, significant differences exist between (G1 vs G2), (G1 vs G3), and (G2 vs G3) with p-value &lt;0.05 Diabetic nephropathy G2 had the highest mean urea and creatinine levels (136.69±38.21, 5.99±1.87), followed by G1 (34.92±9.06, 0.89±0.26) and control group G3 (31.00±4.72), with significant differences (p ≤ 0.001) among three groups. Additionally, G1 with G2, G2 with G3, and G1 with G3 had significant differences (p-value&gt;0.01). Conclusion: This study found higher myostatin, urea, and creatinine in diabetic nephropathy and diabetic patients. The data also showed hyponatremia, hypocalcemia, hyperkalemia, and hyperphosphatemia in diabetic nephropathy and diabetic patients.

A study of Some Factors Affecting the Prevalence of Renal Disease in Children

The current study was carried out in the period from 1 to 25 November 2023. It included sixty-two pediatric patients in the age range of (1-12) years and male and female children: twenty-six pediatric patients with chronic renal failure and thirty-six pediatric patients with nephrotic syndrome, who were outpatients and inpatients in the renal diseases unit and dialysis unit of both Al-Mansour Pediatric Teaching Hospital and Child's Central Teaching Hospital in Baghdad, Iraq. The control group consisted of twenty-six children in the same age range as the sick groups of males and females. Blood samples were collected from patients and controls. Then renal function was evaluated by applying the laboratory tests as urea and creatinine levels were measured in serum, besides blood group and Rh factor tests. Factors that may affect renal disease incidence and progress were recorded, such as socioeconomic status, residence (North, Middle, and South), and family history. The results explained the significant increase in both urea and creatinine concentrations (P&lt;0.001) in serum compared with controls. The blood group and Rh factor had no significant differences among children of both sick groups. The entire affected factors had no significant association with renal disease incidence or progress in the current study. The age and gender of each child patient had no significant effect on the type of renal disease (at P value ≤ 0.01).

Socioeconomic determinants of moderate and severe obstructive sleep apnea in children: A pre and post COVID analysis

IntroductionCOVID-19 has disproportionately affected healthcare access of certain minority groups, and thus could contribute to delay in timely evaluation and management of pediatric obstructive sleep apnea (OSA). Socioeconomic status (SES) is known to affect healthcare access in pediatric otolaryngology and may also be a risk factor for OSA and its associated co-morbidities. ObjectivesOur primary objective is to determine the impact of COVID-19 on time to diagnosis (TTD) and time to treatment (TTT) of polysomnography (PSG)-proven moderate to severe pediatric OSA in different socioeconomic classes. Secondary objectives include determining the impact of racial and demographic factors on TTD and TTT. MethodsThis is a retrospective chart review of 120 children; 60 children pre-COVID (February 2018 to February 2020), and 60 children post-COVID onset (March 2020 to March 2022). This study was performed at a pediatric teaching hospital and tertiary referral center, and involved children aged 3–17 years old with outpatient PSG-proven moderate to severe OSA. Approval was obtained from our hospital's institutional review board (IRB). ResultsThere were a total of 120 children, 60 in each group. The average age was 9.5 years old; females constituted 41.6 % of the sample. TTD increased from 53.7 days pre-covid to 103 days post-COVID onset in all children (p = 0.00), 42.5 days–151.9 days in white children (p = 0.00), 38 days–142.7 days in children with high SES (p = 0.00), 32.1 days–146.5 days in children with private insurance (p = 0.00), and 65.7 days–105.8 days in children with public insurance (p = 0.04). TTT did not change significantly. ConclusionOur results show that TTD of OSA and obesity in advantaged groups were affected to a greater degree than disadvantaged groups. This suggests children of all socioeconomic groups are susceptible to healthcare disparities and the COVID-19 pandemic has uncovered the vulnerability of such populations. Policymakers should consider providing more funding and support for all children, including continued funding for those with lower SES.

Retrospective evaluation of a right heart parameter score in the assessment of precapillary pulmonary hypertension in dogs (2017-2021): 135 cases.

To determine if emergency and critical care residents can identify moderate to severe precapillary pulmonary hypertension on cardiologist-obtained cineloops using a pulmonary hypertension score (PHS) and report the interobserver variability of the PHS. Multicenter, retrospective, case-control study from 2017 to 2021. Private referral center and veterinary teaching hospital. One hundred and thirty-five client-owned dogs that underwent diagnostic echocardiography. None. Medical records of dogs with stage B1 myxomatous mitral valve disease (MMVD) and dogs diagnosed with precapillary pulmonary hypertension (PCPH) via echocardiograms were reviewed. Dogs were categorized by a cardiologist into 5 groups (normal, B1 MMVD, mild, moderate, and severe PCPH) based on Doppler pulmonary pressure gradients and right heart morphology. Cineloops from each case were subjectively evaluated by emergency and critical care residents for the presence of right atrial and ventricular enlargement, right ventricular hypertrophy, interventricular septal flattening, and pulmonary artery and trunk enlargement to form a composite pulmonary hypertension score out of 8 (PHS8). When available, signs of peritoneal effusion and distention of the caudal vena cava were subjectively assessed to generate a pulmonary hypertension score out of 10 (PHS10). There was excellent discrimination of moderate to severe PCPH versus grouped absent to mild PCPH using PHS8 (area under the receiver operator curve [AUC] [95% confidence interval, CI]=0.90 [0.84-0.95], P<0.0001) and PHS10 (AUC [95% CI]=0.89 [0.81-0.97], P<0.0001). PHS8≥3 was 64% sensitive and 98% specific for moderate to severe PCPH (positive likelihood ratio [LR+] 32, negative likelihood ration [LR-] 0.37). PHS10≥3.3 was 64% sensitive and 92% specific for moderate to severe PCPH (LR+ 8, LR- 0.39). Interobserver agreement was good to excellent (intraclass correlation coefficient [ICC]=0.74 [95% CI: 0.66-0.80], n=135). Residents identified moderate to severe PCPH in dogs using PHS on cineloops previously obtained by a cardiologist. The interrater agreement was good to excellent with limited training. Prospective studies to determine if residents can obtain diagnostic images for PHS are warranted.

Prescription Pattern of Cholelithiasis at Surgery Ward in Tertiary Care Hospital

Background: Cholelithiasis is a chronic recurrent disease of the hepatobiliary system. The impaired metabolism of cholesterol, bile acids and bilirubin are characterized by gallstone formation.The number of surgical procedures for cholelithiasis has risen markedly in developed countries since 1950. An estimated 90% of cholecystectomies are now performed by the laparoscopic approach worldwide. Objectives: The aim of the study was to study prescription pattern of Cholelithiasis at surgery ward in B&amp;C medical college teaching hospital and research Centre Pvt. Ltd. Materials and Methods: A Retrospective study was conducted and data of Cholelithiasis cases admitted at Surgery ward from 2077/01/01 BS to 2077/12/31 BS were collected. Coding of data , result and interpretation of data were drawn using SPSS version 16 and MS Excel 2016 . Result: The present study included 137 patients.Among them,80.3% were females and 19.7% were males. The high incidence of cholelithiasis was found in the age group 30-39 years (27%). 98.5% of total hospitalized patient were prescribed with antibiotics followed by Proton Pump inhibitors (93.4%) and NSAIDS(92%) .Among antibiotics, Ceftriaxone (65.7%) were the most prescribed one. During discharge , antibiotics (98.5%) were the most prescribed group of medicine followed by Proton Pump Inhibitors (88.3%) and NSAIDS(67.9%). And among antibiotics, Cefixime (52.6%) were mostly prescribed. While analyzing prescription pattern of discharge medication it was found that percentage of drugs prescribed by generic name was 13.86% and percentage of drugs prescribed from essential drug list was 43.36%. Conclusion: The present study revealed that there was greater incidence of Cholelithiasis in females (80.3%) than in males and in the age group 30-39 years (27%) .The results obtained from this study showed that most commonly prescribed medicines were antibiotics. Prescription through generic name and essential drug list was low. Therefore, prioritization on prescribing drugs by generic name and from essential drug list needs to be encouraged.

Longitudinal integrated clerkships from start to finish: A medical curriculum innovation.

Stellenbosch University embarked on a renewal of its MBChB programme guided by an updated set of core values developed by the multidisciplinary curriculum task team. These values acknowledged the important role of (among others) context and generalism in the development of our graduates as doctors of the future for South Africa. This report describes the overall direction of the renewed curriculum focusing on two of the innovative educational methods for Family Medicine and Primary Health Care training that enabled us to respond to these considerations. These innovations provide students with both early longitudinal clinical experience (now approximately 72 h per year for each of the first 3 years) and a final longitudinal capstone experience (36 weeks) outside the central tertiary teaching hospital. While the final year experience will run for the first time in 2027 (the first year launched in 2022), the initial experience has got off to a good start with students expressing the value that it brings to their integrated, holistic learning and their identity formation aligned with the mission statement of this renewed curriculum. These two curricular innovations were designed on sound educational principles, utilising contextually appropriate research and by aligning with the goals of the healthcare system in which our students would be trained. The first has created opportunities for students to develop a professional identity that is informed by a substantial and longitudinal primary healthcare experience.Contribution: The intention is to consolidate this in their final district-based experience under the supervision of specialist family physicians and generalist doctors.

Prevalence of Adverse Drug Reactions in HIV/AIDS Patients on Highly Active Anti-Retroviral Therapy in Bushenyi Medical Centre, Ishaka Adventist Hospital, and Kampala International University Teaching Hospital in Bushenyi District, Western Uganda

The World Health Organization (WHO) delineates an Adverse Drug Reaction (ADR) as an unintended and harmful response to a drug when it is used for disease prevention, diagnosis, treatment, or physiological function modification in humans. This definition specifically excludes therapeutic failures, overdose, drug abuse, noncompliance, and medication errors. The objective of this study is to determine the prevalence of ADRs among HIV/AIDS patients undergoing Highly Active Antiretroviral Therapy (HAART) at Bushenyi Medical Centre, Ishaka-Adventist Hospital, and KIU Teaching Hospital in the Bushenyi district, western Uganda. Patient interviews were conducted using structured questionnaires. A cohort of 333 patients participated in the study. The investigation revealed a prevalence of ADRs at 13.5% (95% CI: 10.2-17.6). Among the 333 patients interviewed, 44 reported experiencing ADRs, with a significant 97.8% of these cases occurring in female patients. Importantly, individuals with co-morbidities had a 55.6-fold higher likelihood of developing ADRs compared to those without any co-morbid conditions (95% CI: 2.4-1286.7). Furthermore, the study indicated an increased risk of ADR development among patients starting HAART within the first year of treatment. In summary, our findings highlight the notable prevalence of ADRs among females, emphasizing the need for gender-specific initiatives to raise awareness and prevent ADRs. Regular monitoring is particularly important for patients with co-morbidities due to the established association between co-medication and susceptibility to ADRs. Additionally, adherence to HAART therapy is essential, as the incidence of ADRs tends to decrease over time. Keywords: Adverse drug reaction (ADR), HIV/AIDS, Co-morbidities, Anti-Retroviral Therapy, Uganda

Pulmonary Tuberculosis in the Elderly: Epidemiological, Clinical, and Evolutionary Aspects

Aims: this study aimed to investigate the epidemiological, clinical, and evolutionary aspects of pulmonary tuberculosis in the elderly and to determine the factors associated with death. &#x0D; Study Design: This was an exhaustive, descriptive, and analytical retrospective study.&#x0D; Place and Duration of Study: Pneumo-phtisiology department of Fann National Teaching Hospital Center over three years, from January 1, 2019, to December 31, 2021.&#x0D; Methodology: This was a study using medical records of patients aged 60 and over hospitalized in the pneumo-phtisiology department. Data were collected on a pre-established from patient medical records entered with Microsoft Excel 2019 software. Data analysis was performed with Statistical Package for Sciences Socials (SPSS) version 18&#x0D; Results: we collected 620 medical records of hospitalized patients aged 60 and over, 69 of whom were diagnosed with pulmonary tuberculosis, standing for a prevalence of 11.12%. The average age was 67.13 [60;85] years, with a sex ratio of 3.92. The 60 to 65 age group was the most represented (n=36 or 52.17%). Smoking and alcoholism were frequent, 82% and 17.4% respectively. A previous history of TB infection was found in 23.19% of cases and TB contagion in 20.3% of cases. An underlying condition was at least observed in 50.72% of patients, dominated by diabetes (29%) and hypertension (23%). Co-infection with HIV-1 and tuberculosis was found in 2 patients (3%). The time to consultation was 75 days [3-180 days]. Symptomatology was polymorphic, dominated by cough (n=65; 94.20%), altered general condition (n=63; 91.30%), sputum (n=58; 84.06%), fever (n=53; 76.81%) and dyspnea (n=47; 68.12%). 46 patients (66.7%) had a BMI &lt; 18.5 kg/m2. Physical signs were dominated by pulmonary condensation (n=52; 75.36%), and a fold of undernutrition was noted in 21.74% of cases. Microbiological evidence was 92.75% and 64 patients (92.75%) were susceptible to rifampin. A rifampin-resistant strain was detected in 5 patients (7.25%) hospitalized in the MDR-TB unit. CRP (75.36%), anemia (68.18%), hyperleukocytosis (47.7%), and hyponatremia (27.54%) were the most frequent biological signs.&#x0D; Alveolar syndrome (n=48 or 70%) and cavitary images (n=34 or 50%) were most frequently found on lung radiography, and for those who benefited from thoracic CT (n=36 or 52.17%), cavitary images were found in 24 cases (66.66%).&#x0D; Pulmonary embolism (n=9 cases, i.e. 40.9%), superinfection (n=4), and excessive hemoptysis (n=3) were the most frequent complications. The mean length of hospital stay was 17 days [3-58 days]. The 2RHZE/4RH protocol was used for 87%. Two patients were placed on a second-line anti-tuberculosis treatment protocol. Treatment was not specified in 7 patients (10.14%). The progression was favorable in 48 patients (69.56% of cases), with a case fatality rate of 30.44%. Dyspnea, chest pain, anemia, hyperleukocytosis, and hyponatremia were associated with the risk of death.&#x0D; Conclusion: The elderly are particularly exposed to tuberculosis, due to physiological aging of the immune system and co-morbidities. This study highlighted the diagnostic and evolutionary particularities of pulmonary tuberculosis in the elderly, as well as the associated fatal factors.

A Study of Some Immunological and Hematological Aspects in Children with Renal Disease

This study was carried out between September 17, and December 25, 2023. It included 62 pediatric patients at the age range (1-12) years of both genders: 26 with chronic renal failure (CRF) and 36 with nephrotic syndrome (NS), who were outpatients and in-patients in the dialysis unit in both Al-Mansour pediatric teaching hospital and Child's central teaching hospital. The control group consisted of 26 children. Blood samples were collected from patients and controls. Immunological tests of interleukin-6 (IL-6) and erythropoietin (Epo) measurement were done by using ELISA technique. Biochemical tests, including blood urea and serum creatinine, were applied to evaluate renal function. Hematological aspects referred to anemia presence or not; by measuring PCV and Hb. The results explained significant increase in serum IL-6 levels (P&lt;0.001), significant decrease in serum Epo levels (P&lt;0.001), significant increase in both urea and creatinine concentrations (P&lt;0.001) in serum and significant decrease in both PCV and Hb (P&lt;0.001) in NS and CRF patients in comparison with the control group

Complications of femoral access for hemodialysis: A surgical perspective

Background: Vascular access, especially arteriovenous fistula (AVF), is critical for patients requiring haemodialysis. Due to delayed diagnosis, late referral, poverty and limited availability of competent access surgeons, many patients commence haemodialysis without an AVF, hence the frequent use of venous catheters. Objectives: To assess the pattern of complications associated with repeated femoral punctures for haemodialysis. Materials and Methods: This is a multicentre prospective study conducted at the Cardiovascular units of the University of Port Harcourt Teaching Hospital, Port Harcourt and Federal Medical Centre, Umuahia between January 2017 and December 2022. 66 patients were recruited for the study. Data obtained were patients’ demography, complications of femoral access, surgical approach and outcome. Results: 15 patients presented with severe lower limb pains and inability to walk, 10 with fibrosis/ hardening of the skin of both groins, 8 with skin infection at the repeated puncture sites, 12 had Pseudoaneurysm of the superficial femoral artery (SFA), 6 had iatrogenic femoro-femoral Arteriovenous Fistula (AVF) of the SFA and superficial femoral vein (SFV), 5 had groin abscess. All the patients had internal jugular venous catheters inserted. Some patients had Fogarty catheter thrombectomies and interposition Great Saphenous Vein (GSV) graft repairs, while some others had successful takedown of the AVF, Fogarty thrombectomy and direct prolene 6/0 repair of the vein &amp; arterial wall defects. All those that underwent surgical treatment had successful recovery. Conclusion: Femoral vein cannulation, apparently easy to perform, should not be used as the vascular access of choice for chronic haemodialysis.