Clinical outcomes, time span for healing of various ocular surface disorders with amniotic membrane: A prospective, an Indian study

Purpose: To study the clinical outcomes, time span of healing of various ocular surface disorders with amniotic membrane graft. Methods: A total of 41 patients, presenting to cornea clinic were included in the study and divided into five groups depending on the type of diagnosis: Group 1, with either >2 weeks of Persistent epithelial defect following cataract/retinal/glaucoma surgeries or Shield ulcers, Group 2 with >4 weeks of Non healing corneal ulcers, Group 3 with chemical injuries, Group 4 with Epithelial defects following keratoplasty, and Group 5 is the miscellaneous group. Results: The mean age of the study subjects was 50.0 years. Overall mean duration between clinical presentation and AMT was 23.59 (30.7) days, a median 16 days (IQR; 2?26 days). Failure rate was high in Group 5 (n = 3: 30.0%) and Group 2 (n = 3: 27.3%). Time taken for epithelial closure was slower in groups 1 and 5 patients. The average time taken for reabsorption of AMG was 14.98 days. The complications included repeat AMG was in four eyes (9.75%), and graft displacement was noted in four eyes (9.75%) required resuturing, three eyes required TPK (7.31%), and one eye underwent evisceration (2.43%) following severe corneal melt secondary to neurotropic ulcer. The mean log MAR visual acuity improved from 1.52 to 1.26 at the 3 months. Conclusion: Understanding on timespan for healing of ocular surface disorders with AMG is needed to assess the prognosis of the disease, preoperative counselling for repeat procedures, and the compliance with regard to follow up.

MTHFR C677T Polymorphism, Plasma Homocysteine, and PDGF-AA Levels and Transcranial Doppler Velocity in Children With Sickle Cell Disease

Objective: To evaluate the effect of methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism on plasma homocysteine (tHcy) and platelet-derived growth factor (PDGF-AA) levels in children with sickle cell disease (SCD), and ascertain their role in predicting high transcranial doppler velocity (TCD). Methods: We estimated MTHFRC677T gene polymorphism, plasma tHyc and PDGF-AA in 44 SCD patients and 44 healthy children. Results: The prevalence of mutant homozygous MTHFR (C677TT) in SCD was 13.6%. Significantly higher plasma tHcy was observed in mutant homozygous MTHFRC677TT patients. Significantly higher plasma tHcy and PDGF-AA levels were observed in SCD patients than in controls. Median (IQR) PDGF-AA levels were significantly higher in conditional and high-risk TCD patients as compared to low-riskTCD patients [325 (93.1-368) and 368 (111-480) vs 111 (56-201) pg/mL, respectively; P<0.001]. Mean (SD) tHcy levels were significantly higher in high-risk TCD children than low-risk TCD children (12.9 (2.7) vs 9.9 (2.5) µmol/L; P=0.006). The receiver operating characteristic revealed that the area under the curve (AUC) of PDGF-AA for high TCD velocity was 0.934 (95% CI 0.845-1.00; P<0.001) and tHcy had an AUC of 0.675 (95% CI 0.517-0.833; P=0.04). Conclusion: PDGF-AA and tHcy levels could be used as predictive markers for stroke in SCD children. MTHFR Polymorphism contributes to elevated tHcy levels.

Preparatory Year Students' Perception of Pharmacy Profession as a Career Choice: A Cross-Sectional Study

Abstract The study attempted to assess preparatory year students' perception towards pharmacists and the pharmacy profession. This cross-sectional survey was conducted between December 2019 and March 2020. The students were invited to complete an anonymous questionnaire via Google Forms®. In total, 244 students, of which 53.7% were female with the mean age of 19.2 ± 0.65, from 12 universities participated in this study. As per our findings, the majority of the respondents (91.8%) regard pharmacy as a well-respected profession, 82.4% thought pharmacists are important decision-makers, 68.4% disagreed that most pharmacists were unkind, and 60.7% did not agree that pharmacy was a low-status occupation. Meanwhile, 95.5% agreed that pharmacists must have a university degree, 88.6% agreed pharmacists must take responsibility for patients, and 82.8% believed pharmacists had to work too hard. Moreover, 62.3% did not think pharmacy was a low-skill occupation, 54.9% did not agree pharmacists must do unpleasant things, and 45.1% disagreed pharmacists only did what physicians requested of them. Lastly, 48.8% had low confidence in choosing pharmacy as a career. The students' overall perception toward pharmacists and the pharmacy profession was favorable. However, only one-fourth of the students displayed a tendency to choose pharmacy as a future career.

Ebola outbreak in Guinea, 2021: Clinical care of patients with Ebola virus disease

Background: Experience from the Zaire Ebolavirus epidemic in the eastern Democratic Republic of the Congo (2018­2020) demonstrates that early initiation of essential critical care and administration of Zaire Ebolavirus specific monoclonal antibodies may be associated with improved outcomes among patients with Ebola virus disease (EVD). Objectives: This series describes 13 EVD patients and 276 patients with suspected EVD treated during a Zaire Ebolavirus outbreak in Guinea in 2021. Method: Patients with confirmed or suspected EVD were treated in two Ebola treatment centres (ETC) in the region of N'zérékoré. Data were reviewed from all patients with suspected or confirmed EVD hospitalised in these two ETCs during the outbreak (14 February 2021 ­ 19 June 2021). Ebola-specific monoclonal antibodies, were available 2 weeks after onset of the outbreak. Results: Nine of the 13 EVD patients (age range: 22­70 years) survived. The four EVD patients who died, including one pregnant woman, presented with multi-organ dysfunction and died within 48 h of admission. All eight patients who received Ebola-specific monoclonal antibodies survived. Four of the 13 EVD patients were health workers. Improvement of ETC design facilitated implementation of WHO-recommended 'optimized supportive care for EVD'. In this context, pragmatic clinical training was integrated in routine ETC activities. Initial clinical manifestations of 13 confirmed EVD patients were similar to those of 276 patients with suspected, but subsequently non confirmed EVD. These patients suffered from other acute infections (e.g. malaria in 183 of 276 patients; 66%). Five of the 276 patients with suspected EVD died. One of these five patients had Lassa virus disease and a coronavirus disease 2019 (COVID-19) co-infection. Conclusion: Multidisciplinary outbreak response teams can rapidly optimise ETC design. Trained clinical teams can provide WHO-recommended optimised supportive care, including safe administration of Ebola-specific monoclonal antibodies. Pragmatic training in essential critical care can be integrated in routine ETC activities. Contribution: This article describes clinical realities associated with implementation of WHO-recommended standards of 'optimized supportive care' and administration of Ebola virus specific treatments. In this context, the importance of essential design principles of ETCs is underlined, which allow continuous visual contact and verbal interaction of health workers and families with their patients. Elements that may contribute to further quality of care improvements for patients with confirmed or suspected EVD are discussed.

Assessment of skipping breakfast at home among adolescent school students in Badia Region, Jordan

@#Introduction: Healthy meals play an essential role in the healthy physical and mental development of adolescents. Breakfast at home is associated with improved nutritional choices, and skipping breakfast is detrimental. This study assessed prevalence of skipping breakfast at home among adolescent students in the Badia Region of Jordan, identifying the reasons and characteristics associated with such behavioural choice. Methods: A cross-sectional survey among adolescent students (aged 13-16 years, in 8th-9th grades) from six public schools in Badia Region, Mafraq Governorate, Jordan, was conducted through self-administered questionnaire from February to March 2022. Results: Results showed that 68.1% of 552 student participants regularly skipped breakfast at home (72.4% boys vs. 61.3% girls; p=0.007). Among those who regularly skipped breakfast, three main rationales for this choice were not feeling hungry (5.3%), lack of time (2.7%), and lack of appetite (3.5%). Conclusion: The prevalence of skipping breakfast at home among adolescents in Badia Region was high for various reasons, including lack of time, not feeling hungry, seeking to manage weight, and insufficient knowledge on the importance of healthy breakfast. Therefore, understanding the reasons and factors that contribute towards breakfast skipping may help in solving the problem, underscoring that positive beliefs should be reinforced in schools, with parents encouraging adolescents to eat healthy breakfast.

Clinical profile and long term outcomes of eyes with choroidal detachment following trabeculectomy

Purpose: To assess the long?term outcomes of choroidal detachments (CDs) in eyes following trabeculectomy. Methods: Retrospective comparative case series. Data of patients with CDs following trabeculectomy (5?year period) with or without cataract surgery with a minimum of 3 months of follow?up were included. Results: In total, 45 patients with CDs following trabeculectomy were included. The mean age was 63.27 ± 8.68 years, (M:F = 2:1); 29 of 45 eyes (64.4%) had a baseline IOP of >24 mm Hg. Patients had a median follow?up of 22.2 (IQR: 16.2–30.5) months. Further, 10 of 45 eyes (22.2%) had CDs following suture lysis. The median onset of choroidal detachment from the time of surgery was 16.0 (IQR: 11–36) days. The mean BCVA improved from 0.62 ± 0.28 to 0.24 ± 0.27 (P < 0.001) and mean IOP increased from 4.07 ± 2.66 to 11.20 ± 5.31 (P < 0.001) at last visit. The cumulative success rates were 76.4% (95% CI: 48.4–90.5) in POAG eyes and 79.3% (95% CI: 62.8–89.1) in PACG eyes (P = 0.547). Medical management was the mainstay in all patients. Four of 45 (8.88%) patients underwent subsequent choroidal drainage. Conclusion: Choroidal detachment following modern?day trabeculectomy has favorable long?term visual acuity and IOP outcomes. There was no difference in the long?term surgical success of trabeculectomy with choroidal detachments in primary angle?closure and open?angle glaucoma eyes. Long?term follow?up is essential to prevent chronic hypotony and trabeculectomy failure

Modified valsalva versus standard valsalva for cardioversion of supraventricular tachycardia: systematic review and meta‑analysis

Background@#Supraventricular tachycardia (SVT) is a major cause of emergency room visits where vagal maneuver is used as first-line therapy. The valsalva maneuver (VM) is proven to be safe and, to some extent, effective in termi‑ nating SVT episodes. We aimed to compare the standard VM (SVM) to the modified valsalva maneuver (MVM). We hypothesized that MVM is more effective in terminating SVT episodes and reducing the time spent in the emergency department. @*Methods@#In this systematic review and meta-analysis, we searched Medline/PubMed, Ovid, Web of Science, and Cochrane Central Register of Controlled trials. We included only randomized controlled trials (RCTs) that compared the modified valsalva to the standard valsalva maneuver in treating SVT. Our main outcome was the termination of SVT within 1 min. @*Results@#Four articles met the eligibility criteria of our review. Sinus rhythm was achieved 2.5 times more in the MVM group compared to the SVM group (risk ratio (RR) = 2.54, CI 1.98–3.24, P < 0.001) and thus lowered the need of intrave‑ nous SVT termination medication without any significant increase in adverse events or time spent in the emergency department. @*Conclusion@#Our review found MVM to be more effective than the SVM in terminating SVT. This should encourage broader adoption of the MVM as a first-line vagal maneuver in subjects presenting with SVT in the emergency room.

Modified valsalva versus standard valsalva for cardioversion of supraventricular tachycardia: systematic review and meta‑analysis

Background@#Supraventricular tachycardia (SVT) is a major cause of emergency room visits where vagal maneuver is used as first-line therapy. The valsalva maneuver (VM) is proven to be safe and, to some extent, effective in termi‑ nating SVT episodes. We aimed to compare the standard VM (SVM) to the modified valsalva maneuver (MVM). We hypothesized that MVM is more effective in terminating SVT episodes and reducing the time spent in the emergency department. @*Methods@#In this systematic review and meta-analysis, we searched Medline/PubMed, Ovid, Web of Science, and Cochrane Central Register of Controlled trials. We included only randomized controlled trials (RCTs) that compared the modified valsalva to the standard valsalva maneuver in treating SVT. Our main outcome was the termination of SVT within 1 min. @*Results@#Four articles met the eligibility criteria of our review. Sinus rhythm was achieved 2.5 times more in the MVM group compared to the SVM group (risk ratio (RR) = 2.54, CI 1.98–3.24, P < 0.001) and thus lowered the need of intrave‑ nous SVT termination medication without any significant increase in adverse events or time spent in the emergency department. @*Conclusion@#Our review found MVM to be more effective than the SVM in terminating SVT. This should encourage broader adoption of the MVM as a first-line vagal maneuver in subjects presenting with SVT in the emergency room.

In vivo experimental infection of sarcosporidiosis and toxoplasmosis of rabbits in Duhok Province, Kurdistan region, Iraq

Background: Sarcocystis species and Toxoplasma gondii are both zoonotic obligatory intracellular protozoan organisms and cyst-forming coccidian parasites that occur in domestic animals and human throughout the world.Methods: Forty local breed rabbits were divided into four groups, each group ten. Group one were infected with Sarcocystis, group two with Toxoplasma and group three with both parasites and last group was non-infected control group. The LAT serological test was used for detection of anti-toxoplasma antibody in serum of Toxoplasma infected rabbits. The direct impression smears stained with Giemsa was prepared from different body organs including; liver, lung, heart, brain and skeletal muscle for detection of tissue cysts (Bradyzoites) of T. gondii and microcysts of Sarcocystis.Results: In group one, 70% of infected rabbits were positive for toxoplasmosis by serological test; both are and by impression smear method 80% of the rabbits were positive for T. gondii with tissue cysts. Fifty percent of rabbits were positive for microcysts of Sarcocystis by direct impression smear method in group two. In group three, the impression smear and latex agglutination method were positive in 40% and 60% of rabbits, respectively. Statistically, there was no significant difference in detection of toxoplasmosis and sarcocystosis by LAT and impression smear method in group one and three.Conclusions: Rabbits could be source of toxoplasmosis and sarcocystosis and have public health implications and hazard as source of food. They might be source of infection for cats and shed environmentally resistant oocysts.

Myeloma coexisting with jejunal light chain amyloidosis

Amyloid Light chain (AL) amyloidosis is a rare disease, which is seen in approximately one-tenth of patients with multiple myeloma. We report a 52 years old male, who presented with complaints of anorexia and weight loss. He was diagnosed to have multiple myeloma-international staging score (ISS) Stage 3 and was started on VTD (Bortezomib, Thalidomide, and Dexamethasone) chemotherapy. Within 2 weeks of therapy, he had abdominal symptoms like abdominal pain, loose stools, vomiting and hematochezia. Imaging showed dilated proximal bowel loops with fluid filled contents and prominent vessels in rectum. Emergency surgical exploration revealed thickened proximal jejunum with blood clots in the lumen. Resection of proximal jejunum was done. Histopathological examination of resected specimen was suggestive of AL amyloidosis. Post-surgical resection of jejunum, patient had initial improvement followed by deterioration. He was discharged against medical advice as per relative’s request. Hence an index of clinical suspicion of amyloidosis must been present in all Multiple myeloma patients.

Immunomodulatory Effects of Zinc as a Supportive Strategies for COVID-19

Coronaviruses 2019 (Covid-19) is a massive family of viruses that causes respiratory illnesses ranging from the common cold to the most severe conditions such as Middle East Respiratory Syndrome and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that represents the humanitarian crisis on a global scale. Currently, there are no therapeutic strategies approved by the U.S.Food and Drug Administration (FDA) to cure or prevent COVID-19. Global researchefforts from around the world extrapolate the updates focusing specifically on the biphasic nature of Covid-19 that involve both innate and acquired immunity. Even though researchers around the globe are racing to invent a life-saving therapeutics and vaccines to tackle COVID-19, the only available venture is a supportive approach in rendering treatment to patients with severe and non-severe cases of COVID-19. Supplementation of several vitamins and trace elements showed the expected favorable impact on enhancing immunity in viral infection. Numerous studies prompted the value of zinc (Zn) supplementation that prevents the virus from entering cells by binding with protein in potentiating antiviral immunity, which is realized through different mechanisms, including the improvement in markers of immune function. Zinc is also an associated factor for several enzymes (needed for the activity for over 300 enzymes), transcription factors, and replication factors. Interestingly, low-level zinc results in dysfunction of all immune cells, subjects with altered zinc state have a high risk for infectious disorders, autoimmune disorders, and cancer. Several assumptions regarding immunomodulators of zinc remain unresolved. This review aimed to explore the hypothetical association of Zinc supplementation (the key immunomodulator) in association with a preventive and therapeutic role of treating patients with COVID-19

Clinical and Humanistic Outcomes of Tuberculosis Treatment in a Nigerian Directly Observed Treatment Short Course Centre

Background:Tuberculosis remainsa major global health problem. It causes ill-health among millions of people each year and ranks alongside the human immunodeficiency virus (HIV) as a leading cause of death worldwide. The objective of the study was to evaluate the clinical and humanistic outcomes of tuberculosis treatment at the directly observed treatment short-course (DOTS)centre in Jos University Teaching Hospital.Methods:Data for clinical outcomes was collected retrospectively at the directly observed treatment shortcousecentre of Jos University Teaching Hospital from a cross-section of patients’ folders who had been treated for tuberculosis at the study site for at least 12months as at 1stApril to 30thSeptember 2018 while a validated questionnaire was administered prospectively to a census population of tuberculosis patients still undergoing treatment between 1stOctober 2018 and 31stMarch 2019 to determine the humanistic outcomes. A descriptive data analysis was done using SPSS version 23 and proportions were tested using chi squared statistics with significance level set at P<0.05.Results:The study revealed that tuberculosis treatment success in the centre was 76.33% which falls short of WHO standard of minimum of 85%. Patients taking tuberculosis treatment in the centre are satisfied with the services rendered to them and the improvement in their health conditions. Unfriendly attitude of some health care providers in the facility is an area for intervention. Conclusion: Clinical and humanistic outcomes of tuberculosis treatment was found to be satisfactory in the facility owing to the level of treatment success and patient reported satisfaction with facility services and improvement in their health conditions

Estimation of Cardiovascular Risk Factors & Their Relative Impact in Diabetic Mellitus-2 Adult Patients’ in Mnazi Mmoja Hospital - Zanzibar

Diabetes is characterized by chronic hyperglycemia and disturbances of carbohydrate, lipid and protein metabolism. We aimed to estimate the cardiovascular risk factors and their correlation with type 2 diabetes mellitus (T2DM) in Zanzibar (Mnazi MMoja Hospital) hypothesizing that early detection and treatment of lipid abnormalities can minimize the risk for atherogenic cardiovascular disorders and cerebrovascular accident in patients with T2DM. Methods: The study populations were those patients who presented themselves at Mnazi Mmoja hospital with T2DM, and who are within the age bracket of 18 to 45 years. Fasting blood glucose (FBG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and triglyceride (TG) levels were evaluated. Pearson’s correlation studies were performed between the variables of blood glucose and serum lipid profiles and also within the lipid profile parameters Results: TC, TG, LDL-C mean levels were significantly higher in diabetics compared with the control subjects p< 0.05. The HDL-C was however lower in diabetics compared with the controls. Also, the mean FBG, TC, TG, and LDL-C were significantly higher in female diabetic subjects compared to the male counterparts p< 0.05. A positive correlation was observed between FBG and TC, TG and LDL-C (r=0.643 p=0.0021; r=0.679, p=0.0001; r=0.534, p=0.0091 respectively) while HDL-C showed a negative correlation (r= -0.799, p= 0.0021). TC also showed a positive correlation with TG and LDL-C (r=0.590, p=0.0021; r= 0.628, p=0.0001) and negative correlation with HDL-C ( r=-0.670, p=0.0041). Conclusion: There is an influence of gender on cardiovascular disease risk factors with more of the females seriously at risk. Measurement of serum lipid profile should be introduced to the management plan of diabetes mellitus. There is an urgent need for the establishment of regional and national training courses for diabetic educators and also the creation of new evidence-based management plan for diabetics in Zanzibar for a better healthcare.

Knowledge, attitude, and practices towards diabetes mellitus among non-diabetes community members of Riyadh, Kingdom of Saudi Arabia

Background: The Kingdom of Saudi Arabia is in the midst of a diabetes mellitus (DM) epidemic whose originscan be traced to (a) the widespread adoption of the Western diet that is high in sugar, (b) an increase in sedentaryactivity, and (c) ignorance of the importance of DM. The purpose of this cross-sectional study was to quantifyvarious aspects of (a) knowledge, (b) attitudes, and (c) practice relating to DM. Methods: The three researchquestions addressed in this study were: (1) Is there any significant relationship between attitudes to DM andpractices related to DM? (2) Is there any significant relationship between knowledge of DM and practices relatedto DM? (3) Is there any significant relationship between knowledge of DM and attitudes to DM? Separate surveysfor each question collected data from a representative sample of 1,067 adult both male and female Saudis fromRiyadh who have not been diagnosed with DM. Results: Data analysis of the data from the study indicated thatfor each of the three research questions, the null hypothesis could not be rejected, indicating that none of therelationships were statistically significant. Conclusion: The absence of significance for each of the findings hasimportant implications, including (a) the possibility that many Saudis incorrectly believe themselves to beunsusceptible to DM and (b) the high prevalence of DM-causing behaviors in the Saudi population. These twoimplications should be of particular concern to public health authorities and health educators in Saudi Arabia,who may need to work more diligently to educate non-DM-diagnosed Saudis on their vulnerability to DM

Literature Review on Prevalence, Risk Factors and, Evaluation of Acute Lower Back Pain

Background: Acute back pain is any pain located at the back that lasts for less than 4 weeks duration. Theprevalence is fair with as many as 84% of the adult population around the globe experience back pain at somepoint in life and is often self-limiting. However, in few selected patients it may serve as indicator of a seriousunderlying disease making it crucial to properly evaluate, characterize and address this concern. Objectives: Inthis review we intend to explore the prevalence, risk factors and highlight the available methods using diagnosticimaging modalities to evaluate and address this condition. Materials and Methods: A review of relevant articlespublished from 1987 onwards in English language was done using the electronic databases of PubMed Pico and,Google Scholar with preset keywords. Conclusion: Acute back pain prevalence range between 22 to 48 percentand risk factors are non-modifiable such as advanced age and female gender while modifiable risk factors areobesity, smoking, low education, sedentary lifestyle, etc. Employment related factors such as physically strenuouswork also increase the risk of developing back pain. Notably, under-appreciated risk factors includingpsychological risk factors such as anxiety should be screened for while evaluating patients. Evaluation of backpain mostly relies on comprehensive history and physical examination, as most cases are self-limited. Diagnosticimaging is only recommended in cases presenting with red flag symptoms.

Hypertension Diagnosis and Management Approach

Background: Hypertension is one of the most common diseases nowadays. It affects about 25% of the adult globalpopulation and can lead to highly morbid cardiovascular or cerebrovascular complications. However, whenrecognized early, appropriate lifestyle-related measures and occasionally pharmacologic interventions can helpgreatly reduce its risks. Objective: In this study, we aim to provide summarized, yet comprehensive review paperfocusing on diagnosis and management of hypertension. Methods: We searched PubMed using keywords such ashypertension, its screening, diagnosis, and treatment, and family medicine. Conclusion: Essential hypertensionis a systemic disease that can kill the affected people silently. Nevertheless, knowing a lot about its risk factorsand how they can be tackled to prevent it or even to greatly reduce its effects once it develops is of highimportance; and here the major role of a family physician is revealed.

The study of hyponatremia in the prognosis of acute ischemic stroke

Background: Stroke is defined as an abrupt onset of a neurologic deficit that is attributable to a focal vascular cause. Acute ischemic stroke is the fourth leading cause of death and most common cause of long-term disability worldwide. Hyponatremia is the commonest electrolyte disturbance encountered in the neurological intensive care units. This study investigated to evaluate hyponatremia in acute ischemic stroke patients as a reliable prognostic marker on admission to ICU.Methods: A total of 150 patients admitted to M S Ramaiah Hospitals during the period of October 2014 to September 2016 who fulfilled the inclusion criteria were considered in the study. All patients were evaluated by neurologist/ physician and the diagnosis of Acute ischemic stroke was made by Clinical examination and confirmed by Computed Tomography (CT) and/ Magnetic resonance imaging (MRI) brain. Hyponatremia was defined as serum sodium level <135 mmol/L and recorded on admission. Outcome was assessed by National Institute of Health Stroke Scale (NIHSS) score at admission, day 5 and at discharge, duration of ICU stay, duration of hospital stay and in-patient mortality.Results: Among the 150 patients admitted with acute ischemic stroke, mean age was 60 years, 68% were males and 36% patients had hyponatremia. Baseline characteristics were similar between groups except for gender distribution (p=0.037). Hyponatremic patients had higher NIHSS score on admission, on day 5 and at discharge (p=<0.001). Hyponatremic patients had a longer duration of ICU stay (p=<0.001) and in hospital stay (p=<0.001). Hyponatremia was associated with higher mortality in hospital (p=0.026).Conclusions: Study demonstrates that hyponatremia at admission in acute ischemic stroke patients is associated with acute mortality, worse NIHSS score at admission and at discharge, and longer duration of ICU and hospital stay.

Role of systemic steroids in acute hemorrhagic edema of infancy: report of two cases

Acute hemorrhagic edema of infancy (AHEI) is an unusual form of leukocytoclastic vasculitis with dramatic distinguishing skin lesions that occurs in infants who age 4 to 24 months old. Clinical presentation at onset requires clinical and, less often, histological evaluation to distinguish it from more serious diseases and other vasculitis. Treatment of AHEI remains controversial; and since it is a self-limiting disease, a conservative approach should be considered first. Although some authors have reported that the use of steroids may be beneficial if started early on, we think their use, based on our presented cases here, may accelerate the healing and improves the color of preexisting skin lesions but does not significantly alter the course of the disease. Authors reported here two clinical Cases of AHEI (Diagnosed based on characteristic skin lesions and confirmed with Histological evaluation) who were treated initially with systemic steroids, besides we reviewed the role of systemic steroids in the treatment of AHEI.

HIV Infection among children aged two years to less than eighteen years admitted to the Emergency Pediatric Unit in a tertiary health facility in Lafia North-Central Nigeria

BACKGROUND: Human Immunodeficiency virus (HIV) is a retrovirus that impairs the immune system by attacking the body's natural defense from infections and diseases. Pediatric HIV continue to be a major public health problem despite the global decline in its seroprevalence rates. The decline in the incidence of new HIV infections is particularly lower in children with a 52% reduction in the last ten years. This is attributed to a wider coverage in the use of antiretroviral therapy (ART) and the prevention of mother to child transmission of HIV (PMTCT) programs. Several programs designed at curtailing mother to child transmission of HIV are yielding positive result. This is not unexpected since most of the HIV infections among children were acquired via maternal to child transmission. With this, the study sets out to determine the prevalence of new HIV infection among patients admitted to the Emergency Pediatrics Unit (EPU) using the provider-initiated testing and counseling approach. METHODS: A prospective cross-sectional descriptive study was conducted at the mini laboratory attached to the EPU of the Dalhatu Araf Specialist Hospital Lafia Nasarawa State between 1st August 2017 to 31st July 2018. Using non-probability sampling, categorical variables were analyzed as frequencies and percentages. The association between categorical variables were analyzed using chi square.RESULTS: A total of 964 children ranging in age from two to less than eighteen years were screened. The total number of males was 550 (57.1%) while females was 414 (42.9%) with a male to female ratio of 1.3:1. Five (0.5%) children were newly diagnosed with HIV of the 964 children tested for the infection. CONCLUSION: The incidence of HIV infection among children admitted into our Emergency Pediatric Unit was 0.5%, comparable to some earlier reports

Predictors of success of shock wave lithotripsy for ureteral stones based on computed tomography scan parameters

Background: For shock wave lithotripsy has proven to be an effective, safe and truly minimally invasive option for the treatment of nephrolithiasis. Various technical factors as well as patient selection can impact the success of the procedure. Objective: The aim of this study was to identify the parameters on NCCT that may predict the success of shock wave lithotripsy (SWL) in ureteral stones. Patients and Methods: 102 patients who underwent SWL for ureteral stones at sayed Galal University Hospital from January 2015 to August 2018 diagnosed by non-contrasted computed tomography were studied. The failure was defined as remnant stones ﻞ4 mm. We assessed age, sex, body mass index, stone size, location, skin-to-stone distance (SSD), presence of JJ and the presence of secondary signs (hydronephrosis, renal enlargement, perinephric fat stranding, and tissue rim sign). Results: 102 patients with success rate 61.8%, stone size, stone density were significantly associated with outcome of SWL. While SSD, JJ and secondary signs (hydronephrosis, perinephric fat stranding and tissue rim sign) were insignificant. On multivariate analysis, stone size and stone density were the independent factors affecting the outcome of SWL. Conclusions: The study demonstrated that stone size and density are significant and independent predictors of outcome in patients with upper ureteral stones. However SSD and signs of impaction still have to be evaluated