Impact of Hospital Closure on Patients with Communicable and Non-Communicable Diseases During the COVID-19 Pandemic in Uganda: A Cross-Sectional and Mixed-Methods Study.

Background: The COVID-19 pandemic and its measures have had a profound impact on universal access to health services. We investigated the impact of the closure of the Entebbe Regional Referral Hospital (ERRH) for two years on the accessibility to necessary healthcare among non-COVID-19 patients. Methods: This mixed-methods study focused on ERRH patients with tuberculosis (TB), human immunodeficiency virus (HIV), diabetes/hypertension, and mental illness. A quantitative study used a structured-questionnaire with a primary outcome measure to assess the discontinuation of healthcare accessibility. A qualitative study with a focus group discussion (FGD) was conducted on eight patients. Results: Of the 202 quantitative survey participants, 17.8% discontinued necessary healthcare due to the ERRH closure, and the discontinuation rates differed by disease: 48.1% of TB patients, 16.0% of HIV patients, 7.8% of diabetes/hypertension patients, and 4.0% of mental health patients (P < 0.001). Almost 90% of the patients reported a worsened health condition, regardless of the disease. Multivariable logistic regression analysis showed that patients with diabetes/hypertension (adjusted odds ratio [AOR], 12.69; 95% confidence interval [CI], 2.57-62.52) and HIV (AOR, 7.52; 95% CI, 1.37-41.27) were more likely to discontinue healthcare than those with mental illness. The factors associated with discontinued healthcare included age ≥50 years vs ≤30 years (AOR, 4.88; 95% CI, 1.07-22.34), and high transportation cost vs low cost (AOR, 3.15; 95% CI, 1.13-8.75). The FGD also identified difficulties in obtaining medication, especially for TB, even though ERRH provided the outreach services. Conclusion: Our study revealed that the ERRH closure and lockdowns had an overall profound negative impact on access to healthcare and health conditions. Younger patients and those with TB were the most affected patients. This study provides practical suggestions from the field for policy makers to strengthen universal health access during health crises in Uganda and other sub-Saharan countries.

High Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Prevalence After the Third Epidemic Wave (May-October 2021) in Matadi, Democratic Republic of the Congo.

Background: By the end of the third wave of the coronavirus disease 2019 (COVID-19) epidemic (May-October 2021), only 3130 of the 57 268 confirmed cases of coronavirus disease 2019 (COVID-19) in the Democratic Republic of the Congo (DRC) were reported in Kongo Central. This province, and especially its capital city, Matadi, has essential trade and exchanges with Kinshasa, the epicenter of the COVID-19 epidemic in DRC. Kinshasa accounted for 60.0% of all cases during the same period. The true burden of COVID-19 in Matadi is likely underestimated. In this study, we aimed to determine the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence and associated risk factors after the third wave in Matadi. Methods: We conducted a population-based cross-sectional study in October 2021. Consenting participants were interviewed and tested using an enzyme-linked immunosorbent assay commercial kit. We applied univariable and multivariable analysis to evaluate factors associated with seropositivity and adjusted the seroprevalence for the test kit performance. Results: We included 2210 participants from 489 households. Female participants represented 59.1%. The median age was 27 years (interquartile range, 16-45 years). The crude SARS-CoV-2 seroprevalence was 82.3%. Age was identified as the main risk factor as younger age decreased the seropositivity odds. Accounting for clustering at the household level increased the seroprevalence to 83.2%. The seroprevalence increased further to 88.1% (95% confidence interval, 86.2%-90.1%) after correcting for the laboratory test kit performance. Conclusions: The SARS-CoV-2 seroprevalence was very high, contrasting with reported cases. Evidence generated from this population-based survey remains relevant in guiding the local COVID-19 response, especially vaccination strategies.

Overcoming Current and Preventing Future Nosocomial Outbreaks during the COVID-19 Pandemic: Lessons Learned at Three Hospitals in Japan.

Hospitals are increasingly challenged by nosocomial infection (NI) outbreaks during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Although standardized guidelines and manuals regarding infection prevention and control (IPC) measures are available worldwide, case-studies conducted at specified hospitals that are required to cope with real settings are limited. In this study, we analyzed three hospitals in Japan where large-scale NI outbreaks occurred for hints on how to prevent NI outbreaks. We reviewed openly available information from each hospital and analyzed it applying a three domain framework: operation management; identification of infection status; and infection control measures. We learned that despite having authorized infection control teams and using existing standardized IPC measures, SARS-CoV-2 may still enter hospitals. Early detection of suspected cases and confirmation by PCR test, carefully dealing with staff-to-staff transmission were the most essential factors to prevent NI outbreaks. It was also suggested that ordinary training on IPC for staff does not always provide enough practical knowledge and skills; in such cases external technical and operational supports are crucial. It is expected that our results will provide insights into preventing NI outbreaks of COVID-19, and contribute to mitigate the damage to health care delivery systems in various countries.

Benign pleomorphic astrocytoma in the hypothalamus--case report.

A 41-year-old woman presented with an unusual case of benign astrocytoma with marked pleomorphism manifesting as consciousness disturbance due to intraventricular hemorrhage. Magnetic resonance imaging revealed a well-enhanced hypothalamic mass protruding into the third ventricle. Despite partial resection of the tumor without additional therapy, there have been no signs of tumor regrowth for 6 years. The histological findings revealed solid proliferation of tumor cells with marked pleomorphism, contrary to the benign clinical course. However, no mitosis, necrosis, or endothelial proliferation were found and the MIB-1 index was less than 0.5%. Immunohistochemical staining indicated the glial origin of the tumor. The tumor was similar to pleomorphic xanthoastrocytoma, but the histological findings were not exactly identical, indicating a new histological entity.

High titer retroviral gene transduction to neural progenitor cells for establishment of donor cells for neural transplantation to parkinsonian model rats.

Neural progenitor cells (NPCs) are expected to be useful donor sources for cell transplantation therapy in Parkinson's disease. However, control of the differentiational lineage, especially into dopaminergic neurons, is still difficult. Thus, genetic modification of NPCs to produce l-dopa is potentially useful. The present study prepared high titer retrovirus carrying human tyrosine hydroxylase-1 (HTH-1) gene. HTH-1 gene could be efficiently transduced into NPCs obtained from the E12.5 rat mesencephalon. This retroviral gene transduction caused no apparent changes in survival, proliferation, or differentiation. In vitro, HTH-1 gene-transduced NPCs released little l-dopa and addition of tetrahydrobiopterin, the cofactor of tyrosine hydroxylase, was required for production of l-dopa. In vivo, three of seven hemi-parkinsonian model rats that received HTH-1 gene-transduced donor NPCs achieved functional recovery. High titer retroviral vector for gene transduction could be used to prepare NPCs for transplantation to hemi-parkinsonian model rats. However, functional recovery after transplantation of HTH-1 gene-transduced NPCs was incomplete.

Remote cerebellar hemorrhage following supratentorial craniotomy--case report.

A 63-year-old man presented with sudden severe headache. Computed tomography (CT) demonstrated subarachnoid hemorrhage. Cerebral angiography demonstrated an aneurysm of the anterior communicating artery. Left frontotemporal craniotomy and neck clipping of the aneurysm via the pterional approach were performed. CT obtained 18 hours after surgery revealed cerebellar hemorrhage, and magnetic resonance (MR) imaging 17 days postoperatively demonstrated that the hemorrhage was located within the folia. Neurological examination after surgery revealed slight dysarthria after drainage of cerebrospinal fluid (CSF) but no other neurological deficits. Follow-up CT and MR imaging showed characteristic findings of postoperative cerebellar hemorrhage clearly different from those of hypertension. The cerebellar hemorrhage was probably secondary to overdrainage of CSF. He was discharged without deficits.

Long-term effects of indirect bypass surgery on collateral vessel formation in pediatric moyamoya disease.

OBJECT: The authors investigated whether revascularization surgeries in children with moyamoya disease could reduce abnormal collateral formations in the posterior circulation; long-term follow-up angiography was performed to assess status. METHODS: In six patients who underwent indirect bypass surgery in childhood, long-term follow-up angiography studies were obtained between 7 and 12 years after surgery. All six patients presented with ischemic symptoms at onset of disease between 2 and 7 years of age. Ischemic insults did not occur after surgery in any patient. In five cases, the angiographically documented stages advanced bilaterally, and in three cases the angiography revealed nearly occluded intracranial carotid arteries bilaterally. In all sides in these five cases, the collateral circulation through the grafts developed well, and collateral formation from the lenticulostriate arteries and from the anterior choroidal artery decreased according to the natural advancement of disease. There was no reduction in the collateral formations from the posterior circulation, however, in four of these five cases. CONCLUSIONS: Although the data cannot directly indicate that the patients in this study remain at potential risk of developing hemorrhage in the future, these facts should be considered when evaluating the efficacy of revascularization surgeries, because the hemorrhagic potential of abnormally dilated collateral vessels from the posterior circulation would increase as the advancement of the disease.

A genotype of the polymorphic DNA repair gene MGMT is associated with de novo glioblastoma.

Glioblastoma is one of the most malignant tumors in humans. This tumor is thought to develop as a result of the accumulation of genetic abnormalities, mainly focused on the loss of heterozygosity on chromosome 10. O6-methylguanine-DNA methyltransferase (MGMT), which is one of the most important DNA repair proteins, has also been reported that enzymatic activity, as well as the methylation status of the promoter region of the MGMT gene, contributes to the therapeutic response of alkylating agents. We previously found three allelic variants in the MGMT gene and assayed the characteristics of these polymorphic proteins. We designed a case-control study to investigate the role of MGMT genotypic risk factors for primary brain tumors. We compared the distributions of MGMT genotypes in primary brain tumors and normal controls. The frequencies of MGMT genotypes in examined primary brain tumors were not different from normal subjects. However, the combined heterozygote of V1 and a wild allele (V1/W) was frequently detected in de novo glioblastoma group with significant difference. Interestingly, among glial tumors, the V1/W genotype was dominantly detected in the patients with de novo glioblastoma. This study suggests that the V1/W genotype of the MGMT gene may contribute to the de novo occurrence of glioblastoma.

Temporal profile of angiographical stages of moyamoya disease: when does moyamoya disease progress?

To elucidate the initiation of Moyamoya disease, we analyzed the progression of angiographical stages in repeated angiographical studies. The clinical subjects consisted of 39 patients. Angiographical stages were classified by the criteria of Suzuki and Takaku. For examinations, conventional cerebral angiography or magnetic resonance angiography was performed. The follow-up period ranged from three months to 17 years. We found the following results. 1. Older patients presented with advanced angiographical stages. 2. Angiographical stages were usually progressive in pediatric patients, while stable in adult patients. In pediatric cases, the disease advanced to stage V within 10 years from the onset in the majority of patients. However, in certain cases the disease progressed after adolescence. 3. Among pediatric patients, certain cases, in whom the onset of the disease was later than five years of age, showed relatively slow progression of angiographical stages. Our data indicate that certain pediatric cases whose disease started after five years of age presented with stable temporal changes in the angiographical stages. These findings might indicate that in only a few adult cases does the disease initiate in adulthood and in the majority of adult patients the disease starts in childhood.

Solitary metastasis of prostatic cancer to the internal auditory canal.

We report a 56-year-old man with a metastatic prostatic tumor who developed left orbital meatus syndrome as the first manifestation. Magnetic resonance imaging (MRI) showed a swollen lesion in the left internal auditory canal that was isointense on T1-weighted images, hyperintense on T2-weighted images, and marked by enhanced after the administration of gadolinium. A biopsy of the affected lesion confirmed the prostatic origin of the metastasis.

TGF-alpha overexpression induces astrocytic hypertrophy after cortical stab wound injury.

To determine the exact role of TGF-alpha in glial activation after traumatic brain injury, we investigated the astroglial and microglial responses after cortical stab wound injury in TGF-alpha overexpressing mice. Adult male B6D2-TgN (MMTVTGFA) 29RjC transgenic mice were used for the subjects. This transgenic line carries a TGF-alpha cDNA under the control of the dexamethasone-inducible MMTV promoter. Thus, exogenous administration of dexamethasone induces TGF-alpha overexpression. Male B6D2F1/J mice at the same age served as wild-type animals. After the cortical stab wound injury, expression of glial fibrillary acidic protein, CD-11b and interleukine-6 were investigated immunohistochemically. The results indicate that TGF-alpha might affect astrocytic hypertrophy without affecting microgliosis not only in the normal condition, but also in the pathological condition. Moreover, overexpression of TGF-alpha induced obvious expression of IL-6 around the lesion. This fact might indicate possible role of TGF-alpha in affecting neuronal function.

Significance of leptin expression in invasive potential of pituitary adenomas.

We immunohistochemically examined the expression of leptin in pituitary adenomas to investigate the correlation between the invasiveness of tumours and leptin expression. The subjects consisted of 79 patients with pituitary adenoma and were classified into the following groups: (1) non-functioning adenomas; (2) GH-secreting adenomas; (3) prolactinomas; (4) ACTH-secreting adenomas; (5) others (LH, FSH or TSH-secreting adenomas). Thereafter all cases were subdivided according to the size of tumour and the presence of invasion to the surrounding tissue. Among non-functioning adenomas, there was no significant difference between invasive and non-invasive non-functioning adenoma. In functioning adenomas, a significant difference in leptin expression was noted in intrasellar non-invasive adenomas compared to other adenomas. There was also a significant difference in leptin expression between non-invasive and invasive adenomas regardless of size. These results suggest that leptin has a role in the invasive potential of functioning adenomas.

Chronic intraventricular encapsulated hematoma presenting unique radiological features: a case report.

BACKGROUND: Chronic encapsulated hematoma is relatively rare and the exact mechanisms of this condition remain uncertain. In this report, we present a case of chronic encapsulated hematoma in the lateral ventricle and discuss the pathophysiology of this condition. CASE DESCRIPTION: A 68-year-old-woman presented with progressive gait disturbance. Magnetic resonance imaging (MRI) showed a dumbbell-shaped mass arising from the wall of the right lateral ventricle. The mass connecting to the ventricle wall mimicked a hemorrhagic tumor and the other part mimicked a cystic mass. Cerebral angiography demonstrated arteriovenous shunt in the right lateral ventricle wall. The operative findings revealed that the part arising from the ventricle wall contained hematoma showing various stages of coagulation and that the cystic mass visible on MRI was a granulomatous solid mass. Histologic examination revealed that the capsules of both were compatible with chronic encapsulated intracerebral hematomas. CONCLUSION: In the present case, one part of the mass contained only granulomatous tissue, indicating the possibility that the mass was undergoing spontaneous resolution. This fact might indicate that the presence of neo-vascularization in the capsule is not the sole factor in the expansion of hematoma.

Various risks of osteoporosis in patients with pituitary adenomas.

Some pituitary adenomas seem to be related to bone loss. It is unknown what kinds of pituitary adenomas affect bone mass. We attempted to determine what kinds of pituitary adenomas caused osteoporosis, and whether hormonal disturbance in pituitary adenoma patients affected bone mass. This study included 53 surgical patients (39 women of premenopausal age and 14 men) aged 21 to 62 years. We measured vertebral bone mineral density (BMD); various bone metabolic parameters, such as serum calcium, phosphorus, alkaline phosphatase, and blood urea nitrogen, parathormone, vitamin D, vitamin K, and hormonal activity in the anterior lobe of the pituitary gland. Comparisons were made of the mean Z scores (the ratio to the mean BMD of age-matched healthy Japanese women and men) among patient groups and controls. Compared with the female controls, the mean Z score was significantly higher in the women with acromegalic adenoma and significantly lower in those with adrenocorticotrophic hormone (ACTH)-secreting adenoma. In male patients, the mean Z scores were significantly decreased in prolactin-secreting adenoma and nonfunctioning adenoma, compared with that in normal controls. Acromegalic adenoma contributes significantly to vertebral bone mass acquisition, although ACTH adenoma may carry a significant risk of osteoporosis in female patients. Male patients with prolactin-secreting and nonfunctioning adenoma have a significant risk of bone decrease.

Hamartoma in the internal auditory canal.

An 11 year old girl presented with hearing loss in her left ear and left trigeminal and facial nerve palsy. Radiological examinations revealed an enlargement of the left internal acoustic canal and the existence of a mass protruding from the canal into the cerebellopontine angle. The partial resection of the mass by a suboccipital craniectomy resulted in ceasing the progression of her symptoms. Histological diagnosis was hamartoma with cerebellar heterotopia. The concurrence of heterotopic cerebellar tissue could help to understand the pathogenesis of hamartomas.

Both MK801 and NBQX reduce the neuronal damage after impact-acceleration brain injury.

To understand the pathogenesis of diffuse axonal injury, we investigated the temporal and spatial profiles of neuronal degeneration in impact-acceleration injury in rats using Fluoro-Jade (FJ) staining. Impact-acceleration injury was produced in Wistar rats by the method described by Marmarou et al. with some modifications. Animals were sacrificed 1, 2, 7, 14, or 28 days after injury. Paraffin-embedded coronal sections were stained with HE or FJ, or analyzed immunohistochemically for GFAP or amyloid precursor protein (APP). FJ-positive degenerative neurons were found primarily in the dorsal brainstem and thalamus from 1 to 2 days following injury and these were associated with GFAP expression. However, FJ-positive cells were rarely found after 7 days. In all rats, significant expression of APP was observed primarily in the cingulum, cerebral peduncle and pontomedullary junction. FJ also stained these injured axons. Intrathecal administration of both NMDA and AMPA/kinate glutamate receptor antagonists MK-801 and NBQX, respectively, reduced the neuronal injury. NBQX showed more significant effects on axonal injury than MK-801. These observations indicate that not only axonal damage, but also primary neuronal damage occurs in this impact-acceleration injury model. It is also suggested that NBQX can act both directly on neuronal cells and white matter and that NMDA could have a significant protective effect against not only neuronal, but also axonal injury.

Stereotactic radiosurgery for aggressive papillary tumor of the temporal bone: case report.

BACKGROUND: Papillary tumors of the temporal bone are very rare neoplasms that show locally aggressive behavior though they have low-grade histologic features. The best treatment for these tumors is a radical resection. However, if the tumor is very large, local invasiveness and hypervascularity can prevent surgeons from achieving a complete resection. As an additional treatment for the residual tumor, it remains controversial whether radiation therapy has any role. CASE DESCRIPTION: The authors describe a 53-year-old woman who suffered from left-sided tinnitus, hearing loss, and diplopia due to a large aggressive papillary tumor of the temporal bone. Radiosurgery was very effective for the tumor, which had regrown a few years after conventional radiation therapy and chemotherapy. CONCLUSIONS: The authors conclude that radiosurgery should be considered as an option for the treatment of aggressive papillary tumor of the temporal bone.

Fulminant subdural empyema treated with a wide decompressive craniectomy and continuous irrigation--case report.

A 56-year-old male presented with fulminant subdural empyema manifesting as rhinorrhea, periorbital cellulitis, fever, convulsions, and consciousness disturbance. Neuroimaging showed pansinusitis with skull destruction and extensive subdural empyema. Decompressive craniectomy, irrigation of the empyema, and subdural drainage were performed. Endoscopic sinus surgery was performed to remove the source of infection at the same time. Streptococcus milleri was cultured from the pus. Continuous irrigation of the subdural space with saline containing gentamicin for 7 days resulted in prompt elimination of pus and debris. The patient was discharged with only a slight neurological deficit.

Possible acute hemorrhagic leukoencephalitis manifesting as intracerebral hemorrhage on computed tomography--case report.

A 15-year-old girl presented with meningeal irritation and bilateral cerebral signs after contracting influenza. A lumbar puncture revealed bloody cerebrospinal fluid and polymorphonuclear predominant pleocytosis with an elevated protein level and normal glucose level. Computed tomography showed a hematoma in the right basal ganglia and lateral ventricles. Symmetrical low density areas were also noted in the bilateral white matter. The preliminary diagnosis was hemorrhagic cerebrovascular disease of unknown cause. However, her neurological condition deteriorated. Magnetic resonance (MR) imaging showed diffuse high intensity signals in the bilateral white matter and small spotty lesions, indicating hemorrhages in various stages. The final diagnosis was acute hemorrhagic leukoencephalitis (AHL). However, high-dose steroid administration and plasmapheresis failed to improve her condition. Hypothermia could not control her intracranial pressure and she died 12 days after admission. The neuroimaging findings indicated the histological characteristics of AHL, but the hematoma formation is rare. AHL is a fulminant form of brain demyelination and can be fatal, so early diagnosis and aggressive treatment are important for successful recovery. Therefore, early investigation by MR imaging is necessary.

A case of schizencephaly with subdural fluid collection in a neonate.

CASE REPORT: A neonate who had schizencephaly associated with ipsilateral chronic subdural fluid collection in the neonatal period is described. A boy was born to a healthy Japanese woman. After birth, the boy presented with rapid expansion of head circumference. Computed tomography (CT) and magnetic resonance images (MRI) of the head demonstrated left schizencephaly combined with a midline shift attributable to hydrocephalus. Thereafter, the patient gradually presented other symptoms caused by increased intracranial pressure. Ultrasonography and MRI of the head showed the presence of a subdural fluid collection overlaid on the schizencephaly. We identified the outer membrane by burr-hole craniotomy. CONCLUSION: This was a rare case of schizencephaly associated with hydrocephalus and the formation of ipsilateral chronic subdural fluid collection.