Authors retain the copyright of their work, and grant this journal the right of first publication with the work simultaneously licensed under a <a id="menurqt" class="fui-Link ___1q1shib f2hkw1w f3rmtva f1ewtqcl fyind8e f1k6fduh f1w7gpdv fk6fouc fjoy568 figsok6 f1s184ao f1mk8lai fnbmjn9 f1o700av f13mvf36 f1cmlufx f9n3di6 f1ids18y f1tx3yz7 f1deo86v f1eh06m1 f1iescvh fhgqx19 f1olyrje f1p93eir f1nev41a f1h8hb77 f1lqvz6u f10aw75t fsle3fq f17ae5zn" title="https://creativecommons.org/licenses/by-sa/4.0/" href="https://creativecommons.org/licenses/by-sa/4.0/" target="_blank" rel="noreferrer noopener" aria-label="Link Creative Commons Attribution-ShareAlike 4.0 License (CC BY-SA 4.0)">Creative Commons Attribution-ShareAlike 4.0 License (CC BY-SA 4.0), that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Biologic Therapies in Pediatric Asthma: A Clinical Review of Current Advances
Asthma is one of the most common chronic respiratory diseases in children and affects approximately 6%–7% of the global pediatric population. Despite advances in standard therapies such as inhaled corticosteroids and bronchodilators, a substantial subset of children continues to experience severe, uncontrolled disease that impairs quality of life and increases morbidity. The advent of biologic therapies targeting specific inflammatory pathways has transformed the management of severe pediatric asthma over the past two decades. This review summarizes the current evidence regarding biologic agents approved for pediatric use, including omalizumab, mepolizumab, dupilumab, and benralizumab. We discuss their mechanisms of action, clinical efficacy, safety profiles, and patient selection criteria. Evidence indicates that these targeted therapies can markedly reduce exacerbation frequency, improve lung function, and reduce corticosteroid dependence in appropriately selected patients. Persistent challenges include precise phenotyping, long-term safety monitoring, and limited accessibility owing to cost. Future research should emphasize biomarker-guided treatment strategies and their real-world effectiveness across diverse pediatric populations.
Copyright (c) 2025 Venkata Sushma Chamarthi, Sastry Chamarthi, Vignesh Gunasekaran https://creativecommons.org/licenses/by-nc-sa/4.0
Zika Virus Infection with Fatal Secondary Hemophagocytic Lymphohistiocytosis Syndrome as an Atypical Presentation
Rationale: Zika virus (ZIKV) is an uncommon tropical viral illness caused by a flavivirus transmitted by mosquitoes such as dengue virus, West Nile virus and yellow fever virus. Clinical manifestations of Zika virus infection are usually milder in nature. It usually presents with a self-resolving triad of fever, rash and polyarthralgia. There are very few case reports of severe or lethal cases. Patients concern: 66 years male patient was admitted with an acute febrile illness for 5 days and underwent evaluation for multiple organ dysfunction. He was diagnosed with Zika virus infection which was confirmed by polymerase chain reaction. He had rapid clinical deterioration with coagulopathy, resistant hypotension, multi- organ dysfunction with secondary Hemophagocytic Lymphohistiocytosis Syndrome (sHLH). He died within 72 hours of presentation. Diagnosis: Zika virus infection with secondary HLH syndrome. Interventions: The patient was admitted to the intensive care unit (ICU). He had multi-organ dysfunction and required mechanical ventilation, sustained low efficiency dialysis (SLED), vasopressors, steroids, intravenous immunoglobulin, antibiotics and supportive treatment. Outcomes: The patient succumbed to his illness within 72 hours of admission. Lessons: Zika infection though considered a mild illness, can rapidly evolve into a severe form of disease and can be lethal. There is a need for increased clinical awareness and watchfulness for such atypical presentations of ZIKV infection.
secondary Hemophagocytic Lymphohistiocytosis Syndrome
Copyright (c) 2025 Arun Agarwal, Sunil Godara, Sachin Chaudhary, Dhruval Trivedi, Hetashree Raval http://creativecommons.org/licenses/by-nc/4.0
Unusually Long Survival (More Than Five Years to More Than 31 Years) in Twelve Patients with Relapsed Medulloblastoma Treated with Antineoplastons in Phase II Studies
Background: Medulloblastoma (MB), a grade 4 embryonal neoplasm, is the most common malignant brain tumor in children and adolescents. Relapsed MB (RMB) carries a poor prognosis with less than 10% surviving more than 5 years post-relapse. Objective: Twelve patients with RMB were treated with Antineoplastons A-10 and AS-2-1 (ANP) according to phase II clinical studies. They are presented here, emphasizing unusually long survival and a lack of long-term negative sequelae. Methods: For clinical studies, the eligibility criteria had to include a Karnofsky/Lansky (KPS/LPS) score of at least sixty and at least a 2- month life expectancy. IV ANP was given to all patients, while some also received maintenance treatment with oral ANP. IV ANP infusions utilized a subclavian catheter and an automated pump. The maximum tolerated doses of A10 and AS2-1 were achieved. Outcome criteria were objective response, survival, and toxicity after ANP therapy. Results: The Kaplan-Meier Survival analysis for the 46 RMB patients gave a median survival of 2.42 years. Twelve of 46 RMB patients survived from more than 5 years to more than 31 years (26.1%). Five of these patients survived more than 12 years, a definition of cure. The patients were between the ages of 1.5 to 29.7 years old with a 9.2-year median age. LPS/KPS ranged from 50 to 100 with a median score of 60. One patient experienced a serious adverse event (somnolence), possibly attributed to ANP, from which he quickly recovered fully. Conclusions: ANP therapy shows promise for the long-term survival of RMB patients with no long-term toxicity.
Copyright (c) 2015 Stanislaw Rajmund Burzynski, Gregory Stanislaw Burzynski, Tomasz Jan Janicki, Radoslaw Jan Siwiec, Samuel Warner Beenken https://creativecommons.org/licenses/by-nc-sa/4.0
Factors Involved in Glucose Metabolism in Community-Dwelling Elderly Caregivers and Dementia Patients
Background: Caregivers of dementia patients are at higher risk of coronary heart disease (CHD) than non-caregivers, and diastolic blood pressure of caregivers is reportedly associated with the frequency of disruptive behaviors in dementia patients. Factors related to the higher risk of CHD in caregivers include the impact of stress on the autonomic nervous system and glucose metabolism, as well as poor blood pressure control. Elevated HbA1c levels have been reported to correlate with the likelihood of developing hyperglycemia under stress. Thus, identifying caregivers’ psychological stressors may help control elevated glucose metabolism. The present study aimed to identify factors that influence the levels of HbA1c, an important stress-related health indicator, in caregivers. Methods: This cross-sectional study assessed the association between HbA1c and hallucinatory symptoms (a peripheral symptom of dementia patients). Subjects were caregivers who provided care at home (hereafter, “caregivers”) and their care recipients with dementia (hereafter, “patients”). Results: Factors significantly associated with caregiver HbA1c were patient sex (OR: 5.423, P = 0.013, 95%CI: 1.435, 20.500), patient age (OR: 0.894, P = 0.049, 95%CI: 0.800, 1.000), and patient hallucinatory symptoms (OR: 0.635, P = 0.070, 95%CI: 0.388, 1.037). Discussion: The proportion of spousal caregivers tended to be higher than other types of caregivers. Caregivers likely felt more difficulty caring for their loved ones and had more anxiety and stress based on their sex. As dementia patients aged, caregivers may have acquired coping skills not only to address physical caregiving but also psychological symptoms associated with dementia. Conclusion: Our findings suggest that monitoring biochemical data is important for understanding the physical condition of and preventing diabetes and cardiovascular disease in caregivers, and highlight the importance of caregivers being aware of their own stress from an early stage.
Copyright (c) 2025 Akemi Hirano, Koichiro Ina http://creativecommons.org/licenses/by-nc/4.0
Clinical Audit of Birth Before Arrival at a Midwife Obstetric Unit from South Africa during 2018 to 2022
Given its link to maternal and perinatal morbidity and mortality, birth before arrival (BBA) is a public health concern. The purpose of this study was to evaluate the prevalence, trends, outcomes, and contributing factors of BBA among women who gave birth in a South African midwife obstetric unit between 2018 and 2022. A cross-sectional descriptive analysis was carried out among women who gave birth and saw a BBA right away using data from the labor ward birth registration. Variables with a p value of less than 0.05 were deemed significant, and descriptive statistics like frequency, cross table analysis, and binary logistic regression analysis were calculated. 4.8% of people had BBA (95% CI: 4.4, 4.9). Between 2018 and 2022, BBA decreased from 5.2% to 3.8% (p= 0.021). Women with nil parity (OR= 0.054, 95% CI; 0.021:0.140, p < 0.001), parity 1–2 (OR= 0.164, 95% CI; 0.076:0.350, p < 0.001), and parity 3–4 (OR= 0.27, 95% CI; 0.12:0.60, p = 0.001) were the variables linked to BBA in logistic regression. Comparing women who received ANC at KCHC to those who received ANC at another medical facility, the former had a lower OR of 0.63 (95%CI; 0.44:0.91, p = 0.014). Conversely, compared to women who had nine or more antenatal care (ANC) visits, those who had none (ANC visit 0 or never scheduled for ANC) had a higher OR of 3.41 (95%CI; 1.205:9.66, p= 0.021). Preterm birth (PTB) had an OR of 1.53 (95% CI: 1.05:2.22, p= 0.024), while Low birth weight (LBW) had an OR of 2.41 (95% CI: 1.53:3.79, p < 0.001). According to the survey, the prevalence of BBA is trending downward. These results demonstrated how crucial early ANC scheduling and sufficient prenatal care are to enhancing pregnancy outcomes.
Copyright (c) 2025 Akm Monjurul Hoque, Maariyah Hoque, Rafiul Hoque, Mir Anwar, Somaya Buckus, Abm Mahbub ul Alam http://creativecommons.org/licenses/by-nc/4.0
Antenatal Care Satisfaction and Willingness to Come Back to the Hospital in Southwestern Nigeria: A Qualitative study
Patient satisfaction is a subjective and dynamic perception of the extent to which the patient’s expected healthcare needs are met. If the pregnant women are satisfied with the quality of service received, they will be willing to come back. The aim of this study is to explore the satisfaction of the pregnant women in Ekiti State University Teaching Hospital, Ado-Ekiti and their willingness to use the facility. The study was a qualitative design with 36 participants in 4 FGD in the antenatal clinic of a tertiary hospital to explore the factors enhancing their satisfaction and their willingness to come back to the hospital. During the discussions, note was taken and recorded with an android phone. Discussions were transcribed and analysed by themes manually. Many of the participants were satisfied with the services received in the hospital. The following were the reasons for their satisfaction; competency, confidentiality, health talk and respect by the health workers. Due to these factors, they were willing to come back to the hospital and to recommend to others. Some were dissatisfied because of the high cost, stress of moving from one pay point to another and lack of regular power supply and shortage of doctors at the radiology department. The factors associated with dissatisfaction are modifiable, and if they can be improved upon utilization rate will increase. We therefore recommend that cost should be reduced, harmonise the pay points, employ more doctors and ensure regular power supply in the radiology department.
Perception of Pregnant women Satisfaction
Copyright (c) 2025 Oluremi Olayinka Solomon, Taiwo Hussean Raimi, Olusola Peter Aduloju http://creativecommons.org/licenses/by-nc/4.0
Predictive Factors of Mortality of Chronic Subdural Hematoma in Adults in Antananarivo Madagascar
Objective: To determine the poor prognostic factors of chronic subdural hematomas in the Neurosurgery Departments of the existing University Hospitals in Antananarivo, Madagascar. Methods: This was a multicenter, retrospective, cross-sectional, descriptive and analytical study of 125 cases of chronic subdural hematoma. Results: Poor prognostic factors for chronic subdural hematoma were age (OR: 4.4100; p = 0.005), male gender (OR: 4.354; p = 0.008), head injury (OR: 5.2250; p = 0.001), arterial hypertension (OR: 3.773; p = 0.028), ethylism (OR: 5.9639; p = 0.035), anticoagulant use (OR: 5.785; p = 0.001), altered general condition (OR: 3.4000; p = 0.001) and low Glasgow (OR: 14.444; p = 0.001). Conclusion: Identification of these mortality risk factors would be beneficial in improving and implementing appropriate management.
Copyright (c) 2025 Radotina Tony Andrianaivo, Mijoro Ramarokoto, Joseph Synese Bemora, Nivolalaiko Marcelle Rakotondrazanany, Willy Ratovondrainy http://creativecommons.org/licenses/by-nc/4.0
Trends and Risk Factors for Low-Birth Weight and Preterm Deliveries between 2018–2022 in a PHC Setting of South Africa
Background: Negative birth outcomes such as low birthweight (LBW) and preterm births (PTB) are public health concerns that require an understanding of the magnitude and risk factors for intervention. Objective: The objectives were to characterize the patterns of maternal demographics and antenatal care (ANC) variables that may be connected to PTB and LBW. Materials and Method: A retrospective cohort study focused on all pregnant women who gave livebirths of singleton babies at Kwadebeka Community Health Centre between January 2018 and December 2022. Data was collected from the birth registration. Cases were categorized as either having or not having PTB, LBW, and both PTB and LBW babies. Each dependent variable of interest was subjected to an independent model. Adjusted odds ratios (OR), matching two-sided 95% confidence intervals (CI), and related p-values were used to express the outcomes of regression models. A p-value of less than 0.05 was deemed significant. Results: A total of 4116 women were registered in the birth register, 48 of whom had stillbirths and delivered multiple babies, and they were excluded from the analysis; thus, 4057 women were the study’s sample. Overall, 8.4%, 15.7%, and 5.6% of women had LBW, PTB, and both LBW and PTB, respectively, showing no annual trend. Logistic regression for PTB showed that ANC at KCHC had a higher OR = 1.4 (95% CI:1.1-1.8, p = 0.004), having no ANC OR = 9.3 (95% CI:3.94-22.22, p < 0.001) and number of ANC visits between 1–3 had OR = 3.85 (95% CI:2.42–6.13, p < 0.001) respectively. On the other hand, having no BBA and no LBW had lower ORs of 0.47 (95% CI:0.28-0.79, p = 0.004) and 0.11 (95% CI:0.08-0.16, p < 0.001) respectively. Variables showed lower ORs of 0.38 (95% CI:0.22-0.67, p < 0.001), 0.33 (95% CI:0.13-0.63, p = 0.002), 0.11 (95% CI:0.08-0.16, p < 0.001) and 0.69 (95% CI:0.49-0.97, p = 0.037) for not having BBA, not having syphilis, not having PTB and having ANC at KCHC respectively for LBW babies. On the contrary, having no ANC (0 visits) showed a higher OR of 2.90 (95% CL:1.24-6.78, p = 0.014). Conclusion: PTB and LBW continue to be common problems at some of the PHC facilities, particularly among those women who do not attend ANC, have low numbers of ANC visits, attend late for ANC, have BBAs, and have syphilis infection. Several types of programs, such as specific medical procedures to broad-scale public health interventions such as screening for risk factors, socioeconomic insufficiencies, and educational programmes should be undertaken simultaneously.
Copyright (c) 2025 Akm Monjurul Hoque, Maariyah Hoque, Rafiul Hoque, Mir Anwar, Somaya Buckus http://creativecommons.org/licenses/by-nc/4.0
ESBL—Multi-Drug-Resistant UTI Creating Outpatient Treatment Challenge
Urinary tract infections (UTIs) are more common in female patients than males in all age groups. Some of the underlying risk factors increase the chances of UTI in male patients as well. Known risk factors like previous antibiotic use, catheterization history, nursing home residence, and previous hospitalizations are associated with drug-resistant UTIs, especially extended-spectrum beta-lactamase (ESBL). The presence of ESBL narrows down the treatment options. This case represents the patient with Klebsiella pneumoniae ESBL multidrug resistance (MDR) UTI, which was complicated by the history of previous pseudomonas UTI. The bacteria were sensitive only to injectable antibiotics, leaving no oral antibiotic options for treatment. This posed a significant challenge in managing the patient’s condition. UTI is the most commonly known cause of delirium and confusion in old age patients, so prompt treatment of UTI in these patients is paramount. This case highlights the need for further research to establish optimal antibiotic choices, particularly in the outpatient setting, for timely and adequate treatment of ESBL MDR UTI cases.
Copyright (c) 2025 Anshuman Srivastava, Sandhya J. Kadam, Rishika Sharma http://creativecommons.org/licenses/by-nc/4.0
Triple Negative Breast Cancer (TNBC) Prognostic Value of Micro RNA-454 Expression for Overall Survival
Breast cancer is the most common type of cancer and the primary cause of death among women who have been diagnosed with cancer. Luminal A, Luminal B, HER2/neu+, and Triple Negative Breast Cancer are the four subtypes that are used to classify breast cancer. Currently, there is no specific targeted therapy for triple-negative breast cancer (TNBC), resulting in a brief median recurrence time and unfavorable prognosis. Recent studies have demonstrated that miRNA-454 plays an oncogenic role in several different malignancies, and this role is associated with the growth, invasion, and metastasis of tumors. We analyzed miRNA-454 expression in 50 paraffin-embedded tissue samples from TNBC patients at Dr. Sardjito Hospital Yogyakarta utilizing qRT-PCR. The purpose of this research was to determine whether or not the expression of miRNA-454 is useful to forecast survival in patients with stage I-III transformational breast cancer. Methods: This investigation was a retrospective cohort study utilizing data from clinical TNBC patients at Dr. Sardjito Hospital in Yogyakarta from 2014 to 2017. Fifty patients were incorporated into the analysis. Data on clinicopathological features were documented. The results of the univariate analysis showed that patients with high miRNA-454 expression had a higher probability of dying within two years compared to those with low miRNA-454 expression (79.2% versus 53.8%; HR = 4.334; P = 0.037). Multivariate analysis indicated that elevated miRNA-454 expression heightened the 2-year mortality risk, with a hazard ratio of 3.086 (95% CI: 1.082-8.806; p=0.035). Conclusions: The expression of MiRNA 454 serves as an independent prognostic indicator for survival in patients with triple-negative breast cancer (TNBC). Patients with triple-negative breast cancer with elevated miRNA-454 expression demonstrate a reduced survival rate. The expression of miRNA-454 is also a factor that can be used to predict the therapeutic response in TNBC.
Copyright (c) 2025 Dita Ria Selvyana, Ibnu Purwanto, Mardiah Suci Hardianti http://creativecommons.org/licenses/by-nc/4.0
Adenoid Cystic Carcinoma of the External Auditory Canal: A Case Report and Literature Review
Adenoid cystic carcinoma is an uncommon neoplasm that originates from the salivary glands, particularly when it developed in the external ear canal. Perineural invasion of this tumor requires aggressive treatment with surgical resection followed by adjuvant radiotherapy. We report a rare case of adenoid cystic carcinoma in a 71-year-old male patient, manifesting with symptoms of hypoacusis and a visible tumor of the external auditory canal. The patient underwent a successful surgery using a radical mastoidectomy followed by radiotherapy as part of her treatment regimen.
Copyright (c) 2025 Driss Elidrissi, Youssef Lakhdar, Omar Oulghoul, Mohamed Rami, Mohamed Chehbouni, Othman Benhoummad, Youssef Rochdi, Abdelaziz Raji http://creativecommons.org/licenses/by-nc/4.0
Implications and Learnings of Measles Outbreak Through a Clinician’s Lens; Mumbai, India 2022–2023
Background: The COVID-19 pandemic has disrupted preventive healthcare, including routine vaccination coverage and surveillance systems. According to the WHO, approximately 40 million children missed measles-containing vaccine (MCV) doses between 2020 and 2021, posing a global threat of measles outbreaks. Objective: This study aimed to investigate the clinical and demographic profiles of suspected Measles children visiting tertiary care hospitals during the measles outbreak in Mumbai, India, during 2022–2023. Methods: A prospective, descriptive study was conducted at a tertiary care hospital in Mumbai from October 2022 to March 2023. The study included 100 consecutive patients aged 1 month to 14 years admitted to the pediatric ward with fever and maculopapular rash. Data collection involved clinical and demographic information, with analysis using Microsoft Excel 2010 and SPSS V23. Chi-square tests and Fisher’s Exact test were applied to evaluate associations between various factors and outcomes. Results: Among the 100 patients, 32 (32%) were under 9 months, 43 (43%) were between 9.1 to 60 months, and 25 (25%) were over 60 months. Male preponderance was seen with a total of 57 (57%) male patients. The study found 62 (62%) of patients were unvaccinated. Clinical presentations included prodromal symptoms 89 (89%), breathing difficulties 34 (34%), GI symptoms 30 (30%), and complications like pneumonia (32%), acute gastroenteritis (17%), and otitis media (8%). Out of 100 patients, 96 were cured and discharged while 4 patients died. All 4 fatalities were among unvaccinated patients, emphasizing the importance of vaccination. Conclusion: The study highlights mortality and morbidity following the resurgence of measles due to decreased vaccination rates during the pandemic. It underscores the need for improved routine and supplementary immunization activities to achieve measles elimination targets. Additionally, the study raises the question of whether the age for the first measles dose should be reduced to 6 months due to the observed waning immunity from maternally transferred antibodies. The real threat of this outbreak will be the long-term sequalae- Subacute Sclerosing Pan Encephalitis (SSPE) which is anticipated to rise in the coming years.
Copyright (c) 2024 Bela Verma, Vinita Tripathy, Meeta Vashi, Suhani Jain http://creativecommons.org/licenses/by-nc/4.0
Brain MRI Abnormalities in Saudi Children with SCA, Retrospective Cohort, Single-Center Experience
Background: Sickle cell anemia (SCA) is a severe healthcare issue in Saudi Arabia. A considerable proportion of SCD patients may experience neurological complications over their lifetime, including infarction, silent ischemia, intracranial hemorrhage, then brain atrophy, and cognitive impairment. Aim: To identify the clinical and brain-imaging findings in SCD subjects with suspected neurological complications in Saudi Arabia and the impact of Hydroxyurea (HU) and chronic transfusion program. Methods: This cohort was undertaken at King Fahad Medical City, Riyadh, between October 2022 and September 2023. A total of 100 consecutive patients aged 2–18 years with homozygous sickle cell disease were included. All subjects underwent an MRI. Result: Abnormal brain MRI was found among 30% of the subjects, and the most common abnormal findings were SCI (16%) and CVA + moyamoya (9%). Of the patients, 46% received HU, and 25% received chronic transfusion programs. The HU group has less CVA + Moya-Moya and less SCI (p = 0.002) and tended to have normal TCD (p = 0.001). TCD was commonly abnormal among 66.7% of patients with CVA + moyamoya and 56.3% of SCI patients (p < 0.001). Conclusion: Neurologic sequences of SCD are a major health issue in Saudi Arabia and impact children’s quality of life. The most common complications were SCI and CVA combined with moyamoya.
Copyright (c) 2024 Mai Al Qasimi, Mohamad Rayis, Sofia Muzzafar, Rawan Alnofee, Rana Alaskar, Ahmed Eidaan, Bader Abdulkareem http://creativecommons.org/licenses/by-nc/4.0
Systemic Vitamin E in Modern Skin Therapy: A Comprehensive Review
With its strong line defense and an essential nutrient in the dermatological field in treating various skin conditions. Antioxidants have always been a topic of interest with their antitumorigenic effects or in protecting cells from reactive oxygen species. One of the most important antioxidants in the body is vitamin E, with its lipid-solubility and regenerative mechanism. This article review focuses on various uses of vitamin E in its systemic form. Numerous clinical trials have been testing various dosages across all ages of the population, such as atopic dermatitis, vitiligo, and other diseases, along with the newest technologies used to bring out the effectiveness of this unique molecule.
Copyright (c) 2025 Mohammed Al Abadie, Marwah Mahfoudh, Al-Hussein Al-Rawi http://creativecommons.org/licenses/by-nc/4.0
Anastomotic Integrity in Colorectal Surgery for Colorectal Cancer: The Role of Protective Ileostomy and the Corner Effect
Anastomotic leakage is one of the most significant complications following low colorectal surgery for rectal cancer, with profound implications on morbidity, mortality, and long-term oncological outcomes. Protective ileostomy has been widely adopted to mitigate these risks by diverting fecal flow away from the anastomotic site, allowing it to heal without exposure to bowel contents. However, recent discourse challenges the routine use of protective ileostomies, suggesting a more selective approach based on patient-specific risk factors, surgical techniques, and intraoperative findings. This review examines the multifactorial nature of anastomotic failure, focusing on the impact of patient comorbidities, neoadjuvant therapies, surgical expertise, and technological advances, such as fluorescence angiography with indocyanine green (ICG), to assess tissue perfusion. The concept of the “corner effect” in low colorectal anastomoses, where tension and ischemia at stapled junctions predispose to leakage, is discussed. The review also explores the implications of long-term ileostomy use, including its association with Low Anterior Resection Syndrome (LARS) and delayed recovery. Further, we address gaps in the literature regarding the timing of ileostomy reversal, the influence of neoadjuvant therapy on anastomotic healing, and the potential role of bioabsorbable materials in reinforcing anastomoses. The review calls for a more personalized approach to protective ileostomy use, integrating patient characteristics, surgical expertise, and technological advancements to optimize outcomes in colorectal cancer surgery.
Copyright (c) 2024 Amália Cinthia Meneses do Rêgo, Irami Araújo-Filho http://creativecommons.org/licenses/by-nc/4.0
Assessing the Impact of Hyperthermic Intraperitoneal Chemotherapy on Anastomotic Integrity after Cytoreductive Surgery in Gastrointestinal Malignancies
Peritoneal carcinomatosis (PC) from gastrointestinal malignancies, particularly colorectal and gastric cancers, represents a significant therapeutic challenge due to the diffuse nature of tumor spread. The combination of cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as a promising treatment modality, offering potential survival benefits by targeting residual microscopic disease. However, this aggressive approach is associated with a heightened risk of gastrointestinal anastomotic leaks, one of the most severe complications of gastrointestinal surgery. These leaks result from a complex interplay of factors, including hyperthermia-induced ischemia, chemotherapy-induced cytotoxicity, and a pro-inflammatory cytokine cascade involving IL-6, TNF-α, and IL-1β, which impair tissue healing. Furthermore, dysbiosis of the intestinal microbiota induced by HIPEC contributes to local inflammation and an increased risk of infection, exacerbating the likelihood of anastomotic failure. The duration and temperature of the HIPEC procedure, the extent of surgery, and the patient’s performance status and tumor burden further influence the risk of leaks. Preventive strategies such as preoperative nutritional optimization, meticulous surgical technique, intraoperative reinforcement of anastomoses, and selective use of protective ileostomies are critical for minimizing these risks. Early detection and prompt management of leaks are essential for reducing morbidity and mortality, improving both short-term and long-term outcomes. This review comprehensively examines the multifactorial causes of anastomotic leaks in the setting of CRS and HIPEC and highlights potential strategies for prevention and improved management.
hyperthermic intraperitoneal chemotherapy
Leveraging Artificial Intelligence to enhance the Quality of Life for patients with Autism Spectrum Disorder: A Comprehensive Review
Integrating Artificial Intelligence (AI) into healthcare, specifically for managing autism spectrum disorder (ASD), offers transformative potential to enhance diagnostic accuracy, personalize treatment, and improve patient outcomes. This review explores the application of various AI programs in ASD management, discussing their functionalities, ethical considerations, implementation challenges, and the need for comprehensive regulatory frameworks. Critical AI applications such as AI-driven diagnostic imaging, predictive analytics, assisted therapy robots, remote monitoring, treatment personalization, decision support systems, and therapeutic chatbots are examined. Each technology is analyzed for its ability to improve the quality of life for individuals with ASD by offering more personalized, efficient, and effective care and support. Ethical issues, particularly concerning data bias and privacy, are highlighted as significant challenges that need addressing to maximize AI’s benefits while minimizing risks. Practical hurdles like integration with existing healthcare systems, the need for scalable solutions across diverse geographic and socio-economic contexts, and the high costs associated with AI development are also discussed. Furthermore, the review underscores the necessity for robust regulatory policies that ensure patient safety, protect data privacy and maintain high ethical standards in AI deployment. The paper concludes that while AI presents substantial opportunities for advancing ASD management, achieving these benefits requires a concerted effort from technologists, clinicians, ethicists, and policymakers to develop AI tools that are not only innovative but also ethical, equitable, and universally beneficial.
Assessment of Risk Factors for Women with Iron Deficiency Anemia During Pregnancy
Background: Globally, iron insufficiency is the most common nutrient deficiency and the primary cause of anemia. Iron deficiency can result in maternal anemia and decreased infant iron reserves due to increased iron demand during pregnancy. Objective: The study was designed to assess the risk factors encountered during pregnancy among pregnant women with iron deficiency anemia. Materials and Methods: The study was conducted on one hundred pregnant women enrolled on the health care centers who were diagnosed as anemic. The data were obtained from all through direct interviews using a special questionnaire covering the sociodemographic characteristics, diet habits, and supplements taken during pregnancy. The one-way ANOVA test analysis was done to see the association of each variable with the anemia severity. The probability value <0.05 was considered statistically significant. Results: The results indicated that there was no statistically significant relation between iron deficiency anemia and all the socio-demographic characteristics which included; age, parity, educational level, occupation, family size, and gestational age. While there is a highly statistically significant relation between iron deficiency anemia and diet habit of pregnant women regarding the frequency of intake of meats, fishes, vegetables, and fruits at p-value = 0.001, intake pulse at p-value = 0.012, intake of nuts at p-value = 0.021, and drinking tea at p-value = 0.001. Conclusion: Educating pregnant women to eat iron-rich foods may be useful as a strategy for reducing iron deficiency anemia during pregnancy, also using of iron supplements, folic acid and vitamin B12 is regarded as a successful way to treat anemia.
Copyright (c) 2024 Maha Abdulredha Muhsen, Dheya Shinyar Hamad http://creativecommons.org/licenses/by-nc/4.0
Intermittent Fasting on Cancer: An Update
Intermittent fasting (IF) has garnered considerable interest as a dietary intervention with potential therapeutic benefits for various medical conditions, particularly cancer. This review provides a comprehensive update on the effects of IF on cancer, emphasizing its impact on metabolic, hormonal, and cellular mechanisms. IF has been shown to improve glycemic control and reduce liver enzyme levels in patients with non-alcoholic fatty liver disease (NAFLD), suggesting a reduction in liver cancer risk. It can significantly reduce tumor growth and enhance apoptosis in breast cancer by lowering insulin-like growth factor 1 (IGF-1) levels. In patients with polycystic ovary syndrome (PCOS), IF offers superior metabolic and hormonal regulation, potentially lowering cancer risk. IF mitigates chemotherapy-related toxicities, thereby improving patient quality of life. It modulates metabolic pathways, reduces inflammation, and enhances drug delivery in cancer therapy. Personalized dietary strategies, including IF and ketogenic diets, are crucial in cancer care. IF also benefits liver conditions by reducing inflammation and fibrosis, preventing the progression to hepatocellular carcinoma. In obesity-induced triple-negative breast cancer, IF disrupts critical processes involved in cancer progression. In addition, aligning IF with circadian rhythms has shown promise in treating lung cancer. Patient perspectives reveal that IF is feasible and acceptable, improving treatment adherence and quality of life. Overall, IF represents a multifaceted approach to cancer prevention and therapy. This review advocates for further research to establish standardized guidelines for implementing IF in oncology, aiming to develop more effective and holistic cancer treatment strategies.
Copyright (c) 2024 Amália Cinthia Menseses do Rêgo, Irami Araújo-Filho http://creativecommons.org/licenses/by-nc/4.0
Effect of Immunosuppressive Therapy After Liver Transplantation and the Relationship Between Changes in the Gut Microbiome and Graft Rejection
Solid organ transplantation, particularly liver transplantation, necessitates the use of immunosuppressive therapy to prevent organ rejection. However, these agents profoundly affect the gut microbiota, whose altered state can significantly impact transplant outcomes. This review synthesizes current knowledge on the interactions between immunosuppressants and the gut microbiota and explores the mechanisms by which these interactions affect graft survival and rejection. Immunosuppressive drugs, including cyclosporine, tacrolimus, sirolimus, mycophenolate mofetil, prednisone, and azathioprine, are known to cause dysbiosis by decreasing microbial diversity and favoring pathogenic bacteria and fungi. This disruption can lead to increased susceptibility to infections, chronic inflammation, impaired drug metabolism, and direct effects on graft rejection. The review also discusses the potential of modifying the gut microbiota to improve transplant outcomes through dietary interventions, probiotics, prebiotics, and fecal microbiota transplantation (FMT). These interventions aim to restore a healthy microbial balance, enhance immune tolerance, and reduce the incidence of graft rejection. The paper highlights the need for integrated approaches that consider the microbiome’s role in transplantation and outlines future directions for research and clinical practice, aiming to optimize the management of transplant recipients. By understanding and manipulating the gut microbiome, new therapeutic strategies could revolutionize transplant medicine, reducing complications and improving the quality of life for recipients.
Self-Efficacy and Determinants of Newborn Resuscitation Practices among Healthcare Professionals in Chipata District, Eastern Province, Zambia
Background: Effective newborn resuscitation in healthcare institutions depends on factors like supervisor support, knowledge, availability of functional equipment, and self-efficacy of healthcare professionals. This study investigated self-efficacy and related factors in newborn resuscitation among healthcare professionals in Chipata District Health facilities. Methodology: This cross-sectional study involved 85 healthcare professionals selected through simple random sampling. Data were collected using a self-administered questionnaire on self-efficacy for newborn resuscitation, completed after obtaining consent. Data analysis was performed using SPSS version 21, employing Pearson chi-square or Fisher’s exact tests. A multivariate binary logistic regression model analyzed associated factors, with significance set at p < 0.05. Results: Overall, 69% of respondents exhibited high self-efficacy in newborn resuscitation. Among females, 88.5% reported low self-efficacy compared to 11.5% of males. High self-efficacy was seen in 83.1% of those trained in the past five years. Additionally, 58.8% demonstrated high knowledge levels. Supervisor support was reported by 56%, but 85.7% of facilities lacked functional resuscitation equipment and supplies. Conclusion: Despite high self-efficacy levels, gaps remain in the provision of newborn resuscitation and professional self-efficacy. Ineffective supervision and lack of resuscitation equipment hindered practice experience and full commitment, especially among female participants.
Copyright (c) 2024 Mwanida Daka, Anatolii Tsarkov, Petro Petlovanyi, Maureen Masumo Makoleka, Gabriel Lungu, Gabriel Mpundu, Estella Mukuka Chanda, Crecious Phiri http://creativecommons.org/licenses/by-nc/4.0
Prevalence and Incidence of Hypertension and Diabetes Mellitus Among HIV-Infected Individuals Receiving HAART in Chongwe District, Lusaka Province, Zambia
Background: The Zambia National Health Strategic Plan (ZNHSP) 2011–2017 underscores the need for community-level risk factor stratification to bolster insufficient incidence and prevalence data. This study evaluates the prevalence and incidence of hypertension and diabetes mellitus in HIV-infected patients on Highly Active Anti-Retroviral Therapy (HAART) and assesses associations with ARV use. Methodology: A retrospective cohort analysis was conducted using the SMART CARE database in Chongwe district, involving 2070 HIV-infected persons on HAART. Statistical analysis included Chi-square, Kruskal-Wallis tests, and logistic regression. Results: Among participants, 33.8% exhibited hypertension, with an incidence case fatality rate of 85.7 per 1000 person-years (PYFU). Hypertension was notably higher in men (64%) than women (49%) and prevalent in the 18–45 age group (57.2%). The incidence of type II diabetes was 37.4 per 1000 PYFU. Logistic regression highlighted significant predictors for both conditions, including ART combination, age, and smoking status. Conclusion: High prevalence and incidence rates of hypertension and type II diabetes were observed among HIV-positive individuals on HAART. Certain HAART combinations, particularly twoNRTIs plus a PI or INSTI, correlated with increased hypertension risk, while combinations including NNRTI or INSTI were linked to higher diabetes incidence.
Copyright (c) 2024 Bona Mwiinga Hamoonga, Anatolii Tsarkov, Petro Petlovanyi, Pamela Ayiera Marinda, Chiza Kumwenda, Tom Joseph Oguta, Evans Musonda, Crecious Phiri http://creativecommons.org/licenses/by-nc/4.0
Determinants of Prenatal Depression in Teenage Pregnant Women: A Comparative Study of Urban and Rural Settings in Lusaka Province, Zambia
Background: Perinatal depression manifests during or after pregnancy, with prenatal depression occurring during pregnancy. Traditionally, research has focused more on postpartum depression, with less attention on prenatal depression among teenagers. Objective: This study aims to examine the correlates of prenatal depression among teenage pregnant women aged 13 to 17 and to explore the relationship between these factors and depression. Methods: A cross-sectional study was conducted at a university teaching hospital and a rural health facility, involving 105 pregnant teenagers. Initial screenings to assess depression were performed using the Edinburgh Postnatal Depression Scale, complemented by psychosocial evaluations with the Perceived Stress Scale and the Rosenberg Self-Esteem Scale. Data analysis was carried out using SPSS version 20, employing both descriptive and inferential statistical methods to interpret the findings. Results: Significant factors influencing prenatal depression included attempts to abort, stress, social support, household income, education level, and marital status. Logistic regression confirmed the significance of these correlates. Conclusion: Multiple factors influence prenatal depression in teenage pregnant women. The findings highlight the need for targeted preventive care and early interventions by medical professionals to improve health outcomes for mothers and infants.
Copyright (c) 2024 Maureen Mwalungali, Petro Petlovanyi, Anatolii Tsarkov http://creativecommons.org/licenses/by-nc/4.0
Innovative Topical Therapy for Otic Eczema
An innovative topical treatment for psoriasis and atopic dermatitis has recently received patent approval from the Spanish Ministry of Industry, Trade, and Tourism. This topical treatment Psorisbye, presented in the form of a lotion, includes a combination of clobetasol, papaverine hydrochloride, spironolactone, a milk-peptide complex, and propylene glycol. A 56-year-old female presented to our outpatient clinic with bilateral otic eczema. The patient had no significant past medical history and primarily complained of intense pruritus in the lesions. The patient was advised to use our recently patented lotion, Psorisbye, once daily for 7 days. Two days after beginning the treatment, the patient experienced significant relief from itching sensations. By the 8th day, during an examination at the outpatient clinic, a notable improvement in the scaled lesions was observed. While the preliminary results exhibited by Psorisbye in the context of this specific case are indeed promising, the imperative to establish its efficacy and reliability necessitates the initiation of further investigations characterized by more expansive sample sizes and prolonged follow-up periods.
Copyright (c) 2024 José Miguel Ingelmo Calvo, José Ruiz Cobo, Mohamed Farouk Allam http://creativecommons.org/licenses/by-nc/4.0
Functional Evolution of Spinal Cord Injury Patients Followed by the Rehabilitation Team Residing Outside the Capital of Antananarivo
Spinal cord injury rehabilitation is a complex and continuous process aimed at improving patients' functional capacity and quality of life. The objective of this study was to assess the progress of spinal cord injury patients followed by the rehabilitation team residing outside Antananarivo. A prospective descriptive cross-sectional study was conducted over a period of seven years, from 2015 to 2022, involving all patients who had previously consulted the Rehabilitation Department at CHU-JRA. Follow-up through telephone calls and/or during follow-up consultations was carried out. Of the 50 included patients, a male predominance of 76% was observed, with a mean age of 46 years. The majority were paraplegic (84%), with an ASIA classification predominantly in category A. Only 16% benefited from rehabilitation sessions in a specialized center, while 84% practiced exercises at home. Only 10% of patients achieved a high level of functional independence. However, 62% developed pressure ulcers, and the mortality rate was 28%. The study highlights the urgent need to improve accessibility to rehabilitation services in rural areas and outside the capital, as well as the importance of mastering self-rehabilitation exercises to maintain the autonomy acquired during rehabilitation sessions at the rehabilitation center.
Copyright (c) 2024 Andréa Holiarisoa Raharinantenaina, Zoniaina Valerien Herinandrianina, Synèse Joseph Bemora, Gaëtan Duval Solofomalala http://creativecommons.org/licenses/by-nc/4.0
Impact of Menopausal Hormonal Therapy on Anti-SARS-Cov-2 Antibody Titers in Middle-Aged Women
Aim: Postmenopausal women often contract the common cold. Following treatment with HRT, symptoms resolve in some women. We hypothesize menopausal hormone therapy (MHT) may increase anti-SARS-Cov-2 IgG antibody titers, leading to greater resilience against COVID-19 infection. Methods: 219 patients were enrolled. Anti-SARS-Cov-2 IgG antibody titers were measured, and the number of days since the second SARS-Cov-2 vaccination was recorded. Linear regression analysis was performed to examine the relationship between these two variables for patients receiving MHT, patients with rheumatoid arthritis (RA) receiving methotrexate and non-MHT/non-RA (NMR). Analysis was further divided into groups aged <50, age 50 to 60, and age >60. Results: Anti-SARS-Cov-2 IgG antibody titers in the MHT group were significantly higher than NMR aged >50 (p < 0.05). In addition, anti-IgG antibody values in NMR were significantly higher than in patients with RA aged >60 (p < 0.05). Conclusion: MHT results in increased production of anti-SARS-Cov-2 IgG antibodies in women aged >50. This may confer additional protection against SARS-Cov-2 infection. Women with RA on methotrexate over 60 have lower antibody titers than NMR aged >60.
Key words: SARS-Cov-2 infection, vaccine, anti-SARS-Cov-2 IgG antibody, menopausal hormone therapy (MHT), Methotrexate (MTX), non-MHT/non-RA (NMR)
Copyright (c) 2024 Kiyomitsu Miyachi, Kayoko Yamamoto, Belinda Sasse, Kazuhito Murata, Akiko Ihara, Takao Koyama http://creativecommons.org/licenses/by-nc/4.0
A Report on a Case and Literature Review on Cervical Sympathetic Chain Schwannoma that Mimics a Paraganglioma
Background: Cervical sympatric schwannoma is a rare benign tumor originating from de Schwan cells. Its clinical presentation is misleading and it can remain asymptomatic for a long time. Mostly, it appears as slow slow-growing cervical mass and may be a differential diagnosis with other neck masses such as paragangliomas. We discuss a case of Cervical sympatric schwannoma and go over its radiological, surgical, and surgical characteristics. Case Presentation: With no prior medical history, a 61-year-old lady appeared with a right cervical mass that had been present for over two years but had lately grown in size without causing dysphagia, dysphonia, or dyspnea. Clinical examination found a firm, slightly pulsatile, non-painful latero-cervical mass measuring 2 × 3 cm. Without other abnormalities on examination of the upper aerodigestive tract or thyroid gland and no neurological deficit. Cervical Ultrasound showed an oval tissular mass with regular contours in close contact with the right common carotid artery. Computed Tomography showed a right superior jugulocarotid mass located behind the vascular axis of the neck with early central vascularization. On magnetic resonance imaging (MRI), this mass was well limited, hypointense on T1 and hyper-intense on T2 with intense contrast enhancement, corresponding to a paraganglioma or schwannoma. A full blood work came back negative. Our patient underwent a complete surgical excision of the tumour which originated in the deep branches of the cervical plexus. Following surgery, the patient had Horner’s syndrome, histopathology confirmed the diagnosis of schwannoma. Conclusions: It is still challenging to differentiate between cervical sympathetic chain schwannoma and paraganglioma clinically and radiological. In the case of the schwannoma surgical approaches must be as conservative as possible to avoid damages of the origin nerve and the patient must be aware of the possibility of Horner syndrome.
Copyright (c) 2024 Youssef Lakhdar, Youssef El Khalifa, Aitlhadj Mohamed Amine, Othman Benhoummad, Youssef Rochdi, Abdelaziz Raji http://creativecommons.org/licenses/by-nc/4.0
Prevalence of Malaria among Under-5 Children in a Secondary Care Level, Ondo State, Nigeria
Background: Malaria continues to be a leading cause of ill health among children. Globally, this infection remains the major cause of morbidity and mortality especially among the under-five. Aim: The aim of the study was to investigate and document the prevalence of malaria infection among age groups, genders, birth orders, and blood groups of children who attend a secondary health care level, south-west, Nigeria. Subjects and Methods: Blood samples of 500 children whose ages ranged between 1 day and 5 years were collected through venipuncture, and these were tested for malaria parasites through the microscopy method, positivity was confirmed by Polymerase Chain Reaction (PCR) test. It was a hospital-based cross-sectional study. The children were recruited from various points of entry into the hospital which included the emergency room, newborn unit, and outpatient department (OPD). Data analyses were done using the SPSS statistical software and p-value < 0.05 was considered significant. Results: The prevalence of malaria among the neonates (age group 0 to 28 days) was 60.2%, the prevalence of malaria was 49.2% among the infants (aged 29 days to 1 year) while the prevalence was 52.9% among children aged 1 to 5 years (χ2 = 0.004, p < 0.05). The gender prevalence of malaria infection was 30.4% for males and 21.8% for females (χ2 =0.000, p<0.05). The prevalence of malaria infection among birth orders showed that children in the first, second, third, fourth, and fifth birth orders are 41.0%, 28.0%, 22.6%, 5.4%, and 3.1%, respectively (χ2 = 0.0210, p < 0.05). Prevalence of malaria among the blood groups are; A− (1.92%), A+ (13.41%), B− (1.15%), B+ (19.54%), O− (6.51%), O+ (51.73%), AB− (0.38%) and AB+ (5.36%). Conclusion: There is a high prevalence of malaria among the children examined in this study, there is therefore the need to intensify efforts to reduce the burden of the infection in the study area, especially among the children.
Copyright (c) 2024 Rosena Olubanke Oluwafemi, Olajide Joseph Afolabi, Mobolanle Oladipo Oniya http://creativecommons.org/licenses/by-nc/4.0
Relationship between Atherosclerosis Risk Factors and Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Graft
Background: Evaluation of the risk factors of atherosclerosis and carotid artery stenosis have been subjected to several investigations. The present study was conducted to determine the degree of carotid artery stenosis and investigate the relationship between atherosclerosis risk factors and coronary artery involvement in coronary artery bypass graft (CABG) patients. Methods: This cross-sectional study was conducted on 450 CABG candidate patients who visited Shahid Beheshti Hospital in Qom. The patients were divided into 4 groups according to the degree of carotid artery stenosis and were examined in terms of risk factors for atherosclerosis and coronary artery involvement. Finally, the data were analyzed using SPSS statistical software. Results: In total, about 18% of the patients had carotid artery stenosis, of them 13.6% had stenosis of less than 50%, 3.2% had stenosis of 50%–70%, and 1.2% had stenosis of more than 70%. Age, history of hypertension (HTN), hyperlipidemia, and previous history of cerebrovascular accident (CVA) showed a significant relationship with carotid artery stenosis. However, gender, BMI, diabetes, history of smoking, history of angiography and lipid profile of the patients did not show a significant relationship. Also, the incidence of CVA after CABG was 1.2%. Conclusion: The present study showed that old age, HTN, hyperlipidemia, and history of CVA are directly related to the severity of carotid artery stenosis.
Copyright (c) 2024 Mohammad Saleh Sadeghi, Leili Iranirad, Negar Vakili Razlighi, Fatemeh Lotfi, Hadi Vakili Razlighi, Mohammad Miri http://creativecommons.org/licenses/by-nc/4.0
The Reality of the Management of Spinal Dysraphism in a Country in a Precarious Situation: A Retrospective Study
Background: To report the epidemiological, therapeutic and evolutionary aspects of spinal dysraphism, with emphasis on the difficulties encountered during management in Madagascar. Methods: This is a retrospective, descriptive, multicenter study in the 7 neurosurgical centers of Madagascar over 5 years on children operated on for spinal dysraphism. Results: We collected 50 cases over 5 years. The mean age was 16.95 ± 33.94 months. Girls predominated (sex ratio = 0.85). The absence of folic acid supplementation in the mother was found in 62%. In all cases, the diagnosis was made in the postnatal period. Myelomeningocele is the most frequent form. Hydrocephalus was found in 20% of cases, orthopaedic malformation in 20%, and Chiari type II malformation in 2%. The dysraphism was localized at the lumbar level in 50% of cases. A spinal CT scan was performed in 62% of cases and transfontanellar ultrasound in 22% of cases. No magnetic resonance imaging of the brain or spinal cord was performed. A ventriculoperitoneal shunt was performed in 8% of cases. Postoperative hydrocephalus was 4%and mortality was 1% due to meningitis. The average follow-up time was 3 months with an extreme of 3 months to 3 years. Conclusion: In spite of the difficulties in the management of these children and the technical platform available in the country, they are operated correctly and the hospital mortality is low.
Copyright (c) 2024 Radotina Tony Andrianaivo, Willy Francis Rakotondraibe, Bemora Joseph Synese, Willy Ratovondrainy, Mamiarisoa Rabarijaona, Clément Andriamamonjy http://creativecommons.org/licenses/by-nc/4.0