Annals of Medicine and Surgery最新文献

Introduction: Approximately one-third of maternal deaths worldwide are attributed to unsafe contraceptive practices, a major contributor to maternal mortality. In Ethiopia, immediate postpartum family planning services are not yet widely used. Only 9% of postpartum women use immediate postpartum family planning. Additionally, there was insufficient information regarding the utilization of immediate postpartum family planning in the study area.

Objective: The objective was to assess immediate postpartum family planning utilization and associated factors among mothers attending childbirth at a tertiary hospital in Ethiopia.

Methods: A facility-based cross-sectional study was employed among 402 postpartum women from 1 June to 30 July 2023, using a systematic random sampling technique. Training was provided to data collectors, and data were collected using a structured questionnaire that had been pretested and revised as necessary. The collected data were entered into EpiData 4.6. The data were exported into the software SPSS Version 26 for data cleaning and further analysis. Factors associated with the utilization of immediate postpartum family planning were declared by odds by 95% CI and P < 0.05.

Result: This study involved 393 postpartum mothers, yielding a response rate of 97.76%. As identified from this study, utilization of immediate postpartum family planning was 24.9% (95% CI: 20.6, 29.2) in the study area. Planned pregnancy [adjusted odds ratio (AOR) = 1.84, 95% CI: 1.10-3.13], Postpartum mothers who had five and above children (AOR = 4.68, 95% CI: 1.70-12.88), counseled about family planning before delivery (AOR = 1.78, 95% CI: 1.03-3.10), and intention of postpartum mothers to space their pregnancy (AOR = 3.77, 95% CI: 1.50-9.52) identified associated factors.

Conclusion and recommendation: The utilization of immediate post-partum family planning is low in the study area. Planned pregnancy, the greater number of children, prior information about family planning, and intention to space births during reproductive age were factors significantly associated with the utilization of family planning. Health workers should provide strengthening advice and counseling about family planning, from antenatal care follow-up to the postpartum period. Furthermore, the collaboration of health extension workers provides awareness for the community.

Artificial Intelligence (AI) is shifting oral health care from a hardware-centric to a software-centric approach, with the potential to solve problems similarly to humans. It is transforming endodontics by enhancing diagnostic accuracy, improving treatment planning, increasing clinical efficiency, and supporting personalized care. This review explores AI applications in endodontics, including working length determination, periapical and caries detection, complex root anatomy segmentation, vertical root fracture identification, and surgical planning. AI models such as convolutional neural networks and artificial neural networks demonstrate high accuracy in interpreting cone-beam computed tomography and radiographic data. Benefits include improved workflow efficiency, reduced misdiagnoses, and individualized treatment strategies. However, challenges persist, such as limited high-quality datasets, regulatory gaps, and ethical considerations. Future directions emphasize technological advancements, collaborative AI-clinician integration, and AI-driven education and training tools. AI stands as a transformative force in endodontics, requiring responsible implementation and continued research to optimize its impact on patient care and clinical practice.

Introduction and importance: Dermatofibrosarcoma protuberans (DFSP) is a rare, low-grade dermal sarcoma known for local aggressiveness and high recurrence despite low metastatic potential. Early diagnosis and complete surgical excision with negative margins are critical for management. Reconstruction can be challenging, especially for large lesions. We report a rare case of rapidly enlarging DFSP over the lower chest-epigastric junction, complicated by diagnostic delays and complex reconstruction.

Case presentation: A 45-year-old man presented with a 4-5-month history of progressive midline chest swelling, low-grade fever, discomfort, and weight loss. Imaging revealed a vascular subcutaneous mass abutting the sternum. Fine needle aspiration cytology (FNAC) and biopsy remained inconclusive, delaying definitive diagnosis. Wide local excision with 3 cm margins created a 19 × 21 cm midline defect, requiring further extension based on frozen section. Reconstruction utilized a right paraumbilical perforator-based fasciocutaneous flap for primary closure. Final histopathology confirmed DFSP with clear margins and no high-grade transformation. Postoperative recovery was uneventful.

Clinical discussion: This case posed diagnostic and surgical challenges due to atypical presentation over the midline anterior abdominal wall, rapid enlargement of an otherwise indolent lesion, and inconclusive workup. Intraoperatively, the lesion's vascularity and ill-defined margins prolonged surgery with significant blood loss. Multidisciplinary collaboration and intraoperative flexibility remained critical for achieving optimal oncologic and reconstructive outcomes.

Conclusion: Early diagnosis, multidisciplinary planning, and tailored reconstructive strategies are vital in managing extensive, anatomically complex DFSP. This case highlights the importance of diagnosing rare presentations earlier with individualized, lesion-specific surgical approaches in achieving both functional and oncologic success.

Purpose of review: This review aims to explore the current state of literature on the use of artificial intelligence (AI) in the management of penile cancer. We examined the various applications of AI in penile cancer, including but not limited to image identification, prediction of treatment results, and patient risk stratification. The review evaluates the current limitations and challenges faced in the implementation of AI in penile cancer management.

Recent findings: The present literature emphasized the use of AI using radiomics and pathomics for management strategies and outcomes.

Summary: AI has the power to shape the future of penile cancer management by improving diagnostic precision, treatment strategies, and patient outcomes. Literature has shown improved accuracy and quality of current AI models for the detection and treatment of penile cancer. Further research is required to understand its potential and limitations.

Background: Emergency cricothyrotomy (CTM) is a rare but life-saving procedure performed under "cannot intubate, cannot oxygenate" (CICO) conditions. This study describes five in-hospital CICO cases requiring CTM, including one improvised procedure performed in a psychiatric ward without a formal airway kit, to highlight the procedural challenges and institutional preparedness.

Methods: This retrospective case series included five consecutive patients treated between April 2021 and April 2024. Data on patient demographics, causes of airway obstruction, procedural techniques, operator experience, and outcomes were also collected.

Results: CTM was successful in all patients on the first attempt, and they all survived and were successfully discharged. However, one patient developed hypoxic encephalopathy.

Conclusions: CTM remains a rare but essential life-saving intervention for in-hospital CICO cases. Institutional preparedness - including standardized kits, simulation-based training, and regular competency maintenance - is crucial for improving safety and outcomes across hospital departments.

Introduction and importance: Neuromyelitis optica spectrum disorder (NMOSD) is an auto-immune inflammatory disorder of the central nervous system mediated by auto-antibodies against Aquaporin-4 (AQP4). It causes vision impairment, vomiting, and paralysis.

Case presentation: We report a case of an 11-year-old Nepalese girl who initially presented with persistent vomiting for 2 months, followed by progressive limb weakness and facial asymmetry. She was initially misdiagnosed as gastroduodenitis with mesenteric lymphadenitis and later with major depressive illness and dissociative motor disorder. Neurological examination revealed multiple cranial nerve palsies and upper motor neuron signs. Magnetic resonance imaging (MRI) of the brain and cervical spine demonstrated long segment T2 hyper-intensities involving the medulla, cervicomedullary junction, and cervical spinal cord which was highly suggestive of transverse myelitis with postrema lesions. Serum anti-AQP4 antibody testing done by indirect immunofluorescence assay was positive which confirmed NMOSD. The patient was treated with intravenous methylprednisolone pulse therapy followed by intravenous immunoglobulin and transitioned to oral prednisolone with gradual improvement in neurological function.

Clinical discussion: This case highlights diagnostic challenge of NMOSD, particularly when presented with area postrema syndrome without early neurological findings. Such atypical presentations are frequently mistaken for gastrointestinal or psychiatric conditions, delaying appropriate diagnosis and management. MRI findings and a positive anti-AQP-4 antibody remain key to confirming the diagnosis. Early initiation of immunotherapy is essential to prevent irreversible neurological deficits.

Conclusion: NMOSD should be considered in children presenting with unexplained persistent vomiting and subsequent neurological deficits. A high index of suspicion, prompt antibody testing, and timely immunotherapy are vital for favorable outcomes.