African health sciences最新文献

Background: To analyze the factors associated with tip malposition and spontaneous correction rate of peripherally inserted central catheter (PICC) in newborns.

Methods: Clinical data of 1604 newborns who underwent PICC placement in our neonatal surgery department from January 2018 to January 2023 were retrospectively analyzed. They were divided into malposition group (n=104) and normal group (n=1500) according to the occurrence of tip malposition. The relevant clinical data of newborns were extracted from the hospital information system. The occurrence of PICC tip malposition and spontaneous correction were recorded. Logistic regression analysis was used to identify risk factors for PICC tip malposition in newborns.

Results: The incidence of PICC malposition was 6.48%. There were significant differences in gestational age, birth weight, lesion location, catheter direction and venous placement between the two groups (P<0.05). The independent risk factors for PICC tip malposition in newborns were lesion location, catheter direction and venous placement (P<0.05). The spontaneous correction rate within 24 hours was 27.88%, with the highest rate observed in malposition of the internal jugular vein.

Conclusion: Catheter direction, lesion location and venous placement are independent risk factors for PICC tip malposition in newborns, and some newborns may spontaneously correct within 24 hours.

Background: Carbapenems are the most commonly used antibiotics for severe infections induced by metallo-beta-lactamases producing Enterobacteriaceae and Pseudomonas aeruginosa. Resistance to almost all β-lactam antibiotics, including carbapenems, is conferred by metallo-β-lactamases (MBLs).

Objectives: Detection and inhibition of MBLs production as a promising approach to overcome resistance to carbapenems.

Methods: 160 clinical isolates of Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae were tested for antimicrobial susceptibility by The disk-diffusion method. The ability of the isolates to produce MBL enzyme was detected phenotypically and genotypically by PCR. The potential ability of pantoprazole and omeprazole to inhibit metallo-β-lactamases (MBLs) was confirmed by real-time PCR.

Results: Omeprazole and pantoprazole reduced the hydrolytic activities of MBLs. Both drugs had synergistic effects with meropenem. Meropenem minimum inhibitory concentration decreased in the presence of pantoprazole (2-16) folds, and omeprazole (2-32) folds. The metallo-β-lactamases genes bla_NDM , bla_IMP and bla_VIM were downregulated by both drugs. In silico study showed that both drugs had reasonable binding energy and revealed that omeprazole had higher binding energy and chelating activity of zinc ions of the enzymes.

Conclusion: The combination between meropenem and omeprazole or pantoprazole could be useful for treating infections caused by MBLs producing bacteria.

Background: During 2018-2020, almost half of all neonatal deaths reviewed in Uganda were due to birth asphyxia. In 2015, Uganda adopted the Every Newborn Action Plan interventions to renew the focus on surveillance for birth asphyxia and other childhood-related illnesses. In 2016, the Ministry of Health implemented an evidence-based educational program for birth attendants about neonatal resuscitation techniques to improve the management of birth asphyxia. We described the trends and distribution of birth asphyxia in Uganda during 2017-2020 following these renewed efforts.

Methods: We analysed birth asphyxia surveillance data from the District Health Information System 2 from January 2017-December 2020. We calculated the incidence of birth asphyxia per 1,000 deliveries at district, regional, and national levels. We used line graphs to demonstrate the trend of birth asphyxia incidence with the corresponding reporting rates at national and regional levels. We used logistic regression to evaluate the significance of the trends. Using choropleth maps, we described the distribution of birth asphyxia incidence at district level.

Results: The average national annual incidence of birth asphyxia in 2020 was 31 per 1,000, with an increase of 4.5% from 2017 to 2020 (OR=1.05; 95%CI=1.04-1.05, p=0.001), with national quarterly reporting rates of 70-80% over the same period. Incidence in the Northern and Eastern Regions increased by 6% (OR=1.06; 95%CI=1.05-1.07, p=0.001) and 5% (OR=1.05; 95%CI=1.03-1.05, p=0.001), respectively, over the study period. Bundibugyo, Iganga, and Mubende Districts had rates of >60/1,000 during each of the four years of the study period. The least affected district was Kazo District, with an overall incidence of 3/1,000 over the study period.

Conclusion: The incidence of birth asphyxia increased nationally from 2017-2020. We recommend efforts towards reducing the burden of birth asphyxia in Uganda, with emphasis on the most affected districts.

The Philadelphia chromosome is usually express on about 30% acute B lymphoblastic leukemia. Most of Ph-positive acute lymphoblastic leukemia patients have ela2 BCR-ABL transcripts, other atypical fusion genes such as ela3 have been rare reported. We reported a case of Ph-positive B-acute lymphoblastic leukemia with a scare ela3 fusion transcript. She presented with a complex karyotype and showed good early response to imatinib and dasatinib but relapsed six months after diagnosis, and E255v, T315I mutations were successively detected in the ABL kinase region, then he switched to ponatinib and underwent allogeneic hematopoietic stem cell transplantation. But the Minimal Residual Disease increased after 16 months, the patient was treated with CD19 chimeric antigen receptor T cell immunotherapy, and changed to olverembatinib targeted therapy. This subgroup of acute lymphoblastic leukemia might have poorer prognosis than patients with common transcripts. we recommend the third-generation tyrosine-kinase inhibitor as a first choice for their initial therapy and allogeneic hematopoietic stem cell transplantation or immunotherapy and new clinical trials should be considered as early as possible.

The estimated number of Africans suffering from some form of dementia in 2015 was 2.13 million and this is projected to rise to 7.62 million by 2050. Many sufferers engage in irrational behaviour which, across many African countries, is interpreted as resulting from witchcraft. As a result, the families of dementia sufferers are ostracised and dementia sufferers themselves are subject to violence. This article reports an action research project carried out in four rural communities near Goma in the eastern Democratic Republic of Congo in 2022 and 2023. In the exploration phase, data was collected from the families of dementia sufferers and from other community members concerning their experiences, attitudes and behaviour towards dementia sufferers and their families. This provided the basis for an intervention in the form of a community education programme which presented objective information about the disease. An evaluation of the outcomes of the intervention in two of the communities was carried out nine months later and found that there had been a dramatic positive change in attitudes and behaviour towards dementia sufferers, both by their families and by community members in general.

Background: "Ebinyo" is a form of infant oral mutilation (IOM) practiced by some traditional healers in parts of sub-Saharan Africa, and often results in severe health complications. We present a novel case of ebinyo in a child from northern Uganda which resulted in sepsis and disseminated intravascular coagulation (DIC) with peripheral extremity gangrene.

Case presentation: A 3-year-old male presented with two weeks of epistaxis, oralbleeding, and cough to a large referral hospital in northern Uganda. At home, the child had undergone ebinyo, performed by a traditional healer, and was receiving treatment for malaria. On arrival, the child presented with fever, jaundice, and malaise. Labs revealed pancytopenia and an elevated D-dimer, diagnosed as DIC. On day four, physical exam revealed demarcated darkening of the fourth digit on the right foot and third and fourth digits on the left foot, diagnosed as dry gangrene. A doppler ultrasound revealed lower extremity arterial insufficiency. On day seven, the patient started improving with vancomycin. On day eleven, the patient was discharged.

Conclusion: This case describes an uncommon sequela of sepsis and DIC with peripheral extremity gangrene after undergoing ebinyo. Prompt identification of ebinyo is critical for diagnosis and management of its complications.

Background: Depression affects approximately 364 million people globally. Prenatal depression affects between 26.3% and 32.9% of mothers in Africa. Opportunities for prenatal screening are missed. The gold standard diagnostic, the Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM-5) criteria for Major Depressive Disorder (MDD) has higher technical requirement. There is inadequate information on locally adapted and validated user-friendly screening tools in Uganda.

Objective: To Adapt and validate the Luganda Edinburgh Postnatal Depression Scale (EPDS-L) for screening prenatal depression at Kawempe National Referral hospital (KNRH).

Methods: Cross-sectional study in KNRH using International Society for Pharmacoeconomics and Outcomes Research guidelines for adaptation and quantitative approaches for the validation. Consecutive sampling until the desired sample of 100, all participants responded to both EPDS-L and DSM-5 criteria for MDD. Reliability demonstrated using Cronbach's alpha coefficient, while validity was demonstrated by sensitivity, specificity, Negative Predictive Value (NPV), Positive Predictive Value (PPV) and Area-Under-the-curve (AUC).

Results: EPDS-L had Cronbach's-Alpha of 0.8515. At cut-off of 13, sensitivity was 62.86%, specificity-100%, PPV-100% and NPV-83.3%. AUC was 0.99. Performance was better at cut-off of 10, with sensitivity-97.14% and specificity-98.46%.

Conclusion: The EPDS-L is reliable at cut-off of 13 but performs even better at cut-off of 10.

Background: Obstetric fistula remains a major public health problem which serves as a proxy indicator of the status of Nigerian women and of the availability and accessibility to quality maternal health services. This study aims to assess the knowledge, practice and perceived factors that might hinder preventive interventions to reduce obstetric fistula by service providers in Abakaliki, Ebonyi State Nigeria.

Methods: A cross-sectional survey of 169 service providers (doctors (49) and nurses (120)) in selected health facilities in Abakaliki was conducted using a validated self-administered questionnaire.

Results: Majority (71%) of the participants were registered nurse/midwife while only 29% were doctors. Most (87.0% & 89.9%) of the participants had both adequate knowledge and good practice of preventive measures of obstetric fistula respectively. Major factors perceived to hider the practice of obstetric fistula preventive measures were patient-related factors (mean=2.97) and institutional factors (mean = 2.51). There was significant association between age (p = 0.008), marital status (p = 0.029), profession (p = 0.039), years of experience of work (p = 0.003) and the knowledge of obstetric fistula while none of the demographic characteristics had association (p > 0.05) with the practice of obstetric fistula preventive measures.

Conclusion: Although most participants in this study had adequate knowledge and good practice of obstetric fistula preventive measures, there is still a great need to train and retrain doctors and nurses on current guidelines for obstetric fistula prevention and conservative management. Government should also strengthen the health facilities at all levels to provide emergency obstetric and newborn care.

Objective: To investigate the prognostic value of serum carcinoembryonic antigen (CEA), carbohydrate antigen (CA153), and human epididymal 4 (HE4) combined with a variety of immune inflammatory indicators in breast cancer.

Methods: A sample size of 112 breast cancer patients was selected and all patients underwent surgical treatment. The three-year prognosis of the patients was observed. Patients with poor prognoses were included in the poor prognoses group and the patients with good prognosis were included in the good prognosis group. The levels of serum CEA, CA153, HE4, and related immune inflammatory indicators (including Mon, Lym, Neu, Plt, NLR, and SII) were analysed. The predictive value of serum CEA, CA153, HE4, and immune inflammatory indicators on the prognosis of breast cancer was analysed by Logistic regression and ROC curve method. The area under the ROC curve (AUC) was used to evaluate the predictive efficiency. α=0.05 was used as the test standard.

Results: Compared with the good prognosis group, the CEA, CA153, HE4, Mon, Neu, Plt, and SII of the poor prognosis group were higher, all P<0.05. Logistic regression analysis showed that CEA, CA153, HE4, Neu, and Plt were effective indicators for predicting the poor prognosis of breast cancer. The AUC of CEA, CA153, HE4, Neu, and Plt in predicting the prognosis of breast cancer was 0.929, which was higher than the AUC of a single prediction.

Conclusion: Serum CEA, CA153, HE4 combined with Neu and Plt had predictive value for the prognosis of breast cancer.

Background: Fibrosis in the extracellular matrix of nucleus pulposus (NP) is associated with intervertebral disc degeneration (IVDD). Both connective tissue growth factor (CTGF) and vascular endothelial growth factor (VEGF)-A are responsible for the pathological basis of NP fibrosis. Our study aims to verify the interaction between CTGF and VEGF-A in a vitro NP cell model.

Methodology: Collected human NP tissues of different degeneration degree and isolated the NP cells from the non-degenerated NP tissues. Analysed the CTGF and VEGF-A gene expression in the naturally degenerated NP and IL-1β-induced degenerated NP cells. Additionally, interfered wit the CTGF and VEGF-A expression by exogenic protein treatment, siRNA transfection, or specific inhibitor. The expression of CTGF, VEGF-A, collagen I/II/III and aggrecan with protein or mRNA level was determined by immunological staining, western blotting and RT-PCR.

Results: CTGF and VEGF-A highly expressed in the late-term of degeneration compared to the middle-term, and their expressions were synergistic. Upregulating one of CTGF and VEGF-A could induce the overexpression of the other one and collagen I/III, but suppressed collagen II and aggrecan expression; Besides, the suppression of one of them could inhibited another and collagen I/III expression.

Conclusions: CTGF and VEGF-A increase in late IVDD. Prevent NP fibrosis by suppressing their interaction.