Showing papers in "The Pan African medical journal in 2021"

Dealing with vaccine hesitancy in Africa: the prospective COVID-19 vaccine context.

Abstract: The outbreak of the novel coronavirus disease (COVID-19) has resulted in many cases of morbidity and mortality across the globe, and the lack of the COVID-19 vaccine has contributed greatly to this experience. COVID-19 vaccines have currently been rolled out, and are available in some countries. However, strategies need to be put in place to prevent COVID-19 vaccine hesitancy (VH) especially in Africa; a continent where VH has been previously reported following the introduction of new vaccines. For this cause, we, therefore, recommend optimal community involvement in the structure and modalities for the delivery of the prospective COVID-19 vaccine. Also, feedback mechanisms for the acknowledgement of community efforts in previous health interventions should be improved upon to encourage the acceptance of the prospective COVID-19 vaccine. In addition, improved multi-sectoral collaboration should be initiated and promoted to enhance the acceptance of COVID-19 vaccines through the provision of more resources required to address COVID-19 VH. Furthermore, integration of the COVID-19 vaccine into the routine immunization schedule would strengthen the health system, improve uptake of the COVID-19 vaccine, and improve the health of all persons living on the African continent.

When it is available, will we take it? Social media users' perception of hypothetical COVID-19 vaccine in Nigeria.

Abstract: Introduction: COVID-19 pandemic is a global public health threat facing mankind. There is no specific antiviral treatment for COVID-19, and many vaccine candidates are currently under clinical trials. This study aimed to understand the perception of social media users regarding a hypothetical COVID-19 vaccine in Nigeria. Methods: we conducted a cross-sectional survey among social media users in Nigeria in August 2020 using an online questionnaire. The questionnaire includes sections on the demographic characteristics of the respondents and their perception regarding a hypothetical COVID-19 vaccine. A total of 517 respondents completed and returned the informed consent along with the questionnaire electronically. Data were coded and abstracted into Microsoft Excel spreadsheet and loaded into the STATA 14 software for final analysis. Results: the results showed that more than half of the respondents were male 294 (56.9%). Most of the respondents 385 (74.5%) intend to take the COVID-19 vaccine when it becomes available. Among the 132 respondents that would not take the COVID-19 vaccine, the major reason for non-acceptance was unreliability of the clinical trials 49 (37.1%), followed by the belief that their immune system is sufficient to combat the virus 36 (27.3%). We found a significant association between the age of the respondents and the COVID-19 vaccine acceptance (P-value=0.00) as well as geographical location and COVID-19 vaccine acceptance (P-value=0.02). Conclusion: it was observed that most of the respondents were willing to take the COVID-19 vaccine. Our findings also reiterate the need to reassure the public the benefits an effective and safe COVID-19 vaccine can reap for public health. There is a need for national health authorities in Nigeria to ensure public trust is earned and all communities, including the marginalized populations, are properly engaged to ensure an optimal COVID-19 vaccine acceptance.

The challenges of COVID-19 testing in Africa: the Ethiopian experience.

Abstract: Novel coronavirus disease (COVID-19) is spreading rapidly and creating a huge economic, social and public health challenge worldwide. Although currently an effective vaccine is ready, its distribution is limited, and hence the only currently available lever to reduce transmission is to identify and isolate individuals who are contagious. Thus, testing for SARS CoV-2 has a paramount importance. However, testing in many African countries including Ethiopia has multidimensional growing challenges. Here, we tried to identify, categorize and summarize the challenges of COVID-19 testing in Africa from Ethiopian experience.

The occurrence of long COVID: a rapid review.

Abstract: The long-term effects of the severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) are not well understood. This rapid review was aimed at synthesizing evidence on the long-term effects of the SARS-CoV-2 infection among survivors. We considered both randomised controlled trials and non-randomised studies eligible for inclusion in this review. The following databases were searched: PubMed, Scopus, Cochrane library, Google Scholar, and the World Health Organization (WHO) COVID-19 database. The reference lists of all the included studies were also searched. Two authors independently screened the search outputs and reviewed full texts of potentially eligible articles. Data extraction was done by one author and checked by a second author. A meta-analysis was not conducted due to heterogeneity among the included studies. Results are presented narratively. Eleven studies met our inclusion criteria. All these studies were conducted in high-income countries. Study findings demonstrate that COVID-19 survivors can experience persistent symptoms after recovering from their initial illness, especially among previously hospitalized persons. The majority of symptoms reported were fatigue, shortness of breath, cough, and sleep disorders. Mental conditions, such as depression and anxiety disorders, were also reported. In conclusion, this study showed that COVID-19 survivors can experience persistent symptoms after recovering from their initial illness. Therefore, there is a need for a long-term follow-up of COVID-19 patients and rehabilitation services for survivors. More research is needed in this area, especially in Africa.

Predictors of death in severe COVID-19 patients at millennium COVID-19 care center in Ethiopia: a case-control study.

Abstract: Introduction: as the number of new cases and death due to COVID-19 is increasing, understanding the characteristics of severe COVID-19 patients and identifying characteristics that lead to death is a key to make an informed decision. In Ethiopia, as of September 27th 2020, a total of 72,700 cases and 1165 deaths were reported. Therefore, the study aimed to assess the determinants of death in severe COVID-19 patients admitted to millennium COVID-19 care center in Ethiopia. Methods: a case-control study of 147 severe COVID-19 patients (49 deaths and 98 discharged alive cases) was conducted from August to September 2020. A comparison of underlying characteristics between cases (death) and controls (alive) was assessed using a chi-square test and an independent t-test with a p-value of <0.05 considered as having a statistically significant difference. Multivariable binary logistic regression was used to identify predictors of severe COVID-19 outcome (alive vs death) where adjusted odds ratio (AOR), 95% confidence interval (CIs) for AOR, and P-values were used for testing significance and interpretation of results. Results: having diabetes mellitus (AOR= 3.257, 95%CI=1.348,7.867, p-value <0.001), fever (AOR=0.328, 95%CI= 0.123,0.878, p-value=0.027) and shortness of breath (AOR=4.034, 95%CI=1.481,10.988, p-value=0.006) were found to be significant predictors of death in severe COVID-19 patients. Conclusion: the outcome of death in severe COVID-19 patients is found to be associated with exposures to being diabetic and having shortness of breath at admission. On the other hand, having a fever at admission was associated with a favorable outcome of being discharged alive.

A unique association of bifacial weakness, paresthesia and vestibulocochlear neuritis as post-COVID-19 manifestation in pregnant women: a case report.

Abstract: SARS-CoV-2 is an infection due to a novel virus belonging to the coronavirus family. Since December 2019, first human cases of COVID-19 have been identified in Wuhan (China) and rapidly has been progressed to a global pandemic declared by the world health organization (WHO) on March 11th 2020. The major complication of COVID-19, is pneumonia, but other presentations like cardiovascular and neurological complications have been reported. Herein, we report a first case of pregnant women presented with bifacial weakness and paraesthesia (BFP) associated to a vestibulocochlear neuritis as post-COVID-19 manifestation. This is a 36-year-old Moroccan female patient with a history of SARS-CoV-2 positive 6 weeks before admission. She presented to the emergency department with rapid bifacial paralysis, bilateral lower extremity paresthesia, vertigo, nausea, vomiting and right auricular pain. An acute stroke was ruled out after neurological examination and brain MRI. Clinical presentation, neurophysiological, audiometry and videonystagmography workup additionally to CSF findings were suggestive of a variant of Guillain Barre Syndrome (GBS), which is BFP associated to right vestibulocochlear neuritis. The patient was treated with Intravenous immunoglobulins (IVIG) therapy associated with intravenous steroids. The patient made a complete recovery of the right facial palsy and the sensorineural hearing loss but still have tingling in lower limbs and left facial palsy at 2 weeks´ follow-up. BFP can be induced by COVID-19 as a postinfectious immune-mediated complication. Regarding the pathophysiology of vestibular neuritis, is probably similar to other viral infection causing nerve damage. Clinicians should consider the association of vestibulocochlear neuritis and BFP as a post SARS-CoV-2 manifestation.

Vaccination hesitancy among women of reproductive age in resource-challenged settings: a cause for public health concern.

Abstract: Women of reproductive age are a key population for the control of COVID-19 owing to their levels of socio-economic activities and central role in the upkeep of stable families. Therefore, adequate vaccination uptake in this population is critical. However, this may be negatively affected by circulating rumours regarding SARS-CoV-2 vaccines and subfertility and pregnancy and breastfeeding concerns that have circulated widely on diverse social media. Urgent public health interventions are required to deal with vaccination hesitancy and promote uptake in this key population. This calls for concerted, multidisciplinary and multistakeholder consultative public health forums, public health research and action in the shortest possible period.

Clinical and epidemiological characteristics and outcomes of patients hospitalized for COVID-19 in Douala, Cameroon.

Abstract: Introduction the coronavirus disease (COVID-19) is a disease that originated from Wuhan in December 2019. It rapidly spread across the globe causing high mortality especially among the elderly. Africa though not spared has limited studies regarding its effects on its population. We therefore sought to describe the epidemiological and clinical characteristics of COVID-19 in Douala, Cameroon. Methods we conducted a single-centre, retrospective, and observational study by reviewing records of patients managed for COVID-19 between the 8th March 2020 and 31st, May 2020. Cases were confirmed by real-time reverse transcriptase - polymerase chain reaction and were analysed for epidemiological, demographic, clinical, and radiological features. Outcomes were either clinical improvement by Day-28 or in-hospital mortality. Results we analyzed 282 case files, 192 were males (M: F=2: 1). The mean age was 52 (+/- 15) years. Hypertension and diabetes accounted for 75% of the chronic medical conditions identified. Main presenting complaints were dyspnea, cough, asthenia, and fever (55-60%). Radiographic analysis showed a ground-glass appearance in 85% of cases. Chloroquine/Hydroxychloroquine was the most (91.8%) frequently used drug in management protocols, 35% needed oxygen supplementation while 6 patients were intubated. Severe pneumonia (11.3%) was the commonest complication. They were 91 admissions in the intensive care unit. The average length of hospital stay was 10 (+/- 5) days. The mortality rate was 32%. Conclusion our findings are concordant with universally reported data of COVID-19 hospitalised patients. These parameters are essential in designing effective prevention and control programs aimed at reducing the impact of the COVID-19 pandemic particularly in countries with limited resources.

Digital technologies and COVID-19: reconsidering lockdown exit strategies for Africa.

Abstract: Widespread vaccination provides a means for countries to lift strict COVID-19 restrictions previously imposed to contain the spread of the disease. However, to date, Africa has secured enough COVID-19 vaccine doses for less than 5% of its population. With widespread vaccination not on the horizon for Africa, there is a strong emphasis on non-pharmaceutical interventions which include movement restrictions (lockdowns). This general COVID-19 pandemic response of imposing lockdowns, however, neglects to factor in non-fatal consequences leading to disruption socio-economic wellbeing of the society at large. The economy in most African countries can no longer sustain lockdown restrictions. Some studies have indicated that a hard lockdown statistical value of the extra lives saved would be dwarfed by its long-term cost. At the same time not responding to the threat of the pandemic will cost lives and disrupts the social fabric. This paper proffers ways to mitigate the both and advocate for better policymaking that addresses specific challenges in defined communities thus yield higher population welfare.

Digital health and COVID-19: challenges of use and implementation in sub-Saharan Africa.

Abstract: COVID-19 is a global health emergency that exposed the gaps in health systems globally, especially in sub-Saharan Africa home to many fragile healthcare systems and a region beset with a large burden of disease. Various mitigation strategies have been put in place to stop the spread of COVID-19 and management of patients in sub-Saharan Africa. However, much still need to be done. Digital health provides the promise for the continent to bridge the gap in decreasing the negative impact of COVID-19 and effectively mitigate the pandemic. This commentary argues how countries in sub-Saharan Africa need to embrace the use of digital health in public health interventions to vigorously mitigate the COVID-19 pandemic and to contribute towards attaining universal health coverage (UHC).

Treatment and outcomes in patients with left ventricular thrombus - experiences from the Aga Khan University Hospital, Nairobi - Kenya.

Abstract: Introduction left ventricular thrombus (LVT) may lead to thromboembolism and has been associated with increased morbidity and mortality. Little is known about the incidence, etiology and outcomes in patients with LVT in Africa. The objective was to determine the etiology, treatment practices, rate of resolution and clinical outcomes in patients with LVT in the region. Methods a review of all echocardiograms performed in 2017 and 2018 at the Aga Khan University Hospital, Nairobi was carried out and patients with LVT identified. Physician review of charts was performed to document clinical characteristics and outcomes. Results during the study period 100 patients with LVT were identified (1.3% of adult echoes). The mean LVEF was 28.5% (±11.0%) and 88 (88%) patients had an LVEF of less than 40%. Underlying etiology of LV dysfunction was post myocardial infarction (MI) in 28 (28%), chronic ischemic cardiomyopathy in 42(42%) and non-ischemic cardiomyopathy in 30 (30%) patients. In 15 (15%) patients a stroke or TIA predated the diagnosis of LVT. Long term anticoagulation was given to 92 (92%) patients. Among these, 34 (37%) received warfarin while 58 (63%) were treated with a DOAC. In the 64 patients who had reassessment imaging (median duration 177 days), complete thrombus resolution was noted in 38 (59.4%). One-year clinical outcome data was available for 85 patients: 13 (15.3%) patients had died, 4 (4.7%) had suffered a stroke, and 8(9.4%) had had a bleeding episode. Rates of thrombus resolution (warfarin 64%, DOAC 55.6%, p=0.51), stroke (warfarin 2.9%, DOAC 1.7%, p=1.0) and bleeding (warfarin 5.9%, DOAC 5.2%, p = 1.00 were not significantly different among patients treated with warfarin and DOAC. Conclusion we noted a high incidence of LVT compared to contemporary Western series. The majority of our patients were treated with DOACs. There were no significant differences in outcomes between patients treated with a DOAC and those receiving warfarin. Prospective evaluation on the efficacy and safety of DOACs for this indication is needed.

Mucormycotic osteomyelitis of maxilla post-COVID patient: a case report.

Abstract: Fungal osteomyelitis is a life-threatening and seldom seen opportunistic infection. It is commonly an affectation of the nose and paranasal sinuses within the orofacial region. It is an aggressive infection that needs to be addressed promptly to prevent fatal consequences. The mode of infection is via the inhalation route and infection begins initially in the nose and paranasal sinuses with subsequent invasion into the vascular tissue, eventually leading to thrombosis and necrosis of nearby hard and soft tissues. Here, we report a case of a 31-year-old male who presented with pain over the upper jaw that was sudden in onset, continuous, dull aching, radiating towards forehead and neck of the left side, aggravates on mastication and relives on its own. He had a history of uncontrolled diabetes mellitus. On further investigation, using diagnostic and Interventional aids, a final diagnosis of mucormycotic osteomyelitis of the maxilla was made.

The impact of COVID-19 on the tuberculosis control activities in Addis Ababa.

Abstract: The first COVID-19 case was reported in Ethiopia on 13th March 2020 and series of announcements of set of measures, proclamation and directives have been enacted to fight the coronavirus pandemic. These have implications for the regular health services including the TB control program. This brief communication assesses the impact of the COVID-19 response on the TB control activities of Addis Ababa health centers based on research project data. We compared the patient flows in pre-COVID-19 period (quarter 1, Q1) and during COVID-19 (quarter 2, Q2 and quarter 3, Q3) of 2020 at 56 health centers in Addis Ababa from all 10 sub-cities per sub-city. The patient flow declined from 3,473 in Q1 to 1,062 in Q2 and 1,074 in Q3, which is a decrease by 62-76% and 52-80% in Q2 and Q3 respectively as compared to that of Q1. In Q2, Kolfe keranio and Kirkos sub-cities recorded the biggest decline (76 and 75% respectively) whereas Yeka sub-city had the least decline (62%). In Q3, Kirkos sub-city had the biggest decline (80%) and Addis ketema sub-city had the lowest (52%). We conclude that the series of measures, state of emergency proclamation and government directives issued to counter the spread of COVID-19 and the public response to these significantly affected the TB control activities in Addis Ababa city as attested by the decrease in the patient flow at the clinics. Health authorities may inform the public that essential health services are still available and open to everyone in need of these services.

COVID-19 pandemic: impacts on the achievements of Sustainable Development Goals in Africa

Abstract: Since the launch of the Sustainable Development Goals (SDGs) in 2015, Africa has made some progress towards its achievements, particularly in the area of gender equality- SDG 5, climate change -SDG 13 and preserving life on land- SDG 15. Although, some African countries have made tangible impact on the other goals such as health, food production and economic growth; these efforts experienced some setbacks with attention shifting to curbing the spread of the novel coronavirus. As much as mitigating the spread of the spread of COVID-19 is important, so is ensuring efforts made on other goals are not lost, as the SDGs are much interconnected, and failure in one impacts others. For the African continent to achieve sustainable development beyond COVID-19, strategic actions which will involve innovations, evaluations and strong political will towards implementations must be taken by relevant stakeholders, so the continent is not left behind in the global goals achievement by 2030.

Acceptability of COVID-19 vaccine: a cross-sectional study in a Tunisian general hospital.

Abstract: Introduction the year 2020 was marked by the COVID-19 pandemic that killed more than one million people. Several vaccines have been developed and vaccination campaigns started in December 2020. The objective of our study was to assess the acceptability of the COVID-19 vaccine by hospital staff. Methods cross-sectional study conducted on a representative sample drawn at random from the staff of the Military General Hospital of Tunis. Data was collected between August and September 2020 by a clinical psychologist. We studied the associations between the different characteristics of our population and the decision to accept or refuse vaccination against COVID-19. Results a total of 398 hospital staff agreed to answer our questionnaire. Our sample was composed of 9% (n=36) physicians, 0.9% (n=3) pharmacists, 41.3% (n=164) paramedics, 16.1% (n=64) cleaning staff and 32.7% (n=131) administrative staff. The rapid discovery of the vaccine was hoped by 97% (n=386). Vaccination was considered a means of collective protection by 84.7% (n=337). However, only 58% (n=231) agreed to be vaccinated by the COVID-19 vaccine. The main factors significantly associated with acceptance of the COVID-19 vaccine was previous influenza vaccination (aOR: 2.58, 95% CI 1.69-3.94; p=0.000). Conclusion apprehension about vaccination does not appear to be sparing the future COVID-19 vaccine. Fear of vaccine side effects outweighs fear of the disease, even among hospital staff. To achieve vaccination coverage, several awareness and communication activities must be carried out.

Artificial intelligence (AI) in medicine as a strategic valuable tool.

Abstract: Humans' creativity led to machines that outperform human capabilities in terms of workload, effectiveness, precision, endurance, strength, and repetitiveness. It has always been a vision and a way to transcend the existence and to give more sense to life, which is precious. The common denominator of all these creations was that they were meant to replace, enhance or go beyond the mechanical capabilities of the human body. The story takes another bifurcation when Alan Turing introduced the concept of a machine that could think, in 1950. Artificial intelligence, presented as a term in 1956, describes the use of computers to imitate intelligence and critical thinking comparable to humans. However, the revolution began in 1943, when artificial neural networks was an attempt to exploit the architecture of the human brain to perform tasks that conventional algorithms had little success with. Artificial intelligence is becoming a research focus and a tool of strategic value. The same observations apply in the field of healthcare, too. In this manuscript, we try to address key questions regarding artificial intelligence in medicine, such as what artificial intelligence is and how it works, what is its value in terms of application in medicine, and what are the prospects?

Prevalence and factors associated with hypertension among people living with HIV/AIDS on antiretroviral therapy in Uganda.

Abstract: INTRODUCTION: antiretroviral therapy (ART) has improved survival of People Living with HIV (PLWH); however, this has resulted in an increasingly high prevalence of non-communicable diseases (NCD) like hypertension. Hypertension is a major risk factor for cardiovascular and cerebral vascular disease, which are both associated with high morbidity and mortality rates. We studied the prevalence and factors associated with hypertension among PLWH on ART. METHODS: we conducted a retrospective data analysis of PLWH on ART enrolled between 2011 and 2014 into a randomized double-blinded placebo-controlled trial investigating the safety of discontinuing cotrimoxazole prophylaxis (COSTOP) among PLWH in Central Uganda. We used the mean blood pressure (BP) measurements of the first four monthly clinic visits to define hypertension. Patients were categorised as: having normal BP (≤120/80mmHg), elevated BP (systolic >120-129, and diastolic ≤80), Stage 1 hypertension (systolic 130-139, or diastolic >80-89) and Stage 2 hypertension (systolic ≥140 or diastolic ≥90). Multiple logistic regression was used to evaluate factors associated with hypertension. RESULTS: data from 2026 COSTOP trial study participants were analysed, 74.1% were women and 77.2% were aged 35 years and above. The overall prevalence of hypertension was 29%, of whom 19.5% had Stage 1 hypertension and 9.5% had Stage 2 hypertension. About 21.4% were overweight or obese. Factors independently associated with hypertension among PLWH on ART included increasing age (p≤0.001) and high body mass index (p≤0.001). Efavirenz (p≤0.001) and lopinavir/ritonavir (p=0.036) based regimen had lower odds of hypertension than Nevirapine based regimens. CONCLUSION: PLWH on ART have a high prevalence of hypertension, which rises with increasing age and body mass index (BMI) and among those on nevirapine-based ART. Implementation of hypertension prevention measures among PLWH on ART and integration of NCD and HIV care to improve patients’ management outcomes are required.

The impact of the COVID-19 pandemic on measles surveillance in the World Health Organisation African Region, 2020.

Abstract: Introduction following the declaration of the COVID-19 pandemic, many countries imposed restrictions on public gatherings, health workers were repurposed for COVID-19 response, and public demand for preventive health services declined due to fear of getting COVID-19 in health care settings. These factors led to the disruption in health service delivery, including childhood immunization, in the first months of the pandemic. Measles surveillance supported with laboratory confirmation, is implemented in the African Region as part of the strategies towards attaining measles elimination. World Health Organisation developed guidelines to assist countries to continue to safely provide essential health services including immunization and the surveillance of vaccine preventable diseases during the pandemic. Methods we analysed the measles case-based surveillance and laboratory databases for the years 2014 to 2020, to determine the impact of the COVID-19 pandemic on measles surveillance, comparing the performance in 2020 against the preceding years. Results the weekly reporting of suspected measles cases declined starting in April 2020. Twelve countries had more than 50% decline in both the number of reported cases as well as in the number of specimens collected in 2020, as compared to the mean for the years 2014-2018. In 2020, only 30% of the specimens from suspected measles cases arrived at the national laboratory within 3 days of collection. At Regional level, 86% of the districts reported suspected measles cases in 2020, while the non-measles febrile rash illness rate was 2.1 per 100,000 population, which was the lowest rate documented since 2014. Only 11 countries met the targets for the two principal surveillance performance indicators in 2020 as compared to an average of 21 countries in the years 2014-2019. Conclusion the overall quality of measles surveillance has declined during the COVID pandemic in many countries. Countries should implement immediate and proactive measures to revitalise active surveillance for measles and monitor the quality of surveillance. We recommend that countries consider implementing specimen collection and testing methods that can facilitate timely confirmation of suspected measles cases in remote communities and areas with transportation challenges.

Healthcare providers' knowledge and perceptions regarding the use of modern contraceptives among adolescent girls in Umlazi Township, KwaZulu-Natal province, South Africa.

Abstract: Introduction the phenomenon of unintended adolescent pregnancy continues to be a reproductive and public health concern in sub-Saharan Africa. Healthcare providers play an important role in influencing the use of contraceptives among adolescent girls. This study assessed knowledge and perceptions of healthcare providers regarding the use of modern contraceptives among adolescent girls in Umlazi township, KwaZulu-Natal province, South Africa. Methods this was a descriptive study involving 35 healthcare providers covering all 10 primary healthcare clinics in Umlazi township. Data collected through a structured questionnaire were coded, entered into Epi data manager (version 4.6) and exported to STATA (version 15.0) for analysis. Results of the thirty-five healthcare providers that participated in this study, professional nurses (54.3%) and enrolled nurses (17.1%) constituted the majority. The mean age of the participants was 42.11 years, with 88.6% being females. More than a third (37.1%) of healthcare providers did not know whether or not modern contraceptives make users promiscuous, while more than half (57%) had negative attitudes towards adolescents exploring contraceptive methods. Healthcare providers viewed health systems challenges, such as poor working conditions, long queues, and contraceptives stock-outs, as deterrents towards the provision of quality sexual behaviour counselling and modern contraceptive education to users. Conclusion poor health systems and negative behaviours by healthcare providers influences the delivery of family planning services in primary healthcare clinics and serve as barriers to quality family planning services provided to younger women.

Effectiveness of preoperative tranexamic acid in reducing blood loss during caesarean section at Aminu Kano Teaching Hospital, Kano: a randomized controlled trial

Abstract: INTRODUCTION: Bleeding during and after caesarean section is one of the contributors to maternal mortality and morbidity. Tranexamic acid can be given before surgery to significantly reduce the amount of blood loss during caesarean section. The objective was to evaluate the effectiveness of preoperative tranexamic acid in reducing blood loss during caesarean section at Aminu Kano Teaching Hospital, Kano. METHODS: this was a randomized double blind placebo controlled study that was carried out among 244 women who were to have emergency caesarean section between December 2017 and June 2018 and were randomly assigned to the study group or control group. Women in the study group received lg (10mls) of tranexamic acid intravenously while women in the control group received 10ml of normal saline. Oxytocin was administered in the two groups according to protocol. Measurement of blood loss was done immediately after surgery. Postoperative drop in haemoglobin and haematocrit were also determined. Statistical analysis was done using SPSS Version 22. RESULTS: the average intra operative blood loss was 414.0 ml in the study group and 773.8 ml in the control group (t = - 16.18, p ≤ 0.01). Average postoperative haemoglobin was 10.1 g/dl in the study group and 9.5 g/dl in the control group (t = 4.99, p ≤ 0.01). Average postoperative haematocrit was 31.5% in the study group and 29.9% in the control group (t = 4.70, p ≤ 0.01). CONCLUSION: there was a significant reduction in the blood loss when preoperative tranexamic acid was given to patients who were to undergo emergency caesarean section.

Central adrenal insufficiency and diabetes insipidus as potential endocrine manifestations of COVID-19 infection: a case report.

Abstract: SARS-CoV-2 infection, responsible for the coronavirus disease-2019 (COVID-19) has rapidly spread, causing a global pandemic. COVID-19 can affect any organ system in the body due to overwhelming dysregulated immune response and long-term effects of the disease is still unknown. Endocrine complications associated with COVID-19 is exceedingly rare. Here we present a unique case of a 44-year-old female who developed adrenal insufficiency and central diabetes insipidus following COVID-19 infection.

Oxygen saturation and perceived discomfort with face mask types, in the era of COVID-19: a hospital-based cross-sectional study.

Abstract: Introduction the COVID-19 pandemic has necessitated the prolonged use of facemasks by healthcare workers. Facemask non-compliance has been largely blamed on discomfort associated with the mask, and apprehension regarding potential health hazards such as asphyxia from mask usage. We sought to evaluate the impact of different respiratory mask types on the comfort of healthcare workers and their arterial oxygen saturation during periods of active clinical duty. Methods we conducted a cross-sectional study on healthcare workers donning different types of facemasks in the normal course of duty. Objective non-invasive determination of arterial oxygen saturation of each participant was done using a portable pulse oximeter. Subjective self-assessment of global discomfort was scored by means of a 11-point numerical scale from 0 (no discomfort) to 10 (worst discomfort imaginable). The user's perceived elements of the discomfort were also evaluated. A statistical significance was accepted when P Results seventy-six healthcare workers completed the study, and wore the masks for periods ranging from 68-480 minutes. The discomfort experienced with the use of the N95 mask; 4.3 (2.0) was greater than the surgical mask; 2.7 (1.8); P=0.001. No significant change in arterial oxygen saturation was observed with the use of either of the mask types. The tight strapping of the N95 mask was perceived as a contributor to the discomfort experienced with mask usage; P=0.009. Conclusion the N95 masks imposed greater discomfort than the surgical masks, but neither of the masks impacted on the arterial oxygen saturation of the healthcare workers.

Knowledge, attitude and practice of kangaroo mother care among mothers in the neonatal wards of a tertiary care center.

Abstract: INTRODUCTION: approximately 1 million children die each year due to complications of preterm birth with the major contributor to mortality being hypothermia. Kangaroo mother care (KMC) is an effective and low-cost technique which prevents neonate from hypothermia. The mother uses her body temperature to keep the infant warm thereby preventing demise from cold injury. Not much is known about the perception and practice of this simple and easy method of caring for preterm infants among post-natal mothers in Nigeria. This study aimed to determine the knowledge, attitude and practice of kangaroo mother Care among Mothers in the neonatal wards of a tertiary care center in Nigeria. METHODS: this study was a hospital-based descriptive cross-sectional survey of sixty mothers selected from the Neonatal ward of the Lagos University Teaching Hospital (LUTH), Idi-Araba using convenient sampling technique. Data was collected with the use of a questionnaire and analyzed using descriptive statistics. Frequency and percentages were presented in tables and chi-square was used to test associations between categorical variables; p-value <0.05 was considered significant. RESULTS: the findings revealed that 80% of respondents had heard of kangaroo mother care with 66.6% having good knowledge. Two-thirds (65%) of the respondents had a good attitude towards the use of KMC with 71.7% feeling happy when their baby is in kangaroo position. The knowledge of mothers significantly influenced their attitude and practice of KMC, p <0.05. CONCLUSION: the knowledge of KMC among mothers whose babies were admitted into the newborn wards of LUTH was high and they believe that KMC is helpful to their babies and were happy practicing it.

Assessment of prescribing patterns of antibiotics using National Treatment Guidelines and World Health Organization prescribing indicators at the Ghana Police Hospital: a pilot study.

Abstract: Introduction irrational or inappropriate prescribing of antibiotics is a major problem in healthcare and leads to antibiotic resistance. There is the need to understand the prescribing patterns and antibiotic stewardship in health facilities to support appropriate antibiotic use. A study was carried out to evaluate prescribing pattern of antibiotics at the Ghana Police Hospital using National Standard Treatment Guidelines (STG) and World Health Organization (WHO) prescribing indicators. Methods a cross-sectional descriptive study was conducted at the Ghana Police Hospital. Data on prescriptions of antibiotics for both out-patients and in-patients was collected between December 2019 and March 2020. A pretested self-designed tool was used for data collection. All sampled prescriptions were assessed for appropriateness using the STG of 2017 and WHO "AWaRe" classification. The criteria used in assessment included dose, frequency, duration of treatment and choice of antibiotic prescribed for disease condition. Descriptive statistics were used in data analysis. Results a total of 184 patient prescriptions (286 antibiotics) were included in this study. Results showed that antibiotics were mostly prescribed for dental and dental-related conditions (20.7%) and obstetric post-delivery prophylaxis (18.1%). Appropriateness of indicators for antibiotics prescribed assessed ranged between 89.2% to 97.6%. The most frequently prescribed antibiotics were metronidazole (25.9%), amoxicillin with clavulanic acid (22.0%), amoxicillin (16.4%) and ciprofloxacin (10.1%). Based on WHO "AWaRe" classification, the "access" group of antibiotics (74%) was the most prescribed, followed by "watch" group (24%). There were no antibiotics prescribed from the "reserve" group of antibiotics and another 2% that was not part of AwaRe classification. Conclusion study revealed that the level of appropriateness for prescribing indicators assessed was relatively high and majority of prescribed antibiotics were from the "access" and "watch" group. These observations suggest responsible prescribing of antibiotics at the Ghana Police Hospital and effective antibiotic stewardship should be sustained and improved.

Long QT interval and syncope after a single dose of COVID-19 vaccination: a case report.

Abstract: Adverse consequences of the coronavirus disease 2019 (COVID-19) vaccination which have been reported in scientific papers are varied. One possible but rare consequence is myocarditis, which may have a diversity of clinical manifestations. We report a case of a 70-year-old man who presented to the hospital for some syncope, 3 days after his first COVID-19 AstraZeneca Vaccination. Initial electrocardiogram (ECG) showed a long QT interval (QTc = 600 milliseconds). Laboratory tests revealed elevated troponin and lack of evidence of viral infection. Further investigations revealed the vaccine-induced myocarditis and arrhythmias linked to it. Within one week of magnesium treatment, the QT interval was completely corrected, and the patient discharged with no typical syncope attacks. This case like the previous reported one confirms that myocarditis is a complication of COVID-19 vaccine, but implies its clinical manifestations may be varied and even may happen after the single dose of vaccination.

Fournier´s gangrene: its management remains a challenge

Abstract: Fournier's gangrene (FG) is a rapidly progressive necrotizing bacterial dermo-hypodermitis of the perineum and external genitalia. It represents a real medical and surgical emergency requiring multidisciplinary care. Our study was based on the retrospective analysis of 18 cases of FG, collected in the Department of General and Visceral Surgery of Fattouma Bourguiba University Hospital in Monastir over an 18-year period extending from January 2000 to December 2018. Our series included 18 cases of FG collected over an 18-year period, an annual incidence of one case per year. The average age of our patients was 58 years (36 to 77). The male prevalence was clear. Diabetes and old age were found to be the major risk factors. The treatment was based on an aggressive surgical debridement remains to be the cornerstone of therapy and is commonly preceded by patient preparation for the surgical act by perioperative resuscitation and broad-spectrum antibiotic therapy, possibly accompanied by hyperbaric oxygen therapy (HBOT). The vaccum assisted closure (VAC) therapy is also used, which is a non-invasive system that promotes open wound healing. Healing techniques can be once the septic risk is controlled. Dressings topical treatments, such as fatty substances or calcium alginate, in addition to skin grafts, musculo-neurotic or musculo-cutaneous cover flaps can be used. During the follow-up period, no reccurrence occurred in 14 out of the 18 cases (2 patients were lost to follow-up and 2 patients died). A colostomy was closed in 10 out of 11 cases with simple follow-ups. Restorative surgery (partial thickness skin graft) at the perineal level was performed in only one case. Despite the better understanding of its etiopathogenesis, the advent of targeted antibiotic therapy, the establishment of a better codification of surgical procedures, the contribution of hyperbaric oxygenation and reconstruction techniques, mortality rates are still high and FG remains a real health threat, thus constituting a real medical and surgical emergency.

Challenges in healthcare financing for surgery in sub-Saharan Africa

Abstract: One-third of the global burden of disease is attributed to surgical conditions yet, 5 billion people globally, lack access to surgery. The Lancet Commission on Global Surgery, Obstetrics, and Anesthesia (LCOGS) published guidelines for improving access by reducing catastrophic health expenditures (CHEs) by 2030. This is especially important in sub-Saharan Africa (SSA) where 90% of the extreme poor reside. In this paper, we provide a narrative review of four studies on CHEs for surgical care in SSA published since 2015. We discuss healthcare financing in the countries and summarize the authors' key findings of out-of-pocket payments (OOP) and CHEs. Briefly, the studies enrolled 130 to 300 patients and collected direct OOPs via chart review of health costs or patient interviews. Indirect costs were calculated from lost wages and transportation costs. CHEs were defined as health costs exceeding 10% of the GDP per capita or the household income. Despite healthcare being reported as free in all studies, 60%-90% of surgical patients had CHEs with all costs considered. OOPs persists for medicines and anesthesia that should be covered under any health insurance scheme. In some cases, indirect costs associated with transportation and wages were major drivers of CHEs for surgery. Without addressing these gaps in coverage, more people will risk impoverishment in seeking surgical care in SSA.

COVID-19 control pitfalls and challenges and drivers of SARS-CoV-2 transmission in Zimbabwe.

Abstract: Despite numerous public health interventions introduced by the Zimbabwean government, the COVID-19 burden continues to grow. The number of confirmed cases increased from less than 600 to over 6000 in a period of two months, and the fatalities now exceed 150. The source of infection has significantly changed from imported cases to community transmission. The greatest burden of COVID-19 is in the country's two biggest provinces, Harare and Bulawayo, and differentiated approaches are urgently required to curb further transmissions whilst allowing other aspects of the population's livelihood to continue. We discuss some of the pitfalls and challenges for COVID-19 control, and the possible drivers of SARS-CoV-2 community transmission in the country. An urgent multi-sectoral intersection to effectively deal with these caveats is required, and political commitment to deal with the crisis remains an indispensable variable.

New-onset restless leg syndrome in a COVID-19 patient: a case report with literature review.

Abstract: Restless leg syndrome (RLS) is a sleep disorder characterized by the sudden urge to move the lower limbs during periods of rest accompanied by an unpleasant sensation like tingling or burning in the legs Often, this urge is partially relieved by the movement of legs However, it causes disturbance of sleep leading to daytime fatigue Herein, we present an unusual case of new-onset of restless leg syndrome in a COVID-19 infected patient who presented three weeks after an uncomplicated delivery via caesarean section The patient was managed with sleep hygiene measures, oral iron and vitamin C tablets apart from general COVID-19 management medications, subsequently leading to significant improvements Here we have discussed possible associated factors, pathophysiological mechanisms and management of RLS in the case of COVID infected individuals

Hollow vaginal stent for a case of Mayer-Rokitansky-Kuster-Hauser syndrome: a case report.

Abstract: Congenital vaginal agenesis is a common condition with an instance of 1 in 5000 females. It is usually associated with Mayer-Rokitansky-Kuster Hauser syndrome. Such anomalies have a high impact on the physiology and psychology of patients. A simple approach for the hollowing of the customized vaginal stent prosthesis has been described for the case of Mayer-Rokitansky-Kuster-Hauser syndrome.