Student's Journal of Health Research Africa
Not a member yet
1618 research outputs found
Sort by
A NARRATIVE REVIEW ON EVALUATING THE SAFETY OF JANUS KINASE (JAK) INHIBITORS IN DERMATOLOGICAL PRACTICE: A CLINICAL AND LABORATORY PERSPECTIVE.
Get PDFThe introduction of Janus kinase (JAK) inhibitors has modernized the treatment of various dermatological conditions by targeting the JAK-STAT signaling pathway, essential in the pathogenesis of inflammatory and auto-immune diseases. Despite their therapeutic potential, concerns regarding their safety and tolerability necessitate a comprehensive review. To synthesize current knowledge on the safety and tolerability of JAK inhibitors in dermatology, focusing on adverse effects, to advise clinical practice and guide future research. A systematic literature search identified studies reporting on the adverse effects of JAK inhibitors in dermatological treatments. The review highlights common adverse effects, including infections, hematological changes, and increased risks of malignancies and cardiovascular events. Despite these concerns, JAK inhibitors are generally well-tolerated, with most adverse effects being manageable. Quality assessments of included studies indicate a moderate level of evidence, pointing to the need for ongoing surveillance and research. The findings underscore the importance of careful patient selection, monitoring, and management strategies to mitigate the risks associated with JAK inhibitor therapy. Further long-term studies are essential to fully understand the safety profile of these drugs and their impact on patient outcomes. The review supports the development of clinical guidelines for the use of JAK inhibitors, emphasizing risk assessment, patient education, and regular monitoring. It also highlights the need for post-marketing surveillance to capture real-world data on the long-term safety and efficacy of these treatments
A PROSPECTIVE COMPARATIVE COHORT STUDY: FUNCTIONAL RESULTS OF INTERTROCHANTERIC FEMUR FRACTURES TREATED WITH DYNAMIC HIP SCREW VERSUS PROXIMAL FEMORAL NAIL, BHAGALPUR, INDIA.
Get PDFBackground
Dynamic Hip Screw (DHS) and Proximal Femoral Nail (PFN) are two commonly used devices for managing intertrochanteric femur fractures (ITF), each with its advantages and limitations. Understanding their relative efficacy is essential for informed treatment decisions. The study aims to compare the functional outcomes of intertrochanteric femur fractures managed with DHS versus PFN.
Methods
A prospective comparative cohort study was carried out from July 2021 to July 2023. One hundred participants with ITF were enrolled, with equal distribution between the DHS and PFN treatment groups. Demographic data, fracture classifications, surgical details, functional outcomes, complications, and radiographic assessments were recorded. Statistical analysis was achieved to compare outcomes between the two groups.
Results
The mean age of participants in the DHS group was 72 years, while in the PFN group, it was 69 years, with no significant difference observed. Fracture classifications and surgical durations were comparable between groups. Functional outcomes, assessed using the Harris Hip Score (HHS) at 3, 6, and 9 months post-surgery, showed similar improvement trends with no significant variation between DHS and PFN groups. Complication rates and rates of radiographic union were also similar.
Conclusion
Both DHS and PFN fixation techniques demonstrated comparable efficacy in promoting functional recovery and fracture healing for intertrochanteric femur fractures. The choice between the two methods should be based on individual patient factors, fracture characteristics, and surgeon preference.
Recommendations
Further research should explore long-term outcomes beyond the 9-month follow-up period, including patient-reported quality-of-life measures. Randomized controlled trials with larger sample sizes may provide additional insights into the optimal management of intertrochanteric femur fractures. Surgeons should consider factors such as fracture stability, bone quality, and patient comorbidities when selecting the most appropriate fixation device
A CROSS-SECTIONAL STUDY ON ENHANCING SURGICAL SAFETY: INVESTIGATING ANTIBIOTIC USE IN ENDOUROLOGICAL SURGERY PERIOPERATIVE CARE.
Get PDFBackground
Surgical safety is paramount in healthcare, particularly in endourological surgery, where perioperative antibiotic use plays a crucial role in preventing postoperative infections. The objective of the study was to assess the patterns and efficacy of perioperative antibiotic usage in endourological surgery. This was achieved through a cross-sectional analysis aimed at elucidating current practices and evaluating their impact on patient outcomes and antimicrobial stewardship.
Methods
A cross-sectional study was conducted involving 150 participants undergoing elective endourological procedures. Data on demographics, preoperative antibiotic usage, perioperative antibiotic administration, infectious complications, and surgical details were collected using standardized protocols. Statistical analyses were employed to examine associations and outcomes with a significance level set at p< 0.05.
Results
Involving 150 participants with diverse demographics, the study found a mean age of 57 years (range: 35-75 years), with 65% male and 35% female representation. Preoperatively, 45% of participants exhibited positive urine cultures for urinary tract infections (UTIs), despite 60% receiving antibiotic prophylaxis. Intraoperatively, 25% received additional antibiotics, primarily due to prolonged surgical duration and complications. Postoperatively, 40% required prolonged antibiotic therapy, with 20% experiencing UTIs. Significant correlations were found between preoperative antibiotic use and postoperative UTIs (p < 0.05) and prolonged surgery duration and infectious complications (p < 0.01). No significant differences in UTI rates were observed across different procedures.
Conclusion
Despite prophylactic antibiotic administration, UTIs remained prevalent, emphasizing the need for optimized antibiotic regimens. Prolonged surgery duration emerged as a risk factor for infections, underscoring the importance of surgical efficiency. Tailored approaches to antibiotic prophylaxis and antimicrobial stewardship programs are warranted to mitigate the risk of antimicrobial resistance and improve patient outcomes.
Recommendations
The development of evidence-based guidelines, implementation of antimicrobial stewardship programs, enhancement of surveillance systems, and ongoing education for healthcare providers are proposed to optimize perioperative antibiotic usage in endourological surgery.
NARRATIVE REVIEW AND ERIKSONIAN-SYNTHESIS OF LESSONS FROM ANIMALS: MUTUALITY OF RECOGNITION IN THE AGE OF THE PSEUDO SPECIES.
Get PDFViolence in society has become more pervasive in all facets of life and is often rationalized by the formation of ‘unique identities’. Homes, communities, and places of education have all been implicated. On-going violence and destruction also lead to issues surrounding the sustainability of the environment and the potential long-term impact on humans and animals. Despite technological advancement making the world a smaller place, it has not necessarily brought people together. Increased alienation from the self as well as other people and nature has been associated with decreased stability and increased psychological distress. Post the Covid-19 pandemic there has been a call for greater focus on One Health, which views the health of humans, animals, and nature as interlinked. Animals as aids for healing is ever increasing in medical and therapeutic settings. Increased focus on retaining the healing aspects of nature and relationships with animals in an ever-changing society and technological world may assist a move to a holistic approach to living, education, and ethical treatment of others and the environment. Further research is needed on children's and adults’ understanding of affective empathy and ethical action. Research as well as guidance on the ethical treatment of others may inform school curriculums and may encourage an ethical stance to policy development as well as implementation. An Eriksonian synthesis on lessons from animals regarding mutuality of recognition in an ecologically bound universe is offered as one lesson and philosophy that may facilitate ethical thinking and action
TELEMEDICINE DISRUPTION: A COMPREHENSIVE NARRATIVE LITERATURE REVIEW ON PHYSICIANS' PERSPECTIVES.
Get PDFTelemedicine, the delivery of healthcare services via telecommunications technology, has evolved significantly since the early 20th century. This evolution has been propelled by advancements in digital technology and heightened by the demands of modern healthcare challenges, including the COVID-19 pandemic. Telemedicine offers enhanced access to care, improved patient engagement, and potential cost savings, but it also introduces unique challenges and disruptions to traditional medical practice. This literature review aims to systematically examine and synthesize existing research on physicians' perspectives regarding the disruptions caused by telemedicine, identifying common themes, challenges, and opportunities that influence its integration into routine clinical practice. The review traces the evolution of telemedicine, highlighting key milestones from early radiologic image transmission to the integration of AI-driven tools. Theoretical frameworks like Innovation Diffusion Theory, Technology Acceptance Model, and Disruptive Innovation Theory are explored to understand telemedicine adoption among healthcare providers. The adoption by physicians is influenced by factors such as technological literacy and organizational support, with barriers like data security concerns. Various telemedicine models, including store-and-forward, real-time video consultations, and remote monitoring, are discussed in the context of services ranging from primary care to chronic disease management. Physicians' experiences with telemedicine reveal challenges in quality of care and technical issues, emphasizing the need for comprehensive training and education. The review highlights the necessity for ongoing Continuing Medical Education, certification, and licensure standardization in telemedicine. It suggests a future where telemedicine is seamlessly integrated into healthcare systems, with physicians adept in its use through tailored, hands-on training experiences. To optimize the use of telemedicine in clinical practice, policies must focus on standardizing training and licensure, ensuring data security, and addressing reimbursement issues. Emphasis should be placed on developing clinical guidelines that adapt to the evolving landscape of telemedicine
A CROSS- SECTIONAL STUDY OF HIGHLY SENSITIVE C-REACTIVE PROTEIN IN TYPE 2 DIABETES MELLITUS AND PREDICTION OF CARDIOVASCULAR RISK WITH GLYCEMIC STATUS.
Get PDFBackground
High-sensitivity C-Reactive Protein (hs-CRP) measurement may be useful for the assessment of the risk of complications in diabetes patients. So, the present study is conducted to measure plasma hs- CRP levels in type 2 diabetes mellitus (T2DM) and to determine whether adequate glycaemic control reduces hs-CRP levels.
Aims and objectives
The objectives of this study were to correlate HbA1c and hs-CRP in T2DM and predict cardiovascular risk with glycaemic status.
Methods
The authors took 50 diabetic patients. The investigation includes Fasting Blood Sugar, Postprandial Blood Sugar, hs- CRP, and Hemoglobin A1c (HbA1c). hs-CRP is measured by the immunoturbidimetry method. The reports were collected and compared with the normal reference range.
Results
The correlation between hs-CRP levels and HbA1c level after six months (<0.001) shows a significant relationship where mean HbA1c values on day 1 and after 6 months were 8.088±1.219 and 7.518±0.693 respectively. The hs-CRP values were 2.508±1.050 on day 1 and 2.15±0.927 after 6 months proving that better glycaemic controls decrease hs-CRP thereby decreasing cardiovascular risk.
Conclusions
hs-CRP values are directly related to HbA1c and better glycaemic control reduces the risk of cardiovascular disease.
Recommendations
The study recommends prioritizing effective glycemic control in Type 2 Diabetes Mellitus patients to lower High-Sensitivity C-Reactive Protein (hs-CRP) levels and reduce cardiovascular risk. It suggests regular monitoring of HbA1c and hs-CRP and further research to include additional factors like BMI and lipid profiles to better understand their impact on hs-CRP levels
ASSESSING THE EFFECT OF DEXMEDETOMIDINE DOSAGES ON SHORT-TERM COGNITIVE FUNCTION IN GERIATRIC PATIENTS UNDERGOING HEAD AND NECK CANCER SURGERY: A CROSS-SECTIONAL STUDY.
Get PDFBackground.
Geriatric patients undergoing head and neck cancer surgery often face cognitive challenges postoperatively. The study aims to evaluate the impact of varying dosages of Dexmedetomidine (DEX) on short-term cognitive function in this vulnerable population.
Methods.
A prospective study was carried out, and patients were divided into two groups based on DEX infusion rates. Inclusion criteria encompassed specified surgical regions, while exclusion criteria ensured study population homogeneity. Data on demographics, medical history, surgical details, and DEX infusion were collected. Short-term cognitive function was assessed using the Mini-Mental State Examination (MMSE) on postoperative Day 2.
Results.
Ninety participants were enrolled, with Group A (lower DEX rates, n=40) and Group B (higher DEX rates, n=50). Baseline characteristics were similar between groups. Mean MMSE scores were considerably higher in Group A (27.5, 95% CI: 26.8-28.2) compared to Group B (26.0, 95% CI: 25.3-26.7) (p < 0.05). The incidence of postoperative delirium was lower in Group A (10%) than in Group B (20%) (p = 0.12). Hemodynamic stability and pain scores were similar between groups.
Conclusion.
Lower DEX infusion rates were associated with better short-term cognitive function in geriatric patients undertaking head and neck cancer surgery. However, further research is needed to validate these findings and explore potential mechanisms underlying cognitive effects.
Recommendations.
Based on these findings, clinicians may consider adjusting DEX infusion rates to optimize cognitive outcomes in geriatric patients undergoing similar surgical procedures
HISTOPATHOLOGICAL ANALYSIS OF NASAL MASSES IN PATIENTS VISITING A TERTIARY CARE HOSPITAL: A CROSS-SECTIONAL STUDY.
Get PDFBackground
The prime purpose of this study is to detect the association between clinical signs and cytopathological characteristics, to detect the commonness of several cancerous growths of adenoidal space, and nasal pharynx, and to contrast the cytology of several kinds of nasal polyp.
Methods
The cross-sectional study was conducted for one year. 150 patients were included in this study and carried out for 1 year. Detailed history of the patients was recorded and cytological examination was done.
Results
In the age distribution of nasal polyps observed, 21 patients aged 1-10 years, 42 patients aged 11-20 years, 18 patients aged 21-30 years, 23 patients aged 31-40 years, 18 patients aged 41-50 years, 10 patients aged 51-60 years, 17 patients aged 61-70 years, and 1 patient aged 71-80 years were diagnosed with nasal polyps. The gender distribution showed that 88 of the patients were male and 62 were female. Regarding cytopathological characteristics, the surface epithelium was ulcerated in 112 patients, while 38 patients exhibited non-ulcerated surface epithelium.
Conclusion
In the current research, it is apparent that nasal and paranasal growths comprise a composite of structures that vary from the non – neoplastic reactive conditions to benign and malignant tumors. It is not possible to differentiate simple nasal growth only based on cellular infiltrate. All the cases with nasal growth are under histopathological evaluation because sometimes benign or malignant growths are also present as polyps.
Recommendation
In any kind of nasal or paranasal growth, histopathological examination is important. Sometimes benign and malignant growths are also present which can be differentiated by histopathological examination
IMPACT OF CLINICAL PRACTICE GUIDELINES ON COMPUTED TOMOGRAPHY USE FOR SUSPECTED APPENDICITIS: A PROSPECTIVE AUDIT STUDY.
Get PDFBackground.
The Royal Adelaide Hospital implemented a clinical practice guideline for the treatment of patients with suspected appendicitis. This recommendation suggests using CT scanning sparingly until more research is done. This study compared the CT usage rate for the patients during the pre-and post-guideline implementation periods.
Methods.
The prospective audit study included patients who came to the emergency room with symptoms and physical results that suggested they might have appendicitis. During the period following the implementation of the guidelines, these individuals were also prospectively identified if they were referred to the on-call surgical registrar. They were identified via hospital and emergency department databases.
Results.
The study included 119 individuals, 88 of whom underwent appendectomies for appendicitis. Following new clinical practice guidelines from the hospital that advised limited use of CT scans—specifically for patients over 50 or obese after a 24-hour observation—CT scan usage decreased from a baseline of 33% to 9%, reflecting a 31% overall reduction and a 24% decrease in unnecessary procedures. Significant reductions were observed in two patient groups: Group 2 (from 6 to 4 CT scans, p = 0.0331) and Group 3 (from 11 to 7, p = 0.0088), demonstrating the guidelines' effectiveness despite some limitations in statistical power.
Conclusion.
According to this study, hospitals with high rates of CT use for suspected appendicitis should lower these rates to match the national norm. Clinical practice standards or protocols may help with this effort.
Recommendation.
This study recommends that hospitals with high CT scan usage for suspected appendicitis adopt restrictive CT guidelines similar to those at the Royal Adelaide Hospital, focusing on limited use based on clinical inconclusiveness or specific risk factors like obesity or age over 50.
EXAMINING THE MORPHOLOGICAL AND CLINICAL IMPORTANCE OF NUTRIENT FORAMINA IN THE HUMAN ULNA: A CROSS-SECTIONAL STUDY
Get PDFBackground:
Nutrient foramina in human ulna bones plays a crucial role in bone vascularization and is of significant clinical importance. Understanding their morphological characteristics and distribution is essential for various medical applications. The investigation aimed to evaluate the morphological and clinical significance of nutritional foramina in the human ulna.
Methods:
A total of 100 ulna bones were examined without specific age or sex determination, and NF was identified, characterized, and quantified. Data collection included measurements of bone length and foraminal index using standardized techniques. Statistical analysis was performed to assess correlations and differences between variables.
Results:
Nutrient foramina (NF) was identified in 85% of 100 ulna bones, primarily distributed along the diaphysis, with an average of 1.2 (±0.4) NF per bone. The mean diameter of NF was 1.5 mm (±0.3 mm). Bone length positively correlated with the foraminal index (r = 0.62, p < 0.001). Three types of foraminal indices were classified: Type I (<33.33%), Type II (33.34–66.6%), and Type III (>66.67%). No significant differences were found between left and right ulna bones or between male and female ulna bones in foraminal characteristics (p > 0.05). Ulna bones with gross pathology showed a lower NF prevalence compared to those without pathology (p = 0.021). These findings provide insights into ulna NF morphology and clinical relevance.
Conclusion:
The study highlights the clinical importance of ulna nutrient foramina morphology, aiding in surgical planning and bone health assessment. The positive correlation between bone length and foraminal index suggests implications for bone growth, while the classification of foraminal indices offers a framework for assessing ulna vascularization variability.
Recommendations:
Further research is warranted to explore the clinical significance of NF in various orthopedic conditions and to investigate potential correlations with bone health indicators