Student's Journal of Health Research Africa
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ULTRASOUND FINDINGS OF BREAST MASSES WITH HISTOPATHOLOGICAL CORRELATION: A PROSPECTIVE STUDY.
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Breast carcinoma is the most frequent cancer and cause of death in women worldwide and in India. Early breast cancer diagnosis and therapy reduce mortality. Breast lesions are first imaged using ultrasound due of its availability, radiation-free nature, and good cost-benefit ratio. Ultrasound is preferred over mammography for diagnosing breast lesions in thick breasts and during pregnancy and lactation.
Aim
To differentiate breast lesions into benign and malignant lesions. Correlate benign and malignant lesions with histopathological findings.
Methodology
This was a prospective study. 100 patients were evaluated by ultrasound and lesions were categorized according to the Breast Imaging Reporting and Data System, Sonographic findings were correlated with histopathological findings, and statistical analysis was done.
Results
The age distribution of the patients ranged from 15 to 75 years, with a mean age of approximately 45 years. The study found that 68% of the patients had benign lesions and 32% had malignant lesions according to ultrasound. Histopathological examination confirmed that 63 patients had benign lesions, while 37 had malignant lesions. There were 2 false-positive cases (radial scars) and 5 false-negative cases (malignant phyllodes, metastatic lesions, and papillary carcinoma). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ultrasound in diagnosing breast lesions were found to be 85.7%, 96.9%, 93.7%, 92.6%, and 93%, respectively. The most common benign lesions were fibroadenomas, followed by fibrocystic disease. Among malignant lesions, infiltrative ductal carcinoma was the most common.
Conclusions
Results demonstrated a positive correlation between the sonographic findings and histopathological diagnoses of the breast masses.
Recommendation
Ultrasound should be utilized as a primary imaging modality for evaluating breast lesions, particularly in resource-limited settings and for patients with dense breast tissue, to facilitate early and accurate differentiation between benign and malignant lesions, thereby improving patient management and outcomes
DOES MICRORNA-140 PLAY A ROLE IN THE DEVELOPMENT AND PROGRESSION OF OESOPHAGEAL SQUAMOUS CELL CARCINOMA? - A SYSTEMATIC REVIEW.
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Oesophageal squamous cell carcinoma (OSCC) is one of the most common and lethal cancers worldwide. Despite advances in treatment, the five-year survival rate for OSCC remains suboptimal. Recent studies reveal that microRNAs (miRNAs) are involved in developing and progressing various types of cancer. Therefore, the modulation of miRNAs could have implications for new OSCC treatments. The purpose of this research was to summarise the published evidence on the impact of miRNA-140 on OSCC development and progression.
Methods
PubMed and Scopus were searched for the relevant literature. Study inclusion criteria were: basic science studies published during 1 June 2014–1 June 2023. Study exclusion criteria were: research without an appropriate analysis, non-English language publications, and grey literature. No study quality assessment tool currently exists for basic science studies, and all studies that met the eligibility criteria were incorporated in the review. The literature search results were analyzed with descriptive statistics (frequencies, percentages) and presented as a narrative synthesis.
Results
Eight papers were included in this review. All included studies were from China, and ECA109 was the most common OSCC cell line used (8 studies, 100%). Findings from studies involving transfection of OSCC cell lines with miRNA-140 mimics suggest that increased levels of miRNA-140 impair OSCC development and progression. Several genes appear to be regulated by miRNA-140 in OSCC development and progression (NFYA, ZEB1 & 2, ErbB4, and NRIP1). Hypoxia reduces miRNA-140 levels, thereby promoting OSCC development and progression. High levels of miRNA-140 were found to confer resistance to platinum-based chemotherapy drugs.
Conclusion
miRNA-140 plays multiple roles in the development and progression of OSCC, including influencing tumorigenesis, apoptosis of tumor cells, genome instability, invasion, metastasis, and chemotherapy resistance.
Recommendation
More research is needed to extend and validate these results, and to develop OSCC therapies aimed at modulating miRNA-140
A RETROSPECTIVE STUDY OF MANAGEMENT OF UNSTABLE INTERTROCHANTERIC FEMORAL FRACTURES IN THE ELDERLY: A COMPARISON OF PROXIMAL FEMORAL NAIL ANTI-ROTATION AND CEMENTED HEMIARTHROPLASTY.
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Unstable intertrochanteric femoral fractures (IFF) are common in elderly populations and are correlated with significant morbidity and mortality. Surgical management is the mainstay of treatment, with two commonly used options: Proximal Femoral Nail Antirotation (PFNA) and cemented hemiarthroplasty. This study compared the clinical outcomes, perioperative characteristics, and complication rates in elderly patients with unstable intertrochanteric femoral fractures treated with PFNA versus cemented hemiarthroplasty.
Methods
A retrospective study involved 78 individuals aged 65 years or older with AO type 31 A2 or A3 unstable IFF. Patients were treated with either PFNA (n=42) or cemented hemiarthroplasty (n=36). The primary outcome was functional recovery assessed by the Harris Hip Score (HHS), while secondary outcomes encompassed operating time, blood loss, hospital stay, and complication rates. SPSS was used for the statistical analysis, with a significance level of p < 0.05.
Results
With 52 female patients and 26 male patients, the average age was 72.6 ± 4.8 years. Patients in the hemiarthroplasty group showed better functional results, as evidenced by a greater mean HHS (88.6 vs. 85.8, p<0.01). The PFNA group saw decreased intraoperative blood loss (220 mL vs. 410 mL, p<0.001) and a shorter mean operating time (85.3 vs. 110.6 minutes, p<0.001). Patients who underwent hemiarthroplasty, however, spent much less time in the hospital (7.3 vs. 10.2 days, p=0.02). There were no appreciable differences in the rat
Conclusion
Hemiarthroplasty provided better short-term functional outcomes and a quicker recovery, while PFNA resulted in shorter surgical times and less blood loss. Both methods are effective, but the choice should be individualized based on patient health, fracture type, and rehabilitation needs.
Recommendations
Further long-term studies are recommended to assess the durability of both treatments. Individual patient factors, such as comorbidities and pre-fracture mobility, should guide treatment decisions to optimize outcomes
The Influence of Chronic Inflammation on the Development of Atherosclerosis and Cardiovascular Events
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Atherosclerosis, a key contributor to cardiovascular diseases (CVD), is influenced by multiple risk factors. Chronic inflammation has been increasingly recognized as a significant driver in the progression of atherosclerosis and the subsequent development of cardiovascular events. This study investigates the role of chronic inflammation in accelerating atherosclerotic plaque formation and its contribution to cardiovascular complications.
Materials and Methods
A cohort of 200 patients, selected from various hospitals in Kerala, india aged 40–70 years, with established risk factors for atherosclerosis (hypertension, hyperlipidemia, smoking) were enrolled in this prospective study. Inflammatory markers, including C-reactive protein (CRP) and interleukin-6 (IL-6), were measured at baseline and followed over a 2-year period. All patients underwent carotid intima-media thickness (CIMT) measurements and coronary artery calcium (CAC) scoring as indicators of atherosclerotic burden. The cohort was divided into two groups based on baseline inflammation levels: high inflammation (n=100) and low inflammation (n=100). Cardiovascular events, including myocardial infarction (MI) and stroke, were recorded.
Results
At the 2-year follow-up, patients in the high inflammation group demonstrated a significant increase in CIMT (mean increase of 0.15 mm) and CAC scores (average increase of 120 points) compared to the low inflammation group (mean increase of 0.05 mm in CIMT and 40 points in CAC). Cardiovascular events were more frequent in the high inflammation group, with 25% experiencing MI or stroke compared to 10% in the low inflammation group. Elevated CRP (>3 mg/L) and IL-6 (>10 pg/mL) were independently associated with a 2.5-fold increased risk of cardiovascular events.
Conclusion
Chronic inflammation plays a pivotal role in the progression of atherosclerosis and the occurrence of cardiovascular events. Higher levels of inflammatory markers are associated with increased atherosclerotic plaque burden and a greater risk of MI and stroke. Targeting chronic inflammation may provide a novel therapeutic avenue to mitigate the progression of atherosclerosi
RISKS OF GLAUCOMA TREATMENT IN PATIENTS WITH CATARACTS: A PROSPECTIVE COHORT STUDY
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Glaucoma and cataracts frequently coexist in older adults, with glaucoma being a leading cause of irreversible blindness and cataracts contributing to reversible vision loss. Medical therapy for glaucoma primarily targets intraocular pressure (IOP) reduction, but its potential effects on cataract progression are not fully understood. This study assessed the risks associated with medical glaucoma therapy in patients with cataracts.
Methods
A total of 100 patients diagnosed with both glaucoma and cataracts were recruited. Baseline data included age, cataract severity, and IOP measurements. Patients were followed at 1, 3, and 6 months to assess cataract progression, visual acuity changes, and any side effects related to glaucoma treatment. Statistical analysis involved paired t-tests for intraocular pressure changes and Chi-square tests for cataract progression.
Results: A total of 100 participants (56 males, 44 females) aged 40 years and older (mean age 65.4 ± 10.2 years) diagnosed with both glaucoma and cataracts were included. Thirty-five percent of participants experienced significant cataract progression, with those having more advanced baseline cataracts being at higher risk (p = 0.01). Mean IOP decreased significantly from 24.1 mmHg to 16.8 mmHg (p < 0.001) over the study period, indicating effective glaucoma control. Visual acuity worsened from 0.4 LogMAR to 0.6 LogMAR in patients with cataract progression (p = 0.02). Ocular side effects, such as dry eye and hyperemia, were reported in 25% of the cohort.
Conclusion
While medical therapy effectively controls IOP in glaucoma patients, it is correlated with an increased risk of cataract progression, particularly in those with severe cataracts at baseline. The decline in visual acuity highlights the need for careful monitoring of cataract status during glaucoma treatment.
Recommendations
Regular cataract progression monitoring and glaucoma medication adjustments may be needed for coexisting cataract patients. Alternative treatments include cataract and minimally invasive glaucoma operations may improve results
KNOWLEDGE AND ATTITUDE ASSOCIATED WITH SELF-MEDICATION AMONGST MEDICAL STUDENTS AT MEDICARE HEALTH PROFESSIONALS’ COLLEGE. A DESCRIPTIVE CROSS-SECTIONAL STUDY.
Get PDFBackground Self-medication is the consumption and use of medicinal products to treat disorders or symptoms of disease; it can also be the intermittent or continued use of a previously prescribed drug to treat recurring and chronic illness. PurposeTo assess the knowledge and attitude of medical students towards self-medication in Medicare health professionals’ college ObjectiveTo determine the prevalence, assess the knowledge determine the attitude toward self-medication among medical students at Medicare health professionals’ college. MethodologyA descriptive cross-sectional study was used which employed a quantitative method where data was collected once with no follow-up of respondents. This was a cheaper study design and it was done in a shorter period of time. Data was analysed using MS Excel package and descriptive statistics which include frequency and percentages were used and data was presented on figures, graphs, and tables. FindingsThe prevalence of self-medication was found to be high at 93% with the majority of respondent’s 32% practicing self-medication five times or more. 68.4% of the respondents had good knowledge of self-medication with 89% reporting having heard about self-medication before, almost all respondents 97.9% correctly defined Self-medication as consuming a drug without a prescription from a health worker, and 64.5% of respondents had good attitude towards self-medication with up to 43% believing that self-medication is not a dangerous practice,49.3 agreeing that SM is a part of self-care and 84% admitting they would recommend Self-medication to a colleague .ConclusionDespite their good knowledge about self-medication and its effects, the respondents had a positive attitude towards self-medication leading to them practicing it. This is evidenced by the high incidence rate of self-medication. RecommendationSensitization of students on self-medication and its effects should be implemented by the institution to promote attitude change and increase knowledge among students
AN OBSERVATIONAL STUDY TO ASSESS THE CLINICAL-ETIOLOGICAL PROFILE OF HYPONATREMIA IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT IN A TERTIARY CARE HOSPITAL.
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When the serum sodium level is less than 135 mmol/l, it is called hyponatremia. It may show a range of symptoms, including nausea, tiredness, seizures, coma, and sometimes even death. If identified immediately, proper treatment can reduce these symptoms and fatality rates. This study assessed the clinical characteristics and underlying causes of hyponatremia in admitted patients.
Materials and Methods
This study was observational. Patients who were at least 14 years old and had serum Na+ levels ≤130 meq/l were included in the study. Patients were diagnosed as having hypovolemic hyponatremia, hypervolemic hyponatremia, or euvolemic hyponatremia based on the results of their medical histories and physical examinations. The syndrome of inappropriate antidiuresis (SIAD) was identified in patients with clinical euvolemia, urine Na+ >20 mmol/l, serum uric acid ≤4 mg/dl, satisfactory renal function (serum creatinine and blood urea), and no pituitary or thyroid disease.
Results
The study comprised 100 individuals with hyponatremia. 56 individuals had severe hyponatremia. 38 patients experienced vomiting, 7 experienced hiccups, 19 hyponatremic patients were asymptomatic, and 43 patients had altered levels of consciousness manifested as sleepiness, disorientation, irrelevant talking, or coma. Euvolemic hyponatremia (71%) was the most common, followed by hypervolemic hyponatremia (27%), and hypovolemic hyponatremia (2%).
Conclusion
Ages 60 to 69 were the most common range for hyponatremia. The majority of patients belonged to the hypervolemic category after the euvolemic group. The most typical signs of hyponatremia were impaired sensorium, vomiting, and, infrequently, seizures.
Recommendation
Diuretics should be used with caution, especially in more vulnerable groups, as they often result in hyponatremia. Diuretic-induced hyponatremia may occur, but additional factors, including the patient's euvolemic status, should be considered to prevent it from always turning hypovolemic. The intensity of the symptoms should be given priority over serum salt levels, as there is no correlation between them
MANAGEMENT PRACTICES OF ADVERSE REACTIONS RELATED TO ANESTHESIA USE AMONG EYE SURGERY PATIENTS IN JINJA REGIONAL REFERRAL HOSPITAL, JINJA, UGANDA. A CROSS-SECTIONAL STUDY.
Get PDFBackground.Uganda, like any other developing country, bears a heavy burden of eye disease which contributes significantly to visual problems. Increasing eye surgeries, therefore, demands analyzing anesthetics to enhance patient safety. This study aimed to determine the management practices of adverse reactions related to anesthesia use among eye surgery patients in Jinja Regional Referral Hospital, Jinja, Uganda.
Methodology.The study used a descriptive cross-sectional design and quantitative data were collected from 72 patients. A simple random sampling technique was used to pick respondents and pre-tested structured questionnaires were formulated and used to collect data.
Results.(42%) of the patients had previous history of eye surgery, 75% of patients recovered within the first hour. (70%) of healthcare providers primarily managed adverse anesthetic reactions using medication, Oxygen therapy (14%) was used to stabilize patients with respiratory distress, vital sign monitoring (16%) ensured patient safety by tracking key indicators. Patient education (11%) helped reduce anxiety by preparing patients for potential side effects. In cases of excessive sedation, reversal agents (8%) like flumazenil were used to awaken patients.
Conclusion.Management of anesthesia-related side effects primarily relied on medication and postoperative monitoring. While these strategies were largely effective, there is room for improvement in managing severe pain, reducing side effects, and enhancing patient education before surgery.
Recommendation.Ensure careful titration of sedatives and monitor sedation levels closely during surgery. Increase the use of reversal agents in cases of excessive sedation to promote quicker recovery and minimize postoperative complications
CHARACTERIZATION OF MORTALITIES REQUIRING AUTOPSY BY A MEDICAL BOARD
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In general, a single autopsy surgeon undertakes medico-legal autopsies; nonetheless, in particular scenarios, a collaboration of medical experts may occur. This study aims to characterize the mortalities necessitating medicolegal autopsies by a Medical Board over an extended timeframe, thereby facilitating the development of a comprehensive profile of such cases pertinent to this region.
Methods
A cumulative total of 262 records about post-mortem examinations performed by Medical Boards from April 2015 to March 2020 were acquired after the fulfillment of our established criteria through the method of consecutive sampling in this retro-prospective observational study, which was executed within the Department of Forensic Medicine and Toxicology at the Rajendra Institute of Medical Sciences, Ranchi.
Results
In 17 cases (6.5%), the identification of the deceased individual could not be ascertained. A total of 5.3% (14) of the cases exhibited a considerable degree of decomposition. The majority of the autopsies [19.5% (51)] were conducted on individuals within the 21 to 30 years age demographic, comprising 212 males and 47 females. Nearly half, specifically 46.6% (122), of the autopsies were carried out on individuals identified as adherents of Hinduism, whilst 34.0% (89) were performed on adherents of the Sarna faith. Out of all autopsies, over half, accounting for 55.3% (145), were done on non-tribal people, contrasting with 38.2% (100) that were on tribal people. A significant majority, amounting to 74.0% (194), of the autopsies were conducted on individuals who were married.
Conclusion
The majority of the autopsies were conducted within the younger demographic strata, exhibiting a significant predominance of male subjects alongside a remarkable scarcity of unidentified and decomposed remains.
Recommendations
Comprehensive protocols are essential to guarantee that the performance of autopsies by Medical Boards upholds the trust and dependence of legal entities
A PROSPECTIVE STUDY EVALUATING ELECTIVE ORTHOPEDIC OPERATING THEATRE EFFICIENCY AT A SOUTH AFRICAN TERTIARY HOSPITAL
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The demand for elective orthopedic surgery has increased in South Africa due to an increasing burden of trauma and financial constraints caused by a poorly performing economy. This highlights the importance of orthopedic operating theatre (OT) efficiency in this resource-constrained country. This study aimed to assess the efficiency of elective orthopedic operating theatres at a SA tertiary hospital.
Methods
This was a cross-sectional study of elective orthopaedic OT lists over 8 weeks, at Chris Hani Baragwanath Academic Hospital, SA. Data assessed during the study included sub-specialty, number of scheduled and completed cases, time OT commenced activities, time OT ceased activities, case time, turnover time, raw theatre utilization as well as the day of surgery cancellations. The data was collected using a password-protected REDCap database form and analyzed with descriptive statistics.
Results
A total of 117 OT lists equating to 342 cases were included from different orthopaedic subspecialities. The total available OT time was 58331 minutes, of which a large majority, 46638 minutes (80%), was used as case time during conventional OT working hours (95.4%). Fifty-three percent of OT lists started early, whereas 29.9% started late; 65% of them were underran and 30% overran. The mean turnover and first-case starting times delays were 39 minutes and 7.1 minutes, respectively. The overall raw theatre utilization was 83.0% (range: 71.8-88.2%, SD 16.3) with a DOSC (day of surgery cancellation) rate of 19%.
Conclusion
Overall, elective orthopedic OT utilization was efficient at CHBAH. The challenge posed by cancelled surgeries in CHBAH must be addressed as facility-related reasons were cited as the main reason for cancellations. This will further improve the orthopedic OT efficiency in this hospital.
Recommendation
Optimizing preoperative patient assessment and preparation to identify cases that could lead to DOS