Student's Journal of Health Research Africa
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CADAVERIC STUDY OF ANATOMICAL VARIATION OF SCIATIC NERVE IN POPULATION OF BIHAR AND ITS CLINICAL APPLICATION: A CROSS-SECTIONAL STUDY.
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The sciatic nerve is the largest in the body. It has peroneal and tibial components. The sciatic nerve (SN) leaves the pelvis through the larger sciatic foramen under the Piriformis muscle (PM) to become the tibial nerve. After that, the sciatic nerve crosses between the pelvic ischial tuberosity and the bigger femur trochanter, ending at the popliteal fossa. Aim- Cadaveric research was undertaken to ascertain the differences in the anatomy of the sciatic nerve.
Methods
A cross-sectional investigation was done in 50 equally divided anatomical cadavers of both genders to determine the occurrence of anatomical variations in the SN exit associated with the PM. One of the methods used to acquire the data from the bodies of equal males and females involved dissecting 100 SN. The gluteal regions of the cadavers had to be in ideal condition and have been kept adequately to enable data collection and dissection, which was one criterion for inclusion.
Results
The study included 52% males and 48% females. The sciatic nerve exited inferior to the PM in 90% of limbs, inferiorly and between the PM's fascicles in 6%, and superiorly and between the fascicles in 4%. Unilateral abnormalities were 12% more common on the left side and 12.5% more frequent in females than males. The SN most often branched in the popliteal fossa (54%), followed by the gluteal region (38%) and the middle third of the thigh (8%).
Conclusion
This study highlights the anatomical variations between the SN and PM, which are crucial for clinical and surgical procedures. Awareness of these variations can enhance diagnostic accuracy and surgical outcomes, particularly in the context of SN-related conditions and interventions.
Recommendation
Further large-scale, multicenter studies are recommended to confirm these findings and provide more comprehensive insights into SN anatomical variations' prevalence and clinical implications
FUNCTIONAL OUTCOME OF LATERAL APPROACH FOR TOTAL HIP REPLACEMENT: A COHORT STUDY.
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The majority of the cases undergoing total hip replacements have favorable outcomes in a significant number of cases the outcomes are not as per the requirement. The outcome of the surgery depends on the approach taken to perform Total hip replacement (THR). This study aims to determine the effect of the lateral approach in performing total hip replacement on the outcome of the surgery.
Method
This study considered the retrospective data as well as the prospective data of the patients undergoing total hip replacement surgery. The patients underwent THR by lateral modified approach. Harris hip score was used for functional evaluation of the hip bone and the Trendelenburg test was performed for abductor muscle strength.
Results
Among the 100 patients included in the study, the mean age was 55.55 years (SD ± 7.2), with 45% being male and 55% female. THR was performed on the left side in 63% of patients and on the right side in 37%. The most common indication for surgery was a fracture of the neck of the femur (66%). Postoperatively, 39% of patients had excellent outcomes, 55% had good outcomes, and 6% had fair outcomes based on the Harris hip score. No patients were reported to have poor outcomes. Complications included heterotrophic ossification in 5% of patients and superficial infections in 4% of patients.
Conclusion
The modified lateral approach provides a better visualization of the hip, the dissection of the muscles is not involved and the retention of the posterior capsule prevents it from dislocation and provides extra stability.
Recommendation
A lateral modified approach should be considered for performing total hip replacement surgery irrespective of the indication as the complications reported in this study are comparatively lesser than the other approaches used
ASSOCIATION OF ABNORMAL UTERINE BLEEDING WITH BODY MASS INDEX AMONG WOMEN ATTENDING GYNAECOLOGY OUTPATIENT DEPARTMENT, PURNEA, BIHAR.
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Abnormal uterine bleeding (AUB) is a general gynecological condition that significantly affects women’s health and quality of life. Body mass index (BMI) is a well-established factor influencing reproductive health, and its impact on AUB has been observed but not extensively studied in low-resource settings. This study aims to examine the association between BMI and AUB among women attending the gynecology OPD.
Methods
A total of 144 women were included based on specific inclusion and exclusion criteria. Data were collected on socio-demographic parameters, menstrual history, obstetric history, and BMI. BMI was calculated and categorized according to the World Health Organization (WHO) classification. The prevalence of AUB was determined across different BMI categories, and statistical analysis was accomplished using SPSS version 23.0.
Results
The study found that 54.9% of participants had AUB. Obese women had the highest incidence of AUB (73.7% in obese class I and 100% in obese class II and III), with a substantial relationship between higher BMI and increased AUB prevalence (p < 0.05). Obesity was also associated with higher rates of ovulatory dysfunction (32.4%) and iatrogenic causes of AUB. The prevalence of heavy menstrual bleeding and irregular periods was notably higher in women with higher BMI categories.
Conclusion
There is a significant association between higher BMI and increased incidence of AUB among women attending the gynecology OPD. These findings suggest that obesity is a critical factor contributing to menstrual irregularities and AUB, underscoring the need for targeted interventions in this population.
Recommendations
Comprehensive AUB care should include BMI testing in routine gynecological exams and weight management counseling. More study is needed to understand the processes between BMI and AUB and create customized therapies for obesity-related menstrual problems
OUTCOME PREDICTION IN INDIVIDUALS WITH ORGANOPHOSPHORUS AND CARBAMATE POISONING: A PROSPECTIVE COHORT STUDY.
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The study evaluated the predictive utility of Erythrocyte Acetylcholinesterase (E-AChE) and Butyrylcholinesterase (BChE) levels in individuals presenting with OP and carbamate poisoning.
Methods
Of the 60 patients, 42 had Organophosphorus (OP) poisoning, and 18 had Carbamate poisoning in the ER. Vital signs, symptoms, and POP Severity Scale scores were recorded. E-AChE levels were measured using the Rapid ChE Check Mobile, and BChE levels were assessed through standard lab techniques. SPSS was used for statistical analysis, examining correlations between E-AChE levels and outcomes like ICU stay, mechanical ventilation, and mortality.
Results
The study involved 60 patients (mean age 32.5 years, ± 10.7), 66.7% male and 33.3% female. Of these, 60% consumed OP chemicals and 40% carbamate. Severe poisoning was associated with significantly lower E-AChE levels (mean = 2.1 U/g Hb) compared to moderate (3.5 U/g Hb) and mild cases (5.1 U/g Hb) (p < 0.001), showing a strong negative correlation with POP Severity scores (rho = -0.76, p < 0.001). Butyrylcholinesterase (BChE) levels also showed a significant decrease in severe poisoning cases, aligning with clinical outcomes, although the correlation was less robust than with E-AChE. Delays in care led to severe consequences in 80% of low-income patients. Lower E-AChE levels correlated with prolonged ICU stays (r = -0.68, p < 0.001), increased ventilation needs (r = -0.62, p < 0.01), and higher mortality (r = -0.74, p < 0.001). Rural patients faced worse outcomes due to inadequate healthcare access.
Conclusion
Although BChE levels were also measured, their correlation with outcomes was less pronounced but still valuable. Incorporating early measurements of both E-AChE and BChE could enhance clinical decision-making in OP and carbamate poisoning cases.
Recommendations
Incorporating rapid diagnostic tools for cholinesterase measurement in emergency settings could improve clinical decision-making and patient outcomes
HYDROPS FETALIS SECONDARY TO TOXOPLASMA GONDII AND TREPONEMA PALLIDUM COINFECTION: CASE REPORT AND BRIEF LITERATURE REVIEW: case report and brief literature review
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Hydrops fetalis is a pathological condition in which fluid accumulates in the fetus in an extracellular environment, leading to subcutaneous edema and possible accumulation in the fetal body and abdominal cavity. The most common causes in this region are infectious, making systematic monitoring during pregnancy essential. However, it is difficult to apply this guideline in urban areas, and even more so in rural areas with few resources for investigation, as in this patient's case, monitoring was ineffective.
The aim was to carry out infection studies in maternal blood samples taken after giving birth to a newborn in hydrops.
Case presentation
A 36-year-old rural woman in her 6th pregnancy presented with uterine contractions in what was thought to be a full-term pregnancy. The progress of this pregnancy had not been monitored throughout the antenatal period for unknown reasons despite a clinical presentation characterized by breathlessness and generalized edema. The obstetric gynecology clinical examination revealed a mattress-like appearance suggestive of placenta previa, and a cesarean section was indicated with the extraction of a newborn with hydrops fetalis who died despite resuscitation efforts. An infectious disease investigation after delivery revealed the presence of both Treponema pallidum and Toxoplasma gondii in the maternal blood sample.
Conclusion
This state of hydrops fetalis was secondary to this co-infection, which is very difficult to manage in such conditions, facilitated by the lack of systematic biological monitoring for pathogens that could harm both the fetus and the mother.
Recommendation
Facilitate prenatal visits to women, especially in rural areas where access to services is limited, through home visits from health workers and community relays.
During the monthly antenatal visit, pregnant women should be subjected to compulsory infectious screening to provide suitable conditions for the fetus
A COMPARATIVE STUDY ON THE EFFECTS OF 0.5% EPIDURAL LEVOBUPIVACAINE AND 0.75% ROPIVACAINE IN LOWER LIMB SURGERY: A CROSS-SECTIONAL STUDY
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Levobupivacaine and ropivacaine are widely used local anesthetics in lower limb surgeries. Both agents offer favorable safety profiles, but their comparative effects on anesthesia quality and duration remain a subject of interest. This study compared the clinical efficacy, onset, duration, and safety of 0.5% levobupivacaine and 0.75% ropivacaine in lower limb surgeries.
Methods
Eighty patients were randomly randomized into two groups: Group R (ropivacaine 0.75%, 20 ml) and Group L (levobupivacaine 0.5%, 20 ml). Onset times, duration of sensory and motor block, anesthetic quality, and hemodynamic parameters were recorded and analyzed using SPSS version 20.0.
Results
The mean age of participants was comparable between groups (Group R: 42.5 ± 12.1 years; Group L: 41.8 ± 11.6 years; p = 0.76). Levobupivacaine had a faster onset of sensory block (8.3 ± 1.5 minutes vs. 10.2 ± 1.7 minutes; p < 0.001) and motor block (12.5 ± 1.8 minutes vs. 14.7 ± 2.0 minutes; p < 0.001). Sensory block duration was longer in Group L (240.5 ± 20.3 minutes) compared to Group R (215.7 ± 18.6 minutes; p < 0.001). Motor block duration was also longer in Group L (205.4 ± 17.2 minutes vs. 185.9 ± 16.5 minutes; p < 0.001). Both groups had similar safety profiles, with no significant differences in hemodynamic stability or adverse effects.
Conclusion
Levobupivacaine demonstrated faster onset, longer duration, and better anesthesia quality than ropivacaine, making it more suitable for longer surgeries. Both agents were well tolerated, with comparable safety profiles.
Recommendations
Further research is recommended to explore the long-term outcomes and cost-effectiveness of these anesthetic agents in different surgical settings
DYSLIPIDEMIA IN ELDERLY PATIENTS WITH CEREBROVASCULAR ACCIDENTS: A CROSS-SECTIONAL STUDY.
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Dyslipidemia is a significant risk factor for cerebrovascular accidents (CVA), especially among the elderly, due to age-related metabolic changes. This demographic is more vulnerable to lipid abnormalities, which increase the risk and severity of ischemic strokes. Despite established guidelines, dyslipidemia remains poorly controlled in elderly populations, underlining the need for targeted lipid management. This study aimed to examine the prevalence of dyslipidemia in elderly CVA patients.
Methods
A study was conducted at MGM Institute of Health Sciences, Navi Mumbai, over 1.5 years, involving 150 elderly CVA patients. Participants underwent lipid profile assessments, and data were collected on demographic, clinical, and lifestyle factors. Statistical analyses were performed using SPSS version 22.0, with chi-square tests and logistic regression applied to determine associations between dyslipidemia and risk factors.
Results
Of the 150 participants, 74.7% had dyslipidemia, with high LDL levels in 60% and low HDL levels in 70.7% of cases. Dyslipidemia was significantly associated with hypertension (OR 2.58, p < 0.01) and diabetes (OR 1.98, p = 0.02). Patients with severe CVA had significantly higher LDL and total cholesterol levels than those with milder CVA presentations (p < 0.05).
Conclusion
The study reveals a high prevalence of dyslipidemia in elderly CVA patients, particularly among those with hypertension and diabetes. Dyslipidemia is associated with increased CVA severity, suggesting that lipid abnormalities may exacerbate stroke outcomes in elderly individuals.
Recommendations
Regular lipid screenings and targeted lipid management should be prioritized in elderly patients with CVA, especially those with hypertension and diabetes. Implementing effective lipid management strategies may reduce morbidity and improve outcomes in this high-risk population
INCIDENCE OF PSYCHOTROPIC DRUGS PRESCRIBED IN CHILDREN AND ADOLESCENTS WITH AUTISM AT EL. TEGANI-ALMAHI REFERENCE HOSPITAL KHARTOUM SUDAN. A CROSS-SECTIONAL STUDY.
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Autism spectrum disorder (ASD) among vulnerable populations frequently presents with complex mental health diagnoses, and psychotropic medications are often a component of comprehensive biopsychosocial treatment plans for these conditions. The primary aim of this study is to determine the incidence of usage of psychotropic drugs and to assess the response of psychotropic medications prescribed in children and adolescents with autism in a resource-constrained setting in Khartoum Sudan.
Materials and methods:
Following an institutional review board approval, Department of Innovation, Development and Scientific Research, Ministry of Health, Khartoum State (IDSREC-2020-EATA/44/A), A cross-sectional retrospective hospital-based study was conducted from January 2018 to Jan-2021 among 261 children and adolescents aged 1 to 17 years diagnosed with ASD using The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) as a guideline. SPSS version 25.
Results:
The prevalence of ASD was greater in males than females; 45% of autistic patients have at least one comorbid disease. Attention Deficit Hyperactivity Disorder (ADHD), learning disability (LD), and epilepsy are the three most comorbid diseases among autistic patients. The Average number of psychotropic drugs per prescription was 1.8 out of 2.61. The most often prescribed medications among this group were risperidone (49%), methylphenidate (33%), and valproic acid (15%). All the patients received at least one psychotropic prescription; 30% of the patients were receiving polytherapy. Non-adherence of the patient to their medication account for 24%. This indicated the efficacy of other treatment approaches and the importance of combining medication and non-medication therapy.
Conclusion:
The study revealed a significant use of psychotropic medication, with a notable emphasis on antipsychotics. There is a high incidence of prescription rates for psychotropic medications for comorbid psychiatric disorders
A CROSS-SECTIONAL STUDY: PREVALENCE OF DEPRESSION AMONG DIABETIC PATIENTS
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Type 2 diabetes mellitus (T2DM) is a growing global health concern, with a significant prevalence in India. Depression is commonly observed in individuals with T2DM, negatively impacting disease management and outcomes. The coexistence of these conditions exacerbates complications and patient well-being. This study seeks to assess the prevalence of depression in patients with T2DM.
Methods
A cross-sectional study was conducted at Jawaharlal Nehru Medical College & Hospital, Bhagalpur, Bihar, on 480 T2DM patients attending outpatient and inpatient services. Depression was assessed using the Beck Depression Inventory-II (BDI-II), and various disease-related variables were evaluated. Data was collected through interviews, clinical evaluations, and laboratory tests to assess glycemic control and medication adherence.
Results
The study included 480 diabetic patients, with 85% over 40 years of age and 61.9% male. Moderate depression was observed in 31.3% (n=150) of patients, while 35% (n=168) had no depression. Depression severity was significantly associated with factors such as age, marital status, family history of diabetes, BMI, fasting blood sugar levels, and duration of diabetes (p<0.001). A high prevalence of depression was noted in patients with a BMI >30 (63.9%), fasting blood sugar >125 mg/dl (72.7%), and those with diabetes for over 5 years (54.7%).
Conclusion
The study emphasizes the strong link between depression and factors like age, BMI, diabetes duration, and blood sugar levels, highlighting the need for integrated mental health care in diabetes management.
Recommendation
Proper screening for depression among diabetic patients with neuropathy and early screening for neuropathy in type 2 diabetic patients to prevent depression is recommended
A RETROSPECTIVE COHORT STUDY STATIN LIPOPHILICITY AND THE RISK OF DEVELOPING HEART FAILURE
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The cornerstone of the battle against cardiovascular disease is statin medication, which lowers cholesterol. In recent research, there has been considerable discussion regarding whether the lipophilicity of statin raises the risk of heart failure. Examining the relationship between incident heart failure and statin lipophilicity is the aim of this retrospective cohort investigation.
Methods
For this retrospective cohort study, electronic health records were utilized. Every participant had to be at least eighteen years old and have a history of taking statins. The two types of statins were classified as less lipophilic and highly lipophilic. Heart failure rates were assessed during the study. A statistical model accounting for confounding variables was used to compute hazard ratios and 95% Confidence Interval.
Results
Those on highly lipophilic statins had a slightly greater overall rate of heart failure (3.3 cases per 1,000 person-years) than those taking less lipophilic statins (2.5 cases per 1,000 person-years) in our study of 100 patients. The association between highly lipophilic statins and an increased risk of heart failure was not statistically significant (Hazard Ratio: 1.31, 95% CI: 0.88 - 1.95).
Conclusion
In line with earlier studies, this study highlights the complex relationship between the lipophilicity of statin and heart failure risk. Even though there was no statistically significant trend, the complex nature of the link necessitates more research in bigger, more representative cohorts.
Recommendations
Clinicians should consider the unique characteristics of each patient while prescribing statins in the absence of conclusive proof