Student's Journal of Health Research Africa
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STUDY ON EVALUATION OF SFLT1/PLGF RATIO FOR PREDICTION OF PRE-ECLAMPSIA IN THE SECOND AND THIRD TRIMESTER OF PREGNANCY: AN OBSERVATIONAL STUDY.
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Pre-eclampsia (PE) is a critical pregnancy complication leading to adverse perinatal outcomes like fetal growth restriction, stillbirth, oligohydramnios, eclampsia, and HELLP syndrome. An imbalance between pro-angiogenic (PlGF) and anti-angiogenic (sFLT-1) factors increases the sFLT-1/PlGF (sFlt1/PlGF) ratio, detectable about four weeks before the symptoms appear. The study was conducted to determine the predictive value of the sFlt1/PlGF ratio for the development of PE in high-risk pregnant women during the late 2nd and 3rd trimesters.
Methods
The study included 50 high-risk pregnant females between 24 and 32 weeks of gestation. Participants were selected based on criteria such as age > 30 years, BMI > 30 kg/m², previous history of PE, PAPPA < 0.4 MoM, increased UtA PI at 11-13 weeks, twin pregnancy, IVF conception, and history of FGR. The sFlt1/PlGF ratio was determined, and participants were monitored for the development of Pre-Eclampsia. The study determined the specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV).
Results
Among the participants, 70% were over 30 years of age, and 30% were under 30. The sFlt1/PlGF ratio demonstrated a high NPV of 96.7%, indicating a reliable prediction for the absence of PE within a week. The PPV was 63.5%, suggesting a strong indication of PE development with a high ratio (>38). The sensitivity of the ratio was 92.3%, and the specificity was 81.08%, confirming its effectiveness in correctly identifying both the presence and absence of pre-eclampsia.
Conclusion
The sFlt1/PlGF ratio is a valuable predictive tool for identifying the possibility of the development of PE in high-risk pregnancies, with high NPV, sensitivity, and specificity. It effectively aids in early identification and management, potentially improving maternal and fetal outcomes.
Recommendations
Clinicians should consider incorporating the sFlt1/PlGF ratio in the routine assessment of high-risk pregnant women to enhance early detection and intervention strategies for pre-eclampsia
CONGENITAL HEART DEFECTS AND NON-CARDIAC MALFORMATIONS IN PATIENTS WITH A NORMAL KARYOTYPE, ODISHA: A COHORT STUDY.
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Congenital heart defects (CHDs) are the most common type of birth defect, frequently associated with non-cardiac malformations, even in patients with normal karyotypes. Understanding these associations can enhance diagnosis, management, and outcomes. The study investigated the prevalence and types of non-cardiac malformations in patients with CHDs and normal karyotypes and identified significant associations between these anomalies.
Methods
A retrospective observational study was conducted. The study included 300 patients with CHDs and normal karyotypes. Data were collected from medical records, including demographic information, types of CHDs, and non-cardiac malformations. Statistical analysis was performed, employing chi-square tests and logistic regression.
Results
The participants comprised 160 males (53.3%) and 140 females (46.7%), with a mean age of 3.5 years. The study found that 33.3% of patients had musculoskeletal anomalies, 28.3% had genitourinary anomalies, and 21.7% had gastrointestinal anomalies. Significant associations were observed between VSD and musculoskeletal anomalies (χ² = 12.5, p = 0.0004) and ASD and genitourinary anomalies (χ² = 5.8, p = 0.02). A family history of anomalies was a significant predictor of multiple congenital anomalies (OR = 3.2, 95% CI: 1.8-5.7, p =0.00002). Surgical interventions led to favorable outcomes in 83.3% of patients.
Conclusion
The study highlights a high prevalence of non-cardiac malformations in patients with CHDs and normal karyotypes, with significant associations between specific CHDs and certain non-cardiac anomalies. These findings underscore the necessity for a multidisciplinary approach to improve diagnosis and management, as well as the importance of considering family history in assessing risks for multiple congenital anomalies.
Recommendations
Future research is needed to explore the genetic and developmental mechanisms underlying these associations. A multidisciplinary approach should be implemented in clinical practice to improve diagnosis and management of patients with CHDs and associated non-cardiac malformations
COMPARING TECHNIQUES FOR ABDOMINAL RECTOPEXY IN RECTAL PROLAPSE: A RANDOMIZED CONTROLLED STUDY.
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Abdominal rectopexy is a surgical option for rectal prolapse, but various techniques exist, prompting the need for comparative studies to assess their efficacy and safety. The study aimed to compare different techniques of abdominal rectopexy for rectal prolapse treatment, evaluating their effectiveness, safety, and long-term outcomes.
Methods
A randomized controlled trial design was employed. Forty participants meeting inclusion criteria (full-thickness rectal prolapse, ability to participate, informed consent) were included. Exclusion criteria encompassed irreducible prolapse, age below 18, and pregnancy. Randomization, stratification, and blinding techniques were used to minimize bias. Primary outcomes included bowel function, quality of life (QoL), recurrence rates, and surgical complications, assessed using validated measures and statistical analyses.
Results
Forty participants were randomized into perineal (n=20) or abdominal (n=20) groups. Both groups showed significant improvement in bowel function postoperatively (p < 0.001), with increased bowel movements, faster evacuation, and reduced incomplete evacuation. QoL scores significantly improved across all dimensions (p < 0.001). Recurrence rates were 10% in the perineal group at 1 year and increased to 15% at 3 years. Minor complications occurred in 20% of perineal and 15% of abdominal cases within 30 days, with no major complications.
Conclusion
Abdominal rectopexy techniques demonstrate improved bowel function and QoL, but long-term recurrence rates require monitoring. Both perineal and abdominal approaches show safety and efficacy, with considerations for recurrence and minor complications.
Recommendations
Continued follow-up and larger studies are recommended to validate findings and guide clinical practice
OUTCOMES OF A HOME-BASED UNSUPERVISED REHABILITATION PROTOCOL FOLLOWING ROTATOR CUFF REPAIR: A COHORT STUDY
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Rotator cuff tears are a general cause of shoulder pain and dysfunction, often requiring surgical repair. Postoperative rehabilitation is crucial for optimal recovery, but traditional supervised physical therapy can be resource-intensive and costly. This study aimed to evaluate the outcomes of a home-based unsupervised rehabilitation protocol following rotator cuff repair performed through a mini-open incision.
Methods
A cohort study was carried out involving 50 individuals who underwent rotator cuff repair. Patients were taught a standardized home-based rehabilitation protocol and followed up at regular intervals. Pain levels (VAS score), functional status (DASH score), range of motion, cuff strength, and return-to-work rates were assessed over a 12-month period. Statistical analyses were performed to compare pre--operative and postoperative outcomes.
Results
Significant improvements were observed in pain levels, with the mean VAS score decreasing from 7.8 preoperatively to 2.3 at one year postoperatively (p < 0.001). The DASH score improved from a mean of 65.4 preoperatively to 20.7 postoperatively (p < 0.001). Forward flexion increased from 85.3 degrees to 165.7 degrees, and external rotation improved from 20.4 degrees to 55.6 degrees (both p < 0.001). Cuff strength increased from 48% to 92% of the opposite side (p < 0.001). Ninety percent of patients returned to full work duties within a mean of 10.2 weeks. The failure rate was low at 6%.
Conclusion
The home-based unsupervised rehabilitation protocol after rotator cuff repair significantly improved pain, functional status, range of motion, and cuff strength. Most patients returned to work promptly, and the low failure rate indicates this approach is effective and safe.
Recommendations
Home-based unsupervised rehabilitation should be considered a viable option for postoperative recovery following rotator cuff repair, providing a cost-effective and accessible alternative to supervised therapy. Further research with larger sample sizes and long-term follow-up is recommended to validate these findings
CORRELATION OF CLINICAL SEVERITY AND LABORATORY PARAMETERS WITH DIFFERENT SEROTYPES IN DENGUE VIRUS: A CROSS-SECTIONAL STUDY.
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In tropical and subtropical nations, dengue fever a serious public health concern is brought on by the dengue virus (DENV). Dengue hemorrhagic fever (DHF) and dengue shock syndrome are two examples of the mild to severe forms of the virus. In order to improve knowledge of the variables influencing severe dengue outcomes, the study examines the correlation between clinical severity, laboratory markers, and dengue virus serotypes.
Methods
The study comprised 130 patients diagnosed with dengue at a tertiary care hospital. Patients were classified into three stages of dengue severity based on WHO guidelines. Serological and molecular diagnostics, including ELISA and RT-PCR, were used to identify DENV serotypes and analyze laboratory parameters. Statistical analyses were performed to evaluate the correlations.
Results
The participants had average age of 34.5 years, with 55.4% males. Patients were categorized into Stage 1 (43.1%), Stage 2 (36.9%), and Stage 3 (20%) based on severity. Significant differences in laboratory parameters were observed across the stages, with lower platelet counts and higher levels of hematocrit, liver enzymes (AST and ALT), and ferritin in severe dengue cases (p < 0.001). DENV-2 was the most prevalent serotype (35.4%) and was significantly associated with severe dengue (p = 0.025). ROC curve analysis identified ferritin as a potential marker for severe dengue with a cutoff value of 300 ng/mL and an AUC of 0.88.
Conclusion
The study shows that dengue patients' platelet count, hematocrit, liver enzymes, and ferritin levels are strongly correlated with clinical severity. Serious illness symptoms are associated to DENV-2. These findings emphasise the necessity of serotype identification and laboratory monitoring in dengue management.
Recommendations
Future studies with bigger sample sizes are recommended to validate these findings. Routine monitoring of ferritin levels and early identification of DENV serotypes could enhance the management and prognosis of dengue patients
ANTIMICROBIAL DRUG MISUSE IN THE EASTERN DEMOCRATIC REPUBLIC OF THE CONGO A CROSS-SECTIONAL STUDY: FACTORS INFLUENCING THE EMERGENCE OF ANTIMICROBIAL RESISTANCE
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Antimicrobial resistance is a major global public health challenge. In sub-Saharan Africa, Plasmodium resistance to new molecules on the market continues unabated. This increase in resistance is mostly due to unhealthy community practices, and also to microbial control methods that are ineffective because of our health policies. This study aimed to analyze factors involved in the emergence of antimicrobial resistance in ancient Kivu, in the eastern part of the Democratic Republic of Congo (DRC).
Materials and methods
A cross-sectional study was carried out from November 2023 to February 2024 in two cities east of the Democratic Republic of the Congo, surveying pharmacies using a standardized questionnaire. We focused on four elements within the pharmacies: the nature of the provider, the way medicines are sold (consumption), the location of the pharmacies, and the nature of drugs.
Results
Our study included 98 (56.9%) pharmacies, 66.3% (65/98) of which were located in peripheral areas with most of the untrained providers (91.7%; 11/12; p = 0.006) and in all pharmacies, 81% (47/58; p < 0.001) of their sales were based on patients' wishes. Nursing sales are 76.9% (20/26; PR: 1.9; 95% CI: 0.5-7.4; p = 0.009) undocumented among qualified staff involved in pharmacy sales.
Conclusions
The risk factors for developing antimicrobial resistance in these two cities in eastern DRC are related to undocumented drug sales and qualified providers in pharmacies. This requires a high level of awareness among those involved in the sale of medicines and those who receive them.
Recommendation
Our proposal is for strict protection of antimicrobial resources through regulation of their sale in the region
ASSOCIATION OF SERUM VITAMIN D LEVELS WITH SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS- A CASE CONTROL STUDY FROM TERTIARY CARE HOSPITAL.
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The Vitamin D deficiency prevalence is increasing and has been linked to numerous chronic and autoimmune conditions. This research aims to establish the relationship among Vitamin D and SLE (Systemic Lupus Erythematosus).
Methodology- A case-control research has been conducted on 42 confirmed SLE patients at the Department of Dermatology and the Department of Medicine at Silchar Medical College and Hospital, along with 50 healthy controls matched for age and gender. All samples underwent immunofluorescence testing for dsDNA, ANCA, ANA, and radioimmunoassay for levels of Vitamin-D.
Results- The average Vitamin-D levels in the SLE cases group have been calculated to be 17.57 with a SD (Standard Deviation) of 4.51. The control group had a mean of 52.23 and an SD of 2.01. A paired test comparing Vitamin-D levels in the cases of SLE as well as control groups showed a p-value of <0.001, indicating statistical significance. Following supplementation of Vitamin-D, the average in the SLE cases group had been 46.82, with an SD of 14.65. A paired sample t-test has been conducted on the data collected before as well as after Vitamin D supplementation in the SLE cases group, giving a p-value of <0.001, indicating statistical significance. There has been no statistically major relation between the various ANA types, with p-values of 0.09 following supplementation and 0.21 prior to it. As a result, statistical insignificance was concluded.
Conclusion- SLE patients have lower levels of Vitamin-D than the healthy individuals. Vitamin-D did not display a major correlation with the different patterns of ANA in patients of SLE.
Keywords: Vitamin D, SLE, Immune responses.
 
COMPARING THE EFFECTIVENESS OF ORAL ISOTRETINOIN AND CYPROTERONE COMPOUND IN ACNE TREATMENT AMONG ADULT FEMALES WITH CUTANEOUS HYPERANDROGENISM: A PROSPECTIVE STUDY.
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Acne is a complex illness caused by androgenic stimulation of the sebaceous glands. As a result, combined oral contraceptives (COCs) including anti-androgenic progestogens are good candidates for acne treatment. The purpose of this study is to compare the effectiveness of oral isotretinoin and cyproterone compound in the treatment of nodulocystic acne, in adult females with signs of cutaneous hyperandrogenism.
Materials and Methods:
Thirty female patients with SAHA syndrome were randomly assigned into two groups of fifteen each. Group A got cyproterone compound (35 μg ethinyl estradiol and 2mg cyproterone acetate) starting day 5 of the menstrual cycle. Group B got isotretinoin at a dose of 0.5mg/kg daily. All recruited patients got topical benzoyl peroxide 3.5% gel regularly. SPSS was used to do statistical analysis. P-values < 0.05 were considered significant.
Results:
Despite a consistent reduction in ASI score in both groups, according to both physician (P = 0.63) and patient (P = 0.25) assessment, the cyproterone compound was not statistically more successful than traditional treatment of nodulocystic acne at the end of the trial. Patients in both groups reported minor and acceptable side effects, except in two cases.
Conclusion:
This study found that cyproterone compound is not more effective than isotretinoin in the treatment of nodulocystic acne in patients with SAHA syndrome or cutaneous hyperandrogenism. Indeed, additional research is needed to assess the efficacy of cyproterone molecules (independent of testosterone level) and isotretinoin in people with just nodulocystic acne.
Recommendation:
Oral isotretinoin is recommended for treating nodulocystic acne in patients with cutaneous hyperandrogenism due to its comparable efficacy to cyproterone compound and established effectiveness in reducing acne lesions. Further research should compare these treatments regardless of androgen levels in nodulocystic acne patients
POSTOPERATIVE COMPLICATIONS RATE IN EARLY AND LATE PRESENTING CASES OF GASTROINTESTINAL TRACT PERFORATION IN BIHAR: A COHORT STUDY.
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Gastrointestinal (GI) tract perforation is a life-threatening surgical emergency requiring immediate intervention. This study aims to evaluate the postoperative complication rates in early versus late presenting cases of gastrointestinal tract perforations in Northern India.
Methods
A prospective cohort study included 182 individuals with confirmed GI tract perforations, who presented to the emergency department and outpatient clinic. The patients were allotted into 2 groups: Group A (presentation within 48 hours) and Group B (presentation between 48 and 144 hours). Both groups underwent exploratory laparotomy followed by standard postoperative care. Data on postoperative complications, hospital stay, and mortality were collected and analyzed using SPSS version 23.0.
Results
The study included 182 patients, with 48 in Group A and 134 in Group B. The mean age was 42.5 ± 10.6 years, with a male predominance (70% male, 30% female). Group B experienced significantly higher rates of postoperative complications compared to Group A. Local complications, such as surgical site infection, were observed in 25.4% of Group B patients versus 10.4% in Group A (p=0.028). Systemic complications, including septicemia and respiratory complications, were more common in Group B (55.2%) compared to Group A (27.1%) (p=0.001). The mortality rate was significantly higher in Group B (17.9%) compared to Group A (6.2%) (p=0.047). The mean hospital stay was longer for Group B, averaging 12.6 ± 4.3 days, compared to 8.9 ± 3.1 days for Group A (p<0.001).
Conclusion
Delayed presentation of GI tract perforations is correlated with notably higher postoperative complications, longer hospital stays, and increased mortality. Early intervention is crucial to improving patient outcomes.
Recommendations
There is an urgent need to enhance healthcare accessibility and education in rural areas to encourage early presentation. Strengthening healthcare infrastructure and implementing community outreach programs can help reduce delays in seeking medical care for GI emergencies
LAPAROSCOPIC VERSUS OPEN APPENDICECTOMY IN ADULTS
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One of the most popular techniques is appendectomy. Though it is still debatable, laparoscopic appendectomy (LA) is thought to be the initial course of treatment for complex appendicitis. This study examines mean operating time, surgical site infection, and duration of hospital stay to compare open and laparoscopic appendectomy procedures for individuals with perforated appendices.
MATERIALS AND METHODS
This randomized research was performed at the Department of General Surgery, KIMS, Bhubaneshwar from 2022-23. A total of 100 individuals were enrolled in the research, with 50 people in both groups. Analysis was done on outcome metrics such as blood loss, length of hospital stays before oral intake, mean operating time and postoperative problems.
RESULTS
The mean operating time was significantly longer for LA (101.46 ± 44.4 minutes) compared to OA (84.4 ± 43.1 minutes; p = 0.008). However, LA showed a lower incidence of wound infections (2%) compared to OA (8%), though this difference was not statistically significant (p = 0.09). LA patients experienced a significantly shorter hospital stay (10.54 ± 5.57 days) compared to OA patients (13.19 ± 8.4 days; p = 0.015).
CONCLUSION
The laparoscopic procedure for appendectomy is an effective and efficient surgical procedure with marginally increased hospital expenses. The laparoscopic procedure has clinically advantageous benefits over the open method, including a reduced rate of wound infection, early food tolerance, a shorter stay in the hospital, and less need for postoperative analgesics.
RECOMMENDATIONS
LA is recommended over OA for perforated appendices due to its advantages, such as fewer wound infections and shorter hospital stays, despite longer operating times. Further research with larger randomized trials is needed to confirm these findings and evaluate the cost-effectiveness of LA