Category: Nevin Manimala

Pan Afr Med J. 2026 Apr 2;53:151. doi: 10.11604/pamj.2026.53.151.49695. eCollection 2026.

ABSTRACT

INTRODUCTION: Hepatitis B virus (HBV) remains a major occupational hazard for healthcare workers (HCWs), particularly in low-resource settings like Sierra Leone, where systemic challenges hinder effective prevention efforts. Despite the availability of an effective vaccine since 1982 and widespread screening initiatives, HBV vaccination uptake among HCWs remains alarmingly low. This study investigates the disconnect between HBV screening and subsequent vaccination among HCWs in Sierra Leone, examining individual, institutional, and systemic factors.

METHODS: we employed a mixed-methods cross-sectional design. A total of 432 HCWs were sampled across public, private, NGO, and faith-based hospitals using multi-stage techniques to assess screening uptake, vaccination coverage, and influencing factors. Additionally, 12 in-depth interviews were conducted with senior staff and health administrators. Quantitative data were analysed using SPSS, while the qualitative data were thematically analysed.

RESULTS: quantitative findings revealed suboptimal levels of HBV vaccination and screening among HCWs. Overall, – 65% of HCWs were screened for HBV, while 52% received at least one vaccine dose, and only 34% completed the full three-dose series. Nearly half of those screened were not vaccinated, exposing critical failures in follow-up care. Screening and vaccination rates varied by cadre. Higher uptake was observed among administrators (100.0%), doctors (88.2%), community health officers (68.8%), other clinical staff (68.8%), and laboratory technicians (54.2%). In contrast, nurses (43.4%), pharmacists (34.9%), and other essential staff (13.2%) reported lower coverage levels. Differences were also noted across facility types. Private facilities recorded the highest screening (77.3%) and vaccination (62.5%) rates, followed by NGOs (70.8% and 66.7%). Faith-based facilities recorded moderate levels (56.4% screening and 54.5% vaccination), while public facilities had 64.4% screening but relatively the lowest 44.7% vaccination coverage. Screening and vaccination uptake were significantly associated (Χ² = 317.27, p < 0.05).

CONCLUSION: the findings underscore critical missed opportunities in HBV prevention among HCWs in Sierra Leone. Despite moderate screening rates, vaccine coverage remains low, primarily due to institutional weaknesses such as inadequate follow-up systems, limited vaccine access, and weak policy enforcement – rather than individual neglect. These gaps place frontline health professionals at continued risk of HBV infection. Strengthening HBV prevention requires integrated screening-vaccination programs, mandatory occupational health policies, and sustainable vaccine supply systems. Targeted education, consistent advocacy, and inclusive strategies that engage all healthcare worker cadres are also vital. Such interventions are essential not only for protecting the healthcare workforce but also for reinforcing public health resilience in Sierra Leone.

PMID:42604405 | PMC:PMC13477185 | DOI:10.11604/pamj.2026.53.151.49695

Pan Afr Med J. 2026 Apr 17;53:163. doi: 10.11604/pamj.2026.53.163.49196. eCollection 2026.

ABSTRACT

INTRODUCTION: WHO and other partners initiated Big Catch-up (BCU) to catch up children aged 12 to 59 months (about 5 years) who have never been vaccinated or are under-vaccinated because of the COVID-19 pandemic. Among the eligible countries are 16 from Central and West Africa. This study aims to analyze challenges and opportunities for this global initiative’s success.

METHODS: this was a secondary analysis of aggregated program data conducted in 16 countries in Central and West Africa eligible for the BCU. Data were collected through the BCU plans developed by countries, on vaccination coverage for each antigen included, epidemiological surveillance data for vaccine-preventable diseases (VPD) in countries and narrative reports on the implementation of BCU. The proportions of remaining targets to be achieved by country are obtained by dividing the number of children vaccinated in the numerator by the targets for zero doses or under-immunized children in the denominator by antigen. A simple logistic regression was performed to establish relationships between vaccination and the occurrence of vaccine-preventable diseases after COVID-19 and the implementation of BCU.

RESULTS: outbreaks of VPD increase significantly in post-COVID-19 cases and during BCU implementation. All countries except Nigeria still have at least 70% of targets to catch up by December 2025. Two countries are categorized as making good progress, having achieved more than 50% vaccination coverage and DTP and measles: Nigeria and Mali. Cameroon, Côte d’Ivoire and Burkina Faso are making average progress in terms of vaccination coverage of the same antigens between 20-49%.

CONCLUSION: this initiative helped to curb the occurrence of VPD epidemics. However, the challenges are enormous. Countries must continue to organize further large-scale catch-up rounds and seize every opportunity for vaccination to significantly reduce ZD and Ui and thus VPD epidemics.

PMID:42604400 | PMC:PMC13477188 | DOI:10.11604/pamj.2026.53.163.49196

Cureus. 2026 Jul 16;18(7):e112792. doi: 10.7759/cureus.112792. eCollection 2026 Jul.

ABSTRACT

Palatally displaced canines (PDCs) are a common orthodontic anomaly that frequently require surgical exposure to facilitate orthodontic alignment. Two primary techniques exist: open surgical exposure, where the canine is left to erupt spontaneously, and closed surgical exposure, where an attachment is bonded for immediate orthodontic traction. This meta-analysis aims to compare the efficacy of closed versus open surgical exposure for PDCs regarding pain, surgical time, complications, eruption time, and patient-reported outcomes. We systematically searched the following databases: PubMed, Cochrane Library, Scopus, and Web of Science. Studies were included if they compared open versus closed surgical exposure techniques for palatally displaced canines. R software was used for statistical analysis. Continuous outcomes were analyzed as mean differences (MD) or standardized mean differences (SMD) and dichotomous data as risk ratios (RR), with 95% confidence intervals (CI). Our review included six studies with 450 participants. Pooled analysis demonstrated that closed exposure was associated with significantly less pain at 1 day (SMD=-0.39, 95% CI -0.75 to -0.04) and less discomfort (SMD=-0.25, 95% CI -0.42 to -0.07). However, closed exposure required significantly longer surgical time (MD=5.09 minutes, 95% CI 1.35 to 8.82) and longer eruption time (MD=3.37 months, 95% CI 2.02 to 4.73). No significant differences were observed for analgesic consumption, gingival recession, or overall complications. Closed surgical exposure offers advantages in early postoperative pain and discomfort but requires longer surgical and eruption times. Both techniques appear comparable regarding complications and periodontal outcomes. The choice of technique should be individualized based on clinical factors, patient preference, and clinician expertise. Future large-scale RCTs with standardized protocols are warranted to further refine these findings.

PMID:42604397 | PMC:PMC13477204 | DOI:10.7759/cureus.112792

Pan Afr Med J. 2026 Apr 19;53:164. doi: 10.11604/pamj.2026.53.164.49885. eCollection 2026.

ABSTRACT

INTRODUCTION: heroin is the most commonly injected drug among people who inject drugs globally. Heroin injection disrupts the hypothalamic-pituitary axis, leading to hormonal imbalances such as altered testosterone concentrations in men. Men who inject heroin concurrently use other substances, which may further affect testosterone levels. Lower testosterone levels are associated with increased central adiposity and decreased sexual function. This study aimed to determine how substance use patterns and adiposity markers are associated with testosterone concentrations among heroin-injecting men in Mombasa County.

METHODS: in this analytical cross-sectional study, serum samples from male participants with a documented history of substance use were included. Exclusion criteria included HIV-positive status and incomplete data. Demographic, substance use profiles, and clinical data were extracted from existing records. Serum total testosterone levels were measured using a chemiluminescence immunoassay technique. Descriptive statistics, non-parametric between-group comparisons, Spearman correlations, and multivariable linear regression were used to analyze the data, with statistical significance set at p < 0.05.

RESULTS: relatively higher median testosterone concentrations were observed in heroin-injecting men (3.570 nmol/L) compared to non-heroin-injecting men (0.097 nmol/L) (p < 0.0001). Hypogonadism, defined as testosterone below 8.0 nmol/L, was present in 97.9% of heroin-injecting men and in all non-heroin-injecting men (100.0%), with no significant difference between the two groups (p = 0.712). Heroin-injecting men working in small businesses and transport sectors had relatively higher testosterone levels compared to those working in the hospitality sector (p = 0.001). Hip circumference was positively correlated with testosterone levels in the heroin-injecting men, with a significant positive correlation (Spearman’s ρ = 0.173, p = 0.039). Similarly, waist-to-hip ratio showed a significant negative correlation in the heroin-injecting men (Spearman’s ρ = -0.204, p = 0.014). On multivariable linear regression, employment in the small business sector (B = 3.147, p < 0.001) and transport sector (B = 3.103, p < 0.001), duration of heroin injection of one year or more (B= 0.802, p = 0.012), and waist-to-hip ratio (B= -6.146, p = 0.006) were independent predictors of serum total testosterone concentrations (Adjusted R²= 0.201).

CONCLUSION: this study reports that serum total testosterone concentrations were significantly higher in heroin-injecting men than in non-heroin-injecting men, though both groups fell below the clinical threshold for hypogonadism. Multivariable regression analysis identified employment in the small business and transport sectors, prolonged heroin injection of at least one year, and waist-to-hip ratio as independent predictors of serum total testosterone concentrations. Cigarette smoking was independently associated with lower testosterone after adjustment, though this association warrants cautious interpretation. These findings emphasize the need for integrated interventions that address both the endocrine consequences of heroin injection and the occupational and lifestyle factors that modulate testosterone in this population.

PMID:42604395 | PMC:PMC13477183 | DOI:10.11604/pamj.2026.53.164.49885

Pan Afr Med J. 2026 Apr 21;53:169. doi: 10.11604/pamj.2026.53.169.49506. eCollection 2026.

ABSTRACT

INTRODUCTION: dry eye disease (DED) is a multifactorial ocular surface disorder that remains underdiagnosed, particularly in sub-Saharan Africa, where epidemiological data are limited. This study aimed to describe the distribution and severity of DED using the Ocular Surface Disease Index (OSDI), and to evaluate its association with demographic factors and objective diagnostic tests among adults in Lagos, Nigeria.

METHODS: we conducted a hospital-based cross-sectional study involving 173 consecutive participants recruited from ophthalmology, rheumatology, and dental clinics in Lagos, Nigeria. Participants completed the OSDI questionnaire and underwent Schirmer´s test and Tear Break-Up Time (TBUT) assessment. Demographic and clinical variables were analysed using STATA version 16.1. The sensitivity, specificity, and predictive values of OSDI were evaluated against objective measures of ocular dryness.

RESULTS: the mean OSDI score was 21.2 ± 18.9. Forty percent of participants had scores within the normal range, while 24.3% had severe DED. Higher OSDI scores were observed among females, older participants, and those with a prior diagnosis of dry eye or systemic dryness symptoms, although not all associations reached statistical significance. When compared with objective tests, OSDI demonstrated high sensitivity but low specificity (7-13%).

CONCLUSION: dry eye disease is common among adults attending tertiary clinics in Lagos and presents with heterogeneous ocular and systemic features. While OSDI is a useful high-sensitivity screening tool, its low specificity underscores the need for confirmatory objective testing. Larger population-based studies are warranted to better define the epidemiology and determinants of DED in Nigeria.

PMID:42604376 | PMC:PMC13477187 | DOI:10.11604/pamj.2026.53.169.49506

Cureus. 2026 Jul 16;18(7):e112812. doi: 10.7759/cureus.112812. eCollection 2026 Jul.

ABSTRACT

Background International Medical Graduates (IMGs) entering U.S. residency programs often encounter challenges during the transition to internship, including unfamiliarity with the U.S. healthcare system, clinical workflows, electronic medical records (EMRs), and expectations within graduate medical education. Despite these challenges, structured onboarding interventions designed to support IMG transition remain limited. Objective To describe the implementation of a Transitional Elective Block (TEB) designed to support IMG pediatric interns during the transition to residency and to evaluate its early educational outcomes using quantitative self-reported measures and qualitative participant feedback. Methods A four-week transitional elective block was implemented for incoming IMG pediatric interns during the summers of 2024 and 2025 at a university-affiliated pediatric residency program. The curriculum emphasized supervised clinical exposure, mentorship, patient presentations, handoff communication, electronic medical record (EMR) navigation, and clinical workflow acclimation. Program evaluation used a mixed-methods approach, including baseline and follow-up surveys assessing self-reported confidence using five-point Likert scales and open-ended responses. Quantitative analyses were exploratory and performed using nonparametric statistical methods, while qualitative responses were analyzed using rapid content analysis. Results At baseline, TEB participants reported lower self-reported confidence across multiple domains than non-participants. By three months of internship, participants demonstrated greater relative improvements in confidence, partially narrowing baseline differences. All TEB participants reported that they would recommend beginning residency with the elective. At follow-up, participants reported higher self-rated clinical skill and comfort across several domains, whereas EMR use and system navigation remained common challenges across the intern cohort. Qualitative responses highlighted improved confidence, a clearer understanding of residency expectations, and the value of structured mentorship and early clinical exposure. Given the pilot study design and small sample size, quantitative findings should be interpreted as exploratory and hypothesis-generating. Conclusions The Transitional Elective Block was feasible to implement using existing residency resources and was well accepted by participants. These preliminary findings suggest that a structured transitional elective may enhance perceived preparedness for the transition to residency among international medical graduates. Larger multicenter studies incorporating objective measures of clinical performance are needed to evaluate the effectiveness and generalizability of this educational model.

PMID:42604375 | PMC:PMC13477336 | DOI:10.7759/cureus.112812

J Pain Res. 2026 Aug 11;19:644717. doi: 10.2147/JPR.S644717. eCollection 2026.

NO ABSTRACT

PMID:42604364 | PMC:PMC13477167 | DOI:10.2147/JPR.S644717

Med Devices (Auckl). 2026 Aug 11;19:614792. doi: 10.2147/MDER.S614792. eCollection 2026.

ABSTRACT

BACKGROUND AND RATIONALE: Various guidance techniques can be performed under ultrasound (US), computed tomography (CT), fluoroscopy, and magnetic resonance imaging (MRI) guidance; They pave the way for simple, intermediate, and complex minimally invasive procedures by improving visualization of the target, the access route, and device progression.

OBJECTIVE: This study aimed to evaluate the availability and utilization of radiological guidance tools in interventional radiology units in Kinshasa, Democratic Republic of the Congo.

MATERIALS AND METHODS: This descriptive study was conducted in selected medical facilities in Kinshasa. Data were collected from January 2018 to June 2024 using a structured questionnaire and medical record review. Eligible cases included patients who underwent semi-invasive diagnostic or therapeutic interventional radiology procedures performed under direct imaging guidance, with acceptable hemostatic parameters and documented informed consent. The evaluated outcomes included the type of radiological guidance used, anatomical or disease target, procedure complexity, and procedure-related incidents. Data were analyzed using descriptive statistics. Categorical variables were summarized as frequencies and percentages, and continuous variables were summarized as means and standard deviations when applicable.

RESULTS: A total of 471 image-guided interventional radiology procedures were analyzed. The evaluated cases involved a range of anatomical and disease-related targets, including liver, breast, thyroid, prostate, spinal, cervical soft-tissue, splenic, pancreatic, renal, lymph-node, and other abdominal or soft-tissue lesions. Female patients represented 55.3% of the study population. Among the 471 interventional radiology procedures analyzed, age was available for 469 cases. The mean age was 48.2 ± 17.2 years, with a range of 1 to 84 years. Ultrasound was the most frequently used guidance modality, accounting for 384 procedures (81.5%), followed by CT guidance in 63 procedures (13.4%) and fluoroscopic guidance in 24 procedures (5.1%). Cone-beam CT guidance was not used. Simple interventional radiology procedures were the most common, accounting for 327 procedures (69.4%), followed by intermediate procedures in 126 cases (26.8%) and complex procedures in 18 cases (3.8%).

CONCLUSION: This study shows that ultrasound guidance remains the most commonly used radiological guidance method in interventional radiology settings in Kinshasa. However, MRI, fluoroscopy-CT, electromagnetic, and cone-beam CT guidance were not used in this series. These findings provide baseline local evidence on current technical capacity and unmet equipment needs, and may help guide future planning and development of interventional radiology services in the Democratic Republic of the Congo.

PMID:42604354 | PMC:PMC13477163 | DOI:10.2147/MDER.S614792

Res Rep Trop Med. 2026 Aug 11;17:622004. doi: 10.2147/RRTM.S622004. eCollection 2026.

ABSTRACT

INTRODUCTION: The Integrated Disease Surveillance and Response (IDSR) strategy was adopted in Cameroon in the early 2000s. However, some limitations in terms of the detection rates of diseases under surveillance are still observed. The present study was conducted to assess the effect of supervision or Short Message Service (SMS) reminders on the detection rate of cholera and measles in health facilities in Douala.

METHODS: This was a randomised controlled health facility-based trial that involved assigning health facilities to either monthly supervision of personnel in charge of surveillance, SMS reminders, or a control group. The effect of the interventions was assessed by comparing the detection rates of cholera and measles by personnel with respect to the number of expected suspected cases in consultation records.

RESULTS: A total of 271 health facilities were assessed for eligibility and 159 were included in the trial (53 per study group). The health facilities were assigned to either supervision, SMS or control group using stratified randomisation by health district. The detection rates of suspected cholera and measles cases were 11.05% and 35.19% in the control group, respectively. Health facilities in the supervision group demonstrated significantly higher detection rates of cholera cases [IRR (Incidence Rate Ratio) =1.87 (1.09-3.19); p = 0.022] and measles cases [IRR=1.78 (1.01-3.15); p=0.046], while there was no detected difference in the SMS group compared to the control group for both cholera and measles. The combined detection rate of both cholera and measles was significantly higher in the supervision group than in the control group; however, exposure to SMS did not produce a significant effect. After adjustment, results were consistent, except for detection of cholera cases, where the effect of supervision was attenuated and no longer statistically significant (adjusted IRR=1.39 (0.80-2.42); p=0.243).

CONCLUSION: Supervision significantly improved the detection of suspected cholera and measles cases, whereas SMS reminders showed no significant effect. Strengthening routine supportive supervision should be prioritised to improve IDSR performance.

PMID:42604353 | PMC:PMC13477155 | DOI:10.2147/RRTM.S622004

JTCVS Open. 2026 Jun 11;32:101925. doi: 10.1016/j.xjon.2026.101925. eCollection 2026 Aug.

ABSTRACT

OBJECTIVES: Cardiopulmonary bypass is necessary for surgical repair of complex congenital heart disease. We studied whether whole blood use in circuit prime and for initial intraoperative transfusion needs improved postoperative outcomes in infants less than 2 months of age.

METHODS: This was a single-center retrospective chart review of infants who underwent cardiac surgery using cardiopulmonary bypass between May 2019 and February 2023. We reviewed and analyzed intraoperative and postoperative variables for whole blood and standard blood prime use in patients, whereas the remainder of clinical management stayed unchanged.

RESULTS: Ninety-five patients were included in our analysis. Donor exposure was reduced in the whole blood group with a median of 3 donors (Q1-Q3: 2-4) compared with the standard group with 5 donors (Q1-Q3: 5-6, P < .001). The whole blood cohort used whole blood for intraoperative transfusion needs over individual blood components. Whole blood recipients had lower postoperative platelet counts and fibrinogen levels, but no clinical markers of increased postoperative bleeding compared with the standard group. There was no statistically significant difference in length of stay, mechanical ventilation days, postoperative transfusion requirements, or time to delayed sternal closure between groups.

CONCLUSIONS: The whole blood cohort was found to have fewer donor exposures and less intraoperative individual blood component use but no difference in postoperative outcomes. Continued research must be pursued to understand if whole blood with new circuit techniques and hemostatic interventions can reduce transfusion needs and lead to superior results.

PMID:42604351 | PMC:PMC13477141 | DOI:10.1016/j.xjon.2026.101925