Nevin Manimala

West Afr J Med. 2024 Sep 30;41(9):966-971.

ABSTRACT

INTRODUCTION: Prostate cancer (PCa) is the commonest urologic cancer worldwide and the leading cause of male cancer deaths in Nigeria. In Nigeria, orchidectomy remains the primary androgen deprivation therapy. Dihydrotestosterone (DHT) is the active prostatic androgen, but its relationship with PCa severity has not been extensively studied in Africa.

OBJECTIVES: This study assessed the relationship between serum levels of DHT (pre- and post-orchidectomy) and serum prostate specific antigen (PSA), as well as Gleason scores.

METHODS: Patients undergoing orchidectomy for histologically confirmed prostate adenocarcinoma were studied. Serum PSA and DHT levels were assessed before orchidectomy, and 6 weeks afterwards. This was correlated with their Gleason scores. Data was analyzed using the IBM SPSS Statistics version 20. P < 0.05 was considered significant.

RESULTS: Fifty-three patients completed the study. The mean age was 69.3 ± 6.9 years. Pre- and post-orchidectomy serum PSA ranged from 11.30 to 562.00 ng/ml and 0.01ng/mL to 245.00 ng/mL respectively. Pre- and post-orchidectomy DHT ranged from 6.91ng/mL to 4,996.38 ng/mL and 6.56 ng/mL to 2,575.03 ng/mL respectively. Up to 40% still had normal DHT post-orchidectomy. There was a positive but statistically insignificant correlation between pre-orchidectomy serum PSA and DHT (r = 0.089, p = 0.527). There was however a direct and significant relationship between pre-orchidectomy serum DHT and Gleason scores (p = 0.042).

CONCLUSION: This study showed a relationship between preorchidectomy serum DHT and Gleason scores. Assessing DHT in patients with high Gleason scores could influence hormonal manipulation.

PMID:39863964

West Afr J Med. 2024 Sep 30;41(9):959-965.

ABSTRACT

BACKGROUND: This study estimated the cost of providing free maternal and child health (MCH) services at the primary health centre (PHC) level in southeast Nigeria. The costs of providing an essential benefit package of maternal and child health (MCH) services are unknown. Such information is required for optimal resource allocation decisions and for replicating similar programmes in different settings.

METHODS: The full and unit costs of providing a thin benefit package of MCH services in all the 418 PHC centers in Imo State, southeast Nigeria were computed using an ingredient and activity costing approach from a provider perspective. Data on costs were collected both retrospectively and cross-sectionally. Data on service utilisation by mothers and children under five years were collected from the PHC attendance registers.

RESULTS: The total cost was $27,710,009.00, whilst the unit costs for delivering combined MCH services in 418 PHCs were $37.2. However, for just child health services, the unit cost was $13.7 per child, whilst the unit cost of providing just maternal health services was $42.7 per pregnant woman. Personnel costs contributed 84.6% of the total cost.

CONCLUSION: The findings will guide the design and scale-up of a similar programme towards the achievement of universal health coverage of MCH services.

PMID:39863959

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S369-S380. doi: 10.3855/jidc.19897.

ABSTRACT

INTRODUCTION: The present study aimed to explore the epidemiologic threats and factors associated with the coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM) epidemic that emerged in Egypt during the second COVID-19 wave. The study also aimed to explore the diagnostic features and the role of surgical interventions of CAM on the outcome of the disease in a central referral hospital.

METHODOLOGY: The study included 64 CAM patients from a referral hospital for CAM and a similar number of matched controls from COVID-19 patients who did not develop CAM.

RESULTS: The most frequent factors among CAM patients were the use of corticosteroids, older age, and diabetes. CAM patients presented with facial pain (98.4%), black coloring on nasal endoscopy examination (87.5%), orbital invasion (70.3%), and loss of vision (68.8%). Despite treatment, CAM led to the death of 30 patients and 34 patients survived until the end of the study. CAM patients with death outcomes had orbital invasion, disturbed consciousness level, referral to intensive care units, and invasive mechanical ventilation. The patients who survived received more surgical interventions than dead patients, including functional endoscopic sinus surgery (FESS) and maxillofacial surgery.

CONCLUSIONS: CAM treatment requires complex, time-consuming, and expensive diagnostic approaches. Therefore, preventative measures should focus on early source control, strict glycemic control, and limiting steroids to COVID-19 patients especially older patients (> 40 years). Early antifungal treatment and surgical techniques such as FESS and necrotic tissue debridement were associated with better prognosis, indicating the efficiency of multidisciplinary medical and surgical teams.

PMID:39863956 | DOI:10.3855/jidc.19897

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S344-S352. doi: 10.3855/jidc.19019.

ABSTRACT

INTRODUCTION: Antimicrobial resistance (AMR) is a major public health challenge globally. This study aimed to analyze the antibacterial consumption (ATBc), and the incidence of multidrug-resistant organisms (MDRO), focusing on pathogens Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. (ESKAPE group), in a Brazilian tertiary care hospital.

METHODOLOGY: The ATBc was measured by defined daily doses (DDD) calculated per 1000 patient days. The incidence of MDRO was collected from the hospital infection control committee specialized reports. Changes in ATBc and MDRO incidence over time were explained by the compound annual growth rate (CAGR) represented by the average yearly change as a proportion (%) of consumption in the starting year. This was a time series study using data collected retrospectively from January 2015 to December 2021.

RESULTS: There was an increase in consumption of daptomycin and linezolid during the study period (39.4% and 27.7%, respectively), followed by polymyxins (9.8%). The MDRO of the ESKAPE group with the highest variation in the period were Staphylococcus spp (29.2%), Enterococcus spp (27.8%), and Acinetobacter spp (18.4%). Other MDROs, outside the ESKAPE group, such as Providencia sp (51.2%) and Clostridioides dificille (37.7%) had significant variation.

CONCLUSIONS: The coronavirus disease 2019 (COVID-19) pandemic may have reinforced the deterioration of the scenario of accelerating AMR increase. This warrants investigations of further surveillance data to assess the impact of the pandemic on AMR epidemiological trends.

PMID:39863953 | DOI:10.3855/jidc.19019

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S337-S343. doi: 10.3855/jidc.20182.

ABSTRACT

INTRODUCTION: The frequency of scabies and its relationship with the coronavirus disease 2019 (COVID-19) pandemic is a current scientific curiosity in Turkey and worldwide. The data presented in this article will help raise awareness of dermatologists in situations such as pandemic-induced quarantines where scabies can spread rapidly.

METHODOLOGY: This was a retrospective study to compare patients who presented with scabies and were evaluated during the COVID-19 pandemic, with those who presented before and after the pandemic, in terms of the diagnosis ratios. In addition, the recurrence rates were compared in terms of age, nationality, and the environment in which they lived.

RESULTS: The frequency of scabies was statistically significantly higher in the post-COVID period in all quarters of the year, with a higher rate of patients in the first and last quarters, which is typical of scabies patients. However, a significant difference in recurrence rates was not detected.

CONCLUSIONS: Several factors might be responsible for the increased frequency of scabies during the lockdown periods in Turkey. First, entire families, including relatives, had to live together in a crowded space. Second, there was a relative increase in doctor visits, in spite of the stay-at-home policy, owing to the overwhelming itchiness of scabies.

PMID:39863952 | DOI:10.3855/jidc.20182

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S331-S336. doi: 10.3855/jidc.19092.

ABSTRACT

INTRODUCTION: Acute kidney injury involves inflammation and intrinsic renal damage, and is a common complication of severe coronavirus disease 2019 (COVID-19). Baseline chronic kidney disease (CKD) confers an increased mortality risk. We determined the renal long-term outcomes of COVID-19 in patients with baseline CKD, and the risk factors prompting renal replacement therapy (RRT) initiation and mortality.

METHODOLOGY: We included 77 patients (median age was 67.1 ± 13.7 years) with a history of renal failure at baseline and recovery from COVID-19 at our institution, in a retrospective analysis from December 2020 to May 2021. Demographic, clinical, and laboratory data were compared between patients requiring RRT and those who did not. A correlogram analysis determined the risk factors for RRT. Survival analysis using the Kaplan-Meier method and Cox regression statistics assessed in-hospital mortality.

RESULTS: 70.1% of the patients had CKD. RRT initiation was higher in patients with known CKD (46.4%) than in those with no known CKD (28.5%). Those with diabetic nephropathy had a higher predisposition for RRT initiation compared to other CKD etiologies. Diabetics (42.3%) and hypertensive nephropathy (33%) were the most common etiologies in the general population. Blood urea nitrogen (BUN), creatinine, phosphorus, lactate dehydrogenase, and proteinuria were significantly higher; and platelets and calcium levels were lower; in patients requiring RRT. Decreased lymphocyte count negatively correlated with BUN levels.

CONCLUSIONS: Known CKD patients had a higher initiation rate of RRT, and laboratory features suggestive of kidney damage. However, RRT patients did not have an increased risk of mortality.

PMID:39863951 | DOI:10.3855/jidc.19092

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S318-S325. doi: 10.3855/jidc.19332.

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is associated with long-term symptoms, but the spectrum of these symptoms remains unclear. We aimed to identify the prevalence and factors associated with persistent symptoms in patients at the post-COVID-19 outpatient clinic.

METHODOLOGY: This cross-sectional, observational study included hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients followed-up at a post-COVID-19 clinic between September 2021 and January 2022. Persistent symptoms, defined as lasting > 4 weeks after infection, were analyzed alongside symptom timing (28-90, 91-120, and > 120 days) and associated factors using multivariate analysis.

RESULTS: Among 277 patients, mean (SD) age was 56 (16.6) years, and 58.5% were male. Of these, 80.9% reported at least one persistent symptom. Common symptoms included dyspnea (48.2%), insomnia (42.4%), and myalgia (42.1%). In multivariate analysis, being female [odds ratio (OR) 3.41; 95% confidence interval (CI) 1.5-7.76], and oxygen therapy (OR 3.39; 95% CI 1.3-8.81) were independently associated factors with persistent symptoms. High-sensitivity C-reactive protein (HsCRP) (> 75 mg/dL) was an independent risk factor for dyspnea (adjusted OR 2.29; 95% CI 1.28-4.12), and fatigue (adjusted OR 2.24; 95% CI 1.25-4). Oxygen therapy was an independent risk factor for neurologic symptoms, i.e. insomnia (adjusted OR 2.05; 95% CI 1.15-3.65), and brain fog (adjusted OR 2.02; 95% CI 1.14-3.58).

CONCLUSIONS: There was a high prevalence of persistent COVID-19 symptoms. The most common symptom was dyspnea. Female gender and oxygen supplementation were independent associated factors. Continuous follow-up of these patients is still required.

PMID:39863949 | DOI:10.3855/jidc.19332

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S310-S317. doi: 10.3855/jidc.19595.

ABSTRACT

INTRODUCTION: The global healthcare system faced unparalleled challenges during the coronavirus disease 2019 (COVID-19) pandemic, potentially reshaping antibiotic usage trends. This study aimed to evaluate the knowledge, perceptions, and observations of community pharmacists concerning antibiotic utilization during and after the pandemic; and offer crucial insights into its impact on antibiotic usage patterns and infection dynamics.

METHODOLOGY: This cross-sectional study involved 162 community pharmacists in Northern Cyprus. Data were gathered via a structured survey, including pharmacist demographics, antibiotic knowledge, perceptions of antibiotic resistance, and observations on antibiotic misuse during and after the COVID-19 pandemic. The data were analyzed by biostatistical methods.

RESULTS: Over 90% of pharmacists demonstrated high awareness of antibiotic overuse and resistance. The average antibiotic use knowledge score was 5.09/7. The majority expressed interest in further education (85.2%) and participation in campaigns (96.9%) to promote appropriate antibiotic use. Notably, 87.7% of participants observed an increase in respiratory infections post pandemic, and 45.7% reported administering more antibiotics, reflecting heightened demand. Furthermore, 63.6% noted increased demand for unprescribed antibiotics, while 45.7% expressed concerns about potential neglect of the antibiotic resistance issue as a consequence of the pandemic.

CONCLUSIONS: The study highlights critical changes in antibiotic dispensing patterns among community pharmacists during and after the COVID-19 pandemic. The results here underscore the pivotal role of pharmacists in antibiotic stewardship, advocating for ongoing education, and stricter prescription regulations to optimize antibiotic use and combat resistance.

PMID:39863948 | DOI:10.3855/jidc.19595

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S305-S309. doi: 10.3855/jidc.19843.

ABSTRACT

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted public transportation systems worldwide. In this study, we evaluated the rate of COVID-19 positivity and its associated factors among users of public transportation in socioeconomically disadvantaged regions of Brazil during the pre-vaccination phase of the pandemic.

METHODOLOGY: This ecological study, conducted in Aracaju city in Northeast Brazil, is a component of the TestAju Program. This initiative was designed to expand COVID-19 testing to asymptomatic individuals in public spaces such as squares and bus terminals. Using logistic regression, we examined the relationship between COVID-19 positivity and factors such as demographics, socioeconomic status, and travel frequency. The Fruchterman-Reingold algorithm was used to explore transmission pathways across neighborhoods with varying living conditions.

RESULTS: Of the 1,420 public transport users tested via real time reverse transcriptase polymerase chain reaction (RT-PCR), 249 were positive, indicating a 17.5% positivity rate (95% CI: 15.7-19.6). Our findings revealed a higher positivity rate during periods of increased viral spread (OR = 4.3, 95% CI: 3.1-5.9) and in neighborhoods with poorer conditions (OR = 1.5, 95% CI: 1.1-2.1). Network analysis revealed affluent neighborhoods as significant transmission hubs of the disease.

CONCLUSIONS: Our study highlights the vital role of urban mobility patterns in the spread of COVID-19. Neighborhoods with better living conditions that serve as hubs of activity and movement, enable gatherings and interactions among people from diverse regions, including those from areas with higher infection rates.

PMID:39863947 | DOI:10.3855/jidc.19843

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S298-S304. doi: 10.3855/jidc.19862.

ABSTRACT

INTRODUCTION: The objective of this study was to assess the effectiveness of ivermectin and colchicine as treatment options for coronavirus disease 2019 (COVID-19).

METHODOLOGY: A three-arm randomized controlled clinical trial was conducted in the Triage Clinic of the family medicine department at Ain Shams University Hospitals on participants who had been diagnosed with moderate COVID-19. Patients aged < 18 years or > 65 years, with any co-morbidities, pregnant or lactating females, and those with mild or severe COVID-19 confirmed cases were excluded. Sealed envelopes were used for randomization of intervention or control. Patients are followed until there was improvement of symptoms and no development of new symptoms for over one month.

RESULTS: A total of 120 patients (40.16 ± 10.74 years) with COVID-19 were enrolled; 40 patients in each arm. Out of them, 44 (36.6%) were male and 76 (63.4%) were female. Fever and cough were the predominant symptoms in each group. There was no statistically significant difference in the mean duration of fever between the ivermectin, colchicine, and control groups (7.3 ± 1.68, 6.6 ± 1.58, and 7.075 ± 1.58 days, respectively). The majority of patients (67.5%, 70%, and 72.5%) were completely cured within 10 days of infection, with no differences between the three groups (p > 0.05). A statistically significant improvement of inflammatory markers occurred in each of the three groups over time with no statistically significant difference between them.

CONCLUSIONS: Ivermectin and colchicine have no beneficial effect over standard care in the treatment of COVID-19.

PMID:39863946 | DOI:10.3855/jidc.19862