Health-seeking behaviors and determinants among herpes zoster patients in South Wollo public hospitals, Ethiopia, 2022

Background

Health-seeking behavior towards herpes zoster is vital to find an appropriate remedy for patients and utilization of timely healthcare services can have an impact on good health outcomes. The study aimed to assess the health-seeking behavior and determinants among Herpes Zoster patients in public hospitals, South Wollo, Ethiopia.

Method

A hospital-based cross-sectional study was conducted from September 1, 2022, to November 30, 2022. The simple random sampling technique was used to select 419 participants. Pretested, structured questionnaires and patient interviews were used to collect the data. The bivariable analysis was done and variables with p-value <0.25 were further examined using a multivariable logistic regression model. AOR with a 95 % CI and a P-value <0.05 at a 5 % level of significance were considered.

Results

About 55.6 % of patients had poor health-seeking behavior towards herpes zoster, with a response rate of 99.1 %. Distance from health facilities (AOR = 4.9; 95 % CI: 1.33-10.35), being rural residence (AOR = 0.3; 95 % CI: 0.17-0.40), being illiterate (AOR = 5.9; 95 % CI: 3.40-10.32), poor self-care adherence (AOR = 1.8; 95 % CI = 1.14-3.07), moderate depression (AOR = 7.3; 95 % CI: 4.10-11.50), moderate (AOR = 0.3; 95 % CI: 0.10-0.70) and severe anxiety (AOR = 0.1; 95 % CI: 0.01-0.63), and duration more than seven days of herpes zoster (AOR = 3.1; 95 % CI = 1.42-6.97) were statistically significant.

Conclusion

Nearly half of the study participants had poor health-seeking behavior. Being a rural resident and illiterate, poor self-care adherence, moderate and severe anxiety, moderate depression, and duration of more than 7 days were significantly associated. with health-seeking behavior towards Herpes Zoster. Proper guidance, psychological support, and awareness creation about Herpes Zoster severity and complications.

Surgical management of spontaneously ruptured kidney with peritonitis due to neglected renal and ureteric calculi

A 30-year-old woman presented with right-sided abdominal pain associated with fever. Her ultrasound showed right renal calculus with no hydronephrosis along with collection in peritoneal cavity and pouch of Douglas. CT showed ruptured right kidney with multiple renal and ureteric calculi as well as displaced renal calculi in perinephric space and pararenal space. Exploratory laparotomy and right nephroureterectomy were done. Nephrolithiasis with secondary infection makes the kidney fragile due to pathological changes, which may cause rupture of the renal calyces with trivial trauma or may be spontaneous. Distal obstruction by the stone and increased back pressure in the calyces may have added to the spontaneous rupture of the calyx and subsequently renal parenchyma. Management includes early exploration with nephrectomy and it is often life saving.

Venous Air Embolism: A Rare but Possible Complication During Retrograde Intrarenal Surgery-A Case Report and Review of Literature

Background: Venous air embolism (VAE) during various urologic surgeries such as transurethral resection of prostate, percutaneous nephrolithotomy (PCNL) and occasionally while performing air pyelogram during PCNL have been reported in the literature. Case Presentation: In this study, we present a case of 34 year-old gentleman who developed intraoperative VAE during retrograde intrarenal surgery (RIRS). The clinical suspicion and diagnosis were made by fall in end-tidal carbon dioxide and oxygen saturation, transient hypotension, and bradycardia. The patient was managed conservatively. The most important factor was timely detection and early management by the anesthetist. Conclusion: To our knowledge, this is the first case of VAE reported during RIRS. For procedures such as RIRS complicating to VAE, a high index of suspicion and prompt management is required.

Secondary stone formation over a suture material after partial nephrectomy

We hereby present the treatment of renal pelvic and lower pole stones of sizes 2.74×1 cm and 1.38×0.92 cm, respectively, forming over a nidus of non-absorbable suture, in a 50-year-old female patient with a history of open partial nephrectomy done for renal angiomyolipoma around 10 years back. She was successfully treated with percutaneous nephrolithotomy technique under spinal anaesthesia. There was complete stone clearance, and she was discharged in stable condition within 40 hours of surgery without any stent. There is no case report showing the presence of suture material in the renal stone after partial nephrectomy. This case report highlights the fact that the non-absorbable suture material used during the open surgery especially for haemostasis can also act as nidus for future stone formation. This also suggests that percutaneous techniques can be considered to avoid repeat open surgery and the associated morbidity.

The morbidity and utility of periaortic radiotherapy in cervical carcinoma

From 1971 through 1981, 81 women received 4350 to 5075 rad to the periaortic lymph nodes as part of their primary management for carcinoma of the uterine cervix. While two patients developed chronic small bowel damage, only one required surgical intervention. Five-year disease-free survival was 40%. Approximately one-third of the first recurrences were within the pelvic and periaortic radiation portals, with the remainder in the lungs, liver, bones, abdomen, and supraclavicular lymph nodes. Radiation dose and volume guidelines are presented in order to minimize enteric morbidity.

Sequential surgery, radiation therapy, and Alkeran in the management of epithelial carcinoma of the ovary

In 1970, a prospective multidisciplinary protocol was initiated for Stages I through III obviously malignant ovarian epithelial carcinomas. The planned sequential therapy included 1) surgery, 2) radiotherapy (2000 rads to whole abdomen, 3000 rad boost to pelvis), 3) chemotherapy (ten cycles of Alkeran), and 4) a "second-look" surgical procedure. Ninety-six patients were enrolled in this program through 1976. Median follow-up of the survivors was greater than 44 months. Adjusted disease-free survival was 90 percent for Stage I, 64 percent for Stages IIB--IIC, and 16 percent for Stage III. Stage III patients with no palpable tumor at time of initiation of radiation therapy had a survival of 37 percent. No Stage III patient with palpable tumor at time of initiation of radiation therapy was cured. Eight percent of patients developed small bowel obstruction requiring surgical intervention. Three percent of all patients died of hematologic causes; of the 30-month-plus survivors, 5 percent (2 of 37) developed acute myelogenous leukemia. Cure and toxicity will be examined in detail and compared with the literature.

A comparison of medroxyprogesterone serum concentrations by the oral or intramuscular route in patients with persistent or recurrent endometrial carcinoma

A randomized study, comparing serum medroxyprogesterone concentrations by the oral and intramuscular routes, was performed on 22 patients with persistent or recurrent endometrial adenocarcinoma by six institutions of the Gynecologic Oncology Group. The oral group (11 patients) received cutaneous Provera (medroxyprogesterone), 50 mg three times a day, and the intramuscular group (11 patients) received 300 mg of Depo-Provera (medroxyprogesterone) weekly for at least 2 months. Serum levels were evaluated at 0, 2, 4, 6, 8, 10, and 12 hours after administration and every day for the first week and weekly thereafter for 8 weeks. The mean serum levels (nanograms per milliliter) of medroxyprogesterone in the oral group were consistently higher than the corresponding mean levels of the intramuscular group. In addition, from the first through eighth weeks, the measurements (medians) for the oral group were statistically higher than those for the intramuscular group. Although the study indicates a significant increase in serum levels achieved by the oral route, the follow-up period of patients under study is too early to evaluate its clinical effectiveness as compared to the intramuscular route.

Postpubertal evaluation of gonadal function following cyclophosphamide therapy before and during puberty

Evaluation of pituitary gonadotropins, gonadal steroids, spermatogenesis, and menstrual function was undertaken in 32 patients (19 males and 13 females) treated with cyclophosphamide because of nephrotic syndrome. Patients were treated before, during, or after puberty. Evaluations took place after or in very late puberty. Spermatogenic dysfunction occurred in six of 15 boys who received the entire course before and during puberty and was probably dose related. Menstrual dysfunction did not occur following treatment of six prepubertal or pubertal girls, though only low total doses were used. Therapy after puberty was associated with spermatogenic dysfunction in all four boys, but did not cause menstrual dysfunction in any of seven women. Tentative guidelines are suggested that many minimize gonadal toxicity when cyclophosphamide is used in children with nephrotic syndrome. Factors of particular importance in the interpretation of gonadotropin determinations and of sperm counts in young cyclophosphamide-treated patients are discussed.