Risk factors associated with congenital anomalies among newborns in southwestern Ethiopia: A case-control study

INTRODUCTION

Human embryo is well protected in the uterus by the embryonic membrane, although teratogens may cause developmental disruptions after maternal exposure to them during early pregnancy. Most of the risk factors contributing to the development of congenital anomalies are uncertain; however, genetic factors, environmental factors and multifactorial inheritance are found to be risk factors. Regardless of their clinical importance, there are little/no studies conducted directly related to predisposing risk factors in southwestern Ethiopia.

OBJECTIVE

The study aimed to determine the associated risk factors with congenital anomalies among newborns in southwestern Ethiopia.

METHODS

Case-control study was conducted on newborns and their mothers in six purposively selected hospitals in southwestern Ethiopia from May 2016 to May 2018. Data was collected after evaluation of the neonates for the presence of congenital anomalies using the standard pretested checklist. The data was analyzed using SPSS version 25.0. P <0.01 was set as statistically significant.

RESULTS

Risk factors such as unidentified medicinal usage in the first three months of pregnancy (AOR = 3.435; 99% CI: 2.012-5.863), exposure to pesticide (AOR = 3.926; 99% CI: 1.266-12.176), passive smoking (AOR = 4.104; 99% CI: 1.892-8.901), surface water as sources of drinking (AOR = 2.073; 99% CI: 1.221-3.519), folic acid supplementation during the early pregnancy (AOR = 0.428; 99% CI: 0.247-0.740) were significantly associated with the congenital anomalies.

CONCLUSIONS

In this study, risk factors such as passive smoking, exposure to pesticides, chemicals and use of surface water as a source of drinking during early pregnancy had a significant association with congenital anomalies. There is a need to continuously provide health information for the community on how to prevent and control predisposing risk factors.

Prevalence and predictors of metabolic syndrome among people living with human immunodeficiency virus (PLWHIV)

BACKGROUND

Use of combination antiretroviral therapy (cART) has led to significant reductions in morbidity and mortality. However, there is a growing concern about metabolic syndromes (MS), among patients receiving cART. Despite this fact, there is limited evidence for the prevalence of the MS among HIV-infected persons receiving cART in developing countries, particularly Ethiopia.

OBJECTIVE

To determine the prevalence and predictors of MS among people living with HIV/AIDS in Jimma health centre, Jimma Zone south west Ethiopia.

METHODS

A cross-sectional study was conducted on people living with HIV/AIDS (PLWHA) in Jimma health centre that fulfilled the inclusion criteria. Data on demographic and anthropometric characteristics were collected using World health organization (WHO) stepwise approach. Fasting blood glucose and lipid profile was measured. The Third Report of National Cholesterol Education Program-adult treatment panel III (NCEP-ATP III)-2001, the International Diabetes Federation (IDF)-2005 and the Joint interim statement-2009 (JIS) criteria were used to define MS. Data were analyzed using statistical software package (SPSS) version 20.0. Logistic regression analysis was done to identify predictors of MS and predictors with p value < 0.05 were used to declare statistical significance.

RESULTS

Of 268 HIV-infected participants included in the analysis, 211 (78.7%) were women. The mean age of the participants was 39.32 ± 10.626 years. Using the NCEP-ATP III criteria, the prevalence of MS was found to be 23.5% (63 patients). While it was 20.5% (55 patients) and 27.6% (74 patients) with IDF and JIS criteria respectively. Enrollment in formal education resulted in 75% increment in the odds of MS (AOR = 0.25, 95% CI [0.072-0.879]). The odds of MS in patients with body mass index > 25 kg/m² was elevated to 13.4 times (AOR = 13.39, 95% CI [3.943-45.525]) and exposure to D-drugs was attributed to 59% increment in the odds of MS (AOR = 1.59, 95% CI [0.58-4.56]), although the finding lacks statistical significance.

CONCLUSIONS

Metabolic syndromes was relatively common to the study population. Hence, promoting health education and monitoring patient's clinical and laboratory parameters at every visit and taking appropriate measure is ideal.

The evolution of nutritional status of geriatric patients without cachexia is associated with food intake in sub-acute care

OBJECTIVES

To determine if changes in patients' nutritional status during hospitalization are related to daily energy and protein intakes when cachectic/inflammatory conditions are controlled for.

DESIGN

Prospective study.

SUBJECTS

A total of 32 non-cachectic patients (21 women; 65-92 y).

METHODS

Nutritional status was evaluated at admission and discharge using the Protein-Energy Malnutrition Index which includes BMI, %IBW, TS, MAC, albumin, hemoglobin and lymphocyte count. Food intake was assessed 3 meals/day every other day for an average of 46.2 +/- 14.6 meals/participant.

RESULTS

In all, 47% of the study sample was malnourished at admission. Nutritional status improved in 73% of patients who had been identified as malnourished and in 30 % of non-malnourished patients at admission. Total energy intake correlated with improvements in BMI, %IBW and total lymphocyte count (all p < 0.04). Improvement in PEMI score for the whole group was associated with functional status (p < 0.05). Controlling for this variable, energy (kj/kg body weight) and protein (g/kg body weight) intakes correlated positively with improvements in BMI, %IBW and MAC (Energy: partial r = 0.644, 0.624, 0.466 respectively; Protein: partial r = 0.582, 0.554, 0.433 respectively; all p < 0.05).

CONCLUSIONS

Results from this study offer strong evidence that when cachectic/inflammatory conditions are controlled for, standard nutrition care is compatible with the maintenance or improvement of nutritional status during the hospital stay.

Gas embolism: an exceptional complication of radial arterial catheterization

BACKGROUND

We report a rare complication of radial arterial catheterization in a 74-year-old man who had undergone retroperitoneal surgery for an infra-renal aortic aneurysm. A right subclavian venous catheter and a right radial artery catheter were inserted for hemodynamic monitoring.

RESULTS

The patient suddenly went into a coma, with dyspnea and bradycardia, 1 day postsurgery, as a result of a cerebral gas embolism produced by the accidental entry of pressurized air into the artery via the arterial catheter. Cerebral Magnetic Resonance Imaging revealed multiple, diffuse brain lesions. Six months later the patient still had a left hemiparesis and a cognitive deficit. He walks with assistance.

CONCLUSION

Misuse of an arterial catheter can lead to a severe gas embolism. The infusion system used to flush arterial catheters should be checked regularly to ensure it contains no gas.

In vivo efficacy of continuous infusion versus intermittent dosing of ceftazidime alone or in combination with amikacin relative to human kinetic profiles in a Pseudomonas aeruginosa rabbit endocarditis model

Ceftazidime and amikacin were administered in a Pseudomonas aeruginosa rabbit endocarditis model using computer-controlled intravenous (iv) infusion pumps to simulate human serum concentrations for the following regimens: continuous (constant rate) infusion of 4, 6 or 8 g of ceftazidime over 24 h or intermittent dosing of 2 g every 8 h either alone or in combination with amikacin (15 mg/kg once daily). The in vivo activities of these regimens were tested on four Pseudomonas aeruginosa strains. Animals were killed 24 h after the beginning of treatment. Efficacy was assessed by comparing the effects of the different groups on bacterial counts in vegetations for each strain tested. For a susceptible reference strain (ATCC 27853; MICs of ceftazidime and amikacin 1 and 2 mg/L, respectively), continuous infusion of 4 g alone or with amikacin was as effective as intermittent dosing with amikacin. For a clinical isolate producing an oxacillinase (MICs of ceftazidime and amikacin 8 and 32 mg/L, respectively), continuous infusion of 6 g was equivalent to intermittent dosing. For a clinical isolate producing a TEM-2 penicillinase (MIC of ceftazidime and amikacin 4 mg/L), continuous infusion of 6 g, but not intermittent dosing, had a significant in vivo effect. For a clinical isolate producing an inducible, chromosomally encoded cephalosporinase (MIC of ceftazidime and amikacin 8 and 4 mg/L, respectively), neither continuous infusion nor intermittent dosing proved effective. Determination of ceftazidime concentrations in vegetations showed that continuous infusion produced tissue concentrations at the infection site far greater than the MIC throughout the treatment. It is concluded that continuous infusion of the same total daily dose provides significant activity as compared with fractionated infusion. This study confirms that a concentration of 4-5 x MIC is a reasonable therapeutic target in most clinical settings of severe P. aeruginosa infection.

Transient ST segment elevation in right precordial leads induced by psychotropic drugs: relationship to the Brugada syndrome

Psychotropic Drugs and ST Segment Elevation. Transient ST segment elevation in right precordial leads with use of psychotropic drugs is reported in two cases of overdose and one case of therapeutic administration. Flecainide did not reproduce ST segment elevation. The relationship of these abnormalities to the Brugada syndrome and the electrophysiologic hypothesis are discussed.

Ketamine: new uses for an old drug

Over the years, ketamine has found many applications in paediatric anaesthesiology. Recent insights into the mechanism of its central action, and the pharmacology of its isomers have led to a re-evaluation of this drug, expanding the range of indications in adults. The best examples of the uses of ketamine as an analgesic are: in brief diagnostic or therapeutic procedures, during the post-operative period in neonates and infants as well as in paediatric anaesthesia and intensive care.

The organization of monoamine-containing neurons in the brain of the sunfish (Lepomis gibbosus) as revealed by fluorescence microscopy

The morphological organization of the monoamine-containing neurons in the brain of the sunfish (Lepomis gibbosus) was studied by means of the Falck-Hillarp histofluorescence method. No attempt was made to distinguish between norepinephrine and dopamine, both primary catecholamines (CA) yielding a similar yellow-green fluorescence after paraformaldehyde treatment. In the brain stem of this teleost fish, three groups of CA-containing neuronal somata have been found. First, there is a small collection of CA perikarya located just caudal to the obex of the fourth ventricle. The neurons of this medullo-sinal group give rise to numerous CA fibers many of which ascend within the central portion of the medulla. Intermingled with these CA fibers are some CA cells that constitute the central medullary group. The CA perikarya of this group are scattered between the levels of cranial nerves X and VIII. The tegmentum of the isthmus also contains a small group of very closely packed CA neurons. The large-sized CA cells of the isthmal group are located dorsolateral to the medial longitudinal fasciculus, partly within the periventricular gray. High densities of CA varicosities were also disclosed in various brain stem structures such as the optic tectum, the torus semicircularis and the cerebeller valvula. In addition, numerous serotonin (5-HT)-type neuronal somata were found in the raphe region of the brain stem, particularly at caudal mesencephalic, isthmal and rostral medullary levels. A large number of CA cell bodies were visualized in the sunfish hypothalamus. Most of them form two populations of small, round cells that are located along and partly within the ependymal walls of the posterior and lateral recesses of the third ventricle. These bipolar cells possess one short club-like process protruding into the ventricle and their thin ependymofugal processes contribute to the CA innervation of numerous hypothalamic regions. Large CA neurons apparently without direct CSF contact also occur in the area of nucleus posterior tuberis, at the level of the mesodiencephalic junction. Although the hypothalamic inferior lobes are devoid of CA cell bodies they are heavily innervated by CA axons. The sunfish telencephalon also receives a strikingly massive and complex monoaminergic innervation. Numerous CA fibers which are first observed at the level of the preoptic area, ascend through the central zone of the telencephalon and arborize profusely particularly within the medial zone of area dorsalis telencephali. Other CA fibers, as well as abundant fine 5-HT varicosities were found in the lateral zone of area dorsalis. Although the exact origin of the telencephalic CA afferents in Lepomis is not known, part of it may arise from the isthmal CA cell group which appears similar to the locus coeruleus of reptiles, birds and mammals.