Crimean-Congo Hemorrhagic Fever (CCHF): An Emerging Disease in Afghanistan

Crimean-Congo hemorrhagic fever (CCHF) seems to be a severe viral infection that is spreading throughout Afghanistan. The first case of CCHF was recorded in March 1998 in Takhar province, located in the country’s north. And since then, multiple new cases and outbreaks have occurred over the years and continue to do so now. CCHF is a viral disease that is transmitted to humans mostly by hard tick bites or direct contact with the blood of infected animals. In Afghanistan, the prevalence of CCHF outbreaks has grown dramatically around Eid-ul-Adha. The primary symptom of this fatal disease is bleeding. There is no cure for CCHF at the moment, but the antiviral drug Ribavirin is used to treat it. This disease presently lacks a commercially accessible vaccine. The disease is recommended to be controlled through preventative measures such as Avoiding insect bites and coming into touch with the blood of a suspicious animal are just a few of the precautions that can be taken

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Crimean-Congo Hemorrhagic Fever (CCHF): An Emerging Disease in Afghanistan

Crimean-Congo hemorrhagic fever (CCHF) seems to be a severe viral infection that is spreading throughout Afghanistan. The first case of CCHF was recorded in March 1998 in Takhar province, located in the country’s north. And since then, multiple new cases and outbreaks have occurred over the years and continue to do so now. CCHF is a viral disease that is transmitted to humans mostly by hard tick bites or direct contact with the blood of infected animals. In Afghanistan, the prevalence of CCHF outbreaks has grown dramatically around Eid-ul-Adha. The primary symptom of this fatal disease is bleeding. There is no cure for CCHF at the moment, but the antiviral drug Ribavirin is used to treat it. This disease presently lacks a commercially accessible vaccine. The disease is recommended to be controlled through preventative measures such as Avoiding insect bites and coming into touch with the blood of a suspicious animal are just a few of the precautions that can be taken.</jats:p

Duplicate bladder exstrophy in a female infant: A case report

Duplicate bladder exstrophy, a rare variant of the bladder exstrophy-epispadias complex, was diagnosed in a 5-month-old female infant presenting with a 4 × 4 cm lower abdominal mass. Physical examination revealed absent umbilical scar, wide symphysis pubis, and anteriorly displaced genitalia and anus. Imaging ruled out classic bladder exstrophy and vesicoureteral reflux. Surgical exploration confirmed a suprapubic exstrophic mucosal plaque without communication to a functional bladder. Management involved excision of the exstrophic plaque and primary abdominal wall closure. Post-operative course was normal intravenous pyelogram findings. This case emphasizes the importance of accurate diagnosis and tailored surgical approach for rare bladder exstrophy variants