Measurement of Fertility Benefits with Low Dose Thyroxine in Sub-fertile women

Introduction: High prevalence rate of thyroid dysfunction associated infertility is identified by a number of studies in Nepal. Thyroid dysfunction not only affects fertility but is also associated with miscarriage and fetal death. The objective of this study was to measure the fertility rate after low dose Thyroxine, 12.5 microgram, in women with subfertility. Methods: This was a descriptive and observational study done among women visiting infertility and in-vitro fertilization (IVF) center at Nepalgunj Medical College, Nepal. After undergoing baseline investigations for infertility, all women diagnosed with primary or secondary infertility were enrolled in the study. Male factor and tubal factor infertility was excluded. All 136 women who were enrolled in the study received 12.5 microgram of thyroxine supplementation for a period of three months and subsequently followed up until the same time period. Results: Out of 136 women, 83 (61.02%) women achieved pregnancy within three months of supplementation with low dose thyroxine. Among them, 34 (40.9%) women with primary infertility achieved pregnancy within three months. Similarly 14 (16.8%) women with previous miscarriage, 20 (24.09%) women with previous caesarean section within past five years back, and 15 (18.07%) with previous IUFD achieved pregnancy within three months. Conclusion: Low dose thyroxine supplementation would be beneficial and recommended to subfertile women of reproductive age group in the endemic regions of hypothyroidism. Dose adjustment would give extended benefits as soon as pregnancy is achieved

Outcome of Eclamptic Mothers Attending Tertiary Care Centre from Home and those Referred from Primary Heath Care Site

Introduction: Magnesium sulphate (MgSO4) is an effective and safe drug which stabilizes the patient within few hours of eclampsia and terminates subsequent seizures if it is given on time. The aim of this study was to compare maternal and fetal outcome between a group of eclamptic mothers who came to the tertiary care hospital directly without receiving MgSO4 (Group 1) and those referred from primary care centers after receiving loading dose of MgSO4 (Group 2). Methods: This is a retrospective cohort study of eclamptic mothers who were admitted and managed from the period of 1st January 2012 to 31st March 2016 at Nepalgunj Medical College Teaching Hospital, Nepal. Sociodemographic characters and maternal and fetal outcome was compared between the two groups. Results: Among 92 cases, 57 (62%) were from Group 1 and 35 (38%) were from Group 2. Most of the mothers attended from Banke district (n=52, 56.5%) followed by Bardia district (n=17, 18.5%). Brahmin and Chhetri were 20 (35%) and 10 (29%); Muslim 16 (28%) and 4(11%); Janajati from Terai 16 (28%) and 8 (23%); Janajati from hilly region 4 (7%) and 5 (14%); and Chaudhari 1 (2%) and 8 (23%) in Group 1 and Group 2 respectively.  More (n=26, 74%) mothers had baby with good Apgar score in Group 2 than in Group 1 (n=33, 58%). There were 14 (15.2%) still births; 9 (16%) in Group 1 and 5 (14%) in Group 2. Complication rate was observed more in Group 1 (n=16, 28%) than in Group 2 (n=7, 20%) and the most common complication in both groups was wound infection. The mean days of hospital stay was 5.96 (SD=3.32) and 5.91 (SD=3.38) in Group 1 and Group 2 respectively. Conclusion: The group receiving magnesium sulphate in primary care centre have good fetal outcome and less maternal complications compared to those who were admitted directly in tertiary care centre and receive the treatment there

Prevalence of Malaria among Infants and Children with febrile illness: A Hospital Based Study

Background: About half of the world’s population is at risk of malaria and the burden is particularly high in low-income countries like Nepal. Infants and children are more vulnerable to malaria. Acute febrile illness is the commonest presentation of malaria. Since it is one of the major causes of persistent febrile illnesses in Nepal, empirical antimalarial therapy is usually practiced, especially the endemic areas. A better understanding of the prevalence and clinical profile of malaria helps to tailor the treatment accordingly in cases of undifferentiated febrile illnesses and make the sue of antimalarials more rational. Methods: A cross-sectional observational study was conducted on 200 infants and children presenting with acute febrile illness in the Departments of Pediatrics, Nepalgunj Medical College, from June 2018 to May 2019.Patients were divided in two groups based on the Malarial parasite antigen status. Clinical and laboratory profile of both the groups were compared using Chi square Test. Results: Maximum number of cases in the malaria positive group were of age group 12-15 years. Palor, icterus, hepatomegaly and splenomegaly were significantly more in malaria positive cases (p-value <0.001in all cases) eosinophilia and leucopenia were common in malaria positive cases. Diagnostic accuracy of malaria was found to eb 82 % on combining serology with clinical findings. Conclusion: Prevalence of malaria was found to be more among children than the infants. Although symptoms of malaria are non-specific, clinical findings like palor, icterus, hepatomegaly and splenomegaly were found to have a significant association with malaria. Combining serology with clinical profile in the prediction of malaria helps promote rational use of antimalarial drugs

Assessment of Causes and Clinical Symptoms of Menorrhagia and Its Co-relation with BMI in Western Nepalese Women - An Observational Study

Background: Menorrhagia is defined subjectively as heavy menses lasting for more than 7 days or objectively as a mean menstrual blood loss of >80 ml during three consecutive menses. It can occur due to organic causes like fibroids, polyps, cervitis, ovarian cysts, adnexal masses, uterine cancer or systemic causes like hypothyroidism, bleeding disorders, pregnancy and prolapse or dysfunctional uterine bleeding. Body Mass Index may have a correlation with menorrhagia. Aim and Objectives: This study was carried out in western Nepalese women to assess the causes of menorrhagia; report most common symptoms associated with it and assess the correlation of causes of menorrhagia with BMI. Material and Methods: A hospital based observational study was carried out between 1st January 2015 to 31st January 2016 on 157 volunteer women who consulted the Department of Gynaecology and Obstetrics for menorrhagia. Data were collected via interview and with the help of a questionnaire. Height and weight of the patients were recorded for calculation of BMI. The data was analysed with SPSS 17 vesion. Mean,Standard Deviation and Chi-square test were applied and p value <0.05 was considered to be statistically significant. Results: In our study, maximum patients were from the age group of 36-40 years (51 {32.48%}) followed by 31-35 years (38 {24.2%}) whereas the least number of patients (6 {3.8%}) belonged to the age group of 51-55 years. Uterine fibroids was the most common etiology for menorrhagia seen in 76 (48.4%) patients with maximum cases (24 {31.6%}) being in 36-40 years age group and minimum (4 {5.3%}) in 51-55 years age group. Dysfunctional uterine bleeding (24{15.3%}) was the second most common etiology with 6 (25%) cases being in 31-35 years age group. No statistically significant association was observed between BMI and etiology of menorrhagia. Backache, abdominal distension, pain abdomen, breast pain, headache, weakness and pelvic pressure were the seven most common symptoms experienced by patients with menorrhagia. All the seven symptoms showed statistically significant association with menorrhagia (p<0.05). Conclusion: Menorrhagia is most prevalent among the age group of 31-35 and 36-40 years with uterine fibroids and dysfunctional uterine bleeding being the most common etiologic factors. There seems to be no clear association of menorrhagia with BMI. It is significantly associated with common symptoms like backache, abdominal pain, breast pain, weakness, abdominal distension, pelvic pressure and headache which considerably affect the quality of life of patients

Outcome of Eclamptic Mothers Attending Tertiary Care Centre from Home and those Referred from Primary Heath Care Site

Introduction: Magnesium sulphate (MgSO4) is an effective and safe drug which stabilizes the patient within few hours of eclampsia and terminates subsequent seizures if it is given on time. The aim of this study was to compare maternal and fetal outcome between a group of eclamptic mothers who came to the tertiary care hospital directly without receiving MgSO4 (Group 1) and those referred from primary care centers after receiving loading dose of MgSO4 (Group 2). Methods: This is a retrospective cohort study of eclamptic mothers who were admitted and managed from the period of 1st January 2012 to 31st March 2016 at Nepalgunj Medical College Teaching Hospital, Nepal. Sociodemographic characters and maternal and fetal outcome was compared between the two groups. Results: Among 92 cases, 57 (62%) were from Group 1 and 35 (38%) were from Group 2. Most of the mothers attended from Banke district (n=52, 56.5%) followed by Bardia district (n=17, 18.5%). Brahmin and Chhetri were 20 (35%) and 10 (29%); Muslim 16 (28%) and 4(11%); Janajati from Terai 16 (28%) and 8 (23%); Janajati from hilly region 4 (7%) and 5 (14%); and Chaudhari 1 (2%) and 8 (23%) in Group 1 and Group 2 respectively.  More (n=26, 74%) mothers had baby with good Apgar score in Group 2 than in Group 1 (n=33, 58%). There were 14 (15.2%) still births; 9 (16%) in Group 1 and 5 (14%) in Group 2. Complication rate was observed more in Group 1 (n=16, 28%) than in Group 2 (n=7, 20%) and the most common complication in both groups was wound infection. The mean days of hospital stay was 5.96 (SD=3.32) and 5.91 (SD=3.38) in Group 1 and Group 2 respectively. Conclusion: The group receiving magnesium sulphate in primary care centre have good fetal outcome and less maternal complications compared to those who were admitted directly in tertiary care centre and receive the treatment there

Antibiotic resistance of Mycobacterium tuberculosis complex in Africa: A systematic review of current reports of molecular epidemiology, mechanisms and diagnostics

Figure S1: Frequency of M. tuberculosis Lineages/sub-lineages in Africa, January 2007-December 2018: Frequency of Indo-oceanic lineage/sub-lineages (A); Beijing sublineage (B); CAS-sublineage (C), Euro-American lineage/sub-lineages (D); M. africanum West Africa I & II (E); M. tuberculosis Eth lineage 7 and sub-lineages (F); and proportion of each M. tuberculosis lineage in Africa (G).Table S1: Distribution of M. tuberculosis complex strains, specimen source/s, genotyping method/s, molecular anti-TB drug resistance rate and resistance mechanisms in M. tb across African countries, January 2007 to December 2018Table S2: Resistance mechanisms, molecular diagnosis method/s used, frequency and proportion of gene mutation per total resistant M. tuberculosis complex isolates across African countries, January 2007- December 2018Table S3: Molecular antibiotics resistance rates and resistance mechanisms in M. tuberculosis complex across African countries, January 2007-December 2018.Table S4: Frequency of gene mutation(s) and specific amino acid/nucleotide changes conferring antitubercular drug resistances across African countries January 2007- December 2018Table S5: Distribution of specimen source/s, phenotypic DST method/s used, total number of isolates, and phenotypic antibiotics monoresistance rate, MDR and XDR rate of M. tb complex across African countries, January 2007- December 2018Table S6: Distribution of genotypes/lineages/sub-lineages, frequency and patterns of antibiotics resistance-conferring mutations across African countries, January 2007- December 2018Supplementary dataset 1: Metadata of M. tuberculosis isolates included in phylogenomic analyses.Supplementary dataset 2: Country-by-country frequency of lineage and sub-lineage of M. tuberculosis in Africa: January 2007-December 2018BACKGROUND : Tuberculosis (TB) remains a main global public health problem. However, a systematic review of TB resistance epidemiology in Africa is wanting. METHODS : A comprehensive systematic search of PubMed, Web of Science and ScienceDirect for English research articles reporting on the molecular epidemiology of Mycobacterium tuberculosis complex resistance in Africa from January 2007 to December 2018 was undertaken. RESULTS AND CONCLUSION : Qualitative and quantitative synthesis were, respectively, undertaken with 232 and 186 included articles, representing 32 countries. TB monoresistance rate was highest for isoniazid (59%) and rifampicin (27%), particularly in Zimbabwe (100%), Swaziland (100%), and Sudan (67.9%) whilst multidrug resistance (MDR) rate was substantial in Zimbabwe (100%), Sudan (34.6%), Ivory Coast (24.5%) and Ethiopia (23.9%). Resistance-conferring mutations were commonly found in katG (n = 3694), rpoB (n = 3591), rrs (n = 1272), inhA (n = 1065), pncA (n = 1063) and embB (n = 705) in almost all included countries: S315G/I/N/R/T, V473D/F/G/I, Q471H/Q/R/Y, S303C/L etc. in katG; S531A/F/S/G, H526A/C/D/G, D516A/E/G etc. in rpoB; A1401G, A513C etc. in rrs; -15C→T, -17G→A/T, -16A→G etc. in inhA; Ins456C, Ins 172 G, L172P, C14R, Ins515G etc. in pncA. Commonest lineages and families such as T (n = 8139), LAM (n = 5243), Beijing (n = 5471), Cameroon (n = 3315), CAS (n = 2021), H (n = 1773) etc., with the exception of T, were not fairly distributed; Beijing, Cameroon and CAS were prevalent in South Africa (n = 4964), Ghana (n = 2306), and Ethiopia/Tanzania (n = 799/635), respectively. Resistance mutations were not lineage-specific and sputum (96.2%) were mainly used for diagnosing TB resistance using the LPA (38.5%), GeneXpert (17.2%), whole-genome sequencing (12.3%) and PCR/amplicon sequencing (9%/23%). Intercountry spread of strains was limited while intra-country dissemination was common. TB resistance and its diagnosis remain a major threat in Africa, necessitating urgent action to contain this global menace.http://www.elsevierhealth.com/journals/jinf2020-12-01hj2020Medical Microbiolog