Clinicohaematological study of anaemia in antenatal patients

Background: According to WHO, approximately 75% of pregnant women in developing countries and 18% in developed countries are anaemic. In India prevalence of anaemia is reported to be 33%-89% and is one of the important causes of maternal morbidity and mortality. The present study was done with the objective to study the socio-demographic factors related to anemia and the distribution of different types of anaemia in antenatal patients.Methods: A prospective analytical study was done on 205 pregnant females who presented with anemia (Hb <11 gm/dl) in 1st, 2nd and early 3rd trimester (up to 30 weeks of gestation) in the department of obstetrics and gynecology of Swaroop Rani Nehru Hospital, Prayagraj from September 2017 to September 2018.Results: The rural background with lower socio-economic status comprised majority of the anemic patients (65.9%) with the major cause being iron deficiency anemia (68.8%). The patients mainly presented with anemia at late second or early third trimester (82.4%). Clinical signs like pallor, oedema and symptoms like palpitations and dyspnoea were more associated with severe anemia than mild and moderate anemia.Conclusions: Anemia prevention and prompt detection is the need of the hour with effective management. In India, major cause of anaemia are nutritional deficiencies which can be treated by proper diet and medications. The advises of routine iron supplementation during pregnancy, regardless of whether the mother is anemic or not, is strongly recommended by this study.

Case Report of Kikuchi-Fujimoto Disease from Sub-Saharan Africa: An Important Mimic of Tuberculous Lymphadenitis

Kikuchi-Fujimoto disease (KFD) is a rare form of painful lymphadenopathy, usually cervical, which is more common in Southeast Asia and rarely reported from Africa. Symptoms are usually nonspecific (fever, night sweats, etc.), and can mimic more common diseases such as tuberculosis (TB) in endemic areas. We report a case of a 29-year-old black African woman who was admitted with headache, neck pain, fever, and lymphadenopathy. She was found to have aseptic meningitis, eventually attributed to TB based on cervical node biopsy, although further histology suggested KFD. Blood tests for systemic lupus erythematosus (SLE) were negative; she had already been commenced on anti-TB treatment and had responded well and so was continued with this therapy. She was also later diagnosed with Hashimoto’s thyroiditis 3 months after her diagnosis of KFD. Five months after stopping TB treatment, she was readmitted with the same symptoms and associated painless lymphadenopathy. Repeat biopsy was morphologically similar to that of 2017, and repeat evaluation confirmed SLE. She has since been managed by a rheumatologist and continues to do well

Qualitative Approach to Understanding Barriers to Delivering Difficult News in Sub Saharan Africa

Communication, especially delivery of difficult news (DDN), remains a key part of clinical practice. Despite its importance, many medical providers lack the skill and ability to effectively DDN to their patients. Due to lack of data specific to sub-Saharan Africa and to help us develop an appropriate training tool for this geographical area, we sought to explore what challenges and barriers residents at our institution faced when they deliver difficult news to their patients

COVID-19 Vaccines: Characterizing Misinformation Campaigns and Vaccine Hesitancy on Twitter

Vaccine hesitancy and misinformation on social media has increased concerns about COVID-19 vaccine uptake required to achieve herd immunity and overcome the pandemic. However anti-science and political misinformation and conspiracies have been rampant throughout the pandemic. For COVID-19 vaccines, we investigate misinformation and conspiracy campaigns and their characteristic behaviours. We identify whether coordinated efforts are used to promote misinformation in vaccine related discussions, and find accounts coordinately promoting a `Great Reset' conspiracy group promoting vaccine related misinformation and strong anti-vaccine and anti-social messages such as boycott vaccine passports, no lock-downs and masks. We characterize other misinformation communities from the information diffusion structure, and study the large anti-vaccine misinformation community and smaller anti-vaccine communities, including a far-right anti-vaccine conspiracy group. In comparison with the mainstream and health news, left-leaning group, which are more pro-vaccine, the right-leaning group is influenced more by the anti-vaccine and far-right misinformation/conspiracy communities. The misinformation communities are more vocal either specific to the vaccine discussion or political discussion, and we find other differences in the characteristic behaviours of different communities. Lastly, we investigate misinformation narratives and tactics of information distortion that can increase vaccine hesitancy, using topic modeling and comparison with reported vaccine side-effects (VAERS) finding rarer side-effects are more frequently discussed on social media

Student Satisfaction with Hotel Management Internship in the multi - cultural context of the University of the South Pacific

Many international hospitality organisations interact and effectively work with people from different cultural backgrounds. The issue of cultural awareness, sensitivity, and understanding of cultural differences has created unusual challenges for interns to work effectively in a multi-cultural workplace and deliver quality services to an international tourism market. This qualitative study of student reflections and staff facilitation of internships will determine the factors that contribute to student satisfaction with their working and learning experiences. The proposed research will be of value and have practical implications for both academics who wish to further study student internship satisfaction, sponsors and industry professionals as this research will serve as a framework for a successful internship experience for future hospitality practitioners

Effect of anaemia on maternal and fetal outcome: an observational study

Background: Anaemia in pregnancy is a globally health-related issue that affects both mothers and their new-born. Hence an observational study to see the effect of anaemia on maternal and foetal outcome was conducted. Methods: 15024 mothers coming in OPD or IPD in past 4 years were recruited and their haemoglobin measured. Descriptive statistics was used for baseline characteristics. This observational study was conducted in department of obs and gynae, GSVM Medical College Kanpur from August 2018 to August 2022. All the data gathered was processed by SPSS version 25. Results: The main outcomes included 4 maternal outcomes (postpartum haemorrhage, shock, ICU admission, and maternal mortality) and 4 neonatal outcomes (foetal growth restriction, birth weight, NICU admission, stillbirth). 60.03% of the mothers were anaemic in our study. Maternal and foetal complications were more in anaemic than non-anaemic mothers with incidence of PPH, shock, ICU admission, and maternal mortality being 14.07%, 11.33% ,4.30 and 1.31% respectively than non-anaemic mothers with incidence of 11.22%, 7.26%, 1.76%, and 7.28% respectively. Foetal outcome was also poorer in anaemic mothers with incidence of FGR, LBW, NICU admission, Still birth being 3.15%, 8.85%, 12.96%, and 1.09% higher than non-anaemic group with incidence being 1.80%, 3.43%, 9.75%, and 0.30 % respectively. Conclusions: This observational study provides valuable insights into the effect of anaemia on both maternal and foetal outcomes. It emphasizes the importance of early detection and management of anaemia to mitigate the risks associated with this condition

Adult secondary hemophagocytic lymphohistiocytosis

Background: Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of excessive inflammation and tissue destruction due to abnormal immune activation. HLH carries a very high mortality, and while delays in patients’ presentation to hospital, time to suspicion of HLH, investigation, and initiation of therapy all play a part, mortality remains high even with timely diagnosis and treatment. Classical manifestations of HLH include persistent fever, cytopenias, and liver dysfunction. Case presentation: We present four cases of secondary HLH, highlighting the demographic and clinical characteristics of these patients, underlying triggers (including systemic lupus erythematosus, lymphoproliferative disorders, and leishmaniasis), together with challenges associated with the diagnosis and treatment of this rare disorder and a brief review of literature. Conclusion: LH has protean manifestations and requires a high index of suspicion as it can be a great clinical masquerader. Mortality due to multiorgan failure is often high even with early recognition and treatment

Heidenhain Variant of Sporadic Creutzfeldt-Jakob Disease: First Reported Case from East Africa

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare prion disease that causes rapidly progressive fatal neurodegeneration. The rarer Heidenhain variant of sCJD presents with visual symptoms and is rarely reported in the literature from sub-Saharan Africa. We report the case of a 57-year-old male with a three-week history of losing direction when driving home and visual hallucinations described as seeing rainbows. Magnetic resonance imaging (MRI) of the brain revealed unilateral parieto-occipital sulcal hyperintensities with restriction on diffusion-weighted imaging (DWI), and electroencephalography (EEG) showed right para-central slowing leading to an initial diagnosis of non-convulsive status epilepticus. He was treated with anti-epileptic medication but was re-admitted less than a month later with worsening spatial memory, aggression, ataxia, dysarthria, myoclonic jerks and a positive startle response, later developing generalised tonic-clonic seizures. Repeat MRI brain scan showed widespread posterior-predominant sulcal DWI restriction in a cortical ribboning pattern pathognomonic for sCJD. EEG showed diffuse slowing, and cerebrospinal fluid was analyzed for abnormal prion protein using real-time quaking-induced conversion but was inconclusive due to suboptimal sample collection. The patient fulfilled the diagnostic criteria for probable sCJD, Heidenhain variant; the family declined brain biopsy for definitive diagnosis. He was subsequently palliated at a local hospice where he died approximately three months after the onset of symptoms. Our case highlights the presence of a rare form of sCJD, and the diagnostic challenges faced in our resource-limited setting