Prevention of Congenital Transmission of Malaria in Sub-Saharan African Countries: Challenges and Implications for Health System Strengthening

Objectives. Review of burden of congenital transmission of malaria, challenges of preventive measures, and implications for health system strengthening in sub-Saharan Africa. Methods. Literature from Pubmed (MEDLINE), Biomed central, Google Scholar, and Cochrane Database were reviewed. Results. The prevalence of congenital malaria in sub-Saharan Africa ranges from 0 to 23%. Diagnosis and existing preventive measures are constantly hindered by weak health systems and sociocultural issues. WHO strategic framework for prevention: intermittent preventive therapy (IPT), insecticide-treated nets (ITNs), and case management of malaria illness and anaemia remain highly promising; though, specific interventions are required to strengthen the health systems in order to improve the effectiveness of these measures. Conclusion. Congenital malaria remains a public health burden in sub-Saharan Africa. Overcoming the challenges of the preventive measures hinges on the ability of national governments and development partners in responding to the weak health systems

Delay in diagnosis of PD-1 Inhibitor induced Secondary adrenal Insufficiency

Introduction: Immune checkpoint inhibitors including PD-1 inhibitors, were initially approved for the treatment of metastatic melanoma but are now increasingly being used for different types of solid organ malignancies. Despite the important clinical benefits, they are associated with immune-related adverse events. The most critical endocrinopathy associated with PD -1 inhibitor is adrenal insufficiency (AI), which requires prompt diagnosis and management to avoid fatality. Case presentation: We present the case of a 78-year-old woman with colon adenocarcinoma treated with Nivolumab (PD-1 inhibitor) after her pulmonary metastases progressed on chemotherapy. She presented to the hospital with progressive generalized weakness, fatigue, headache, lightheadedness, nausea, myalgia, reduced oral intake. She had 2 prior hospitalizations on account of similar symptoms with workup negative for cancer progression or gastrointestinal obstruction. Her laboratory values showed Na 128mmol/L, K 3.4mmol/L, Cr 0.52mg/dL and blood sugar 42mg/dL. Morning cortisol was low at 2.2µg/dL and ACTH stimulation test was positive. She was diagnosed with AI secondary to Nivolumab use and was started on Hydrocortisone while Nivolumab was discontinued. Conclusion: Immune checkpoint inhibitors have a unique side effect profile of immune-related adverse events, the most critical of which is AI. However, the non-specific manifestations of AI can lead to misdiagnosis or delay in diagnosis. Therefore, it is important for physicians to have high index suspicion for AI in acutely ill patients on PD-1 inhibitors for prompt recognition, diagnosis and treatment of AI which is important to prevent life-threatening adrenal crisis

Prevention of Congenital Transmission of Malaria in Sub-Saharan African Countries: Challenges and Implications for Health System Strengthening

Objectives. Review of burden of congenital transmission of malaria, challenges of preventive measures, and implications for health system strengthening in sub-Saharan Africa. Methods. Literature from Pubmed (MEDLINE), Biomed central, Google Scholar, and Cochrane Database were reviewed. Results. The prevalence of congenital malaria in sub-Saharan Africa ranges from 0 to 23%. Diagnosis and existing preventive measures are constantly hindered by weak health systems and sociocultural issues. WHO strategic framework for prevention: intermittent preventive therapy (IPT), insecticide-treated nets (ITNs), and case management of malaria illness and anaemia remain highly promising; though, specific interventions are required to strengthen the health systems in order to improve the effectiveness of these measures. Conclusion. Congenital malaria remains a public health burden in sub-Saharan Africa. Overcoming the challenges of the preventive measures hinges on the ability of national governments and development partners in responding to the weak health systems

Job satisfaction among anesthesiologists at a tertiary hospital in Nigeria

Background : We assessed job satisfaction among anesthesiologists at a tertiary hospital in Nigeria and identified elements of job stress and dissatisfaction. Methods : A cross-sectional study design was employed; a structured self-administered questionnaire was distributed, which focused on sociodemographic data, rating of job satisfaction, identification of stressors, and work relationships. Results : Out of 55 questionnaires distributed, 46 (83.6%) completed questionnaires were returned. Overall, 27 (58.7%) of the anesthesiologists were satisfied with their job. While 8.7% were very satisfied (grade 5), 6.5% were very dissatisfied (grade 1) with their job. The stressors identified by the respondents were time pressures, long working hours with complaints of insufficient sleep, and employment status. Among the respondents, the medical officers were the most discontented (9 out of 12, 75%), followed by senior registrars (5 out of 9, 56%). A high percentage of participants (54.1%) declared that the one change if implemented that would enhance their job satisfaction was having a definite closing time. Conclusion : Our results showed that despite the demanding nature of anesthesiology as a specialty, many anesthesiologists were contented with their job

A 62-year-old man with acute alcohol withdrawal and stress-induced cardiomyopathy

Objective: Background: Case Report: Conclusions: Unusual clinical course Stress-induced cardiomyopathy is also known as takotsubo cardiomyopathy, broken heart syndrome, and left ventricular apical ballooning syndrome. Patients may present with chest pain and electrocardiogram (EKG) changes, but without coronary artery occlusion, and a reduced ejection fraction that may undergo spontaneous reversal if the patient receives appropriate hemodynamic support. This is a case report of stress-induced cardiomyopathy associated with alcohol withdrawal in a 62-year-old man. We present the case of 62-year-old man who came to the emergency room on account of nausea and vomit-ing after a reduction in the daily intake of alcohol. He had no chest pain or shortness of breath but had new T wave inversions in anterolateral leads on EKG, elevated troponin, and apical wall hypokinesis with ejection fraction 40% on echocardiography. He subsequently developed active symptoms of alcohol withdrawal and was managed with intravenous Lorazepam and chlordiazepoxide. With the improvement in his mental state over the next couple of days, he had a coronary angiogram which showed no coronary disease. He was diagnosed with stress-induced cardiomyopathy or takotsubo cardiomyopathy due to alcohol withdrawal. This report describes a case of takotsubo cardiomyopathy, or stress-induced cardiomyopathy, that was believed to be associated with acute alcohol withdrawal, with spontaneous improvement in the reduced left ventricular ejection fraction following medical support

Bell\u27s Palsy as a Late Neurologic Manifestation of COVID-19 Infection.

Bell\u27s palsy is acute peripheral facial nerve palsy; its cause is often unknown but it can be triggered by acute viral infection. Coronavirus disease 2019 (COVID-19) infection commonly presents with respiratory symptoms, but neurologic complications have been reported. A few studies have reported the occurrence of facial nerve palsy during the COVID-19 pandemic. We present a case of Bell\u27s palsy in a 36-year-old man with COVID-19 infection and a past medical history of nephrolithiasis. He presented to the emergency room with a day history of sudden right facial weakness and difficulty closing his right eye four weeks following a diagnosis of COVID-19 infection. Physical examination revealed right lower motor neuron facial nerve palsy (House-Brackmann grade IV). Serologic screen for Lyme disease, human immunodeficiency virus (HIV), and herpes simplex virus (HSV) 1 and 2 were negative for acute infection; however, neuroimaging with MRI confirmed Bell\u27s palsy. He made remarkable improvement following treatment with a course of valacyclovir and methylprednisolone. This case adds to the growing body of literature on neurological complications that should be considered when managing patients with COVID-19 infection

Right Ovarian Vein Thrombosis in the Setting of COVID-19 Infection.

Ovarian vein thrombosis is a rare condition associated with the postpartum state, pelvic disease, gynecological surgeries, and other thrombophilic states. We present the first reported case of right ovarian vein thrombosis (OVT) in the setting of Coronavirus disease 2019 (COVID-19) unrelated to pregnancy, pelvic disease, or surgery. This case highlights the breadth of the hypercoagulable state induced by COVID-19. We also put forward the use of novel oral anticoagulants in the case of OVT

Trends of Opioid Use Disorder and Associated Factors in Hospitalized Patients With Arthritis.

Introduction Opioid use was primarily limited to acute pain, postsurgical care, and end of life care setting but now is the most prescribed medication for chronic pain. Arthritis is a chronic disease associated with chronic pain. Given limited options for pain relief in the patient population, these patients are often prescribed opioids and are at increased risk of opioid use disorder (OUD). Therefore, our study aimed to identify factors associated with OUD in patients with arthritis. Methods We analyzed hospitalized adult patients with arthritis with and without OUD using discharge data from National Inpatient Sample (NIS) over five years from January 1, 2010, to December 31, 2014. We looked at trends of OUD in hospitalized patients with arthritis and compared demographic and clinical characteristics of patients with and without OUD using Student\u27s t-test and chi-square test. Multivariate analysis was also used to adjust for variables. Results A total of 21,396,252 arthritis hospitalizations were identified during the five-year study period among which 227,608 had OUD. The prevalence of OUD in arthritis hospitalization increased over the five-year period by 43%. After adjusting for other variables, mental health (OR 2.50 (2.43-2.58)), and substance use (OR 6.39 (6.14-6.66)) disorders were associated with increased odds of OUD. Conclusion The prevalence of OUD among patients with arthritis increased over the five-year study period. Mental health and substance use disorders were associated with increased odds of OUD. More studies are needed to explore alternative pain management options for arthritis patients particularly in those with mental health and substance use disorders

Predictors and Outcomes of Invasive Mechanical Ventilation in Opioid Overdose Hospitalization in the United States.

Introduction Opioid overdose is increasingly becoming common and so is the need for invasive mechanical ventilation (IMV) for opioid overdose admissions in hospitalized patients. Respiratory failure requiring invasive mechanical ventilation is the most common reason for the admission of opioid-associated overdose patients. The aim of our study was to assess the demographic and clinical characteristics associated with the increased need for IMV in hospitalized opioid overdose patients. Methods We analyzed all adult admissions (18 years and above) using the National Inpatient Sample (NIS) database for five years from January 1, 2010-December 31, 2014 to identify opioid overdose patients requiring invasive mechanical ventilation. We compared the demographic and clinical characteristics of opioid overdose patients requiring and not requiring mechanical ventilator support and performed univariate and multivariate analyses to determine the odds ratio (OR) of association. Results A total of 2,528,751 opioid overdose patients were identified among which 6.4% required IMV during hospitalization. The prevalence of opioid overdose and the need for IMV increased by 31% and 38%, respectively, over the study period. Multivariate logistic regression (OR (95% CI)

Closure of a Prosthetic Mitral Valve Paravalvular Leak Using a Ventricular Septal Defect (VSD) Amplatzer Occluder Device.

BACKGROUND Paravalvular leaks (PVL) are becoming more commonly experienced in clinical practice due to the increasing number of mitral valve replacements performed. There are about 182 000 valve replacements performed annually, with a 5-15% prevalence rate of paravalvular leaks. Due to increased mortality associated with surgical repair, percutaneous transcatheter closure procedures are increasingly being performed as an alternative to repeat surgery. CASE REPORT We present the case of a 52-year-old woman with past medical history of mitral valve endocarditis who developed worsening acute heart failure 1 month after surgical bioprosthetic mitral valve replacement. Transesophageal echocardiography at the time revealed dehiscence of the bioprosthetic mitral valve and severe mitral regurgitation. She subsequently had emergent surgical bioprosthetic mitral valve replacement and annular reconstruction. The post-operative course was complicated by increasing dyspnea and lower-extremity edema, with recurrent pericardial tamponade requiring placement of a pericardial window. Based on her multiple comorbidities, most notably the concomitant right ventricular failure with severe pulmonary hypertension and prior pericardial patch repair with compromise of her mitral valve annulus, she was deemed inoperable for re-do surgery and eventually underwent a successful percutaneous closure of the mitral paravalvular leak with a ventricular septal defect (VSD) Amplatzer occluder device. The patient made good recovery and was discharged home a few days after the procedure. CONCLUSIONS Although use of the Amplatzer VSD occluder device for this indication currently remains off-label, our report supports the use of the VSD occluder device in this subset of patients considering the high mortality rates associated with repeat surgical procedure