Background: Screening for asymptomatic atrial fibrillation (AF) can identify patients at risk of stroke and help initiate treatment. Apex-pulse deficit, the difference between apex beat rate and peripheral pulse rate, has been described as a clinical sign to identify AF. However, the accuracy of this measure to identify AF has not been studied before. Aims: The primary aim of this study was to determine the sensitivity and specificity of apex-pulse deficit more than 10, measured over 1 min, to identify AF using 12-lead electrocardiogram (ECG) as the gold standard. Methods: This was a prospective cross-sectional study. Subjects were those above 30 years of age with known AF (cases) or not in AF (controls). Apex-pulse deficit was measured in each of them and correlated with rhythm detected in 12-lead ECG. Results: A total of 70 patients were studied, 35 cases and 35 controls. Apex-pulse deficit was significantly larger for cases as compared to controls and was a good discriminant to identify AF. Receiver operating characteristic curve analysis showed an area under the curve of 0.86. With a cutoff of 10, sensitivity and specificity to identify AF were 62.8% and 85.7%, respectively. Using a cutoff of 5 increased the sensitivity to 80%. Counting over 30 s was significantly less accurate than counting over one full minute. Conclusion: Apex-pulse deficit is a low-cost method to identify AF and may be useful for screening. A cutoff of 5 may enhance the sensitivity of measurement as compared to the traditional cutoff of 10.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

In tackling the unconscionably high neonatal mortality rate much has been done, but much more remains to be done. The 1^st minute after birth sets the foundation for the individual's future quality of life, and any intervention which facilitates the smooth transition from the cocooned fetal life to the independent adult life will quickly find worldwide acceptance. However, it is imperative that we also look for resource neutral interventions so that a neonate even in the most resource-challenged setting gets an opportunity to smile. The interventions we have elaborated upon in this article fall in this category. They are simple, easily applied in all settings, and are evidence-based.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Introduction: Antenatal care is a medical service provided to women during pregnancy with the aim of improving the pregnancy outcome. The approach considers that every pregnancy has the potential to be complicated. Objective: This study aimed to assess the utilization and factors associated with attending focused antenatal care (FANC) service in Wolaita Zone, Southern Ethiopia. Materials and Methods: A community-based cross-sectional study was conducted among 551 women who gave birth in the last 2 years. In this study, multistage cluster sampling technique was employed to select primary and secondary sampling units. Univariate and multivariable logistic regressions were done to determine associated factors. P < 0.05 and 95% confidence interval were considered to declare statistical significance. Results: The mean age of the respondents was 26.4 ± 4.9 years. The overall utilization of FANC was 85%. Among 540 interviewed mothers, 243 (45%) followed four and above times antenatal care visits during their last pregnancy, whereas 297 (55%) mothers followed <4 times. Mother's educational status, travel time, knowledge of danger signs, plan for last pregnancy, and knowledge on starting FANC were associated with FANC utilization. Conclusion: The findings of this study showed low utilization of recommended FANC. Efforts to improve utilization of FANC must strengthen initiatives that promote pregnant mothers' awareness on benefits of antenatal care, promote pregnancy planning, and reduction of travel time to health facility.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Gastric outlet obstruction is one of the most common clinical presentations of carcinoma of the stomach, especially in South-West Asia. Although gross gastric dilatation is common in benign obstruction of the pylorus due to peptic ulcer disease, a hugely dilated and distended stomach can be a very rare presentation in a patient with malignancy. A 65-year-old female patient presented with recurrent episodes of vomiting immediately after food, ball-rolling movements in the abdomen, and loss of appetite and significant weight loss in the past 1 month. Upper gastrointestinal endoscopy revealed a dilated stomach and an ulceroproliferative growth in the antropyloric region. A biopsy of the growth revealed moderately differentiated adenocarcinoma of the stomach. Contrast-enhanced computed tomography of the abdomen and pelvis showed proliferative growth at antrum and the hugely dilated stomach reaching up to the pelvis. The patient underwent exploratory laparotomy. Intraoperative findings were that of a dilated and thickened stomach with growth at the antropyloric region of the stomach. Metastatic omental deposits were also seen, and thus, palliative gastrojejunostomy was carried out. This case is being reported to highlight that occasionally malignant gastric outlet obstruction may lead to a massive dilatation of the stomach.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Malaria and human immunodeficiency virus (HIV) account for significant morbidity and mortality in Cameroon. Studies on malaria and HIV coinfection in the Southwest Region of the country are few. The aim of this study was to determine the prevalence of malaria and HIV coinfection as well as the association between HIV and severe malaria (SM), in febrile patients attending the Regional Hospital of Buea. Materials and Methods: In this cross-sectional study, 218 febrile patients were enrolled from the Outpatient Department/Emergency Unit of the Regional Hospital of Buea. Their vital signs were collected, and the consulting physician examined them. Their HIV and malaria statuses were determined by serology and Giemsa microscopy, respectively. SM was classified according to the WHO criteria. Results: The participants' age ranged between 2 weeks and 79 years, and the majority were females (59.2%). The prevalence of malaria, HIV, and coinfection with malaria and HIV were 30.7%, 6.9%, and 2.3%, respectively. Malaria prevalence was significantly higher in children 10 years and below (P = 0.018); meanwhile, HIV prevalence was significantly higher in participants between 31 and 40 years (P = 0.005). The mean hemoglobin concentration was significantly lower while the malaria parasite density was significantly higher in malaria and HIV-coinfected group. The rate of SM was 13.8%, and this was higher in children ≤10 years (P = 0.037). The association between HIV and SM was not statistically significant (P = 0.308). Conclusion: In general, a low prevalence of coinfection with malaria and HIV was observed, and HIV infection was not found to be associated with SM in this study. Further studies in other populations from Cameroon are required to shed more light.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Psychological factors are key determinants of outcomes in psoriasis. Little is known about burden of psychological morbidity, coping styles of patients with psoriasis, and relationship between coping styles, psychiatric morbidity, and quality of life (QoL) in this group. Methods: A cross-sectional, comparative study was carried out on cases with psoriasis and apparently healthy age- and gender-matched controls (n = 72 each). Both groups were compared on depression, anxiety, QoL, and coping preferences using standard measures. Multiple linear regression (MLR) analysis was used to assess predictors of depression and anxiety in psoriasis. Results: Cases with psoriasis had less schooling (P < 0.001) and belonged to lower socioeconomic class (P = 0.005). They also preferentially used emotion-focused coping strategies (P = 0.007) compared to controls and scored higher on depression and anxiety and had poorer QoL across all domains (P < 0.001 for all comparisons). In MLR analysis, female gender (B = 3.04, 95% confidence interval [CI] = 1.22–4.86, P = 0.001), lower QoL (B = −0.06, 95% CI = −0.12–−0.01, P = 0.033), and higher anxiety (B = 0.68, 95% CI = 0.45–0.91, P < 0.001) were the predictors of depression while higher depression (B = 0.57, 95% CI = 0.39–0.76, P < 0.001) predicted anxiety in psoriasis. Conclusion: Significantly, higher psychiatric morbidity, poorer QoL, and maladaptive coping are present in patients with psoriasis when compared with controls. Gender appears to be an important moderator in the relationship between psoriasis and depression.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Acute lymphoblastic leukemia (ALL) patients are susceptible to hepatitis B infection due to profound immunosuppression and repeated transfusions. However, the comparative effectiveness of hepatitis B vaccination in different phases of chemotherapy has not been studied. Aim: In this comparative interventional study (CTRI/2017/08/009402), vaccination in the induction phase (IP) was compared to that in the maintenance phase (MP). Materials and Methods: The participating ALL patients in both groups (29 per group) were vaccinated with double the dose of hepatitis B vaccine at 0, 1, and 2 months. The proportion of patients with seroprotective anti-hepatitis B surface titers (>10 IU/ml) was compared between the two groups after each dose. Results: The seroprotection rates between both the phases were similar following the first (relative risk [RR] = 4, confidence interval [CI]: 0.47–33.65) and third (RR = 1.4, CI: 0.73-2.84) doses of vaccination, whereas following the second dose of vaccination, the seroprotection rate in IP was significantly higher than that of MP (RR = 1.9, CI: 1.07–3.35). Conclusion: This study concluded that a 0, 1, and 2 schedule of hepatitis B vaccination has similar efficacy in both the IP and the MP of chemotherapy in ALL patients. As the IP has a higher trend of seroprotection rates compared to MP, vaccination in IP followed by revaccination postchemotherapy may be preferred in countries with a high prevalence of hepatitis B infection.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]