The rapid onset of life-threatening clinical manifestations in venomous snake bite could be due to an intravenous bite. This article seeks to review and consider the clinical implications, pathophysiology, and management of this rare route of snake envenomation broadly by venomous snakes which are little described in the available literature.

Background: Connective tissue disease associated with interstitial lung disease, or CT-ILD, is a lung condition that affects a large number of patients with a connective tissue disease. Objective: Our aim in this study is to correlation between images of high-resolution computed tomography (HRCT) of different connective tissue diseases associated interstitial lung diseases (CTD-ILDs). Methods: We shall be aiming to investigate the feasibility of HRCT imaging and thereby avoid lung biopsy in such patients. Results: Rheumatoid arthritis predominantly presented with usual interstitial pneumonia (UIP) (47.8%), followed by nonspecific interstitial pneumonia (NSIP) (30.4%). Mixed connective tissue disorder predominantly presented with NSIP and UIP (42.8%), followed by organizing pneumonia (OP) (14.2%). Systemic lupus erythematosus predominantly presented with UIP (38.8%), followed by NSIP (27.7%). Sjogren's syndrome predominantly presented with lymphocytic interstitial pneumonia (40%), followed by UIP (26.6%). Scleroderma predominantly presented with UIP (45.4%), followed by NSIP (36.4%). Sarcoidosis predominantly presented with UIP (75%), followed by NSIP (25%). Dermatomyositis predominantly presented with NSIP (50%), followed by UIP and OP each (25%). Conclusion: Both clinicians and radiologists should be aware of the expected evolution of HRCT changes in a variety of CT-ILDs.

Purpose: To assess community-directed treatment coverage with Ivermectin (CDTI) in Onchocerciasis-endemic communities in Birnin Kudu local government area (LGA) Jigawa state. Subjects and Methods: This was a community-based multistaged cross-sectional survey based on probability proportional to size. The study involved the administration of a questionnaire on 2021 respondents from 207 households. Also, 30 Community Leaders and Community Directed Distributors (CDDs) were purposively selected for interview from the communities visited. Results: Overall, 2021 respondents from the 2031 sampled population took part in the study giving a response rate of 99.6%. Slightly above half, 1130 (55.9%) were males. The geographic and therapeutic coverage of mass drug administration of Ivermectin achieved in the LGA was 100% and 79.9%, respectively. The key factors affecting coverage includes the unavailability of drugs (48.8%), absenteeism of some of the household members (31%), and inadequate incentives to the CDDs by the government and poor record keeping by the CDDs. Conclusion: This study found that the minimum geographic and therapeutic coverage of Ivermectin distribution was achieved by CDD as recommended by the World Health Organization for the control of onchocerciasis. For this to be sustained and to achieve elimination, there must be an adequate supply of ivermectin, training of CDDs, retraining of CDDs, adequate supervision in record keeping, and health education to the community.

Background: Nerve block anesthesia is a common regional anesthesia used for upper limb surgeries because of its ability to target the operative site and provision of impressive postanesthetic pain relief. This randomized, single-blinded study compared the quality of block of the perineural (PN) and perivascular (PV) techniques of axillary brachial plexus block under ultrasound guidance. Methods: Sixty-six participants were recruited into either PV or PN groups. The local anesthetic (LA) comprised 14 ml of 0.5% bupivacaine, 14 ml of 1% lidocaine, and 2 ml of dexmedetomidine (50 μg/ml). Under ultrasound guidance, 6 ml of LA was deposited around the musculocutaneous nerve for both groups. For the PV group, 24 ml was deposited dorsal to the axillary artery while 8 ml each was deposited around median, radial, and ulnar nerves for the PN group. Results: The mean total procedure time in PN group was significantly longer than in the PV group (7.82 ± 0.95 min vs. 4.79 ± 1.11 min; P = 0.001). Participants in the PN group required more needle passes (66.7% required 4 passes while 81.8% required only 2 passes in the PV group). The success rate was 100% in PN group and 93.9% in PV group (P = 0.49). Conclusion: The PV and PN techniques were comparable in terms of their success rates and total anesthesia-related times. The PN technique had higher success rate and faster block onset, but the PV provided a quicker performance time and fewer needle passes. Hence, PV technique may be preferable to PN for high-volume surgical units.

Introduction: Maternal and perinatal deaths could be prevented if functional referral systems are in place to allow pregnant women to get appropriate services when complications occur. Methodology: The study was a 1-year retrospective study of obstetric referrals in Aminu Kano Teaching hospital, from 1st January to 31st December 2019. Records of all emergency obstetrics patients referred to the hospital for 1 year were reviewed. A structured proforma was used to extract information such as sociodemographic characteristics of the patients, indications for referral, and pre-referral treatment. The care given at the receiving hospital was extracted from the patients' folders. An Audit standard was developed and the findings were compared with the standards in order to determine how the referral system in the study area perform in relation to the standard. Results: There were total of 180 referrals, the mean age of the women was 28.5 ± 6.3 years. Majority (52%) of the patients were referred from Secondary Centres and only 10% were transported with an ambulance. The most common diagnosis at the time of referral was severe preeclampsia. More than half of the patients (63%) had to wait for 30 to 60 minutes before they see a doctor. All the patients were offered high quality care and majority (70%) were delivered via caesarean section. Conclusion: There were lapses in the management of patients before referral; failure to identify high risk conditions, delay in referral, and lack of treatment during transit to the referral centre.

Context: Newborns' low birth weight (LBW) has been linked to early infant morbidity and mortality. However, our understanding of the determinants and outcomes of LBW in this population is still poor. Aim: This study aimed to assess determinants and outcomes of LBW among newborns at a tertiary hospital. Settings and Design: Retrospective cohort study at Women and Newborn Hospital in Lusaka Zambia. Subjects and Methods: We reviewed delivery case records and neonatal files between January 1, 2018, and September 30, 2019, for newborns admitted to the neonatal intensive care unit. Statistical Analysis Used: Logistic regression models were used to establish determinants of LBW and describe the outcomes. Results: Women living with human immunodeficiency virus infection were more likely to deliver LBW infants (adjusted odds ratio [AOR] = 1.46; 95% confidence interval [CI]: 1.16–1.86). Other maternal determinants of LBW were; increased parity (AOR = 1.22; 95% CI: 1.05–1.43), preeclampsia (AOR = 6.91; 95% CI: 1.48–32.36), and gestational age <37 weeks compared to 37 weeks or more (AOR = 24.83; 95% CI: 13.27–46.44). LBW neonates were at higher odds of early mortality (AOR = 2.16; 95% CI: 1.85–2.52), developing respiratory distress syndrome (AOR = 2.96; 95% CI: 2.53–3.47), and necrotizing enterocolitis (AOR = 1.66; 95% CI: 1.16–2.38) than neonates with a birth weight of 2500 g or more. Conclusions: These findings underscore the importance of effective maternal and neonatal interventions to reduce the risk of morbidity and mortality for neonates with LBW in Zambia and other similar settings.

Background: Retinal vascular occlusions are a common cause of visual impairment. Studies on retinal vascular occlusions in sub-Saharan Africa (SSA) have primarily been retrospective and on retinal vein occlusion (RVO) only. The aim of this study, therefore, was to determine the prevalence and pattern of retinal vascular occlusions and their systemic associations in SSA. Materials and Methods: This was a hospital-based, cross-sectional study involving all new patients presenting at the general ophthalmic and specialty retina clinics in four hospitals in Nigeria over a 1 year period. All the patients underwent a comprehensive eye examination. The demographic and clinical data of patients with retinal vascular occlusions were entered into an excel sheet and analyzed using the Statistical Package for the Social Sciences (SPSS) software version 22.0. Statistical significance was indicated by P < 0.05. Results: A total of 8614 new patients were seen, and a diagnosis of retinal vascular occlusion was made in 90 eyes of 81 patients giving a disease prevalence of 0.9%. Eighty-one eyes of 72 (88.9%) patients had RVO, while 9 eyes of 9 (11.1%) patients had retinal artery occlusion (RAO). The mean age of patients with RVO and RAO was 59.5 years and 52.4 years, respectively. Increasing age, hypertension, and diabetes were the significant associations with retinal vascular occlusion with P < 0.0001. Conclusion: Retinal vascular occlusions are an increasing cause of retinal disease in SSA and tend to occur at an earlier age. They are associated with hypertension, diabetes, and increasing age. Further studies will, however, be required to establish the demographic and clinical profile of patients with RAO in the region.

Introduction: Coronavirus disease 2019 (COVID-19) pneumonia is a heterogeneous disease with variable effects on lung parenchyma, airways, and vasculature, leading to long-term effects on lung functions. Materials and Methods: This multicentric, prospective, observational, and interventional study included 1000 COVID-19 cases confirmed with reverse transcription–polymerase chain reaction. All cases were assessed with high-resolution computed tomography thorax, oxygen saturation, inflammatory marker as D-dimer at the entry point, and follow-up. Age, gender, comorbidity, use of bilevel positive airway pressure/noninvasive ventilation (BiPAP/NIV), and outcome as with or without lung fibrosis as per CT severity were key observations. In selected cases, we have performed lower limb venous Doppler and computed tomography (CT) pulmonary angiography to rule out deep-vein thrombosis (DVT) or pulmonary thromboembolism (PTE) respectively. Statistical analysis is performed by using Chi-square test. Observations and Analysis: Age (<50 and >50 years) and gender (male vs. female) has a significant association with D-dimer level (P < 0.00001 and P < 0.010, respectively). CT severity score at the entry point with the D-dimer level has a significant correlation (P < 0.00001). The D-dimer level has a significant association with the duration of illness before hospitalization (P < 0.00001). Comorbidities have a significant association with D-dimer levels (P < 0.00001). D-dimer level has a significant association with oxygen saturation (P < 0.00001). BIPAP/NIV requirement has a significant association with the D-dimer level (P < 0.00001). Timing of BIPAP/NIV requirement during hospitalization has a significant association with D-dimer level (P < 0.00001). Follow-up D-dimer titer during hospitalization as compared to normal and abnormal to entry point level has a significant association with post-COVID lung fibrosis, DVT, and PTE (P < 0.00001). Conclusions: D-dimer has documented a very crucial role in COVID-19 pneumonia in predicting the severity of illness and assessing response to treatment during hospitalization, and follow-up titers have a significant role in step-up or step-down interventions in a critical care setting.

Aim: The aim of this study was to describe the use patterns of antibiotics in periodontal therapy among Moroccan dentists. Materials and Methods: It was a cross-sectional study. An online survey among 2440 registered dentists was conducted in public, private, and semi-public sectors in Morocco. Within the interrogated dentists, 255 answer the online survey. Data analysis was done by the laboratory of biostatistics-epidemiology of the Faculty of Medicine of Casablanca. Results: The antibiotics were prescribed for different pathologies. 26.8% of dentists prescribed antibiotics for gingivitis, 91.5% in case of ulcero-necrotizing gingivitis, 92.7% for aggressive periodontitis, 77% to chronic periodontitis patients, and 97.6% in the presence of periodontal abscess. Dentists prescribed penicillin to 37.3% of cases presenting ulcero-necrotizing gingivitis and 62.3% of patients presenting periodontal abscess. Cyclins are prescribed at a rate of 60% to aggressive periodontitis patients. The association of penicillin + metronidazole is prescribed to 37.3% of ulcero-necrotizing gingivitis patients, 47% of patients presenting aggressive periodontitis, 42.5% of chronic periodontitis patients, and 65.5% of cases presenting periodontal abscess. Discussion: There are major discrepancies among dentists in antibiotic prescription patterns. Some dentists prescribe antibiotics to patients with gingivitis or patients undergoing noninvasive oral procedures such as air polishing and scaling which is worrisome. Dentists are prescribing antibiotics when local treatment would have sufficed. Dentists also commonly prescribed antibiotics as an adjunct to mechanical therapy for the treatment of periodontal disease. Conclusion: Systemic antibiotics are prescribed for different conditions according to variable protocols. The appropriateness of antibiotic prescription must be reassessed critically to improve antibiotic stewardship among dentists.

Background: COVID-19 pandemic has emerged as one of the worst humanitarian crises in human history. Viral sepsis is implicated as a major source of morbidity and mortality in COVID-19 infection. The study provides an insight into impact of COVID -19 associated sepsis on the patient's clinical course and mortality. Materials and Methods: The study was conducted on 112 participants admitted with symptomatic COVID -19 infection in a COVID -19 designated center in New Delhi, India between July and October 2020. Result: 41.1% (n=46) of the participants had critical disease which includes sepsis. Out of 46 Critical patients 19 (41.3%) had sepsis, 21(45.7%) had septic shock and 6 (18.8%) had Sepsis with ARDS. Sepsis and septic shock at time of presentation was associated with higher mortality. Conclusion: Severe and critical illness was marked by advance age, comorbidities like Diabetes mellitus, high total leucocyte count and deranged renal and hepatic function in the study. Thus COVID-19 induced sepsis is an important determinant of disease severity precipitating multiorgan dysfunction and adverse outcome in patients.

Context: Studies have reported multiple variables that can affect the level of burden on informal caregivers. The need for informal caregivers is expected to increase in the upcoming years. Informal caregivers are an important extension of the formal health-care system. Aims: The aim of this study was to discover the characteristics of informal caregivers of adult patients, to determine the socioeconomic, psychological, and physical consequences facing informal caregivers, and to measure caregivers' burdens and needs. Settings and Design: An analytical cross-sectional study that was carried out in Saudi Arabia, in the home health-care unit of King Abdelaziz University Hospital in the city of Jeddah. Subjects and Methods: A validated self-administered questionnaire in Arabic and English was used. The required sample size was 122 participants. Ethical approval was obtained. Statistical Analysis Used: Descriptive statistics consisted of means, standard deviations, frequency tables, cross-tabulation, and charts. Categorical variables were compared using the Chi-square test to determine significant relationships between variables. Results: A total of 124 participants responded to a request to participate in the study. The majority of the caregivers (92) were family members. There was a significant relationship between the nature of the connection between the caregiver and the recipient in association with the burden scale (P = 0.001). No significant relationship was found between caregivers' gender, marital status, or income level and the burden score. Conclusions: Most of the caregivers reported no burden to minimal burden. The relationship with the care recipient has a negative impact on the burden scale.

Background and Purpose: During complete denture fabrication making Interocclusal records plays an integral role to obtain the condylar guidance value. The study was conducted to compare the protrusive condylar guidance registration by two interocclusal recording materials-Quick setting plaster and Luxabite®(bisacrylic composite) in semi adjustable articulator for completely edentulous patients. Methodology: Maxillary and Mandibular casts of the completely edentulous patients were mounted in Hanau®Wide Vue articulator. The Quick setting plaster and Luxabite®(bisacrylic composite) was used as interocclusal recording materials to program the protrusive condylar guidance angles in the articulators. Results: The protrusive condylar guidance values registered in the articulator for the different interocclusal records were tabulated and statistically analyzed.. The mean protrusive condylar guidance values registered in the articulator was compared with two parameters obtained from the radiographic tracings -- the protrusive condylar path angle obtained with Quick setting plaster and Luxabite with the inclination of articular eminence to the Frankfort horizontal plane. Conclusion: From the study it was concluded that the Luxabite®(bisacrylic composite) material demonstrated better reproducibility of protrusive condylar guidance registration.than the Quick setting plaster.

Background: Postpartum hemorrhage remains a challenge in obstetric practice in developing climes and contributes immensely to the horrendous figures of maternal mortality worldwide. Aim: The aim was to compare the effect of intravenous (IV) carbetocin on uterine tone under different anesthetic techniques for elective cesarean section. Methods: Four hundred and seventy-eight consecutive women scheduled for elective cesarean section were recruited into two groups by convenience. While 445 parturients received subarachnoid block (SAB), 33 had general anesthesia (GA). At delivery, IV carbetocin was administered. The uterine tone was assessed manually and blood loss from intraoperative period to the 24^th h was determined. Other variables such as hemodynamic profiles and Apgar scores were determined and recorded. Results: The bio-characteristics between the two groups were essentially the same in terms of age, weight, height, body mass index, preoperative hemoglobin, and gestational age. While the response to the administered carbetocin was slower in the GA group, there was no need for additional dose. The mean estimated intraoperative blood loss under SAB was 250.44 ± 50.59 ml and that under GA was 470.89 ± 35.70 ml, P = 0.000000. The ephedrine consumption was 6.25 ± 2.05 mg in the SAB group while it was 11.25 ± 2.49 mg, P = 0.000000. There was no further maternal blood loss observed after the intraoperative period until the end of 24-h period. The hemodynamic profiles were significantly different in terms of mean systolic blood pressure, mean diastolic blood pressure, and mean arterial blood pressure, P = 0.006, P = 0.002, and P = 0.003, respectively. However, the difference in the mean heart rate was not statistically significant, P = 0.304. While the Apgar scores between groups were not statistically significant, the mean umbilical pH was 7.34 ± 0.09 in the SAB group, it was 7.35 ± 0.02 in the GA group, P = 0.071. Conclusion: Intraoperative maternal blood loss was more among the parturients who received GA than subarachnoid blood. This could probably be due to the effect of the halogenated vapor used for the GA on the uterine tone. There was no further blood loss after the intraoperative period. The hemodynamic profile was better under SAB as evidenced by the total ephedrine consumption.

Context: Odontogenic sinusitis is a prevalent but frequently unrecognized condition, and periapical pathologies of maxillary posterior teeth are accused as one of the main causative factors. Aim: This study aimed to evaluate the relationship between the periapical status of maxillary posterior teeth and its proximity to the maxillary sinus floor in the occurrence of incidental sinus pathologies using cone-beam computed tomography (CBCT). Methodology: CBCT scans of 118 patients of age range 18–77 years were evaluated retrospectively to determine the relationship of maxillary posterior teeth to sinus floor in which vertical relationship was assessed using modified Kwak's classification and periapical status using CBCT periapical index. Statistical analysis was performed using SPSS statistics software. Results: Of all 227 sinuses examined, 56.8% showed pathological changes, with mucosal thickening being the most common. More than 50% (50.2%) of sinuses were associated with periapical lesions of at least one maxillary posterior tooth based on evidence of pathological mucosal thickening. The presence of pathologic mucosal thickening was also significantly related (P < 0.05) to the presence of periapical pathologies. There was a significant association between tooth position and pathological sinus mucosal thickening, especially with second molars, first molars, and second premolars, respectively (P < 0.05). Second molar involvement was the most significant (P < 0.05). Conclusion: The present study established a positive association between periapical disease status of maxillary posteriors and maxillary sinus mucosal thickening. Maxillary second premolar and first and second molars pathologies can significantly affect the maxillary sinus compared to other maxillary posterior tooth. CBCT proved to be an efficient imaging modality in detecting these changes.

Background: The Nigerian government implemented the National Tobacco Control Act (NTCA) in 2015, which prohibits tobacco advertising, promotion, and sponsorship (TAPS) exposure to children under 18 years of age. This study was conducted to assess the prevalence of attitudes and exposure to TAPS among in-school adolescents in Lagos State, Nigeria, 5 years after the implementation of the Act and to identify the factors associated with TAPS exposure among the adolescents. Materials and Methods: This cross-sectional study was conducted among 968 in-school adolescents selected through multistage random sampling. The data were collected using self-administered questionnaires adapted from the Global Youth Tobacco Survey. Results: Overall, 77% had been exposed to at least one form of TAPS in the past 30 days. The most frequently reported channel of exposure was through product placements, with 62% reporting exposure in films, TV, and videos. Up to 15.2% and 12.6% were exposed to TAPS through promotional activities and sponsorships, respectively. The majority (82.3%) had pro-tobacco attitudes, while about a third (33.1%) had pro-TAPS attitudes. Factors associated with TAPS exposure were having pro-TAPS attitudes (odds ratio [OR]: 3.5, 95% confidence interval [CI]: 2.3–5.3), being female (OR: 2, 95% CI: 1.4–2.7), and residing in a rural area (OR: 1.6, 95% CI: 1.2–2.3). Conclusion: Five years after implementing the NTCA, more than two-thirds of the adolescents reported exposure to TAPS, mainly through films, TV, and videos. This suggests that the NTCA is poorly enforced. Efforts to ensure the effective implementation of comprehensive TAPS bans are warranted. Gender-sensitive strategies that target adolescents' attitudes and school-level factors should be emphasized.

Introduction: Acute pancreatitis (AP) is one of the most common yet, the most complex and challenging abdominal emergencies encountered by clinicians globally. It runs an unpredictable course. One-fifth of all AP patients develop complications. Many prognostic predictive scoring systems are used for AP. The aim of our study was to evaluate the usefulness of modified computed tomography severity index (MCTSI) scores to predict the need for intensive care unit (ICU) stay, complications, and mortality in patients of AP. Methodology: An observational, prospective study was conducted for 1 year. Fifty cases diagnosed as AP were included in this study. Contrast-enhanced computed tomography of the abdomen and pelvis was carried out in all patients. MCTSI was calculated according to CT findings. Patients' demographic details, clinical findings, duration of hospital stay, complications, and interventions were recorded. SPSS version 26.0 was used for statistical analysis. Results: A total of 50 patients were enrolled in the study. The mean age was 43.34 years. Total hospital stay was 9.02 ± 6.47 days, mean ward stay was 6.08 ± 2.73, and mean ICU stay was 2.94 ± 4.7 days. Five deaths were reported. There was a significant correlation between the necessity of ICU admission and grade of pancreatitis. There is significant correlation with age and ICU stay (r = 0.344, P = 0.014), age and ward stay (r = −0.340, P = 0.016), total duration of hospital stay and MCTSI score (r = 0.742, P = 0.000), duration of ward stay and MCTSI score (r = −0.442, P = 0.001), and strong correlation with duration of ICU stay and MCTSI score (r = 0.869, P = 0.000). A higher MCTSI score was significantly associated with the presence of local as well as systemic complications and with death (P = 0.0001). Conclusion: Grading by modified CT severity index has a significant direct correlation with the necessity of ICU admission, duration of ICU stay, and total duration of hospital stay. A modified CT severity index can be used to predict the possibility of developing local and systemic complications as well as the need for interventions. Modified CTSI is a reliable predictor of clinical course and outcome in cases of acute pancreatitis.

Introduction: Chronic kidney disease (CKD) patients have increased vulnerability to infections including Covid-19. There is limited availability of antiviral in CKD patients. All guidelines have prioritized vaccinations for CKD patients. The variability in immunogenic response is multifactorial in CKD group. We have tried to analyze the outcome of Covid-19 infection and the impact of COVID-19 vaccination [COVAXIN / COVISHIELD] in our cohort. Materials Methods and Statistical Analysis: In a retrospective observational study, 73 cases of Covid-19 positive CKD patients were selected, who were managed as per MOFHW guidelines. The data of first laboratory values and radiological findings were evaluated. Their treatment outcome and stay during hospitalization were studied. All data were later analyzed using STATA 16.1 software. Results: In this study, 73 cases of CKD with Covid-19 were included. There were 38 patients who were vaccinated with at least one dose of the Covid-19 vaccine, while there were 35 patients who were unvaccinated. Out of 38 patients, 20 were vaccinated with 2 doses of Covid-19 while 18 received only one dose. The unvaccinated group was having more hypoxia and raised inflammatory markers, and had more lung involvement [i.e. higher CT severity value] [p value for CTSS-0.0765]. There was a higher mortality rate observed in the unvaccinated group [i.e-65.71%] than the vaccinated group [39.47%] [p-value 0.0249]. Dialysis was needed in 57.50% of the study population either due to failure of conservative management for renal failure or due to maintenance dialysis. The mean duration of hospitalization was 11.47 days with a mortality rate of 52% which is much higher than the reported average data in CKD patients. Conclusion: Vaccination seems to be very helpful in combating the adverse effect of Covid-19 in CKD patients. It also reduces mortality significantly in Covid-19 infected CKD patients.

Objective: The objective of the study was to determine the prevalence and relationship between sexual autonomy and modern contraceptive use among Nigerian women. Methods: Secondary data analysis of the 2018 Nigerian Demographic and Health Survey was conducted among Nigerian women aged 15–49 years who were married or had a partner. Analysis was conducted using descriptive analysis and univariate and multivariate logistic regression. P < 0.05 was considered statistically significant. Results: Participants that had never heard or seen a family planning awareness message were 59.6%, whereas 55.9% were capable of deciding whether to refuse their husband/partner's sex or not. The prevalence of modern contraceptive use was 12%, and the likelihood of using modern contraceptives increased with the level of education, wealth status, and the number of living children. Sexual autonomy was also a significant predictor of modern contraceptive use (odds ratio = 1.35, 95% confidence interval: 1.25–1.46). Conclusion: There is a very low prevalence of modern contraceptive use among women in Nigeria. Sexual autonomy, poverty, education, and the number of living children play a major role. Thus, women empowerment and girl-child education are critical interventions needed for the best outcomes on contraceptive use in Africa. Male involvement in sexual autonomy is also key since they are major decisionmakers regarding women's issues.

Background: Biceps brachii is an elongated two-headed fusiform muscle of the anterior compartment of the arm which crosses the shoulder as well as the elbow joint. It assists in flexion of the shoulder joint and elbow joint and powerful supinator of the forearm. It also assists in the abduction of the shoulder joint. Accessory heads of biceps brachii muscle not only give additional strength to the joints, at the same time, they may also simulate soft-tissue tumors that can result in neurovascular compression. Aims and Objectives: Accordingly, the aim of this study was designed to evaluate the prevalence of accessory heads of biceps brachii muscle in human cadavers. Materials and Methods: This study was conducted on 107 formalin embalmed human cadavers (male 62 and 45 female), and dissections were performed in accordance with the institutional ethical standards and the Indian Anatomy Act. Results: Out of 107 cadavers, three-headed biceps brachii was noted in 18 cadavers (16.82%) associated with the unusual course of musculocutaneous nerve. Rare and unusual unilateral five-headed biceps brachii was noted in one male cadaver (0.93%). All accessory heads noted in this study were supplied by the separate branches of musculocutaneous nerve except the humeral head of five-headed biceps, which was supplied by the radial nerve. Conclusion: Awareness of these anatomical variations, knowledge is necessary for radiologists, anesthetists, physiotherapists, and orthopedic surgeons to avoid complications during various radiodiagnostic procedures or surgeries of flexor deformities of the upper arm and forearm.

Background: Dental caries is one of the most common chronic childhood diseases and is a cause of continuous discomfort through impaired function and esthetics. To control dental caries, the removal of plaque is of utmost importance, and that further necessitates the use of chemotherapeutic agents. Several side effects associated with chlorhexidine have stimulated the search for an alternative chemotherapeutic agent. Aims: This study aims to compare the effectiveness of probiotic mouth rinse with kidodent mouth rinse, and placebo against mutans Streptococcus and Lactobacillus acidophilus (LA). Materials and Methods: The present study was a randomized parallel double-blinded clinical study which included 90 children of ages 6–15 years who were randomly allocated into three groups: Group 1 – placebo (n = 30), Group 2 – kidodent (n = 30), and Group 3 – probiotic (n = 30). Stimulated salivary samples were collected from all the children after rinsing with distilled water (first reading), and after rinsing with respective mouthwash (placebo/kidodent/probiotic mouth rinse) of their groups during the first visit (second readings). Samples were collected again after using mouth rinse for 14 days (third readings) and used for detection of pH, and levels of Streptococcus mutans (SM) and LA counts. Data were subjected to statistical analysis. Results: Statistically significant difference was seen between placebo versus kidodent, placebo versus probiotic but there was no statistically significant difference between kidodent versus probiotic after the immediate rinse and post 15 days of rinse. Conclusion: Kidodent and probiotic mouth rinse are more efficacious and have equivalent efficacy in reducing SM and LA.

Background: Human immunodeficiency virus (HIV) infection constitutes a major medical complication of pregnancy and is associated with adverse feto-maternal outcomes. However, the relationship between maternal serum selenium levels and pregnancy outcomes has been inconsistent. Objective: This study aimed to determine the relationship between maternal serum selenium status and pregnancy outcome in HIV-positive and HIV-negative women in a tertiary health facility. Methodology: A comparative cross-sectional study was carried out among HIV-positive and HIV-negative pregnant women at a tertiary health-care facility in Owerri. Participants were recruited from the labor ward and interviewed using a structured questionnaire. One hundred and ten HIV-positive pregnant women were compared with an equal number of HIV-negative pregnant women. They were matched for age, parity and gestational age. Selenium level was measured using atomic absorption spectrophotometer. Maternal packed cell volume (PCV) was also assessed at recruitment. At delivery, the birth weight was measured using a standard weighing scale and documented. Cases of preterm births, perinatal deaths, major congenital abnormalities, and neonatal admission were noted and also documented. Statistical analysis was performed using means and standard deviation. Chi-square test, Student's t-test, logistic regression, and Pearson correlation were also employed. Statistical significance was considered at P < 0.05. Results: HIV-positive pregnant women had significantly lower mean serum selenium concentration compared with HIV-negative pregnant women (64.3 ± 19.6 μg/L vs. 100.1 ± 30.9 μg/L; P < 0.001). There was a statistically significant association between serum selenium concentration and birth weight among both HIV-positive and HIV-negative pregnant women (P < 0.001). Similarly, a statistically significant association was seen between serum selenium and maternal PCV in HIV-positive and HIV-negative pregnant women (P = 0.024 and P < 0.001, respectively). However, there was no association found between serum selenium and other pregnancy outcomes. Conclusion: HIV-positive pregnant women had a lower mean serum selenium level compared to HIV-negative pregnant women. There was a significant association between low maternal serum selenium level and maternal anemia, as well as low birth weight, especially in HIV-positive pregnant women.

Earlier reports suggest that cancer patients were twice more likely to contract severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this report, we describe two patients with hematological malignancies seen at the peak of the first wave of the coronavirus disease 2019 pandemic. A 61-year-old man was referred to our urology unit he was diagnosed with nodular hyperplasia and multiple myeloma and commenced on bortezomib, thalidomide, and dexamethasone combination chemotherapy. He developed a cough and fever, with SPO₂ 86%, He was positive for SARS-CoV-2 and died a few days later. A 42-year-old man with Hodgkin lymphoma on treatment with Adriamycin, bleomycin, vincristine, and dacarbazine with positive SARS-CoV-2 exposure was diagnosed with pleural effusion at A/E. Three days postadmission, his condition worsened with low SPO₂ despite intranasal oxygen. He died after testing positive for SARS-CoV-2. Patients with hematological malignancies tend to have a greater risk of SARS-COV-2 infection and severe disease due to immunosuppression from cancer and its treatment.

Emphysematous pancreatitis (EP) is a rare and potentially fatal condition of the pancreas. It is associated with gas-forming bacteria and is characterized by the presence of gas in or around the pancreas. It is identified by a computed tomography scan of the abdomen. Although predisposing factors are not precisely known, diabetes mellitus, which predisposes to gas gangrene, is seen to be commonly associated with patients of EP. EP being potentially fatal requires immediate management. Surgery is generally indicated in EP. However, EP can also managed conservatively. In our case, the patient developed recurrent pancreatitis, the cause being idiopathic, and the second episode of acute pancreatitis was complicated by EP and gastroduodenal artery pseudoaneurysm.

Two 8-year-old girls were admitted to the emergency department with diabetic ketoacidosis (DKA) approximately 10 days apart. The patients with resistant severe acidosis and high infection parameters were diagnosed with COVID-19 by real-time reverse transcription-polymerase chain reaction test. Accompanying pneumonia was observed in one of the patients. Here, we aimed to discuss the difficulties in the management of patients with a new diagnosis of DKA with COVID-19 infection. In addition, we wanted to emphasize that COVID-19 infection may be effective in the development of diabetes in patients with a genetic predisposition.

Caffeine, a popular over-the-counter methylxanthine, is widely consumed for its potent psychoactive properties. Toxicity generally occurs with intentional overdose and is often multisystemic and life-threatening. Consumption by children is rarely planned, and safe doses are potentially toxic in them. A 12-year-old boy whose parents had denied him coffee on several occasions eventually had access to it. The caffeine dose ingested was sub-toxic although he developed severe and life-threatening multisystemic caffeinism. Following ingestion, he became aggressive and was talking irrationally, with visual and auditory hallucinations. In addition, he had severe abdominal pain, multiple vomiting episodes, circulatory collapse, hypertension, angioedema, dysfunctional tear syndrome, hyperglycemia, ketonuria, hypokalemia, and metabolic acidosis. The clinical presentation, laboratory findings, and interventions are reviewed and discussed. Besides routine immunization, routine anticipatory guidance should be at the center of preventive pediatrics. Packaging of caffeinated beverages should also target the prevention of caffeine toxicity in children.

We present the case of a middle-aged female Nigerian diagnosed to have right eye peripapillary polypoidal choroidal vasculopathy (PCV). At presentation, her right eye Snellen visual acuity was 6/24+ (unaided) and 6/12 (aided) and the left eye was 6/9 (unaided) and 6/6 (aided). Fundus fluorescein angiography showed a hyperfluorescent peripapillary subretinal lesion associated with subretinal fluid demonstrated on spectral-domain optical coherence tomography. The PCV lesion was successfully treated using a combination of 3 monthly doses of intravitreal ranibizumab initially, followed by one session of focal thermal retinal laser photocoagulation. Her clinical state has remained stable after 5 years of follow-up, requiring no further treatment. This case demonstrates the effectiveness of combination therapy and can be a strategy for treating this PCV type. Successful treatment using this approach will reduce the burden of intravitreal anti-vascular endothelial growth factor, e.g., ranibizumab injections.

Sub-Saharan Africa has the highest burden of childhood and adolescent mortality in the world. The leading causes of mortality in pediatric populations in Africa include preterm birth complications, pneumonia, malaria, diarrheal diseases, HIV/AIDS, and road injuries. These causes of childhood and adolescent mortality often lead to emergency room utilization due to critical presentation, placing emphasis on the importance of pediatric emergency services in Africa. Despite the criticality of pediatric emergency medicine (PEM) in the region, there is a paucity of PEM training programs in Africa. Ongoing interventions focused on addressing the poor access to PEM training and services include isolated efforts to provide PEM-specific training to nonemergency medicine (EM)-trained practitioners and expand current EM training to include PEM piloted in a single center in Kenya. Sustainable efforts require organized efforts with government and graduate medical education bodies. We discuss the existing infrastructure that can be utilized in promoting the establishment of PEM training programs and urge local governments' investment as well as other stakeholders, including graduate medical education, to address the issue of childhood mortality in Africa through the improved provision and access to PEM training.