International Journal of Medicine and Medical Sciences

International Journal of Medicine and Medical Sciences | Vol. 13, No. 3, March 2023 | pp. 17–24

DOI: 10.46882/2023/IJMMS/130017

Original Research Article

Seroprevalence and Risk Factors of Hepatitis E Virus Infection among Pregnant Women in an Urban Setting

Patrick O. Diallo¹, Cynthia U. Nwachukwu², Jean-Pierre B. Diop¹*

¹Department of Infectious Diseases, Faculty of Medicine, Université Cheikh Anta Diop, Dakar, Senegal.

²Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.

Abstract:

Hepatitis E Virus (HEV) infection during pregnancy is associated with a high risk of fulminant hepatic failure and adverse perinatal outcomes. This cross-sectional epidemiological study investigated the seroprevalence and underlying socio-demographic risk factors for HEV infection among pregnant women attending antenatal clinics in an urban setting. Blood samples from 450 pregnant women were screened for anti-HEV IgM and IgG antibodies using a third-generation Enzyme-Linked Immunosorbent Assay (ELISA). Structured questionnaires were used to collect information on water supply sources, sanitation practices, and dietary habits. The overall seroprevalence of anti-HEV IgG was 11.1% (50/450), while active or recent infection (anti-HEV IgM positivity) was confirmed in 2.2% (10/450) of the participants. HEV exposure was significantly higher among third-trimester pregnant women (15.6%) than first-trimester participants (6.4%, p < 0.05). Multivariate logistic regression analysis identified several independent risk factors associated with HEV seropositivity: using untreated well water as the primary drinking source (OR = 3.4, 95% CI = 1.8–6.5, p < 0.01), lacking pour-flush toilet facilities at home (OR = 2.8, 95% CI = 1.3–5.8, p < 0.01), and a history of consuming raw street food (OR = 2.1, p < 0.05). HEV seroprevalence is high among urban pregnant women and is closely linked to poor water quality and sanitation infrastructure. Routine screening for HEV during pregnancy and public education on water hygiene are essential to lower maternal mortality risks.

Keywords: Hepatitis E Virus, Pregnancy, Seroprevalence, Risk Factors, Water Hygiene, Public Health

Manuscript Timeline: Received: December 05, 2022; Revised: January 14, 2023; Accepted: February 08, 2023; Published: March 14, 2023.

Citation: Diallo PO, Nwachukwu CU, Diop JPB. Seroprevalence and Risk Factors of Hepatitis E Virus Infection among Pregnant Women in an Urban Setting. International Journal of Medicine and Medical Sciences, 2023, 13(3): 17–24. DOI: 10.46882/2023/IJMMS/130017

International Journal of Medicine and Medical Sciences | Vol. 13, No. 2, February 2023 | pp. 9–16

DOI: 10.46882/2023/IJMMS/130009

Original Research Article

Diagnostic Utility of Plasma Neutrophil Gelatinase-Associated Lipocalin versus Serum Creatinine for Early Detection of Acute Kidney Injury in Severe Burn Patients

Charles O. Igwe¹, Rachel L. Sanon², Anthony D. Boateng¹*

¹Department of Surgery, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Abuja, Nigeria.

²Department of Nephrology, Faculty of Health Sciences, Université de Ouagadougou, Ouagadougou, Burkina Faso.

Abstract:

Acute kidney injury (AKI) significantly increases morbidity and mortality in severe burn patients, but traditional serum creatinine variations are slow. This prospective diagnostic study evaluated the accuracy of plasma neutrophil gelatinase-associated lipocalin (pNGAL) for early AKI detection following major thermal injury. We evaluated 120 adult patients with burns exceeding 20% of their total body surface area. Plasma NGAL was quantified at admission, 6, 12, and 24 hours post-injury, while serum creatinine was monitored daily for 7 days. AKI was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Thirty-six patients developed confirmed AKI (30.0%) within 48 hours. In the AKI cohort, pNGAL concentrations rose significantly from a baseline of 92.4 ± 14.8 ng/mL to 215.8 ± 32.4 ng/mL at 6 hours post-burn (p < 0.01), long before serum creatinine showed changes. Receiver Operating Characteristic (ROC) analysis showed that 6-hour pNGAL at a cutoff value of 150 ng/mL had a sensitivity of 91.7%, a specificity of 85.7%, and an Area Under the Curve (AUC) of 0.91 (95% CI = 0.84–0.96). In comparison, 24-hour serum creatinine achieved an AUC of only 0.65. Plasma NGAL serves as a highly sensitive and precise early diagnostic biomarker for thermal-injury-induced acute renal damage, allowing for early optimization of fluid resuscitation and renal preservation protocols.

Keywords: Acute Kidney Injury, Severe Burns, Neutrophil Gelatinase-Associated Lipocalin, Biomarkers, Thermal Injury, Renal Function

Manuscript Timeline: Received: November 12, 2022; Revised: December 20, 2022; Accepted: January 15, 2023; Published: February 15, 2023.

Citation: Igwe CO, Sanon RL, Boateng AD. Diagnostic Utility of Plasma Neutrophil Gelatinase-Associated Lipocalin versus Serum Creatinine for Early Detection of Acute Kidney Injury in Severe Burn Patients. International Journal of Medicine and Medical Sciences, 2023, 13(2): 9–16. DOI: 10.46882/2023/IJMMS/130009

International Journal of Medicine and Medical Sciences | Vol. 13, No. 1, January 2023 | pp. 1–8

DOI: 10.46882/2023/IJMMS/130001

Original Research Article

Evaluation of Thromboelastography Parameters and Conventional Coagulation Assays for Predicting Bleeding in Severe Hepatic Cirrhosis

Ibrahim K. Diallo¹, Victoria N. Eke², Jean-Baptiste M. Diop¹*

¹Department of Haematology, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta Diop, Dakar, Senegal.

²Department of Hematology and Blood Transfusion, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.

Abstract:

Conventional coagulation parameters such as the International Normalized Ratio (INR) often fail to reflect the true complex hemostatic state of patients with hepatic cirrhosis. This prospective clinical study evaluated the utility of Thromboelastography (TEG) parameters compared to conventional coagulation assays (CCA) for predicting acute variceal bleeding events in patients with severe hepatic cirrhosis. We enrolled 110 adult patients with confirmed Child-Pugh Class B or C hepatic cirrhosis. Baseline TEG variables (R-time, K-time, alpha angle, and maximum amplitude [MA]) and CCA profiles (INR, activated partial thromboplastin time, and platelet count) were measured at admission, and patients were monitored for 6 months for any significant gastrointestinal bleeding events. Over the follow-up period, 28 patients experienced acute bleeding events (25.5%). In the bleeding group, the TEG maximum amplitude (MA)—a marker of platelet-fibrin clot strength—was significantly lower (42.4 ± 5.1 mm) compared to non-bleeding patients (56.8 ± 6.4 mm, p < 0.001). Conversely, baseline INR values did not show a statistically significant difference between bleeding and non-bleeding cohorts (mean = 2.1 ± 0.4 vs. 1.9 ± 0.3, p = 0.24). Receiver Operating Characteristic (ROC) analysis showed that a TEG MA cutoff value < 45 mm predicted bleeding with a sensitivity of 89.3% and a specificity of 81.7% (AUC = 0.89), significantly outperforming the INR (AUC = 0.62, p < 0.01). Thromboelastography parameters provide a more accurate evaluation of bleeding risks in cirrhotic patients than conventional clotting assays. Utilizing viscoelastic testing can improve clinical management and guide targeted blood product utilization.

Keywords: Hepatic Cirrhosis, Thromboelastography, Variceal Bleeding, Hemostasis, International Normalized Ratio, Platelet Function

Manuscript Timeline: Received: October 14, 2022; Revised: November 24, 2022; Accepted: December 16, 2022; Published: January 13, 2023.

Citation: Diallo IK, Eke VN, Diop JBM. Evaluation of Thromboelastography Parameters and Conventional Coagulation Assays for Predicting Bleeding in Severe Hepatic Cirrhosis. International Journal of Medicine and Medical Sciences, 2023, 13(1): 1–8. DOI: 10.46882/2023/IJMMS/130001

International Journal of Medicine and Medical Sciences | Vol. 12, No. 12, December 2022 | pp. 89–96

DOI: 10.46882/2022/IJMMS/120089

Original Research Article

Assessment of Exclusive Breastfeeding Barriers and Growth Velocity Patterns in Infants inside Urban Low-Income Settings

Evelyn N. Kamau¹, Tunde O. Adebayo², Sarah M. Touré¹*

¹Department of Paediatrics and Child Health, School of Medicine, University of Nairobi, Nairobi, Kenya.

²Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Abstract:

Suboptimal exclusive breastfeeding (EBF) rates in low-income urban settings are linked to poor infantile somatic development and an increased infectious disease burden. This prospective longitudinal cohort study investigated specific socio-environmental barriers to EBF and monitored infant growth velocity patterns over the first six months of life. We enrolled 240 mother-infant pairs at birth from peri-urban primary healthcare centers. Infant anthropometric data (weight, length, and head circumference) were captured monthly, while breastfeeding practices and adherence barriers were tracked using standardized structural interviews. The confirmed rate of EBF at 6 months was only 32.5% (78/240). Early introduction of complementary liquids or solids occurred at a median infant age of 3.4 months. The most common self-reported barriers to maintaining EBF were an early return to informal work (62.5%), maternal perception of insufficient breast milk supply (54.0%), and lack of family or spousal support (38.0%). Anthropometric growth modeling showed that infants who completed the full 6 months of EBF had a significantly higher mean weight-for-age Z-score at month 6 (+0.24 ± 0.15) compared to the non-EBF cohort (-0.48 ± 0.22, p < 0.01). Non-EBF infants experienced a 2.8 times higher incidence of acute diarrheal illnesses during the follow-up period (p < 0.001). Low EBF adherence in urban low-income populations is primarily driven by maternal economic obligations. Improving EBF rates requires community-based support programs and targeted nutritional counseling during early infancy.

Keywords: Exclusive Breastfeeding, Infant Growth, Low-Income Settings, Growth Velocity, Diarrheal Morbidity, Nutritional Status

Manuscript Timeline: Received: September 10, 2022; Revised: October 20, 2022; Accepted: November 11, 2022; Published: December 16, 2022.

Citation: Kamau EN, Adebayo TO, Touré SM. Assessment of Exclusive Breastfeeding Barriers and Growth Velocity Patterns in Infants inside Urban Low-Income Settings. International Journal of Medicine and Medical Sciences, 2022, 12(12): 89–96. DOI: 10.46882/2022/IJMMS/120089

International Journal of Medicine and Medical Sciences | Vol. 12, No. 11, November 2022 | pp. 81–88

DOI: 10.46882/2022/IJMMS/120081

Original Research Article

Efficacy and Perinatal Safety of Intravenous Hydralazine versus Oral Labetalol in the Acute Management of Severe Pregnancy-Induced Hypertension

Fatima Z. Bello¹, Kwaku A. Mensah², Grace N. Ojo¹*

¹Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, Bayero University, Kano, Nigeria.

²Department of Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

Abstract:

Acute hypertensive crises during pregnancy require rapid, safe therapeutic containment to avoid maternal cerebrovascular injuries or fetal distress. This randomized, open-label, comparative clinical trial evaluated the efficacy and perinatal safety of intravenous hydralazine versus oral labetalol in the acute reduction of severe pregnancy-induced hypertension. A total of 160 third-trimester pregnant women with a blood pressure ≥ 160/110 mmHg were randomly assigned to receive either intravenous hydralazine (5 mg bolus, repeated every 20 minutes up to 20 mg, n = 80) or oral labetalol (200 mg initial dose, repeated up to 600 mg, n = 80). The primary outcomes were the time required to achieve a safe target blood pressure (≤ 140/90 mmHg) and the incidence of maternal and perinatal complications. Both interventions effectively lowered blood pressure; however, the mean time to achieve target stabilization was significantly shorter in the intravenous hydralazine group (32.4 ± 6.2 minutes) compared to the oral labetalol group (46.8 ± 8.5 minutes, p < 0.01). The total number of doses required was lower in the hydralazine arm. Maternal adverse events, specifically persistent tachycardia (18.8% vs. 5.0%, p < 0.05) and headaches (22.5% vs. 7.5%, p < 0.01), were significantly higher in the hydralazine cohort. There were no statistically significant differences between the groups regarding the incidence of fetal bradycardia or low Apgar scores at 5 minutes (p > 0.05). Both therapeutic agents are effective, but intravenous hydralazine offers more rapid blood pressure control, though it causes higher rates of minor maternal adverse effects.

Keywords: Pregnancy-Induced Hypertension, Severe Pre-eclampsia, Hydralazine, Labetalol, Antihypertensive Therapy, Perinatal Safety

Manuscript Timeline: Received: August 14, 2022; Revised: September 22, 2022; Accepted: October 10, 2022; Published: November 11, 2022.

Citation: Bello FZ, Mensah KA, Ojo GN. Efficacy and Perinatal Safety of Intravenous Hydralazine versus Oral Labetalol in the Acute Management of Severe Pregnancy-Induced Hypertension. International Journal of Medicine and Medical Sciences, 2022, 12(11): 81–88. DOI: 10.46882/2022/IJMMS/120081

International Journal of Medicine and Medical Sciences | Vol. 12, No. 10, October 2022 | pp. 73–80

DOI: 10.46882/2022/IJMMS/120073

Original Research Article

Cardiovascular Risk Profiles and Target Organ Damage in Adult Patients with Chronic Essential Hypertension

Chidi O. Okafor¹, Amina J. Hassan², Samuel K. Appiah¹*

¹Department of Medicine, College of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.

²Department of Medicine and Therapeutics, Korle Bu Teaching Hospital, Accra, Ghana.

Abstract:

Uncontrolled essential hypertension causes progressive systemic vascular modifications, resulting in target organ damage (TOD). This prospective cross-sectional study evaluated cardiovascular risk profiles and the prevalence of specific TOD markers in adult patients managed for chronic essential hypertension. We evaluated 200 hypertensive patients aged 35 to 65 years. Risk profiling involved serum lipid screening, fasting plasma glucose measurements, and microalbuminuria assays. TOD was confirmed via electrocardiographic and echocardiographic evaluations for Left Ventricular Hypertrophy (LVH), and fundoscopy for hypertensive retinopathy. The mean blood pressure of the cohort was 154.6 ± 12.8 / 96.4 ± 8.5 mmHg. The overall prevalence of at least one TOD indicator was 54.5% (109/200). Echocardiographic LVH was the most common structural damage marker, identified in 38.0% of the participants, followed by microalbuminuria (28.5%) and hypertensive retinopathy (22.0%). Dyslipidemia was highly prevalent, characterized by elevated low-density lipoprotein cholesterol (mean = 3.82 ± 0.65 mmol/L). Logistic regression modeling showed that a duration of hypertension > 5 years (OR = 3.2, 95% CI = 1.6–6.4, p < 0.01), poor blood pressure control (OR = 2.8, p < 0.05), and concurrent metabolic syndrome (OR = 3.6, p < 0.001) were strongly associated with advanced TOD. Chronic essential hypertension in this population is associated with a high burden of target organ damage, particularly structural cardiac remodeling. Early, aggressive multi-drug therapeutic interventions and routine screening for microalbuminuria are necessary to lower cardiovascular event risks.

Keywords: Essential Hypertension, Cardiovascular Risk, Left Ventricular Hypertrophy, Microalbuminuria, Retinneropathy, Target Organ Damage

Manuscript Timeline: Received: July 12, 2022; Revised: August 20, 2022; Accepted: September 11, 2022; Published: October 14, 2022.

Citation: Okafor CO, Hassan AJ, Appiah SK. Cardiovascular Risk Profiles and Target Organ Damage in Adult Patients with Chronic Essential Hypertension. International Journal of Medicine and Medical Sciences, 2022, 12(10): 73–80. DOI: 10.46882/2022/IJMMS/120073