Euglycemic diabetic ketoacidosis in pregnancy with COVID‐19: A case report and literature review

Diabetic ketoacidosis (DKA) is a life‐threatening complication of diabetes and is considered a medical emergency. Euglycemic DKA (EKDA) is a variant of DKA with a normal or minimally elevated glucose level <200 mg/dl. The condition can be difficult to diagnose due to the relatively normal glucose levels. Pregnancy, infection, and a low‐calorie intake are some of the contributing common etiologies of EDKA. Despite a rapid increase in scientific publications on COVID‐19, there are still knowledge gaps regarding the course of COVID‐19 in some patient subset. This is especially the case for pregnant women. In this case report, we discuss the course of COVID‐19 infection in a pregnant woman with gestational diabetes who developed severe euglycemic diabetic ketoacidosis triggered by various precipitating factors, including starvation, caused by COVID‐19 infection and its gastrointestinal effects.     

Prostate cancer knowledge gaps among community stakeholders in rural Nigeria: implications for seeking screening

Cancer Causes & Control - In Nigeria, knowledge about prostate cancer (PCa) is poor, so are the availability, accessibility, and utilization of PCa screening services. Poor knowledge increases...     

Zea mays,Stigma maydis prevents and extenuates acetaminophen-perturbed oxidative onslaughts in rat hepatocytes

Context: Zea mays L. (Poaceae) Stigma maydis is an underutilized product of corn cultivation finding therapeutic applications in oxidative stress-related disorders.

Objectives: This study investigated its aqueous extract against acetaminophen (APAP)-perturbed oxidative insults in rat hepatocytes.

Materials and methods: Hepatotoxic rats were orally pre- and post-treated with the extract (at 200 and 400?mg/kg body weight) and vitamin C (200?mg/kg body weight), respectively, for 14 days. Liver function, antioxidative and histological analyses were thereafter evaluated.

Results: The APAP-induced marked (p?<?0.05) increases in the activities of alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transferase and the concentrations of bilirubin, oxidized glutathione, protein carbonyls, malondialdehyde, conjugated dienes, lipid hydroperoxides and fragmented DNA were dose-dependently extenuated in the extract-treated animals. The extract also significantly (p?<?0.05) improved the reduced activities of superoxide dismutase, catalase, glutathione reductase and glutathione peroxidase as well as total protein, albumin and glutathione concentrations in the hepatotoxic rats. These improvements may be attributed to the bioactive constituents as revealed by the gas chromatography–mass spectrometric chromatogram of the extract. The observed effects compared favourably with vitamin C and are informative of hepatoprotective and antioxidative attributes of the extract and were further supported by the histological analysis.

Conclusion: The data from the present findings suggest that Stigma maydis aqueous extract is capable of preventing and ameliorating APAP-mediated oxidative hepatic damage via enhancement of antioxidant defence systems.     

Impact of psychiatric morbidity on parent-rated quality of life in Nigerian adolescents with epilepsy

Despite the prevalence of anxiety and depressive disorders in children and adolescents with epilepsy, their impact on the quality of life has not been sufficiently studied. Adolescents with epilepsy (n=90) aged 12 to 18 were assessed for anxiety and depressive disorders with the Diagnostic Interview Schedule for Children, Version IV (DISC-IV), and their quality of life was assessed with the parent-rated Impact of Childhood Illness Scale (ICIS). Sociodemographic and illness variables were also obtained. Predictors of poor quality of life in adolescents with epilepsy include anxiety disorders, depressive disorders, frequency of seizures, and side effects of antiepileptic drugs. Depressive and anxiety disorders impacted on both the adolescents and the family. Programs designed to improve the overall quality of life of these adolescents should include the evaluation and treatment of possible comorbid anxiety and depressive disorders and involve the family.     

Toxicological implications and laxative potential of ethanol root extract of Morella serrata in loperamide-induced constipated Wistar rats

Context: Morella serrata L. (Myricaceae) is commonly used in South Africa to treat several diseases including constipation.

Objectives: This study investigated toxicological implications and laxative potential of the ethanol root extract of the plant.

Materials and methods: While normal control animals were placed on sterile placebo, the loperamide-constipated rats were treated with the extract at 75, 150 and 300?mg/kg doses for 7 days, and their feeding patterns and faecal properties were monitored. Gastrointestinal transit ratio and the toxicity profile of the tested doses were thereafter evaluated.

Results: The significantly increased faecal volume (192.08%), feed (63.63%), water intake (55.97%) and improved intestinal motility (95.05%) in the constipated rats following treatment with the extract (at 300?mg/kg) suggested laxative potential of the extract. The 1.5–2.0-fold normalization of the platelets, erythrocytes and leukocytes counts in the extract-treated constipated rats suggests its non-haematotoxic tendency. Furthermore, the extract (at the highest investigated dose) reversed the attenuation in the concentrations of the electrolytes (0.5–2-fold), total protein (62.12%) and albumin (55.88%) in the constipated animals as well as attenuated activities of hepatic enzymes (0.5–3.0-fold) and levels of urea (126.67%), creatinine (40.32%), cholesterol (3-fold) and triglycerides (9-fold). These further support its non-toxic and therapeutic attributes against constipation.

Conclusion: Overall, the effect exhibited by M. serrata in this study competed well with Senokot (standard drug) and proved that it may be relatively safe and with excellent laxative potential, thus, supporting its pharmacological applications in South Africa.     

A comprehensive approach to achieving near 100% compliance with The Joint Commission Core Measures for pneumonia antibiotic timing

Background

Adherence to The Joint Commission (TJC) Core Measures benchmarks is required for hospital accreditation, and data are publicly reported as an indication of hospital quality. Published approaches to date for adhering to the pneumonia antibiotic timing (PN5c) Core Measure have shown moderate to limited success in reaching high levels of compliance.

Objective

The objective of the study was to evaluate the effectiveness of a 3-phased intervention directed at improving compliance with TJC pneumonia antibiotic administration within the 6-hour requirement (PN5c) in an academic urban emergency department.

Methods

A 3-phase interventional study with retrospective analysis of contemporaneous data collection during a 57-month period ending September 2009 was performed. Phase 0 was baseline, phase 1 was physician evaluation at triage, phase 2 was implementation of a specific pneumonia screening tool and pathway, and phase 3 was implementation of an emergency department electronic medical record system that facilitates removing subjects with “diagnostic uncertainty” from consideration. Main outcome measure was the proportion of patients receiving antibiotics within 6 hours among those meeting PN5c criteria. Mean times to antibiotics and percentage of compliance with PN5c were compared for each phase.

Results

Percentage of compliance with PN5c increased from a baseline of 77% through each of the 3 phases: 85%, 91%, and 95%, respectively (Cochran-Armitage trend, P < .001). Mean time to antibiotic administration decreased from a baseline of 285 minutes with each successive intervention to 224, 189, and 169 minutes, respectively (linear regression, P < .001).

Conclusion

Implementation of a structured intervention that includes early physician triage, a screening tool for immediate imaging and reporting, and electronic record-facilitated compliance review effectively improves TJC PN5c compliance to high levels.