University Teaching Hospital

To present our experience in the management of penile cancer (PC) in the context of a country with limited resources. This was a cross-sectional study with retrospective data collection and descriptive aim. It was conducted over a 20-year period from 1 January 2005 to 31 December 2024. The frequency was 1.05 cases per year. The mean age of the patients was 60.23±13.10 years. A proportion of 76.19% (n=16) of patients were uncircumcised. One patient was HIV positive. Ulceration of the penis was the main reason for consultation (88.23%). The average time to consultation was 11.7±11.37 months. Phimosis was observed in 2 patients. The histological type found was squamous cell carcinoma in all cases. Stage cT3 was the most common (71.42%), followed by stage cT4 in 28.58%. Twelve patients underwent surgical treatment. Total penectomy was performed in 5 patients, partial penectomy in 6 patients and emasculation in one patient. Node dissection was performed in 3 patients. The one-year survival rate was 83.33%. Penile cancer is rare and consultations are made at advanced stages. Awareness of the population on risk factors remains essential for early diagnosis and prevention.

Intra-dural spinal tumours are a rare, yet diverse group of neoplasms, which may occur anywhere along the spinal neuroaxis. Their clinical presentations are typically slow and progressive in nature. Signs and symptoms are dictated by tumour location and size, and occur due to the sequalae of mass effect, oedema, ischaemia and subsequent metabolic dysfunction of neural tissue occurring secondary to compression of neural elements and neural vasculature. Back/neck pain and stiffness are the most common presenting complaint for patients presenting with intra-dural spinal tumours. Further symptoms are dependent on the location of the tumour. Lesions that compress or develop within the spinal cord are associated with upper motor neuron (myelopathic) signs and symptoms, whilst lesions compressing spinal nerves alone are associated with lower motor neuron (radicular) signs and symptoms. In some circumstances, a mixed picture of both upper and lower motor neuron symptoms may also be observed.

Nanomaterial-based enzyme mimics, known as nanozymes, are extensively applied in chemical sensing and biomedical fields due to their low cost, high stability, and tunable catalytic activity. However, conventional synthesis methods employing hazardous chemicals limit their promotion in undergraduate laboratory training. Herein, an eco-friendly and simple green approach is proposed that utilizes plant extracts as natural reducing agents for nanozyme synthesis. Iron oxide nanozymes (Fe3O4 NZs) were synthesized using lemon peel extract, and their structures and properties were analyzed via SEM, XRD, XPS, and FT-IR. The peroxidase-like activity of Fe3O4 NZs was evaluated using a chromogenic substrate in the presence of H2O2. Additionally, their effectiveness in developing nanozyme-glucose oxidase (GOx) cascade colorimetric sensors for glucose detection was also demonstrated. These experiments have been successfully conducted at various undergraduate levels and have received positive feedback. Experimental assessments indicated that students’ understanding of green chemistry, catalytic mechanisms, and interdisciplinary applications of nanozymes had improved. Moreover, the flexible design of the experiment allows instructors to modify it based on students’ backgrounds, available equipment, and teaching objectives, making it applicable to multiple fields such as chemistry, materials science, and biology. This experiment provides a generalizable case for integrating cutting-edge technology into undergraduate education.

Periprosthetic joint infection (PJI) is one of the most severe complications in hip arthroplasty, and treatment of PJI is associated with high re-infection rates and significant loss of quality of life for patients, as well as socio-economic impact to health systems. Antimicrobial coating of implants with silver is a promising option to improve the outcome of PJI. However, there is no data from randomized control trials on silver-coated versus standard non-silver-coated implants in patients with PJI. Therefore, the aim of the current study is to assess clinical outcome for the use of silver-coated hip implants (further referred to as IP-coated) versus non-IP-coated implants in patients requiring surgical revision for hip PJI. This is a multicenter confirmatory interventional randomized controlled superiority single-blinded study with two stages: pilot stage (part A) and pivotal stage (part B). Patients indicated for unilateral cementless acetabular and hip stem revision due to chronic periprosthetic infection planned for single-stage or two-stage surgical procedures are included. Patients will randomly be assigned either to the IP-coated or the non-IP-coated implant group. The primary outcome parameter is infection-free survival within 12months after hip PJI. The underlying hypothesis is that the IP coating significantly reduces the risk of periprosthetic reinfection compared to the non-IP-coated implants. Secondary outcome parameters include data on the safety and performance of the prostheses through a 2-year clinical follow-up, including patient-related outcome parameters, such as Harris Hip Score, EQ-5D, radiographical assessment, and blood silver concentrations. An adaptive study design is planned with the inclusion of 268 subjects according to initial sample size calculations. Upon follow-up of 134 patients for 12months or inclusion of 90% of the study patients, preliminary study results will be used to re-estimate the sample size, which may be extended up to 400 subjects. The current study aims to fill the evidence gap for the idea of IP-coated implants to reduce re-infection rates in the treatment of hip PJI. To the authors' best knowledge, this is the first randomized controlled superiority trial evaluating the outcome of a silver-coated versus a non-silver-coated prosthesis for the treatment of hip PJI. The adaptive study design allows an adjustment of the initial sample size to reduce the risk of an underpowered superiority. ClinicalTrials.gov NCT06737809(date of publication 17.12.2024).

Abstract Background Orbital and ocular lesions pose significant diagnostic challenges in resource-limited settings like Nepal, where accurate imaging is crucial for timely management. This study aims to evaluate and compare the performance of US, CT, and MRI in the detection and characterization of orbital and ocular lesions in a Nepalese hospital-based cohort. Methods This prospective study, conducted at B&C Teaching Hospital in Birtamode-5, Nepal, enrolled 130 patients with suspected orbital lesions or trauma, presenting with symptoms such as proptosis, vision loss, or pain. All patients underwent USG with a high-frequency linear probe; 85 received CT (Brivo 365, GE), and 45 underwent 1.5T MRI (Philips A series). Diagnostic accuracy was assessed against final diagnoses based on clinical findings, laboratory results, surgery, and histopathology. Metrics included sensitivity, specificity and accuracy across lesion types (tumors, trauma, infections, inflammation) and orbital compartments. Results The cohort (58.4% male, mean age 20–40 years) showed orbital tumors (33.0%), inflammation (20.7%), trauma (17.6%), and infections (13.8%) as primary conditions. MRI excelled in tumor characterization (100% intraocular, 98% intraconal) and inflammation (100% for optic neuritis/perineuritis). CT was superior for trauma (100% foreign body detection) and bony lesions. USG demonstrated 100% sensitivity for retinal detachment and vitreous hemorrhage but lower for deep tumors (50–55% characterization). All modalities achieved high accuracy for infections (90–100%). Conclusion US, CT, and MRI play complementary roles in orbital imaging, with USG ideal for initial screening, CT for emergencies, and MRI for complex soft tissue evaluation. A stepwise approach optimizes resource use in Nepal, enhancing diagnostic accuracy and patient outcomes.

Sickle cell disease (SCD) is a genetic blood disorder associated with chronic cardiovascular and pulmonary complications, including pulmonary hypertension (PHT), venous thromboembolism (VTE), and cardiac involvement (CI), all of which contribute significantly to premature mortality. Despite their clinical importance, the burden of these conditions in adolescents and adults with SCD remains poorly characterized. We conducted a systematic review and meta-analysis to evaluate the prevalence and impact of these complications in SCD patients aged ≥ 10years. Following PRISMA guidelines, we searched MEDLINE/PubMed, Web of Science, and Scopus for observational studies reporting prevalence or incidence. We did not apply any date or time restrictions to the literature search. Pooled estimates were calculated using random-effects meta-analysis. The studies yielded from the search were published between January 1, 1974, and October 12, 2023. Seventy-nine studies met the inclusion criteria, of which fifty-nine were included in the meta-analysis. The pooled prevalence estimates were as follows: PHT 30% (95% CI 26-34), VTE 13% (9-18), and CI 24% (17-33), with substantial heterogeneity (I2 > 90%) among the studies. PHT was primarily diagnosed via Doppler echocardiography, while VTE was identified through ultrasonography or CT angiography. CI manifestations included diastolic dysfunction and structural abnormalities. These complications were strongly associated with increased mortality and functional impairment. Chronic cardiovascular and pulmonary complications are highly prevalent in adolescents and adults with SCD, leading to significant morbidity and mortality. Routine screening and early intervention are essential to mitigate disease progression and improve outcomes. Future research should focus on standardized diagnostic criteria and targeted therapies to reduce the burden of these conditions in SCD. PROSPERO CRD42023474623.

Klebsiella pneumoniae is a leading cause of neonatal sepsis in low- and middle-income countries, with antimicrobial resistance (AMR) significantly contributing to mortality. We used whole genome sequencing to explore the impact of an infection prevention and control (IPC) intervention on K. pneumoniae strains and transmission dynamics responsible for sepsis in a Zambian neonatal unit. Blood culture isolates were collected during the Sepsis Prevention in Neonates in Zambia (SPINZ) study, including a 7-month baseline period and 12 months following implementation of a low-cost IPC bundle. K. pneumoniae genomes associated with 411 neonatal infections were characterised, comprising 24 unique sequence types (STs) and dominated by ST307 (69.3%, n = 285). Nearly all isolates (99.0%) carried extended spectrum beta-lactamases, but few carried carbapenemases (2.7%). Most infections (95.6%) were associated with probable transmission clusters, ranging in size from 2-202 patients and spanning durations of 2-232 days. Most K. pneumoniae (n = 228, 70%) were isolated during the 7-month baseline period and formed six clusters, including one cluster of >200 neonates infected with ST307. Transmission of all strains was periodically suppressed by an IPC bundle; however not all strains were eliminated, and some were able to re-emerge later to re-establish infection and transmission, alongside newly introduced strains that formed additional transmission clusters. Some clusters were associated with rapid onset of disease (within 2 days of admission) and others with delayed onset, suggesting different sources of contamination (e.g., reagent vs environmental). These findings reinforce the need for sustained IPC efforts, and better understanding of environmental reservoirs of opportunistic pathogens in neonatal units to inform such efforts.

Introduction: Stroke is a leading cause of disability in Zambia, with limited resources towards long-term rehabilitation. Our prior work performing focus group interviews with patients with stroke and their caregivers identified varying types of rehabilitation services sought within community settings in Zambia. Objective: We used best-worst decision-making experiments and qualitative term mapping to evaluate how people with stroke and their caregivers prioritize stroke rehabilitation services. Methodology: Adults with stroke with onset > 3 months and their caregivers participated in co-creation workshops in which seven rehabilitation service types (i.e. physical therapy, occupational therapy (e.g. activities of daily living support), mental health counseling, religious support, speech therapy, employment retraining, and social support services) were introduced. Qualitative term mapping was first performed to identify characteristics associated with each service. Participants then completed a best-worst decision-making experiment where they ranked the best and worst service among four presented services, repeated seven times with varying service combinations. Standardized mean best-minus-worst (B-W) scores and relative rescaled B-W scores were calculated by a count-based analysis (Table 1) to evaluate aggregate preferences of participants. Results: 36 participants (64% female) were enrolled with a mean age of 49 years (range: 18-69). Half were people with stroke and half were caregivers. Service prioritization by relative B-W scores and mean standardized B-W scores were calculated, producing the following service ranking (Table 1): (1) Social support, (2) occupational therapy, (3) physiotherapy, (4) mental health counseling, (5) speech therapy, (6) spiritual support, (7) employment training. Participants associated social support services with provision of wheelchairs and transportation stipends to and from clinic, while associating occupational therapy with in-home mobility, cooking, and bathing retraining. Conclusion: In this cohort of Zambians with stroke and their caregivers, social support services and occupational therapy were the most prioritized rehabilitation services, both of which are currently largely unavailable in Zambia. These data will inform our future pilot study of implementing a structured rehabilitation program within community settings.

This work presents a system for automatic detection of various stages of diabetic retinopathy (DR) based on fundus images of patients. The system was built based on a relatively new and little-used image database: ”Dataset of fundus images for the study of diabetic retinopathy” version v3 CastilloBenitez21. The primary dataset was expanded using clinical fundus photographs acquired from the Department of Nephrology at Wroclaw Medical University. The diagnostic system was developed based on various variants of convolutional neural networks (CNNs) that were pre-trained on ImageNet data. The CNN classifier, based on VGG16 with transfer learning, proved to be effective and gave a global accuracy of 83.15%. The evaluation of discrimination between the non-DR and the DR state resulted in an accuracy of 89.7%, with a sensitivity of 94.9%, a specificity of 88.3%, and a Matthews Correlation Coefficient of 0.7665.