INTRODUCTION: The integrity of the Achilles tendon (AT) plays a significant role in foot biomechanical efficiency. Diabetes mellitus contributes to the development of AT tears which impairs movement and productivity. The objective of this study was to sonographically assess the prevalence and associated factors of Achilles tendon tears in Type-2 diabetes mellitus, with and without peripheral neuropathy (PN), and compare with a control population. METHODS: A prospective cross-sectional study was conducted on 71 Type-2 diabetics subjects and 80 controls. AT tears and calcifications were detected in the subjects using high resolution B-mode ultrasound. RESULTS: AT calcification was significantly associated with dominant and non-dominant foot AT tear, while HbA1c and PN were significantly associated with dominant foot AT tear (P < 0.05, respectively). There were significantly more AT calcifications and tears on the dominant foot AT of diabetics with PN (P < 0.001). The prevalence of AT tears in Type-2 diabetics was 7.75%. HbA1c ≥ 6.95% was shown to have a high sensitivity (75%), specificity (74.60%) and accuracy (75.35%) to correctly predict the development of a non-traumatic AT tear in diabetics with PN. CONCLUSION: The prevalence of AT tear in Type-2 diabetics, based on sonographic diagnosis, is low. The likelihood of AT tears increases in the dominant foot when HbA1c level equals or exceeds 6.95% in diabetics with peripheral neuropathy. This preliminary study showcases the need to incorporate Achilles tendon sonographic evaluation to rule out tears in the management of diabetics.
INTRODUCTION: Women of reproductive age often face hormonal fluctuations, dual‐role pressures, and a tendency to use the internet as a coping mechanism, all of which may lead to persistent distress and impair memory and concentration. This study aimed to identify the associations between anxiety persistence and severity, premenstrual dysphoric disorder (PMDD), and problematic internet use (PIU) and cognitive function in women of reproductive age. METHODS: In this cross‑sectional analytic observational study at Baiturrahman Primary Health Care Centers in Banda Aceh, Indonesia (March 2025), 86 women aged 19–45 were recruited via accidental sampling. Initial anxiety screening used the GAD‑7, excluding scores 0–4 and including only respondents with scores ≥ 5. We then assessed PMDD with the Premenstrual Symptoms Screening Tool (PSST), PIU via a standardized questionnaire, and cognitive dysfunction using Montreal Cognitive Assessment-Indonesian Version (MoCA‑INA), where dysfunction was defined as a score < 26. RESULTS: The majority of respondents experienced cognitive dysfunction (74.42%, n=64). This occurred within a sample where 61.63% (n= 53) exhibited severe anxiety and 53.49% (n=46) had anxiety lasting ≥ 5 years. Additionally, 39.53% (n=34) screened positive for PMDD and 77.91% were classified as having problematic internet use. Significant associations were found between cognitive dysfunction and anxiety severity (Odds Ratio, OR = 4.7; 95% Confidence Interval, CI: 1.23–17.9; p-value, p = 0.023), anxiety duration ≥ 5 years (OR = 4.9; 95% CI: 1.27–18.9; p = 0.021), PMDD positivity (OR = 7.3; 95% CI: 1.48–36.6; p = 0.015), and problematic internet use (OR = 5.7; 95% CI: 1.33–24.7; p = 0.019). CONCLUSION: Anxiety severity and duration, PMDD, and problematic internet use are associated with cognitive dysfunction among reproductive-aged women.
INTRODUCTION: Tuberculosis (TB) is a major health burden in the world, and particularly in individuals living with HIV. This study evaluated the comparative performance of GeneXpert MTB/ RIF and Lipoarabinomannan tests against TB culture, in HIV-positive and HIV-negative patients in the University Teaching Hospital of Kigali. METHODS: A total of 124 participants (37 HIV-positive and 87 HIV-negative) were enrolled. Sputum, urine, and other specimens were tested using GeneXpert MTB/RIF and urinary LF-LAM, with results compared against TB culture on Lowenstein–Jensen media as the diagnostic gold standard. RESULTS: In HIV-positive patients, LF-LAM had a sensitivity of 75% (95% CI: 47%-91%) and a specificity of 84% (95% CI: 65%-94%), whereas GeneXpert had a sensitivity of 67% (95% CI: 39%-86%) and a higher specificity of 96% (95% CI: 80%-99%). All tests performed better in HIV-positive patients (p-value = 0.0008 for LAM; p-value = 0.0001 for GeneXpert). In the HIV-negative group, GeneXpert's sensitivity was 65% (95% CI: 41%- 83%), significantly outperforming LF-LAM's sensitivity of 35% (95% CI: 17%- 59%). These findings underscore the importance of tailored diagnostic approaches based on patient immune status to optimize TB detection accuracy. The study elucidated the disparities between the LAM test and GeneXpert in diagnosing tuberculosis among patients with or without HIV, paving the way for more targeted and effective diagnostic interventions. CONCLUSION: The study findings showed a complementary role of both GeneXpert and LF-LAM. LF-LAM is strongly effective as a quick screening test in TB detection and an early intervention tool in HIV-positive patients because it has a much greater diagnostic sensitivity in this population. Integration of the LAM test into TB diagnostic algorithms for immunocompromised populations could improve early detection and treatment initiation, thus reducing TB morbidity and mortality.
INTRODUCTION: Epilepsy stands out as one of the prevalent neurological conditions, especially in children, caused by impaired brain function with the typical symptom of recurrent seizures due to the release of electrical charges from proximal brain neurons without provocation. The aim of this study is to identify the risk factors that contribute to the development of drug-resistant epilepsy (DRE) in pediatric patients with a prior history of epilepsy. METHODS: A cross-sectional observational analytic study was carried out on pediatric patients with epilepsy at Dr. Kariadi Hospital Semarang, Indonesia by analyzing the patient’s medical records. The data were analyzed with univariate and bivariate tests and presented in tabular form. RESULTS: Based on the findings from 73 medical records collected for this study, the incidence of drug-resistant epilepsy (DRE) was identified in 58 subjects (79.5%). Bivariate analysis revealed significant risk factors associated with DRE, namely the type of anti-epileptic drugs (AEDs) used and their dosage (p < 0.001). Another factor shown to increase the risk of DRE was seizure frequency (p = 0.016). CONCLUSION: The risk factors for the occurrence of DRE in children identified in this study include the type and dosage of anti-epileptic drugs (AEDs), as well as seizure frequency. Inadequate or inappropriate administration of AEDs may increase the likelihood of recurrent epileptic seizures and elevate the risk of developing DRE. Frequent seizures, which are commonly associated with DRE in pediatric patients, may further damage the developing brain.
INTRODUCTION: TLower limb amputation (LLA) is the complete loss of any part of the lower extremity along the transverse anatomical plane. It is one of the oldest surgical procedures, with origins tracing back to Hippocrates and evidence of amputation dating 31,000 years ago. LLA is a common disability globally, affecting an estimated 65 million individuals, with 1.5 million amputations performed annually, 60% involving lower limbs. This study aimed to investigate the prevalence, risk factors, outcomes, and management of LLA at Hoima Regional Referral Hospital, Uganda. METHODS: A retrospective cross-sectional study was conducted using data from operating room registries, medical files, and physiotherapy records. After verification for completeness and clarity, data were analysed using SPSS, with results presented in tables and graphs. RESULTS: A total of 60 patient files were reviewed. Most patients were male (68.3%), aged ≥50 years (65.0%), from rural areas (61.7%), with secondary education (41.7%), and Catholic (35.0%). The prevalence of LLA was 6.7%. Significant risk factors included age, sex, diabetes mellitus, BMI, and gangrene. Of the four amputees, 25% required re-amputation, 25% experienced in-hospital mortality, and 50% utilized physiotherapy. Psychological scores ranged from 3 to 10 (mean: 6.0), with 75% showing good psychological status and 25% fair status. CONCLUSION: LLA remains a significant public health concern, impacting quality of life. Key factors associated with LLA include age, sex, diabetes mellitus, BMI, and gangrene.
