ABSTRACT
PURPOSE: To identify specific determinants of non-adherence or cessation of continuous positive airway pressure (CPAP) therapy in a population of patients with spinal cord injuries (SCI). METHODS: Retrospective analysis of data from patients with SCI who underwent a full night supervised polysomnography between 2015 and 2021 and presented with moderate to severe obstructive sleep apnea (OSA) and for whom CPAP was indicated. Adherence was studied at 1, 6, and 12 months. Univariate and multivariate analyses were performed to identify factors associated with non-adherence (< 4 h per night or CPAP cessation). Factors studied were demographic and disease-related data and both subjective and objective sleep parameters. RESULTS: A total of 60 patients were included (40% cervical SCI). In univariate analysis, the only predictive parameters of non-adherence observed at 1, 6, and 12 months were the average use of CPAP on the 1st night (p = 0.02) and over the 1st week (p ≤ 0.001). A complete lesion (AIS-A) was predictive of non-adherence at 1 and 6 months (p = 0.02 at 6 months), while mask leakage was associated with non-adherence at 12 months (p = 0.02). Upper limb autonomy and the presence of family caregivers did not appear to be protective. In multivariate analysis, only the average use in the first week remained predictive of adherence (> 4 h) in the short, medium and long term. CONCLUSION: In patients with SCI and OSA, the 1st week of CPAP treatment seems to be determinant of short-, medium-, and long-term CPAP adherence. Support for SCI patients from the start of treatment is essential and may help avoid treatment failures.
ABSTRACT
Cornual ectopic pregnancy is a rare form of ectopic pregnancy but has catastrophic presentation when diagnosis is missed. It is usually misdiagnosed as degenerated myoma at uterine fundus but can be differentiated by positive pregnancy test, absence of intrauterine gestational sac and diagnostic laparoscopy when necessary. In this case, we present a case of cornual ectopic pregnancy diagnosed by serial serum beta subunit of human chorionic gonadotropin, vaginal ultrasound and diagnostic laparoscopy, which was managed by evacuation of the cornual ectopic by laparotomy, excision of the tube and then suturing the pedicle adjacent to the uterine wall.
ABSTRACT
OBJECTIVES: (a) To determine the natural infection rate of Bulinus truncatus and Biomphalaria pfeifferi snails with trematodes' cercariae. (b) To determine the emergence and rhythmicity of cercariae. (c) To elucidate the high-risk time for man and other animals to acquire infection. METHODS: Snails were collected from Dawar El Mahadi Agricultural Scheme, Khartoum State, identified in the laboratory, kept at room temperature and fed on lettuce. The snails were screened weekly for six weeks for natural infection and infected snails were kept in the dark. The swimming patterns and resting position of the freshly emerged cercariae were studied using a stereomicroscope. The rhythmicity of the different types of cercariae was studied by screening three sets of 5 naturally infected snails under fluorescent light from 07.00 to 19.00 and similar sets from 19.00 to 07.00. RESULTS: Out of 1,257 screened Bulinus truncatus, 187 (14.9%) shed four types of cercariae. The highest prevalence of natural infection (9.5%) was by schistosome cercariae followed by amphistome (2.5%), xiphidiocercariae (2.4%) and lastly by avian cercariae (0.5%). However, out of 200 screened B. pfeifferi, 22 (11%) shed only xiphidiocercariae. The rhythmicity studies showed that the emergence of schistosome cercariae increased steadily from 07.00 to reach its peak at 11.00-13.00. The emergence rhythms of avian cercariae are similar to those of the schistosome, but with an early peak at 09.00-11.00. The xiphidiocercariae and amphistome cercariae started with high rate of emergence at 07.00. and decreased gradually to very low levels or complete disappearance, respectively, around sunset. CONCLUSION: Information on cercarial rhythmicity and chronobiological characteristics are thought to be useful in avoiding water contact during high-risk time of infection and may be helpful in the identification of closely related species and strains of cercariae.
