A qualitative insight into researchers' perceptions of gender inequality in medical and dental research institutions in Nigeria.

OBJECTIVE: The aim of the study was to gain a qualitative insight into scientific researchers' perceptions of gender inequality inside Nigerian research institutions through an investigation of how gender equality is enacted in medical and dental research institutions in Nigeria. METHODS: This descriptive and cross-sectional qualitative study probed decision-making around navigating gender inequity and explored opinions about how a supportive environment for female medical and dental researchers could be established. Data were collected through semi-structured telephone interviews with 54 scientific researchers across 17 medical and dental academic institutions in Nigeria between March and July 2022. Data were transcribed verbatim and analyzed using thematic analysis. RESULTS: Three core themes emerged: institutionalized male dominance in research institutions; changing narratives on gender equalities in research and academic enterprise; and women driving the conscience for change in research institutions. Female medical and dental researchers' perceived gender equality was challenging mainstream androcentric values in knowledge production within the medical and dental field; and queries the entrenchment of patriarchal values that promote a low number of female medical and dental trainees, fewer female research outputs, and few women in senior/managerial positions in the medical fields. CONCLUSION: Despite the general view that change is occurring, a great deal remains to be done to facilitate the creation of a supportive environment for female medical and dental researchers in Nigeria.

Statin-induced autoimmune myopathy: a case report.

Statins are widely used in the treatment of hypercholesterolemia. Muscle weakness and elevated creatine kinase (CK) are frequent side effects of statins with an incidence of about 15%. Statin-associated myopathy is more common in people who receive multiple drugs, the elderly or women but the mechanism underlying it is still unclear. These symptoms generally improve after drug discontinuation. However, there is a type of autoimmune mediated myopathy characterised by the persistence of muscle weakness and CK elevation after stopping statins. Herein, we discuss a case of autoimmune myopathy associated with statin exposure and responsive to immunossupresive drugs. The increased use of statins in recent years raises the importance of acquaintance with this disease in clinical practice.

Combination of ceftaroline and daptomycin as treatment for complicated osteomyelitis.

Osteomyelitis is an infection involving bone. Staphylococcus aureus is the pathogen most frequently implicated; less frequently involved are other gram-positive organisms, such as Staphylococcus epidermidis, and also gram-negative organisms. The antibiotic of choice for treatment of osteomyelitis caused by methicillin-resistant staphylococci (MRS) is vancomycin, although other alternatives such as daptomycin or teicoplanin are also considered. Osteomyelitis caused by MRS can be difficult to treat safely and effectively. This case report describes the successful use of daptomycin combined with ceftaroline for the treatment of osteomyelitis caused by methicillin-resistant S. epidermidis (MRSE) in a 54-year-old woman, emphasising the clinical pharmacist's role in antimicrobial stewardship programmes. This alternative combination has been studied in the treatment of methicillin-resistant S. aureus (MRSA), but it may also be useful in MRSE.

Bullous pemphigoid induced by ustekinumab: a case report.

A possible case of bullous pemphigoid (BP) that developed during treatment with ustekinumab is reported. Ustekinumab is a human monoclonal antibody found in pathologies such as psoriasis, which works by inhibiting the activity of interleukin-12 and interleukin-23. We describe the case of a 75-year-old woman who presented with new onset of erythematous and bullous lesions 5 days after receiving a fifth dose of ustekinumab. The patient was treated with corticosteroids and dapsone, whereupon the lesions disappeared. Ustekinumab was withdrawn. Currently the patient remains asymptomatic. In addition, the histopathological and immunofluorescence findings confirmed the diagnosis of BP. Three causality algorithms were applied and revealed a probable causal relationship. There may be a causal relationship between the use of ustekinumab and BP. This association should be taken into account by physicians when prescribing and reviewing drug therapies.

Ulcerative colitis induced by ixekizumab: a case report.

A possible case of ulcerative colitis (UC) developed during treatment with ixekizumab is reported. Ixekizumab is a human monoclonal antibody approved for chronic plaque psoriasis that works by blocking interleukin-17 (IL-17). Cytoquines, such as IL-17, may be involved in the pathophysiology of psoriasis and inflammatory bowel diseases. We describe the case of a 76-year-old woman who presented with an episode of acute self-limited colitis after receiving ten doses of ixekizumab. It was resolved after treatment withdrawal. A re-challenge was done after 3 months and symptoms returned. Colonoscopy results confirmed the diagnosis of UC. Symptoms remitted after drug discontinuation and treatment with corticosteroids. Four months after stopping ixekizumab, she remains asymptomatic and she is being treated with guselkumab with adequate response. The Naranjo algorithm revealed a probable causal relationship.This adverse event should be taken into account by physicians and pharmacists before prescribing or reviewing therapies in order to improve patients' safety.

Quality of Life and Alleviation of Symptoms After Breast Reduction for Macromastia in Obese Patients: Is Surgery Worth It?

BACKGROUND: Breast hypertrophy can cause a variety of symptoms and affect lifestyle and quality of life. Breast reduction, being the most effective treatment, is sometimes difficult to establish as standard treatment in obese patients (difficulties to differentiate symptoms from macromastia or from obesity, higher rate of complications). AIM: To evaluate the effect of reduction mammaplasty (quality of life and symptoms) in obese patients comparing with non-obese. METHODS: This is a prospective study of patients undergoing reduction mammaplasty. Patients were allocated in non-obese (BMI < 29) and obese (BMI > 30). Demographic data, comorbidities, specific symptoms questionnaire, data from the surgical procedure, Spanish version of the Health-Related Quality of Life (SF-36) questionnaire, complications and sequels were recorded and collected before the operation and at 1 month and 1 year after. Chi-square, Fisher's exact t test, McNemar, Mann-Whitney U and Kruskal-Wallis tests were used for statistical analysis. RESULTS: One hundred twenty-one consecutive patients were operated on; 54 (44.6 %) obese and 67 (55.4 %) non-obese. The average age of patients was 40.7 (18-78), average volume of resected tissue was 1.784 g (401-5.790), and average hospital stay was 2.94 days (1-11). There were no differences between obese and normal BMI patients with regard to length of hospital stay, complications, sequels, or reoperations. Symptoms improved in both groups. Physical and mental components of the SF-36 improved at 1 year in both groups (p < 0.001). The mental health component improved at 1 month (p < 0.001) in both groups. CONCLUSIONS: Obese patients should be considered for reduction mammaplasty surgery in the same way as women of normal weight. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Neurobehçet: a propósito de un caso / NeuroBehçet: a case

La enfermedad de Behçet es un trastorno inflamatorio sistémico, caracterizado por aftosis orogenital así como por alteraciones oftalmológicas y cutáneas. Un 5% de los pacientes presenta manifestaciones neurológicas. Se presenta un caso de neurobehçet con participación neurológica inhabitual.Varón de 28 años con antecedente de aftas orales y genitales recurrentes e historia de foliculitis, que acudió por cuadro de 48 h de fiebre, cefalea, náuseas, paresia del sexto par craneal y del miembro superior derecho. El análisis del líquido cefalorraquídeo reveló pleocitosis linfocitaria con hiperproteinorraquia, se inició tratamiento antibiótico de amplio espectro. Se realizó resonancia magnética cerebral, que mostró lesiones hiperintensas de predominio troncoencefálico con realce tras infusión de gadolinio y trombosis del seno transverso izquierdo. El paciente mejoró progresivamente con tratamiento intravenoso con corticoides hasta quedar asintomático.La afectación neurológica en la enfermedad de Behçet es infrecuente y más aún la coexistencia de lesiones intraparenquimatosas y extraparenquimatosas. Habitualmente, presenta buena respuesta al tratamiento inmunosupresor (AU)

Behçet′s disease is an inflammatory systemic disorder, with oral and genital ulcers, as well as ophthalmologic and cutaneous disturbances. 5% of the patients have neurological alterations. We present a case of neuroBehçet with a rare neurological involvement.A 28 years-old male patient with recurrent oral and genital ulcer history and folliculitis presents 48h progressive fever, headache, nausea, right sixth cranial nerve palsy and right upper limb paresis. The CSF showed lymphocyte pleocytosis and high proteinorrachia, so antibiotic treatment was initiated. Cerebral MR found hyperintense enhancing lesions in the brainstem and left transverse sinus thrombosis. Patient improved with endovenous corticosteroids and was discharged asymptomatic.Neurological involvement in Behçet′s disease is rare and moreover the coexistence of parenchymatous and non-parenchymatous alterations in the same patient. It normally has a good response to immunosuppressant treatment (AU)

[NeuroBehçet: A case]. / Neurobehçet: a propósito de un caso.

Behçet's disease is an inflammatory systemic disorder, with oral and genital ulcers, as well as ophthalmologic and cutaneous disturbances. 5% of the patients have neurological alterations. We present a case of neuroBehçet with a rare neurological involvement. A 28 years-old male patient with recurrent oral and genital ulcer history and folliculitis presents 48h progressive fever, headache, nausea, right sixth cranial nerve palsy and right upper limb paresis. The CSF showed lymphocyte pleocytosis and high proteinorrachia, so antibiotic treatment was initiated. Cerebral MR found hyperintense enhancing lesions in the brainstem and left transverse sinus thrombosis. Patient improved with endovenous corticosteroids and was discharged asymptomatic. Neurological involvement in Behçet's disease is rare and moreover the coexistence of parenchymatous and non-parenchymatous alterations in the same patient. It normally has a good response to immunosuppressant treatment.

Ateromatosis del arco aórtico y riesgo de ictus isquémico: a propósito de un caso / Atheroma of the aortic arch and risk of ischemic stroke: a case

Las placas de ateroma del arco aórtico son un factor de riesgo poco conocido de ictus isquémico, generalmente por la producción de embolias arterioarteriales. Presentamos el caso de un varón de 67 años que llegó a nuestro hospital con un ictus hemisférico izquierdo con estudio etiológico rutinario negativo. En el ecocardiograma transesofágico (ETE), se detectó una gran placa de ateroma en arco aórtico, ulcerada y complicada, con trombo móvil en su pared, presuntamente causante del cuadro actual. La ateromatosis del arco aórtico es un factor de riesgo independiente de infarto cerebral, especialmente las placas grandes, ulceradas o trombosadas, y aparece en un porcentaje elevado de pacientes con ictus criptogénico. La actitud diagnóstica y terapéutica es controvertida en estos casos, pero se suele aconsejar el ETE, como método de referencia diagnóstico, y la antiagregación, como prevención secundaria. En el momento actual, son necesarios más estudios epidemiológicos, así como ensayos clínicos, para elaborar guías de tratamiento en estas situaciones (AU)

Aortic arch atheroma is a poorly understood risk factor for stroke, usually producing arterial embolisms. A 67 year-old male was admitted to our hospital with a left hemispheric stroke with a negative routine aetiological study. Transesophageal echocardiography (TEE) showed atherosclerosis of the aortic arch with mobile thrombus, presumably causing the actual stroke. Aortic arch atheromatosis is an independent risk factor for cerebral infarction, particularly large, ulcerated or thrombotic plaques, and it is found in many patients with cryptogenic stroke. Diagnosis and treatmnent is not clear in these cases, but TEE is used as gold-standard complementary test with antiplatelets as secondary prevention. Further epidemiological studies and clinical trials are necessary for the preparation of clinical guides (AU)

Morbilidad sentida y diagnosticada en cuidadores de pacientes inmovilizados de una zona de salud rural / Morbility perceived and diagnosed among caregivers of immobilized people in a rural health district

Fundamentos: El progresivo envejecimiento de la población ha dado lugar a que muchas familias deban hacerse cargo del cuidado de algunos de sus miembros con incapacidad. Esta nueva situación implica cambios en la situación familiar y en especial en el cuidador principal que puede ver afectada su salud. El objetivo de este trabajo es conocer la morbilidad sentida y diagnostica de los cuidadores principales del paciente inmovilizado, así como identificar sus necesidades de salud. Métodos: Estudio descriptivo transversal. El grupo de estudio está formado por los cuidadores de personas inmovilizadas incluidos en el programa de atención domiciliaria de un Centro de Salud rural. Por muestreo aleatorio simple se extrajo una muestra de 50 cuidadores, para un nivel de confianza del 95 por ciento y una precisión del 6 por ciento. Se realizó una entrevista personal al cuidador y una revisión de su historia clínica en Atención Primaria. Resultados: Entre los cuidadores existe un predominio de mujeres, con una edad media de 60 años, casadas, estudios primarios, hijas del paciente y convivientes con él más de 6 meses al año. La morbilidad sentida más frecuentemente fueron los problemas osteoarticulares (67,9 por ciento). Un 28 por ciento (IC 95 por ciento: 16,2-42,5) presentan malestar psíquico relacionado con la ansiedad y un 32 por ciento (IC 95 por ciento: 19,5-46,7) relacionado con la depresión. El número de problemas en relación al esfuerzo referidos por los cuidadores fue de 72 y los reflejados en la historia clínica fueron 10, el resto de problemas reflejados no tiene relación con el esfuerzo. Conclusiones: El perfil del cuidador encontrado no difiere del de otros estudios. Padece pluripatologia (síntomas físicos y psíquicos), tiene una baja frecuentación al médico y su morbilidad sentida está infradiagnosticada (AU)

Bacground: The progressive aging of the population has led to many families having to take charge of caring for some disabled family member. This new situation involved changes in the family situation, especially in that of the main caregiver, whose health may be affected. The objective of this study is to ascertain the morbility perceived and diagnosed regarding the main caregivers of disabled patients and to detect their health needs. Methods: A descriptive cross-sectional study. The group under study was comprised of the caregivers of immobilized patients registered in the homecare program of a rural Healthcare Center. A sample of 50 caregivers was taken by simple random sampling, with a 95% confidence level and a 6% accuracy. The caregivers in question were surveyed personally and their Primary Care Clinical Record was reviewed. Results: The caregivers in question were predominantly females averaging 60 years of age, married, having an elementary school education, the daughters of the patients, having lived with the patient for more than 6 months a year. The morbility perceived most often were bone and joint problems (67.9%). Twenty-eight percent (28%) (IC 95%: - 16.2-42.5) showed psychological uneasiness with anxiety, 32% (IC 95%: - 19.5-46.7) related to depression. The number of stress-related problems reported by the caregivers totaled 72, a total of 10 being shown in their Clinical Record, none of the other problems in their Records being related to stress. Conclusions: The caregiver profile does not differ from other studies. Caregivers have multiple disorders (physical and psychological symptoms), go to see their physicians little, and their perceived morbility is underdiagnosed (AU)

[Morbidity perceived and diagnosed among caregivers of immobilized patients in a rural health district]. / Morbilidad sentida y diagnosticada en cuidadores de pacientes inmovilizados de una zona de salud rural.

BACKGROUND: The progressive aging of the population has led to many families having to take charge of caring for some disabled family member. This new situation involved changes in the family situation, especially in that of the main caregiver, whose health may be affected. The objective of this study is to ascertain the morbility perceived and diagnosed regarding the main caregivers of disabled patients and to detect their health needs. METHODS: A descriptive cross-sectional study. The group under study was comprised of the caregivers of immobilized patients registered in the homecare program of a rural Healthcare Center. A sample of 50 caregivers was taken by simple random sampling, with a 95% confidence level and a 6% accuracy. The caregivers in question were surveyed personally and their Primary Care Clinical Record was reviewed. RESULTS: The caregivers in question were predominantly females averaging 60 years of age, married, having an elementary school education, the daughters of the patients, having lived with the patient for more than 6 months a year. The morbility perceived most often were bone and joint problems (67.9%). Twenty-eight percent (28%) (IC 95%:--16.2-42.5) showed psychological uneasiness with anxiety, 32% (IC 95%:--19.5-46.7) related to depression. The number of stress-related problems reported by the caregivers totaled 72, a total of 10 being shown in their Clinical Record, none of the other problems in their Records being related to stress. CONCLUSIONS: The caregiver profile does not differ from other studies. Caregivers have multiple disorders (physical and psychological symptoms), go to see their physicians little, and their perceived morbility is underdiagnosed.