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Health Quality of life of children and adolescents with congenital heart disease in Moi Teaching and Referral Hospital Eldoret, Kenya

Myra M. Koech* and Njie Albertine Enjema

Introduction: Congenital heart diseases (CHD) in low- and middle-income countries, remains a leading cause of mortality and morbidity amongst children and adolescents due to the patients and family’s inability to access diagnostic and surgical care. In the last century, however, survival has improved, but there remains scarce evidence in Africa of the health-related quality of life (HRQoL) among these affected children.

Objective: This study set out to assess the HRQoL and its determinants in this group of children with CHD presenting at a tertiary referral hospital in Kenya.

Patients and Methods: This was a hospital based cross-sectional study at the Moi Teaching and Referral hospital, Kenya conducted between November 2023 and June 2024. The participants were children and adolescents aged 0-18 years, who had a confirmed echocardiographic diagnosis of congenital heart disease, as well as being on follow up for at least 6 months in the cardiology clinics. The recruitment was done consecutively. HRQoL was assessed using age-appropriate EuroQol instruments (EQ-5D-Y and EQ-5D-5L). The primary outcome was overall HRQoL, categorised using visual analogue scale thresholds. Sociodemographic and clinical data were collected using structured tools. Associations were evaluated using χ² tests and multivariable logistic regression, with significance set at p<0.05.

Results: A total of 107 participants was included (median age 4.0 years [IQR 1.4–10.0]; 54.2% male). The commonest lesion was acyanotic CHD (81.1%), with ventricular septal defect (32.7%), atrial septal defect (22.4%), and patent ductus arteriosus (16.8%) being the most prevalent defects. Only 24.3% of the participants had had Surgical correction performed on them.

Amongst all the participants, 72.9% had optimal HRQoL, 10.3% suboptimal, and 16.8% poor HRQoL. Many of the children and adolescents reported no limitations in mobility (86.9%) or self-care (87.9%), however, substantial impairments were observed in usual activities (44.8%), pain or discomfort (49.6%), and anxiety or depression (42.1%).

CHD-related hospital admissions (p=0.045) and comorbidities (p=0.005) were significantly associated with poorer HRQoL. Functional impairments, including reduced mobility (p<0.001), self-care limitations (p=0.010), impaired usual activities (p=0.034), pain or discomfort (p=0.001), and anxiety or depression (p=0.014)—were strongly associated with reduced HRQoL. In contrast, age at diagnosis, sex, surgical intervention, and disease severity (Ross heart failure classification) were not significantly associated with HRQoL.

Conclusion: The overall quality of life in this cohort was reported as satisfactory, however many of the participants experienced significant functional and psychosocial impairments. These findings highlight the need for integrated, patient-centred care models in resource-limited settings that extend beyond survival and anatomical correction to address psychosocial wellbeing and functional outcomes. Strengthening access to early diagnosis, reducing hospitalizations, and integrating mental health support into paediatric cardiology services are critical to optimize quality of life of pediatric patients with CHD.

Keywords: Congenital Heart Disease; Children and Adolescents; Health- Related Quality of Life; Resource Limited Settings.

United States Army Casualties during the Puerto Rico Campaign of the Spanish-American War

Cristóbal S. Berry-Cabán*

The Puerto Rico campaign of 1898 was a brief but medically significant phase of the Spanish-American War. During nineteen days of operations, U.S. forces achieved rapid territorial gains with minimal combat losses. Of forty-nine documented battle casualties, only six were fatal, while disease caused 238 deaths, primarily from typhoid fever and malaria, yielding one of the highest disease mortality rates of the war. Military and medical reports show that antiseptic treatment, conservative surgery, and early use of X-ray technology helped reduce combat mortality. In contrast, typhoid fever, largely introduced from U.S. training camps, overwhelmed medical facilities despite reforms implemented by Surgeon General George M. Sternberg. Under the leadership of Colonel Charles R. Greenleaf, the campaign demonstrated advances in military medicine, including improved logistics, professional nursing integration, and more effective field triage. The campaign highlighted both the progress of modern military medicine and the persistent challenge of disease control in wartime.

Keywords: Combat Casualties, Military Medicine, Disease Mortality, Battlefield Surgery, Typhoid Fever, Spanish-American War, Puerto Rico Campaign.

A Practical Algorithm for Evaluation of Men With persistently Raised PSA: Is the Role of DRE Underestimated?

Krishna Rao Gurugubelli, Bharat Kumar, Sachin Bhagwan Dhakare, Atul Vishwanath Domakuntla, Arun Kumar SM, Lal Darsan, H Krishna Moorthy*

Background: Symptomatic men with elevated prostate-specific antigen (PSA) pose a diagnostic challenge due to overlap between benign and malignant conditions. A structured, algorithm-based approach integrating clinical examination, imaging, and appropriate biopsy modality may improve diagnostic accuracy while reducing unnecessary procedures.

Objective: To evaluate an algorithm-based diagnostic approach for symptomatic men with elevated PSA, stratified by clinical palpability, and to assess the diagnostic performance of finger-guided transrectal biopsy and multi parametric MRI-directed TRUS (trans rectal ultrasound) cognitive fusion biopsy.

Materials and Methods: This prospective observational study included 78 symptomatic men with persistently elevated PSA of >4ng/ml who underwent prostate biopsy. Patients were stratified based on digital rectal examination (DRE) into clinically palpable and non-palpable prostate groups. Patients with palpable lesions underwent finger-guided transrectal biopsy, while those with non-palpable prostates underwent multiparametric MRI (mpMRI), followed by TRUS-guided cognitive fusion biopsy for PI-RADS ≥ III lesions. Final diagnosis was confirmed by biopsy, TURP histopathology when performed, or serial PSA follow-up when treatment is inconclusive of malignancy.

Results: Among 56 patients with clinically palpable lesions, finger-guided biopsy detected carcinoma prostate in 36 patients, with one false-negative identified on TURP. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy were 97.2%, 100%, 100%, 95%, and 98.2%, respectively. Among 22 patients with clinically non-palpable prostates and PI-RADS ≥ III lesions, TRUS-guided cognitive fusion biopsy detected malignancy in 13 patients, with 100% sensitivity, specificity, and diagnostic accuracy. No statistically significant difference in cancer detection was observed between groups (p = 1.00).

Conclusion: An algorithm-based approach integrating DRE, mpMRI, and tailored biopsy techniques provides excellent diagnostic accuracy in men with persistently elevated PSA. Finger-guided biopsy remains effective in clinically palpable lesions, while mpMRI-directed TRUS biopsy is highly reliable in clinically non-palpable cases.

Keywords: Prostate-Specific Antigen; Prostatic Cancer Diagnostic Algorithm; Digital Rectal Examination; Multiparametric MRI; TRUS-Guided Biopsy.

The Erased Body: A Theoretical Approach to the Body in Contemporary Artistic Thought

Dr. Antonio Sustaita

Behavioral Variables, Dreaming, and an Inferred Association with Dopamine Modulation

Yuejia Zhuang*, Nicole Jurdak

Dreams, mental experiences occurring during REM sleep, are closely connected with the regulation of dopamine. The study aimed to investigate the association between dopamine and dreaming activity through proxy variables such as aerobic exercise and sugary consumption, both demonstrated to affect dopamine levels. A sample of n=64 participants ranging from 13 to 71 years old with a mean age of 29.9 were asked researcher-developed questions through surveys on SurveyMars. All data was analyzed through Pearson Product Moment correlation using SPSS software. The r and p values were calculated and correlational scatter plots were created. In total, 64 responses were collected in part 1 of the survey and 307 responses were collected in part 2 of the survey. The �indings of the study revealed that there is a signi�icant positive correlation between higher sugary substance consumption and dream vividness. Additionally, there was a positive correlation between the amount and intensity of exercise and dream vividness. However, there was only a non-signi�icant correlation between sugary substance consumption and higher amount and intensity of exercise and dream recall frequency. Future directions and limitations are discussed.

Minimally Invasive Surgery for Resection of Appendiceal Mucocele: A Single-Center Experience Case Series

Abdullah S. Al-Darwish, MD1*, Abdullah Z. Alsaif, MD1, Sami AlHawassi, MD1, Hisham AlKhalidi, MD, PhD2,3, Youssuf AlSuhaibani, MD1, Nahar A. AlSelaim, MD, MPH1,4,5, Abdulrahman Al-Balla, MD1

Introduction: Appendiceal Mucocele is a rare medical condition, sometimes it is discovered incidentally but occasionally it could mimic acute appendicitis. Laparoscopic resection of appendiceal mucocele recently has been reported, but the safety and efficacy are still controversial.
Presentation of Cases: We will present four cases of laparoscopic resection of appediceal mucocele. The First, second, and fourth cases were treated by laparoscopic appendectomy only; While the third case was treated by laparoscopic right hemicolectomy.
Discussion: We elected to do our cases using a Laparoscopic approach. Laparoscopic resection is achievable with expert surgeons, despite the risk of malignancy, but necessary precautions should be taken. The four cases’ final histopathology reports showed the same result: Low-Grade Appendiceal Mucinous Neoplasm (LAMN) .
Conclusion: A Laparoscopic resection of appendiceal mucocele can be done by expert surgeons if the necessary precautions were taken to prevent spillage.