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Review Article
Early Interventions Slow the Progression of Cirrhosis After Acute Variceal Bleeding
Matkuliev Utkirbek Ismoilovich,
Batirov Davronbek Yusupovich,
Umarov Zafarbek Zaripboyevich*
,
Raximov Anvar Polatbaevich,
Yakubov Yaxyo,
Fuzail Ahmad
Issue:
Volume 14, Issue 4, August 2026
Pages:
56-60
Received:
28 April 2026
Accepted:
7 May 2026
Published:
24 July 2026
Abstract: Background: Acute variceal bleeding (AVB) is a life-threatening manifestation of portal hypertension and an important precipitant of acute decompensation in cirrhosis. The present review evaluates whether early post-bleed interventions can reduce not only early mortality and rebleeding but also the subsequent downward spiral of cirrhosis progression. Methods: A narrative review was conducted using recent society guidance and high-level evidence published mainly between 2022 and 2026, including Baveno VII, AASLD guidance, APASL recommendations, EASL guidance on acute-on-chronic liver failure and TIPS, individual patient data meta-analyses, randomized trials and selected real-world studies. Institutional cohort observations from prior doctoral research were integrated to illustrate long-term clinical trajectories after first and recurrent bleeding. Results: Early standard care - restrictive transfusion, vasoactive therapy, antibiotic prophylaxis and timely endoscopic variceal ligation - acts beyond hemostasis by reducing infection, systemic inflammation, treatment failure and organ dysfunction. In high-risk AVB, pre-emptive TIPS within 24-72 hours is consistently associated with lower rebleeding and improved survival when patients are selected appropriately. Cohort data also indicate that patients with a previous bleeding episode have higher long-term rebleeding and functional deterioration, while stepwise endoscopic-endovascular escalation may reduce recurrent bleeding. Conclusions: Early interventions after AVB may slow cirrhosis progression by interrupting repeated bleeding, inflammation and decompensation cycles. Future studies should standardize progression endpoints, including MELD-Na change, ACLF occurrence, readmission, recurrent bleeding and transplant-free survival.
Abstract: Background: Acute variceal bleeding (AVB) is a life-threatening manifestation of portal hypertension and an important precipitant of acute decompensation in cirrhosis. The present review evaluates whether early post-bleed interventions can reduce not only early mortality and rebleeding but also the subsequent downward spiral of cirrhosis progressio...
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Research Article
Systematic Review and Meta-analysis of Neonatal Hyperbilirubinemia in Ethiopia
Issue:
Volume 14, Issue 4, August 2026
Pages:
61-71
Received:
18 June 2026
Accepted:
6 July 2026
Published:
6 August 2026
Abstract: Neonatal hyperbilirubinemia is a common neonatal disorder worldwide and represents an important contributor to newborn morbidity, especially in low- and middle-income countries such as Ethiopia. Although multiple primary studies have investigated this condition, nationally representative and updated pooled evidence regarding its magnitude and determinants in Ethiopia is still limited. Methods: A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and prospectively registered in the PROSPERO database (registration number: CRD420251108378). A comprehensive search of electronic databases, including PubMed, Google Scholar, Cochrane Library, and Embase, was undertaken to identify eligible studies. Observational studies that reported the prevalence and/or determinants of neonatal hyperbilirubinemia among newborns in Ethiopia were included. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. Meta-analysis was performed using a random-effects model to estimate the pooled prevalence of neonatal hyperbilirubinemia and the pooled effect estimates of associated factors. Statistical analyses were conducted using STATA version 14. The extent of heterogeneity among studies was evaluated using the I2 statistic, and potential publication bias was assessed through funnel plot inspection and Egger’s statistical test. Results: A total of nine studies involving 2,476 neonates were included in this systematic review and meta-analysis. The pooled prevalence of neonatal hyperbilirubinemia in Ethiopia was 27.77% (95% CI: 21.29-34.26%). The meta-analysis identified several factors significantly associated with neonatal hyperbilirubinemia, including male sex (AOR = 2.10; 95% CI: 1.37-2.83), neonatal sepsis (AOR = 3.01; 95% CI: 1.40-4.61), and prematurity (AOR = 2.24; 95% CI: 1.21-3.27). These findings indicate that male neonates and those with underlying clinical conditions, particularly sepsis and prematurity, had higher odds of developing neonatal hyperbilirubinemia. Conclusion: Evidence suggested that low pooled neonatal hyperbilirubinemia. The findings highlight a significant association between male neonates, neonatal sepsis, and prematurity with neonatal hyperbilirubinemia. Routine early screening and timely management of neonatal hyperbilirubinemia should be strengthened in Ethiopia. Health facilities need adequate phototherapy and laboratory services. Policymakers should prioritize neonatal care resources, and further high-quality community-based research should be conducted.
Abstract: Neonatal hyperbilirubinemia is a common neonatal disorder worldwide and represents an important contributor to newborn morbidity, especially in low- and middle-income countries such as Ethiopia. Although multiple primary studies have investigated this condition, nationally representative and updated pooled evidence regarding its magnitude and deter...
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Research Article
Clinical Audit on Documentation Completeness After Regional Nerve Block at Hawassa University Comprehensive Specialized Hospital
Issue:
Volume 14, Issue 4, August 2026
Pages:
72-81
Received:
1 June 2026
Accepted:
22 June 2026
Published:
11 August 2026
Abstract: Background: A regional nerve block is a type of anesthesia in which local anesthetic medications are injected near a nerve to prevent nerve impulse transmission. Recording what a professional does is one of the indicators of excellent practice. Documentation and recordkeeping assist professionals in reducing unethical behaviour, becoming aware of ethical issues at work, reducing patient complications, and improving service. The goal of this clinical audit is to assess the level of documentation after regional nerve block according to standards at Hawassa University Comprehensive Specialized Hospital. Methods: This clinical audit was conducted retrospectively on the completeness of documentation after regional nerve block for patients who received regional nerve block for analgesia and anesthesia purposes between April 20, 2023, and May 15, 2023, as part of quality improvement. For data collection, a checklist is created based on NYSORA, ASRA, and AAGBI guidelines. Result: Of the 67 record sheets, documentation of patient identity (sex, age, and name) (80.6%), availability of standard monitoring (n=45, 67.2%), name of nerve block (n=48, 71.6%), use of local anesthesia (n=41, 61.2%), and baseline vital signs (n=43, 64.2%) were recorded above 60%. However, the level of documentation of allergies and coagulation history, test dose, time-out performed before needle insertion, post-procedure instructions to the patient or parents, dose of epinephrine, events during the procedure, starting and ending time of the procedure, and adjuvants used were not recorded. Conclusion and recommendation: The practice of recording after peripheral nerve blocks at Hawassa University Comprehensive Specialized Hospital falls below the standard. This could be due to the lack of a separate sheet for peripheral nerve block and a lack of awareness. As a result, all anesthetists who will be involved in regional nerve blocks should receive training, and the standards should be re-audited to ensure compliance.
Abstract: Background: A regional nerve block is a type of anesthesia in which local anesthetic medications are injected near a nerve to prevent nerve impulse transmission. Recording what a professional does is one of the indicators of excellent practice. Documentation and recordkeeping assist professionals in reducing unethical behaviour, becoming aware of e...
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Research Article
Comparative Study of Conventional Suture Knot Versus Buried Knot Technique in Oral and Maxillofacial Surgery:
A Randomized Clinical Trial
Abubakar Saddique*,
Zubair Ahmad,
Shahab Ud Din Khan
Issue:
Volume 14, Issue 4, August 2026
Pages:
82-85
Received:
22 June 2026
Accepted:
20 July 2026
Published:
17 August 2026
Abstract: Objective: To compare postoperative wound healing, infection rate, wound dehiscence, patient discomfort, food debris and plaque accumulation between conventional external knot suturing and buried knot suturing techniques in oral and maxillofacial surgical procedures. Methods: A prospective randomized clinical trial conducted in the Department of Oral and Maxillofacial Surgery over a period of 40 days. A total of sixty patients undergoing oral surgery require incision closure, All participants of research were randomly placed in two groups. Group A (n=30) Patients surgical incision (site) closure done using conventional interrupted sutures with exposed knots, whereas Group B (n=30) Patients have surgical incision (site) closure done using buried knot sutures. Clinical parameters including Suturing time, patient comfort, wound healing, wound infection; wound dehiscence, pain score, plaque accumulation around sutures, and healing index were assessed on postoperative days 7, 14, 30, and 40. The Statistical analyses was performed using SPSS version 25, with p<0.05 considered statistically significant. Results: Buried knot sutures shows lower postoperative discomfort, plaque, food debris accumulation and infection rates as compared with conventional suture knot. Wound healing were better in the buried suture knot group at postoperative days 14 and 30. The incidence of wound dehiscence were also low in Group B, although the difference was not statistically significant. Patient discomfort and foreign-body sensation were also much reduced in the buried knot suture group (Group B). Conclusion: The buried knot suturing technique shows a better healing, reduced plaque and food debris retention, foreign body sensation and lower postoperative infection rates compared with conventional exposed knot suturing but a little bit more time consuming. Buried knot closure may be considered a preferable alternative for intraoral wound closure in oral and maxillofacial surgery.
Abstract: Objective: To compare postoperative wound healing, infection rate, wound dehiscence, patient discomfort, food debris and plaque accumulation between conventional external knot suturing and buried knot suturing techniques in oral and maxillofacial surgical procedures. Methods: A prospective randomized clinical trial conducted in the Department of Or...
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Research Article
Age-Related Morphometric Changes of the Pituitary Gland in Sudden Cardiac Death
Imomov Khojiakbar*,
Mamataliyev Avazbek,
Fazlitdinova Rokhatoy,
Ahmedova Madina
Issue:
Volume 14, Issue 4, August 2026
Pages:
86-90
Received:
10 June 2026
Accepted:
27 July 2026
Published:
26 August 2026
DOI:
10.11648/j.ajcem.20261404.15
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Abstract: The study describes morphometric changes in the adenohypophysis during sudden cardiac death. The study investigated the morphometric parameters of pituitary gland tissues obtained from 75 individuals who died of sudden cardiac death, categorized according to the WHO age classification into cohorts of 18–44, 45–59, 60–74, and 75–90 years and older. The specimens were examined at the Andijan branch of the Republican Scientific and Practical Center for Forensic Medical Examination during the period of 2015–2024. In acute cardiac death associated with ischemic heart disease (IHD), age-specific features revealed that in the 18–44 and 45–59 age groups, the diameters of acidophilic cells, thyrotroph cells, corticotroph cells, and gonadotroph cells significantly increased; these indicators explained the enhancement of metabolic processes and morphofunctional activity in them. In the 60–74 and 75–90 age groups, a statistically significant decrease in the diameters of acidophilic cells, thyrotroph cells, corticotroph cells, and gonadotroph cells was observed, which manifested a decline in cellular metabolic processes. A decrease in the area occupied by the adenohypophyseal parenchyma accompanied by an increase in the stromal area occurred in parallel with advancing age, demonstrating a decline in the gland's morphofunctional activity. These changes were explained by the fact that age-related atrophic and sclerotic alterations of the pituitary gland in these individuals were accelerated against the background of IHD, and atrophic changes accelerated the aging processes.
Abstract: The study describes morphometric changes in the adenohypophysis during sudden cardiac death. The study investigated the morphometric parameters of pituitary gland tissues obtained from 75 individuals who died of sudden cardiac death, categorized according to the WHO age classification into cohorts of 18–44, 45–59, 60–74, and 75–90 years and older. ...
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Research Article
Comprehensive Physical Rehabilitation for Respiratory Muscle Dysfunction and Pulmonary Ventilation in Post‑COVID Syndrome
Issue:
Volume 14, Issue 4, August 2026
Pages:
91-95
Received:
12 June 2026
Accepted:
14 July 2026
Published:
26 August 2026
DOI:
10.11648/j.ajcem.20261404.16
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Abstract: Introduction: Post-COVID syndrome is characterized by persistent respiratory disorders, a key element of which is dysfunction of the respiratory muscles, especially the inspiratory muscles. This leads to dyspnea, reduced exercise tolerance, and decreased quality of life. Objective: To evaluate the clinical efficacy of a physical rehabilitation program combining osteopathic correction, specialized breathing exercises, and classical chest massage in patients with residual effects after COVID-19-associated pneumonia. Materials and methods: A prospective randomized study included 87 patients (mean age 64.8 ± 7.2 years) admitted to the third stage of rehabilitation between 4 weeks and 6 months after hospital discharge. The main group (n=44) received the full rehabilitation complex (osteopathic correction, breathing exercises, and massage), while the comparison group (n=43) received only breathing exercises and massage. Spirometric parameters (VC, FVC, FEV1), maximal inspiratory (MIP) and expiratory (MEP) mouth pressures, saturation (SpO2), 6-minute walk test (6MWT), dyspnea by mMRC scale, anxiety and depression levels (HADS), and quality of life (EQ-5D) were assessed before and after a 14-day rehabilitation course. Results: Initially, all patients showed a reduction in MIP by 38% of normal (p < 0.001) and MEP by 22% (p < 0.01), as well as restrictive ventilation disorders (VC 83.1 ± 10.4% of predicted). After the course, the main group showed significant increases in MIP (by 24.6%, p=0.003), MEP (by 18.3%, p=0.008), VC (by 12.4%, p=0.0001), and FVC (by 10.9%, p=0.0002), whereas in the comparison group the dynamics were not significant for most parameters. Exercise tolerance (6MWT) increased in the main group by 68.5 m (p=0.0001), and dyspnea (mMRC) decreased from 1.6 to 0.3 points (p=0.0001). Anxiety and depression levels decreased by 5.2 points on HADS (p<0.001). Conclusion: The inclusion of osteopathic correction in a physical rehabilitation program significantly improves respiratory muscle strength, ventilatory function, exercise tolerance, and psychoemotional status in patients with post-COVID syndrome, confirming the feasibility of a multimodal approach.
Abstract: Introduction: Post-COVID syndrome is characterized by persistent respiratory disorders, a key element of which is dysfunction of the respiratory muscles, especially the inspiratory muscles. This leads to dyspnea, reduced exercise tolerance, and decreased quality of life. Objective: To evaluate the clinical efficacy of a physical rehabilitation prog...
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Research Article
Serum Inflammatory Indices and Preeclampsia Risk:
A Matched Case-control Study
Shunping Ma,
Yacong Bo,
Zheng Yuan,
Xianlan Zhao,
Yuan Cao,
Dandan Duan,
Weifeng Dou,
Rui Liang,
Quanjun Lyu,
Xueyang Zhang,
Ping Qiao,
Yanhua Liu*
Issue:
Volume 14, Issue 4, August 2026
Pages:
96-106
Received:
22 June 2026
Accepted:
14 July 2026
Published:
26 August 2026
DOI:
10.11648/j.ajcem.20261404.17
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Views:
Abstract: Background: While numerous studies have linked individual serum inflammatory biomarkers to preeclampsia (PE) risk, few have evaluated how composite inflammatory indices correlate with the condition. Methods: A hospital-based 1:1 matched case-control study including 440 PE cases and 440 controls was conducted. Sociodemographic and lifestyle data were collected through structured questionnaires. Peripheral blood platelet, neutrophil, monocyte, and lymphocyte counts were measured using a fully automated analyzer (Cobas 8000, modules C701/C702/C502), and the corresponding inflammatory indices were subsequently calculated. Results: Multivariable-adjusted regression revealed an inverse risk trend across quartiles for all six evaluated metrics. In the highest-versus-lowest quartile comparison, the most pronounced reduction in odds was observed for PLR (OR = 0.08, 95% CI: 0.05–0.15), followed sequentially by AISI (OR = 0.13, 0.08–0.22), SIRI (OR = 0.23, 0.14–0.37), SII (OR = 0.41, 0.30–0.55), and LMR (OR = 0.53, 0.39–0.71), all presenting a P-trend < 0.001. A similar significant trend was noted for NLR (OR = 0.63, 0.48–0.83, P-trend < 0.01). Among the individual indicators, PLR showed a relatively higher AUC, while the combined model yielded a slightly higher area under the curve (AUC) overall. Conclusion: Lower levels of SII, LMR, NLR, SIRI, AISI, and PLR were associated with an increased risk of PE, while combining these inflammatory indices provided the best discriminative performance.
Abstract: Background: While numerous studies have linked individual serum inflammatory biomarkers to preeclampsia (PE) risk, few have evaluated how composite inflammatory indices correlate with the condition. Methods: A hospital-based 1:1 matched case-control study including 440 PE cases and 440 controls was conducted. Sociodemographic and lifestyle data wer...
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