Volume 8.
Issue 10.

Adult inguinal hernia incarceration represents a significant surgical emergency associated with increased morbidity, risk of bowel ischemia, and potential mortality when treatment is delayed. Despite advances in elective hernia repair techniques, incarcerated inguinal hernias continue to present substantial clinical and epidemiological challenges, particularly among elderly patients and individuals with delayed healthcare access. This research and review article adopts an epidemiological approach to evaluate incidence patterns, determinants, and surgical implications of adult inguinal hernia incarceration through a comprehensive synthesis of contemporary literature. The study examines demographic trends, risk factors contributing to incarceration, management algorithms, emergency intervention strategies, and outcomes associated with different surgical approaches. Particular attention is given to factors influencing bowel resection rates and emergency operative decision-making. The findings indicate that age, delayed presentation, hernia duration, comorbidities, and bowel compromise significantly influence clinical outcomes. Contemporary evidence also demonstrates the growing role of manual reduction techniques and laparoscopic surgery in selected emergency settings. The article highlights the importance of early diagnosis, risk stratification, and evidence-based management protocols to reduce complications and optimize patient outcomes. The study contributes to a deeper understanding of incarcerated inguinal hernia epidemiology and provides a framework for improving emergency surgical care.

Background: Malaria in pregnancy remains a major public health challenge in Sierra Leone, contributing significantly to maternal and neonatal morbidity and mortality. While Intermittent Preventive Treatment in Pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is a proven intervention, adherence remains suboptimal. Perceptions of IPTp including beliefs about benefits, risks, and acceptability are critical determinants of uptake. However, limited research has explored these perceptions among pregnant women in urban Sierra Leone, particularly in the Western Area Urban District.

Objective: To examine the perceptions of pregnant women attending antenatal clinics in the Western Area Urban District regarding IPTp, including perceived benefits, risks, safety concerns, and acceptability.

Methods: A mixed-methods study was conducted among 422 pregnant women attending six selected ANC facilities in Freetown between July and September 2025. Quantitative data were collected using structured questionnaires assessing perceptions of IPTp benefits, risks, and acceptability. Qualitative data were collected through semi-structured in-depth interviews (n=12) and focus group discussions (n=5 groups, 6–10 women each) to explore lived experiences, beliefs, and social norms. Quantitative data were analysed using descriptive statistics and chi-square tests; qualitative data were analysed thematically using a framework approach.

Results: Among 422 participants, 68.5% (n=289) perceived IPTp as beneficial for preventing malaria in pregnancy, and 62.1% (n=262) believed it was safe for both mother and baby. However, 37.4% (n=158) expressed concerns about side effects, and 28.7% (n=121) reported fear of harm to the unborn baby. Only 54.3% (n=229) perceived IPTp as highly acceptable. Perceptions were significantly associated with knowledge level (p<0.001), provider counselling (p=0.002), and previous experience with IPTp (p=0.008). Qualitative analysis revealed three major themes: (1) trust and acceptance grounded in provider confidence and awareness of malaria risks; (2) fear and scepticism driven by side effects, misinformation, and cultural beliefs; and (3) social influences, including partner and community norms, shaping acceptability.

Conclusion: Perceptions of IPTp among pregnant women in the Western Area Urban District are mixed, with significant proportions expressing safety concerns and fear of side effects. Addressing these perceptions through culturally sensitive health education, improved provider communication, and community engagement is essential to improve IPTp acceptability and adherence. Interventions should target both individual beliefs and broader social norms.

Introduction: During the COVID-19 pandemic, numerous extrapulmonary manifestations were the subject of study and research. The relationship between the kidney and COVID-19 attracted particular interest given the frequency of acute kidney injury observed.

Objectives: To determine the characteristics of SARS-CoV-2 infection in dialysis and kidney transplant populations and to describe the clinical, biological, and histological renal manifestations associated with SARS-CoV-2 infection.

Materials and Methods: This was a retrospective descriptive study conducted in the Nephrology Department of CHU Bab El Oued over a 2-year period, from February 2020 to February 2022. We studied the characteristics of COVID-19-related acute kidney injury in patients requiring hemodialysis, the histological renal manifestations associated with SARSCoV-2 infection, and the incidence and characteristics of COVID-19 infection in dialysis patients (hemodialysis and peritoneal dialysis) as well as in kidney transplant recipients.

Results: Eighty patients with renal failure associated with COVID-19 infection were managed with hemodialysis at our center. Thirty-six patients (45%) were dialyzed for acute kidney injury, while 44 patients (55%) already had chronic kidney disease at the stage of extrarenal replacement therapy. The majority of these patients (40 patients, 62%) were hospitalized in the intensive care unit. Most patients were intubated and ventilated (56 patients, 69%), with a high mortality rate of 76% (60 patients). Five patients underwent renal biopsy for renal involvement concomitant with or following COVID-19 infection. Renal histology revealed three cases of membranous nephropathy, one of which was associated with focal segmental glomerulosclerosis, and two cases of IgA nephropathy, one of which was associated with tubulointerstitial nephritis. Among chronic hemodialysis patients in our department, 10 patients (37%) were infected with SARS-CoV-2, presenting with a mild form in the majority of cases (6 patients, 60%). Four patients (40%) presented with severe respiratory distress syndrome, and 3 patients (30%) died. In peritoneal dialysis, 8 patients (32%) were infected with COVID-19, with 100% mild forms and no hospitalization. In the kidney transplant population, 24 transplant recipients (24%) were infected with COVID-19; 18 patients (75%) had mild forms, and only 6 patients (25%) presented with more or less severe forms with complications such as diabetes and graft function deterioration.

Discussion: Renal failure was associated with severe forms of COVID-19 (the majority of hemodialysis patients were hospitalized in the intensive care unit), with significant mortality. Renal involvement during COVID-19 can affect all compartments (glomerular, tubulointerstitial, and vascular). COVID-19 infection in kidney transplant recipients was not particularly more severe despite the immunosuppressed state.

Conclusion: As a newly emerging disease, the characteristics of renal involvement during COVID-19 infection, like the majority of systemic manifestations (cardiac, cerebral, digestive, etc.), have been derived from various studies and experiences from different centers worldwide but remain far from being well-labeled and codified.

Background: Antiphospholipid syndrome (APS) in pregnancy is a complex and clinically important problem. The venous and arterial thromboses characteristic of the syndrome, caused by circulating antiphospholipid antibodies, lead to a range of pregnancy complications and adverse outcomes, which calls for improved treatment strategies.

Objective: to optimize the treatment of antiphospholipid syndrome in pregnant women.

Materials and Methods: The study included 56 pregnant women with APS, who were divided into two groups. The groups were comparable in age, parity, and obstetric and somatic pathology but differed in the treatment received. The comparison group (conventional management) comprised 18 pregnant women with APS, all of whom received standard APS therapy, including anticoagulants, antiplatelet agents, and glucocorticoids. The main group comprised 38 pregnant women with APS, all of whom received systemic enzyme therapy and plasmapheresis in addition to standard therapy. A separate control group consisted of 30 women with uncomplicated pregnancies.

Results: After 30 days, the conventional therapy group showed elevations compared with controls in von Willebrand factor (by 17.7%), the platelet aggregation index (by 24.1%), the total platelet aggregation index (by 26.2%), soluble fibrin monomer complexes (SFMC; by 55.3%), and early fibrin degradation products (EFDP; by 45.6%) (p<0.05). The platelet disaggregation index decreased by 18.5% and antithrombin III activity by 14.3% (p>0.05). Under conventional therapy, hemostatic parameters changed in different directions during treatment; overall, however, these changes aggravated the disturbances present at baseline. In the main group, treatment produced a more pronounced shift toward normalization of the studied parameters. Significant differences from conventional therapy were found for SFMC (29.7%), EFDP (23.3%), and prothrombin time (14.0%) (p<0.05).

Conclusion: Systemic enzyme therapy combined with plasmapheresis and low-molecular-weight heparin in pregnant women with APS results in near-complete normalization of hemostatic parameters.