Malawi Medical Journal最新文献

Objective: This study aimed to assess whether three-dimensional (3D) CT imaging improves the inter- and intra-observer reliability of peri-knee fracture classifications, compared to two-dimensional (2D) CT imaging.

Methods: A retrospective analysis was conducted on 23 patients with peri-knee fractures, using both 2D and 3D-CT scans. Three radiologists classified distal femur, patella, and tibial plateau fractures according to Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) and Schatzker systems. Reliability was measured using Cohen's kappa, with evaluations conducted at two separate intervals to assess intra- and inter-observer consistency.

Results: The intra-observer reliability for 2D-CT was substantial for distal femur (ϰ = 0.737, IQR 0.615-0.788) and tibial plateau (ϰ = 0.732, IQR 0.615-0.819) fractures, improving slightly with 3D-CT (ϰ = 0.775, IQR 0.658-0.869; ϰ = 0.768, IQR 0.628-0.882 respectively). Patella fracture classification showed almost perfect reliability (ϰ = 0.823, IQR 0.707-0.882) with 2D-CT, further improving with 3D-CT (ϰ = 0.865, IQR 0.764-0.951). However, inter-observer reliability showed no significant improvement with the addition of 3D-CT across all fracture types.

Conclusion: While 3D-CT marginally enhances intra-observer reliability for peri-knee fractures, the difference in inter-observer reliability compared to 2D-CT was not statistically significant.

Objective: The aim of this study is to compare the diagnostic value of two-dimensional (2D) CT and three-dimensional (3D) CT reconstruction techniques in detecting maxillofacial fractures in patients at Mzuzu Central Hospital (MCH).

Methods: 67 maxillofacial trauma patients admitted to Mzuzu Central Hospital from Jan to Sep 2024 underwent multi-slice spiral CT (MSCT) scanning. Images were post-processed using 2D and 3D reconstruction techniques. Clinical and radiological data were collected from the patients, and a comparative analysis of the results from the two reconstruction techniques was performed.

Results: In this study, 52 cases of maxillofacial fractures with a total of 83 fractures were diagnosed by 2D CT reconstruction technology, with a fracture detection rate of 77.61% (52/67). Using 3D CT reconstruction technology, 54 cases of maxillofacial fractures with a total of 91 fractures were diagnosed, and the fracture detection rate was 80.60% (54/67). Statistical analysis showed no significant difference in the detection rate of maxillofacial fractures between 2D CT and 3D CT reconstruction (χ² = 35.945, P = 0.687). In the diagnosis of zygomatic fractures, nasal fractures, and upper and lower jaw fractures, 3D CT reconstruction images have obvious advantages over 2D CT in displaying fracture displacement and fracture line course. However, for the display of comminuted fractures combined with sphenoid and ethmoid fractures, the cross-sectional images of 2D CT show higher superiority.

Conclusion: 2D CT reconstruction is a basic diagnostic tool for maxillofacial fractures. 3D reconstruction, with high detection and multi-angle visualization, offers valuable imaging for clinical decision-making, aiding in surgery planning. A combined approach, leveraging the strengths of both modalities, is pivotal for comprehensive assessment and management of maxillofacial trauma.

Objective: To evaluate low-dose Computed Tomography (LDCT) chest vs. routine CT chest for image quality and diagnosis in suspected lung lesions, aiming to optimize LDCT protocol.

Methods: We retrospectively analyzed 85 patients with suspected lung lesions who underwent non-contrast enhanced (NCE) CT chest at Mzuzu Central Hospital from July 2023 to April 2024. The study divided patients into routine dose (43 patients, 120 kV, 300 mAs) and low-dose groups (42 patients, 120 kV with automatic tube current modulation) based on a transition point on February 16th, 2024. Both groups used filtered back projection (FBP) reconstruction with a 1mm layer thickness. Data were analyzed for signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and radiation dose parameters on AVW post-processing workstation, and for background noise and image quality on PACS.

Results: (1) Objective evaluation revealed significantly higher SNR and CNR (6.58 ± 1.70, 175.96 ± 26.06) in the routine dose group compared to the low-dose group (4.17 ± 1.02, 141.23 ± 19.04) (P < 0.001). Additionally, the routine dose group had significantly higher CTDIvol, DLP, and ED [(9.95 ± 0) mGy, (372.84 ± 25.52) mGy·cm, (5.22 ± 0.37) mSv] compared to the low-dose group [(5.76 ± 1.12) mGy, (211.48 ± 50.64) mGy·cm, (2.96 ± 0.71) mSv] (P < 0.001). (2) Subjective evaluation showed no significant difference in scoring for background noise and overall image quality between the routine dose group [(1.95 ± 0.21) points, (4.09 ± 0.42) points] and the low-dose group [(1.93 ± 0.26) points, (3.98 ± 0.34) points] (P > 0.05).

Conclusion: The image quality of LDCT protocol is comparable to that of routine dose, while radiation dose is significantly reduced. The image quality meets the requirements for imaging diagnosis of lung lesions, and this protocol can be widely promoted in clinical practice.

Objective: This study aimed to investigate the impact of Clear View dual-domain iterative reconstruction (IR) technology on the quality of low-dose abdominal CT images and to determine the optimal weight ratio to optimize image quality.

Methods: We studied 40 patients (28 males, 12 females, aged 19-69) undergoing low-dose abdominal CT scans (CTDI = 5.32 ± 0.89 mGy). The scanning parameters were set as follows: tube voltage of 120 kVp, tube current modulation based on Signal to Noise Ratio (SNR) at 0.5 mode (O-Dose automatic tube current modulation technology), pitch of 0.9, rotation time of 0.6 s/r, matrix size of 512 × 512, and collimation width of 16 × 1.25 mm. We applied Clear View IR with four weight ratios (20%, 40%, 60%, 80%) and filtered back projection (FBP). Conventional scanning uses with 120 kVp, 280 mAs, pitch of 0.9, rotation time of 0.6 s/r, matrix size of 512 × 512, and collimation width of 16 × 1.25 mm. Conventional dose abdominal CT scans (CTDI = 11.95 ± 0.00 mGy).CT values, standard deviations (SD), signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured for liver, spleen, pancreas, kidneys, and erector spinae muscles. Two deputy chief physicians blindly evaluated image quality on a 1-5 scale. Statistical analysis was done using SPSS 22.0 with P < 0.05 considered significant.

Results: Subjective evaluations revealed the highest diagnostic score with a 40% Clear View reconstruction weight ratio. Higher weight ratios significantly reduced subjective image noise, with the highest noise scores at 80%. Moreover, compared to FBP, especially Clear View reconstruction weight ratios of 20% to 60%, significantly improved the image quality of abdominal solid organs, reducing image artifacts and improving diagnostic acceptability (P < 0.05). Objective evaluation showed that with increasing Clear View reconstruction weight ratios, image noise SD values decreased, while SNR and CNR values increased, and the differences in SD, SNR, and CNR for different reconstruction weight ratios of abdominal solid organs were statistically significant (P < 0.05).

Conclusion: Compared to FBP algorithm, Clear View demonstrates greater potential in low-dose abdominal CT, effectively reducing image noise and artifacts while maintaining image clarity. Based on combined subjective and objective evaluations, a 40% Clear View reconstruction weight ratio provides optimal image quality for abdominal solid organs.

Objective: To investigate the impact of two reconstruction techniques, Filtered Back Projection (FBP) and Clear View (CV) iterative algorithm, on the image quality of low-dose thin-slice chest CT.

Methods: A retrospective study of 42 patients undergoing low-dose chest CT at Mzuzu Central Hospital from Feb-Apr 2024 used automatic tube current modulation at 120 kV Raw data were reconstructed with FBP, 20% CV, 40% CV, 60% CV, and 80% CV, with 1 mm slice thickness and 0.625 mm spacing. Image noise, Signal-to-Noise Ratio (SNR), and Contrast-to-Noise Ratio (CNR) were measured, and image quality was rated on a 5-point scale for lung and mediastinal windows. Qualitative and quantitative parameters of the two different reconstruction algorithms in the five groups were comparatively analyzed.

Results: (1) Objective evaluation showed noise decreased in lung parenchyma, aorta, and erector spinae muscle with increasing CV weight. Mean noise reductions in lung parenchyma were 23.34% and 27.69% in 60% CV and 80% CV (P < 0.05). Aorta noise decreased by 23.43%, 37.16%, and 46.18% in 40% CV, 60% CV, and 80% CV (P < 0.05, P < 0.001, P < 0.001). Erector spinae muscle noise decreased by 35.91% and 44.78% in 60% CV and 80% CV (P < 0.05, P < 0.001). SNR and CNR were higher in CV groups than FBP. Among them, the differences in SNR between the 60% CV and 80% CV groups and the FBP group were statistically significant (P < 0.05). (2) Subjective scores for all groups were > 3, meeting diagnostic standards, with 60% CV yielding the highest lung and mediastinal window image quality (P < 0.05).

Conclusion: Compared to FBP, CV iterative reconstruction reduces noise and improves chest CT image quality under low-dose conditions as the weight increases, with 60% CV showing optimal performance.

Objective: To delve into the clinical and CT imaging manifestations of hydranencephaly, a rare congenital post-neurulation disorder occurring during the second trimester, characterized by the destruction of cerebral hemispheres and cranial cavity filled with cerebrospinal fluid (CSF). This research aims to enhance our understanding of hydranencephaly and establish a standard for its imaging diagnosis.

Methods: A retrospective analysis was conducted using the brain CT images and clinical data of 26 pediatric patients diagnosed with hydranencephaly.

Results: At birth, the primitive reflexes were generally preserved in these infants, who exhibited a spectrum of symptoms including progressive enlargement of head circumference, epilepsy, cerebral palsy, intellectual disability, developmental delay, lethargy, convulsive spasms, and varying degrees of visual and auditory impairment. These infants may also present with other congenital malformations or abnormalities. The primary CT imaging findings revealed complete or near-complete absence of bilateral cerebral hemispheres, replaced by CSF. Specifically, there were 5 cases of complete absence of cerebral hemispheres, with minimal residual brain tissue observed in 17 cases. Bilateral ventricles were approximately normal in 3 cases and completely absent in 19 cases. Falx cerebri was incomplete or/and displaced in 12 cases, and 3 cases were concurrent with Dandy-Walker syndrome.

Conclusion: Hydranencephaly is a congenital disease characterized by destruction of the cerebral hemispheres. CT scan can provide accurate and reliable imaging evidence for the diagnosis of hydranencephaly.

Objective: This study was aimed at investigating if the lymph node aspirated wash-out liquid thyroglobulin level and thyroid imaging reporting and data system (TI-RADS) nodule score can be the predictive factor for cervical lymph node metastasis in patients with papillary thyroid carcinoma (PTC).

Methods: The study included 251 patients with surgically confirmed PTC. All the patients underwent preoperative thyroid and cervical ultrasound examination using ACR TI-RADS classification, fine-needle aspiration biopsy (FNAB) for BRAF V600E gene detection, and thyroglobulin (Tg) detection in lymph node aspiration fluid. The results of these examinations and tests were statistically analyzed. A binary logistic regression model was used to determine the predictive impact of Tg levels, gene mutation status, and TI-RADS nodule score on lymph node metastasis.

Results: Among the enrolled patients, 219/251 (87.25%), had BRAF V600E gene mutations and 132/251 (52.59%) had cervical lymph node metastasis. The Tg level in the lymph node aspiration fluid of patients with metastasis was significantly higher than in those without metastasis (324.94 ± 192.52 ng/mL vs 67.93 ± 136.62 ng/mL, P = 0.000), but there was no significant difference in serum Tg levels between the two groups (27.08 ± 71.60 ng/mL vs 20.73 ± 55.21 ng/mL, P = 0.276). The area under the ROC curve (AUC) for lymph node aspiration fluid Tg was 0.858. Thyroglobulin level has a significant positive effect on lymph node metastasis, with a regression coefficient of 0.003 and P = 0.000 < 0.001. BARF V600E mutation status and TI-RADS nodule score do not have a significant effect on lymph node metastasis, with P-values greater than 0.05.

Conclusion: Thyroglobulin levels of lymph node aspiration fluid has a good predictive value for the diagnosis of cervical lymph node metastasis in PTC patients with larger nodules.

Introduction: Informed consent is critical to medical practice, and a clearly outlined process that results in signing the consent form may improve the validity of the given consent. There is a paucity of studies in Malawi that have assessed the informed consent process in surgical patients.

Aim: To assess the informed consent process for patients undergoing surgery at QECH in Malawi.

Methods: A cross-sectional quantitative descriptive study was conducted among postoperative patients in the adult surgical wards at QECH through face-to-face interviews. The calculated sample size was 235. A consecutive sampling technique was used. Those below 18 years and those who didn't or couldn't consent were excluded. Data was entered and analyzed in Microsoft Excel 2016 and IBM SPSS 25.0. The level of significance was considered as P<0.05.

Results: A total of 222 patients were interviewed. The age range was 21 to 75 years, with a median of 38.5. Two hundred and twelve (95%) patients signed a consent form before surgery, and 21 (9%) knew the content of the form. Most patients, 100 (47%) had a primary school education, and 156 (70%) could read and write. Those with secondary or tertiary education were more likely to want to ask a question given the opportunity (OR 2.82, p= 0.0012), but there was no significant difference in the likelihood of being given time to ask questions between the two groups who had primary and no formal education vs those who had secondary and tertiary education (OR 1.4, p=0.3367).

Conclusion: This study highlights the necessity of employing effective communication strategies during the consent process for surgical procedures and the need to tailor the consent form to the patient's education level.

Objective: The aim of this study was to examine the levels of hematologic parameters in acute ischemic stroke (AIS) and transient ischemic attack (TIA) and to evaluate the use of Neutrophil/Lymphocyte ratio (NLR), Systemic Immune-Inflammation Index (SII), and systemic inflammation response index (SIRI) in the differentiation of AIS and TIA.

Materials and methods: Data and hematological results of patients admitted to the emergency department and diagnosed with AIS and TIA were compared retrospectively.

Results: The study included 36 TIA patients (M/F = 15/21) with a mean age of 64.52 ± 15.597 years and 74 AIS patients (M/F = 35/39) with a mean age of 71.91 ± 13.86 years. Laboratory data showed that lymphocyte count (p = 0.022) and hemoglobin level (p = 0.017) were significantly higher in AIS patients. In addition, monocyte count (p = 0.001), neutrophil/lymphocyte ratio (NLR) (p < 0.001), CRP level (p = 0.007), and SII (p = 0.001) and SIRI values (< 0.001) were significantly increased in AIS patients compared to TIA patients.

Conclusion: The results obtained in the present study show that hematologic inflammatory parameters are increased in AIS. NLR, SII and SIRI may provide insight in the differential diagnosis of AIS and TIA.

Background: Each year, nearly 400,000 new cases of paediatric hydrocephalus are estimated to occur worldwide, and almost half of these cases are expected to affect children in Africa. At Queen Elizabeth Central Hospital (QECH), an urban tertiary hospital in Blantyre, Malawi, located in south-east Africa, around 200 children received neurosurgical treatment for hydrocephalus in 2023. These children require lifelong follow-up and care, which places significant demands on their caregivers.

Objectives: The following research objectives guided the study: 1) To explore how mothers of children with hydrocephalus perceive the condition. 2) To examine the care pathways that mothers and their children with hydrocephalus engage in. 3) To identify the implications of having a child with hydrocephalus.

Methods: We applied a qualitative method with an explorative design. We conducted 15 in-depth interviews and two focus group discussions among 16 mothers (aged 20-35 years) of inpatient or outpatient children with hydrocephalus at QECH. Convenience sampling was used to recruit the 16 participants. We conducted a thematic analysis.

Results: 1) Mothers referred to various disease explanations, often switching between attributing the condition to God, supernatural causes such as bewitchment, and biomedical factors. 2) The care pathways for mothers and their children with hydrocephalus at QECH are fraught with challenges, creating strenuous trajectories that hinder access to care and present significant challenges. 3) Having a child with hydrocephalus has extensive social implications, including stigma and disruption of daily living.

Conclusions: Our findings highlight the need for intersectoral action to optimise treatment and reduce stigma. This involves educational programs and awareness-raising campaigns to improve maternal health literacy. Additionally, targeted initiatives are urgently needed to improve healthcare infrastructure, transportation, and pathways to care. Since hydrocephalus management is a lifelong process, the possibility of conducting follow-up through outreach clinics or telemedicine and community-based rehabilitation should be further explored. Finally, to improve management for children with hydrocephalus in Blantyre and across Malawi includes efforts to bolster the educational, economic, social, and legal position of women.