Annals of African Medicine最新文献

Background: Significant hemodynamic and uterine changes in normal pregnancy allow adequate uteroplacental blood flow. Matrix metalloproteinases (MMPs) are vital for vascular and uterine remodeling. This study evaluated the role of MMP-9 and MMP-13 levels in predicting Preeclampsia and evaluating different genotypes for MMP-9 and MMP-13 polymorphisms.

Methods: This study was a Prospective Cohort study spanning 18 months, involving 90 pregnant women who attended the antenatal care outpatient department during their first trimester. Participants were selected after excluding those with chronic hypertension or multiple gestations. The study focused on women with singleton pregnancies attending routine visits, and informed consent was obtained prior to recruitment. All standard antenatal investigations and care were provided, and blood samples (10 ml of venous blood) were collected at 11-14 weeks of pregnancy to assess serum levels of metalloproteinases.

Results: A total of 90 first-trimester women to assess the role of MMP-9, 13 levels in predicting preeclampsia, and the influence of gene polymorphism. At 11-14 weeks of pregnancy, blood was drawn from all registered participants for serum levels of metalloproteinases. About 14.4% women developed preeclampsia. Mean MMP-9 was found to be significantly lower in preeclamptic women. MMP-13 was found to be higher in preeclamptic women. However, the Allelic distribution was comparable.

Conclusions: Concluded the possible role of MMPs in predicting preeclampsia. Larger studies, including other metalloproteinases and larger sample sizes, may be planned for the future.

Background: Determining the cause of death in suspected asphyxia is often difficult when external findings are absent. Mast cells (MCs) may provide objective histological evidence of hypoxia.

Objective: To compare the efficacy of immunohistochemistry (IHC) using CD117 with Toluidine Blue (TB) and Giemsa (GM) stains in detecting mast cells in asphyxial and non-asphyxial lung tissues.

Materials and methods: Lung samples from 164 medicolegal autopsies at AIIMS Jodhpur were studied, 57 asphyxial and 107 non-asphyxial deaths. Peribronchial and perialveolar regions were examined using TB, GM, and IHC (CD117). Mean mast cell counts were compared using Mann-Whitney U and Kruskal-Wallis tests.

Results: Mast cell counts were significantly higher in asphyxial cases. Peribronchial counts: IHC 2.27 ± 1.02, TB 2.29 ± 1.19, GM 0.84 ± 0.59. Perialveolar counts: IHC 0.74 ± 0.12, TB 0.10 ± 0.19, GM 0.01 ± 0.51. IHC was more sensitive than GM (P < 0.001), while TB showed comparable efficacy to IHC.

Conclusion: CD117-based IHC is the most sensitive method for identifying mast cells in asphyxial lungs, though TB remains a valuable low-cost option. Mast cell analysis can serve as an adjunct marker in diagnosing mechanical asphyxia.

Background: Type 2 diabetes mellitus (T2DM) is a rapidly growing public health challenge in Saudi Arabia, with early screening being critical for timely intervention. Despite national initiatives, community-based evidence on knowledge, attitudes, and practices (KAP) toward diabetes screening in Bisha province remains scarce.

Objective: This study aimed to assess the KAP regarding type 2 diabetes screening among adults in Bisha province and to explore the influence of sociodemographic characteristics.

Materials and methods: A community-based cross-sectional survey was conducted from January 2023 to December 2023 among 374 adults aged ≥40 years without a prior diagnosis of diabetes. Data were collected using a structured bilingual (English-Arabic) questionnaire covering demographics, knowledge of risk factors and symptoms, and attitudes toward screening. Descriptive analysis and proportions were calculated based on exact frequencies from participant responses.

Results: Overall, 82.1% of respondents had heard about diabetes type 2 screening. Knowledge was variable: 41.7% recognized age ≥40 years as a risk factor, while 59.9% identified family history, 81.0% obesity, and 64.7% lack of exercise. Only 32.4% associated pregnancy with increased risk of T2DM. Regarding awareness of symptoms, it was highest for frequent urination (87.4%), followed by excessive thirst (65.0%), while fewer recognized weight loss (43.6%) and excessive hunger (38.5%). Attitude analysis showed that 63.4% agreed family members of diabetics should be screened, 64.4% endorsed early screening for better disease control, and 61.8% supported universal screening at age 40. A large majority strongly agreed to personal screening if risk factors were present (207 agree, 167 strongly agree) or if overweight/obese (199 agree, 175 strongly agree). Regarding practice-related items, 223 participants agreed and 151 strongly agreed that they would advise others to undergo screening, and over 90% supported screening in high-risk situations such as pregnancy or chronic disease.

Conclusion: The findings reveal high general awareness and favorable attitudes toward diabetes screening among adults in Bisha, although knowledge gaps persist regarding specific risk factors and less obvious symptoms. Targeted education to address these gaps, coupled with reinforcement of screening practices, could enhance community-level prevention strategies in Saudi Arabia.

Background: The immune system is suppressed in cancer patients. Identifying the anesthetic procedures that trigger immunomodulation is essential to slow the growth of tumors. Our study's objective was to evaluate how epidural anesthesia affected immunomodulators in individuals having breast cancer surgery.

Methods: Thirty patients undergoing thoracic epidural anesthesia for breast cancer surgery participated in this prospective observational study. Immunomodulator blood samples were taken both before and 2 h after anesthesia.

Results: On comparing interleukin (IL)-1 count before and after epidural anesthesia, there was a statistically significant decrease. On comparing the IL-2, IL-10, and tumor necrosis factor (TNF) before and after epidural anesthesia, there was no change. IL-6 count levels dropped, which was not statistically significant. On comparing the Interferon alpha (IFNα), there was a statistically significant increase. On comparing the leukocyte count before and after epidural anesthesia, there was a rise, which was not statistically significant. On comparing the lymphocyte, eosinophil, basophil, and monocyte count, there was a statistically significant drop. A significant increase in neutrophil count was seen following epidural anesthesia.

Conclusion: IL-1 was significantly reduced, and IFNα was significantly increased during breast cancer procedures conducted under thoracic epidural anesthesia. TNF, IL-2, IL-6, and IL-10 levels were comparable. A considerable increase in neutrophil counts was linked to a significant decrease in lymphocyte, monocyte, eosinophil, and basophil counts, but the overall leukocyte count remained comparable. The possible interaction between anesthesia, the technique of surgery, leukocytes, and cytokine production may have substantial implications during breast cancer surgeries, which needs further evaluation.

Abstract: A young woman presented with acute-onset hypersomnia. Due to the acute onset, the possibility of secondary cause was considered. Magnetic resonance imaging of the brain was showing involvement of deep gray structures surrounding the third ventricle such as thalamus, hypothalamus, and caudate nucleus with true diffusion restriction. Differentials of vasculitic infarct or inflammatory cause were considered. Among inflammatory causes, neuromyelitis optica spectrum disorder (NMOSD) was considered due to predominant diencephalic involvement. Serum aquaporin-4 immunoglobulin G was positive. No other NMOSD core criteria fulfilling finding was there. Only hypersomnia presentation of NMOSD is uncommon. It should be considered in an acute hypersomnia patient as it is reversible with effective treatment.

Abstract: Sepsis remains a leading cause of mortality in older adults, whose age-related immune dysfunction, multimorbidity, and frailty complicate both diagnosis and prognostication. Standard scoring systems Predisposition, Infection, Response, and Organ dysfunction (PIRO), Acute Physiology and Chronic Health Evaluation (APACHE), and Sequential Organ Failure Assessment (SOFA) are widely used for risk stratification but were primarily developed in mixed-age populations. Their accuracy and applicability in geriatric sepsis, where physiological reserve and inflammatory response are altered, remain uncertain. To critically review and compare the predictive validity, clinical applicability, and limitations of PIRO, APACHE, and SOFA scoring systems in geriatric sepsis, emphasizing their strengths, weaknesses, and need for adaptation to aging physiology. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar. Studies evaluating PIRO, APACHE, or SOFA scores in adults aged ≥60 years with sepsis or septic shock were included. Data regarding discrimination (area under the receiver operating characteristic curve [AUC]), calibration, and clinical outcomes were synthesized narratively. All three models demonstrated moderate-to-good prognostic performance (AUC 0.78-0.86). PIRO exhibited slightly superior individualized prediction by incorporating host and infection variables, whereas APACHE provided robust physiological quantification but tended to overestimate mortality in frail elders. SOFA proved effective for serial monitoring but was limited by baseline organ dysfunction. None fully accounted for frailty or functional decline. While PIRO, APACHE, and SOFA retain prognostic relevance in geriatric sepsis, their predictive precision is reduced by the heterogeneity of aging physiology. Future tools must integrate frailty, multimorbidity, and functional status to achieve truly individualized, age-adapted sepsis prognostication.

Abstract: Hypokalemic periodic paralysis (HypoPP) occurs in calcium and sodium ion channelopathy, which is a rare presentation following certain triggers. This typically hereditary condition leads to episodic acute muscle weakness associated with hypokalemia, which can later present as permanent weakness. This article presents the case of a 37-year-old male who developed bilateral lower limb weakness associated with severe hypokalemia following intramuscular administration of 8 mg dexamethasone. HypoPP, though not common, should be evaluated in patients following treatment with glucocorticoids. These patients present with typical symptoms that can be managed accordingly.

Background: Chronic obstructive pulmonary disease (COPD) remains a major contributor to global morbidity and mortality, carrying a substantial clinical and socioeconomic burden. Comprehensive identification of clinical characteristics, biomarkers, and treatment requirements is essential to guide optimal therapeutic strategies. This study aimed to evaluate the clinical determinants associated with the need for triple therapy in COPD patients.

Methods: An analytical observational study with a cross-sectional design was conducted at the Pulmonary Clinic of Universitas Airlangga Hospital. Eligible participants were male patients aged ≥40 years who underwent spirometry and complete clinical evaluation. Patients with incomplete records or concomitant lung diseases were excluded. Clinical data, spirometry, and laboratory results were analyzed using SPSS, with P < 0.05 considered statistically significant.

Results: A total of 50 patients were included. Most were ≥60 years (64%) and severe smokers (74%) with a mean Brinkman index of 827. The majority presented moderate symptom burden according to St. George's Respiratory Questionnaire (SGRQ) (82%), moderate-to-severe functional limitation based on 6-min walk test (60%), and high exacerbation risk (46%). Significant factors associated with the need for triple therapy included blood eosinophil levels (P < 0.001), exacerbation severity (P = 0.001), impaired quality of life (SGRQ, COPD Assessment Test), comorbidity of myocardial infarction, and classification within the Airflow limitation, Burden of symptoms, and Exacerbation risk (ABE) Group.

Conclusion: Triple therapy was predominantly required in patients with eosinophil counts ≥300 cells/μL, a history of severe exacerbations, and those classified as Group E in the ABE group. These patients exhibited poorer quality of life and higher comorbidity burden. The findings align with the WISDOM Trial, underscoring the importance of multidimensional assessment in guiding individualized COPD management.

Background: Postdural puncture headache (PDPH) is a common and often debilitating complication following lumbar puncture, affecting approximately 10%-40% of patients. Minimally invasive procedures, such as sphenopalatine ganglion block (SPGB) and greater occipital nerve block (GONB), have shown promising results in the treatment of PDPH. This study aims to compare the efficacy of SPGB and GONB for PDPH and its associated symptoms.

Materials and methods: This study included 64 patients who developed PDPH following spinal anesthesia and were randomized into two equal groups. Group A received bilateral SPGB, whereas Group B received bilateral GONB using 2 mL of 0.5% bupivacaine with 4 mg dexamethasone. Headache was assessed using the Numerical Rating Scale (NRS) at baseline, 30 min, 1 h, 2 h, 6 h, 12 h, 24 h, 48 h, and 1 week postintervention. In addition to pain scores, associated symptoms, need for rescue analgesia, patient satisfaction score, overall treatment outcomes, and adverse effects were recorded and compared.

Result: The supine NRS scores were significantly lower in the GONB group as compared to the SPGB group at 30 min, 1 h and 2 h (P = 0.029, 0.002, and 0.021, respectively). NRS score was significantly lower in the GONB group as compared to the SPGB group at 30 min, 1 h, 2 h, and 6 h (P = 0.006, 0.042, 0.009, and 0.012, respectively) in the sitting position as determined by independent Student's t-test. However, both the treatments showed similar effectiveness after 12 h (P > 0.05). No major adverse effect was observed in both the groups. None of the patients required epidural blood patch in both the groups.

Conclusion: The GONB demonstrated superior efficacy in early headache relief compared to the SPGB in patients with PDPH. However, both the interventions were found to be equally effective in reducing headache intensity and associated symptoms over time, particularly beyond the initial few hours after the procedure.