Annals of African Medicine最新文献

Abstract: External auditory canal cholesteatoma (EACC) is a rare otologic condition characterized by the accumulation of keratinized material in the external auditory canal (EAC), leading to progressive bony erosion. While typically associated with middle ear disease, isolated EACC in young patients is uncommon and often misdiagnosed. We report the case of a 17-year-old male who presented with left-sided otalgia, purulent otorrhea, and progressive hearing loss over 3 months. Otoscopic examination revealed a firm, yellowish mass occluding the left EAC. High-resolution computed tomography demonstrated a soft-tissue lesion confined to the EAC, with associated bony remodeling and erosion but no middle ear involvement. The mass was excised under local anesthesia, and histopathological examination confirmed the diagnosis of EACC. The patient experienced significant symptomatic relief postoperatively, with no recurrence during follow-up. EACC should be considered in the differential diagnosis of persistent otalgia and otorrhea, particularly when imaging reveals bony erosion of the EAC. Early recognition and surgical intervention are crucial in preventing complications and ensuring optimal patient outcomes.

Context: Medical education has evolved to emphasize active learning and technology for competency development. The flipped classroom (FCR) model shifts from teacher-centered to learner-centered instruction, promoting deep learning through self-study and interactive classroom engagement. This study explores the implementation of FCR in Phase II medical microbiology education, examining its enabling and challenging factors.

Aim and objectives: (1) To introduce FCR in Phase II Microbiology teaching, (2) To assess student perceptions of FCR as a teaching-learning method (3) To evaluate faculty perspectives on FCR as a pedagogical tool.

Settings and design: A cross-sectional mixed-methods educational study was conducted over 3 months in the Department of Microbiology at a teaching hospital, following approval from the Institutional Ethics Committee.

Subjects and methods: Seventy-five Phase II MBBS students and eight faculty members participated after sensitization and consent. Topics such as biomedical waste management and hospital infection control were taught using FCR across five sessions. Preparatory materials were shared through WhatsApp. Classroom sessions involved case-based, team-based, and problem-based learning. Feedback was collected using a validated Likert scale questionnaire. Qualitative data were obtained from focus group discussions with students and faculty interviews.

Statistical analysis used: Quantitative data were analyzed using descriptive statistics (percentages). Qualitative feedback was thematically analyzed using inductive and deductive coding.

Results: FCR improved engagement, understanding, and satisfaction. Students appreciated preclass materials (98.7%) and interactive sessions (90.7%). Faculty support was rated positively (88%). Despite minor challenges, FCR proved effective in enhancing active learning and competency in microbiology education. Thematic analysis revealed outcomes such as increased engagement, improved retention, faculty facilitation, and challenges in preclass preparation.

Conclusions: FCR improved engagement, understanding, satisfaction, and learning outcomes. It presents a practical and scalable approach to embedding active learning within competency-based medical education.

Background: Oral submucous fibrosis (OSF) is a chronic and progressive fibrotic condition affecting the oral cavity and oropharynx, with a reported malignant transformation (MT) rate ranging from 1.9% to 10%. It is characterized by subepithelial fibrotic changes accompanied by epithelial alterations. The primary etiological factors include betel quid chewing and tobacco use. Habitual use of tobacco results in sustained exposure to reactive oxygen species, leading to oxidative stress (OS), which plays a crucial role in the pathogenesis and progression of OSF.

Aim: The objective of this study was to evaluate and compare the role of OS by assessing the immunohistochemical (IHC) staining intensity of 4-hydroxynonenal (4-HNE), a marker of lipid peroxidation (LPO), in OSF tissue samples and normal mucosal tissue.

Materials and methods: The study included 30 formalin-fixed, paraffin-embedded tissue blocks of OSF and 10 normal oral mucosa samples as controls. Tissue sections of 5 μm thickness were prepared and subjected to IHC staining. The stained slides were examined under a light microscope, and the data were analyzed statistically using Fisher's exact test.

Results: OSF tissue samples exhibited significantly higher 4-HNE expression than normal mucosa; a significant difference (P < 0.001) was also observed between the early and advanced stages of the disease.

Conclusions: The increased expression of LPO markers in OSF tissue samples underscores the involvement of OS in the advanced stages of the disease. Further studies incorporating clinicopathological correlations are crucial for early prediction of MT in OSF and for the development of targeted therapeutic strategies.

Abstract: Focal scleral nodule was first described in 1997 by Hong et al. as a unifocal helioid choroiditis. However, based on multimodal imaging utilization, the disease was renamed as a focal scleral nodule by Fung et al. in 2020. Focal scleral nodule is a rare, benign, asymptomatic mass commonly found deep to the retina during a routine retinal examination; it originates from the sclera and usually measures one disc diameter and presents near the optic nerve in Caucasian female patients. Even though it originates from the sclera, over 95% of focal scleral nodule patients show overlying choroidal thinning. In this article, we present a case of a 49-year-old Saudi male patient who was found to have a posterior pole lesion; the patient underwent multimodal imaging to help localize and diagnose the condition as a focal scleral nodule. In this article, we present the utilization of multimodal imaging modalities, including optical coherence tomography (OCT), OCT angiography, and indocyanine green angiography, in the diagnosis of focal scleral nodules.

Background: Serum magnesium is essential for maintaining cellular homeostasis and is commonly disrupted in critically ill patients as a result of sepsis, renal failure, and gastrointestinal losses. Serum magnesium is not often part of scoring systems used in intensive care units, like the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, which helps measure how serious a disease is and predict death, even though it is important for body function.

Objective: The objective is to assess the relationship between APACHE II scores and serum magnesium levels in patients admitted to the Medical Intensive Care Unit (MICU).

Materials and methods: This cross-sectional observational study was carried out over 24 months. Adult MICU patients with APACHE II scores >18 were included in the study. At admission, serum magnesium levels were measured, and 12 physiological parameters were used to calculate APACHE II scores. ANOVA and Pearson correlation tests were used to analyze the data.

Results: Serum magnesium levels and APACHE II severity categories showed a significant inverse relationship (F = 20.752, P < 0.001). Serum magnesium and total APACHE II score showed the strongest negative correlation (r = -0.597, P < 0.001). Serum sodium (r = 0.245, P = 0.007) and packed cell volume (r = 0.383, P < 0.001) showed positive correlations.

Conclusion: According to the APACHE II scores, higher illness severity is substantially correlated with lower serum magnesium levels. In critically ill patients, serum magnesium may be a useful supplemental biomarker for risk assessment.

Introduction: The carpal tunnel is a short canal in the forearm's anterior section that connects the wrist to the palm. This tunnel is frequently prone to pathological compression, resulting in compressive neuropathy and the symptoms and signs recognized as carpal tunnel syndrome (CTS).

Materials and methods: This is a cross-sectional survey assessing the prevalence of CTS in pregnant women. The symptoms and level of awareness of CTS among pregnant women in Abdullah Bin Omran Hospital, Ras Al Khaimah, United Arab Emirates was assessed by a questionnaire incorporating the Boston Carpal Tunnel Questionnaire, which was followed by clinical tests to diagnose CTS in women with symptoms.

Results: A total of 273 women participated in the study. Most women were between 20 and 40 years of age, Asians, and more than 50% did household work. This was the second and third pregnancy for the majority and 80.5% of them were in the third trimester. The prevalence of CTS was 30%, and the most common symptoms were weakness (20.3%) followed by wrist pain. Age between 20 and 40 years, being Asian, being 2nd or third gravida, and being in the 3rd trimester were significantly associated with severity.

Conclusion: Despite the high prevalence of CTS in pregnancy, the awareness of CTS was low. There is a need to create the awareness of the condition in pregnant women to improve their quality of life and implement appropriate management strategies.

Background and aims: Postoperative pain persists after nephrectomy, despite advances in laparoscopic techniques. A traditional epidural is associated with risks, prompting exploration of alternatives, such as the erector spine plane block (ESPB). This study compares the analgesic efficacy of ultrasound-guided continuous ESPB versus epidural block in patients undergoing laparoscopic nephrectomy.

Materials and methods: This prospective, randomized controlled study included 60 patients, aged 18-65, with American Society of Anesthesiologists physical status I-II, undergoing elective laparoscopic nephrectomy. Exclusion criteria included refusal to provide informed consent, local infection, coagulopathies, cardiovascular, respiratory disorders, and chronic opioid use. Patients were randomly assigned to either Group I (ESPB) or Group II (epidural block). Standard monitoring and anesthesia protocols were followed, with a continuous infusion of levobupivacaine plus fentanyl administered postoperatively for 24 h in both groups. The primary outcome measured was time to first rescue analgesia, with secondary outcomes including pain scores, analgesic consumption, and perioperative complications.

Results: The study found that Group I had a longer time to first rescue analgesia (9.50 h) compared to Group II (4.67 h), although the difference was not statistically significant. The cumulative dose of rescue analgesics was lower in Group I (100 mg) than in Group II (166.33 mg), with no significant difference (P = 0.219). Visual Analog Scale scores, hemodynamic changes, intraoperative fentanyl consumption, bowel recovery, and ambulation times were comparable.

Conclusion: ESPB is a suitable and better alternative to epidural block for postoperative analgesia in laparoscopic nephrectomy, in the context of ease administration and unilateral block.

Abstract: We report a 55-year-old female who presented with choreiform movements in the right upper and lower limbs and uncontrolled blood sugar levels. Magnetic resonance imaging (MRI) of the brain revealed hyperdense lesions, without diffusion restriction or blooming on gradient echo, in the left lentiform and caudate nuclei. The clinical presentation and MRI brain findings pointed towards a diagnosis of diabetic striatopathy (DS). DS, an underrecognized and underdiagnosed condition, primarily affects older women with poorly-managed diabetes mellitus. Effective management of this disorder chiefly depends on maintaining optimal blood glucose levels. After rigorous glycemic control using insulin therapy, the patient's symptoms started to improve, achieving complete remission of symptoms in about a month.

Background: Local anesthesia is a fundamental component of dental procedures, particularly tooth extractions. The addition of adrenaline to local anesthetic solutions enhances anesthetic efficacy and prolongs its action, but may induce systemic changes, especially in blood pressure, pulse rate, and blood glucose levels. Understanding these physiological effects is critical to ensuring patient safety, particularly in individuals with cardiovascular or metabolic concerns.

Aim: The aim of this study was to compare the effects of local anesthesia with and without adrenaline on blood glucose concentration, blood pressure, and pulse rate in patients undergoing tooth extractions.

Materials and methods: A prospective, comparative clinical study was conducted over 5 months on 110 patients requiring tooth extraction. Patients were randomly allocated into two groups: Group A received lignocaine 2% with adrenaline (1:80,000) and Group B received lignocaine 2% plain solution. Blood glucose levels, systolic and diastolic blood pressure, and pulse rate were recorded at three intervals: preanesthesia, 10 min postanesthesia, and immediately postextraction. The data were analyzed using SPSS version 25.0, with statistical significance set at P < 0.05.

Results: The demographic characteristics were comparable between both the groups. Group A exhibited significant increases in systolic blood pressure (138.20 ± 10.45 mmHg), diastolic blood pressure (87.10 ± 8.15 mmHg), blood glucose levels (112.85 ± 12.34 mg/dL), and pulse rate (88.40 ± 7.20 bpm) compared to Group B (126.75 ± 8.45 mmHg, 79.85 ± 7.10 mmHg, 101.90 ± 10.55 mg/dL, and 78.45 ± 6.10 bpm, respectively) postextraction (P < 0.001). Percentage changes from baseline were significantly higher in Group A across all parameters.

Conclusion: The present study demonstrates that the use of adrenaline-containing local anesthesia during tooth extractions should have a cautious approach when dealing with patients. While the technique is effective for achieving hemostasis and prolonged anesthetic action, caution is advised, particularly in elderly or medically compromised patients. Careful patient selection and continuous monitoring are essential to minimize potential complications.

Introduction: Dental caries affects both primary and permanent dentitions. This study was done to evaluate the antibacterial effectiveness of Solanum trilobatum (fruit) amla silver nanoparticle (AgNP) varnish, sodium fluoride (NaF) varnish, and silver diamine fluoride (SDF) against streptococcus mutans in the prevention of dental caries.

Materials and methods: In this in vitro investigation, 48 dentine blocks coated with saliva, obtained from extracted primary molars exhibiting deep carious lesions, were inoculated with a monospecies biofilm of S. mutans. These biofilms were nourished with 10% sucrose-enriched brain-heart infusion broth, administered four times daily over a 7-day period. Following the biofilm maturation phase, the dentine blocks were divided into four groups (n = 12 each) and treated with one of the following test agents: Group A was treated with 38% SDF, Group B received 5% NaF varnish, Group C was treated with amla silver nanoparticle fluoride (ASNF), and Group D was treated with S. trilobatum (fruit) AgNP varnish. Postapplication, the samples underwent at 48-h incubation for 37ºC, after that assessments were conducted to measure the zones of inhibition produced by each treatment agents.

Results: After being treated with SDF and the AgNP varnish product, S. mutans count was drastically reduced (P < 0.05). Conversely, SDF indicated maximum antibacterial action followed by amla AgNP varnish and least with NaF varnish (P < 0.05).

Conclusion: Herbal AgNP varnish antibacterial activity is equally effective and can be proposed to use.