Annals of African Medicine最新文献

Abstract: Since 2005, only one case of a male patient presenting with a congenital rectourethroperineal fistula was reported. It was classified as a rare regional variant of an H-type rectourethral fistula in Krickenbeck's anorectal malformations classification. A staged approach was used to manage the patient, including colostomy, anorectoplasty, and a hypospadias correction. We report a second case of a continent rectourethroperineal fistula with the rare association of an atretic bulbomembranous urethra. The patient underwent staged surgeries to separate the rectum and the urethra from the perineal fistula, reposition the neoanus, and anastomose the anterior-to-posterior urethral tracts. These resulted in fecal continence and successful voiding.

Abstract: Cerebral venous sinus thrombosis (CVST) accounts for approximately 0.5%-1% of all strokes. The onset of CVST is usually subacute to chronic, and common clinical presentations are headaches and focal neurological deficits. Patients with chronic liver disease (CLD) are at risk of bleeding as well as venous thromboembolic events. Deep venous thrombosis, thrombosis involving the portal, splanchnic, and hepatic veins, and pulmonary embolism are commonly reported with CLD; however, CVST is not a recognized complication. There are occasional case reports of CVST with hepatitis A or C-related CVST; however, we were unable to find any report of autoimmune hepatitis (AIH)-related CVST in the literature; therefore, we report the case of a 56-year-old female, diagnosed with AIH-related CLD, who presented with sudden-onset confusion and decreased verbal output. She did not have any provoking or underlying hypercoagulable disorder. Her computed tomography (CT) head, followed by magnetic resonance imaging brain, revealed evidence of cerebral venous infarction, and a CT venogram revealed extensive venous sinus thrombosis. Her coagulation profile was deranged, and workup for hypercoagulable state was negative. It was a diagnostic and therapeutic challenge to anticoagulate in the presence of significant derangement of her coagulation profile. The likely etiology for CVST in this scenario was autoimmune liver damage.

Context: Deep level of sedation required during endoscopic retrograde cholangiopancreatography (ERCP) can cause hypoxia in part due to an unsecured airway. This study aims to study the benefits of using the laryngeal mask airway (LMA) Gastro to secure the airway in ERCP.

Aims: To determine the benefit of Gastro LMA for securing airway for ERCP procedure, by recording the incidence of intraprocedural adverse cardiorespiratory events - hypoxia, hypotension, bradycardia, and arrhythmias.

Settings and design: A prospective randomized controlled study was conducted at a tertiary hospital with the American Society of Anesthesiologists (ASA) Grade I to III patients undergoing ERCP procedure in the endoscopy suite.

Subjects and methods: Eighty patients between 18 and 70 years of age fulfilling the inclusion criteria undergoing ERCP were selected for this prospective, randomized controlled study, after obtaining institutional ethical committee approval. Patients were allocated to either LMA Gastro group (G) or to control group (C). Standard anesthesia protocols were followed, and cardiorespiratory parameters were recorded at regular intervals during the course of the procedure.

Statistical analysis used: Comparisons were made using t-tests and Chi-square tests, with significance set at P < 0.05.

Results: Our study demonstrated that the LMA Gastro group maintained significantly greater oxygen saturation, with nil hypoxic events occurring in this group. Comparatively, the control group experienced four episodes of hypoxia. The LMA Gastro group also demonstrated statistically significant increases in mean blood pressure, while mean heart rates were lower. However, these did not translate to any clinically significant differences, and the incidence of hypotension and bradycardia events were comparable between the groups. The total amount of propofol required to maintain desired sedation levels was found to be comparable between the groups. No postoperative hemodynamic or respiratory adverse events were recorded, and incidence of sore throat was found to be statistically insignificant.

Conclusions: The LMA Gastro offers excellent control of the patient airway during TIVA for ERCP, providing superior maintenance of oxygen saturation. It also allows for the initiation of positive pressure ventilation when required. The hemodynamic profile including incidence of hypotension and arrhythmias, while providing sedation with the LMA Gastro in situ is not clinically significant in comparison to sedation with native unsecured airway. It can be easily inserted by an anesthetist, and it offers the same level of efficacy and safety even in ASA class III patients. These characteristics make it an attractive primary airway technique in ERCP.

Background: The aim of anesthetic management of patients undergoing surgeries should be to allow physiological changes during surgery with minimal effects on the vitals and rapid recovery from anesthesia with minimal residual effects. Since opioid-based anesthesia is associated with opioid abuse and side effects peri- and postoperatively, we conducted this study to compare the effects of opioid-free anesthesia using dexmedetomidine and ketamine with opioid-based anesthesia using fentanyl in patients undergoing elective laparoscopic surgeries.

Materials and methods: A randomized prospective double-blinded study was undertaken on 70 adult patients undergoing elective laparoscopic surgeries. The patients were equally and randomly divided into two groups: patients in Group A were administered IV dexmedetomidine 1 μg/kg body weight and ketamine 25 mg and those in Group B were administered IV fentanyl 2 μg/kg body weight. Comparisons of parameters representing hemodynamic stability were done between the two groups, along with the depth of sedation and adverse effects, if any.

Results: There was significantly less increase in heart rate in the dexmedetomidine group than that in the fentanyl group after intubation in intraoperative period as well as after extubation. There was an abrupt decrease in the respiratory rate (RR) at 60th min in the patients administered fentanyl, and the difference in the fall was statistically significant compared to in those administered dexmedetomidine. In the dexmedetomidine group, there was a good stability of RR with the baseline values at all time intervals. There was a decrease in the mean arterial pressure values in both the groups, the difference being statistically insignificant. The depth of sedation was better in the patients administered dexmedetomidine according to the Ramsay Sedation Score as compared to in those administered fentanyl. The incidence of adverse effects was also lesser in the patients administered dexmedetomidine than in those administered fentanyl.

Conclusion: This study concluded that opioid-free anesthesia using dexmedetomidine is better than opioid-based anesthesia using fentanyl for patients undergoing elective laparoscopic surgeries due to better perioperative hemodynamic stability, deeper sedation, and lesser adverse effects postoperatively.

Background: Preterm birth is defined as birth before 37 weeks of gestation. It occurs in 10% of all deliveries worldwide and is a major contributor to perinatal mortality and morbidity. The study aimed to evaluate the role of serum-soluble Endocan levels in the prediction and prognostication of preterm labor.

Materials and methods: This was a prospective observational study carried out for 1 year in the Department of Obstetrics and Gynaecology, in collaboration with Pathology. Preterm labor was defined as per ACOG guidelines. After informed consent and ethical clearance from the institutional ethics committee, a total of 130 pregnant women with established preterm labor were recruited, and finally, 124 women were enrolled and further divided according to their gestation age, extreme preterm (n = 1), very preterm (n = 22), moderately preterm (n = 32), late preterm (n = 39), and term (n = 30) pregnancy. Serum endocan level was measured using the ELISA technique using a human ESM1 ELISA kit as per manufacturer protocol.

Results: 94.4% of women were not registered while 52.4% were urban and 41.9% were primigravida, 88.7% had body mass index (BMI) in the normal range. The mean serum endocan level was maximum in women who delivered moderate preterm babies (866.64 ± 43.42 pg/ml). followed by (730.68 ± 107.05 pg/ml) who delivered very preterm and almost equal to late preterm (659.21 ± 68.17 pg/ml) and term delivery (662.50 ± 38.30 pg/ml). The mean serum endocan level was higher (839.52 ± 81.16 pg/ml) in women who delivered within 24 h.

Conclusion: Serum endocan might be a good prognostic marker in preterm labor; adequate antenatal care is required to prevent preterm labor.

Background: Restless legs syndrome (RLS) is a sensorimotor condition that affects the quality of sleep for those who have it. The diagnosis is made according to the consensus criteria by the National Institute of Health panel as follows: "(i) a strong desire to move one's legs, usually in response to an unpleasant sensation; (ii) a stronger urge in the evening and at night; (iii) movement usually satisfies the urge; and (iv) rest increases the urge." This study aims to investigate the prevalence and associated risk factors of RLS among medical students in Saudi Arabia; furthermore, the severity and impact of RLS on sleep status.

Methodology: A cross-sectional study conducted between 2022 and 2024 in medical students in Saudi Arabia. Three hundred and thirty-one students (233 female and 98 male) participated and completed an online consented questionnaire to detect the prevalence of RLS and associated risk factors including medical comorbidities, smoking, and caffeine intake based on criteria proposed by the International Restless Legs Syndrome Study Group. Furthermore, the severity and impact of RLS on sleep status were studied using the Epworth Sleepiness Scale and the RLS rating scale, respectively.

Results: The frequency of RLS among medical students is 20.2%. The severity of RLS reported in 23.9% of the students with mild-to-severe rates. About 40.3% of students with RLS had daytime fatigue and 33.4% had sleep disturbances. About 64.1% of medical students who suffer from RLS have associated medical comorbidities including iron-deficiency anemia, diabetes mellitus, and peripheral neuropathy. Thirty-seven percent are smokers and 42.9% of students who had 3-4 cups of coffee daily had RLS compared to 18.6% of others who did not.

Conclusion: RLS has a significant prevalence among medical students, in Saudi Arabia. RLS is highly associated with sleeping disturbance and daytime fatigue. Caffeine and smoking are considered risk factors for RLS.

Objective: Alzheimer disease (AD) is the most common cause of neurodegenerative dementia; it is expected to see global cases tripling by 2050. This study evaluates public awareness of AD in the Eastern region of Saudi Arabia, highlighting the need to improve background knowledge of AD and assess the impact of public education on early detection and management.

Methodology: This study was a cross-sectional study that targeted the public in the Eastern region of Saudi Arabia. It was conducted between June 2024 and October 2024. Data were collected using an online questionnaire and analyzed using SPSS software.

Results: Our study involved 814 participants. A significant majority (94.7%) believe that brain-stimulating activities can delay AD onset. However, misconceptions persist, with 49.1% incorrectly thinking that AD can affect those in their 30s or 40s, though 86.9% correctly recognize it primarily affects those over 65 years of age. Awareness of cardiovascular health factors as risks was noted by 68.9% of participants, and 60.2% believed environmental toxins could also be a factor. Key recognized symptoms included difficulty in remembering events (76.5%), planning daily activities (65.4%), handling finances (59.7%), and confusion about time and place (79.7%). Furthermore, 80.1% understood that those with AD might better recall older events. The study also found a reliance on informal information sources, with 51.8% of participants guessing answers about the disease.

Conclusions: Many participants understand that brain-stimulating activities might delay Alzheimer's onset, but significant misconceptions regarding its typical age of onset persist. Education programs using reliable sources are crucial for improving community understanding and management of the disease.

Background: The lumbrical muscles of the foot are intrinsic musculature playing a critical role in maintaining toe alignment and facilitating smooth gait mechanics. Despite their importance, morphological variations remain understudied, which can impact clinical diagnostics and surgical outcomes.

Objective: This study aims to investigate the morphological variations of the foot lumbricals and their clinical significance using cadaveric dissection.

Materials and methods: This study examined 150 lower limbs from 75 formalin-embalmed human cadavers (43 males and 32 females) over the period of 2019-2024. Morphological characteristics of the lumbrical muscles, including origin, insertion, number, and nerve supply, were recorded.

Results: The study revealed a gender variation in the anatomical patterns of the foot lumbricals. In total, 5.33% of cadavers exhibited bilateral unipennate second, third, and fourth lumbricals, with a higher prevalence in females (five cases) compared to males (three cases). Similarly, 8% of cadavers had unilateral unipennate lumbricals, with a dominant occurrence in females (nine cases) versus males (three cases). The absence of the fourth lumbrical was seen in 6% of cadavers, again more frequently in females (six cases) than males (three cases). In addition, accessory lumbricals arising from the flexor hallucis brevis were noted in 2.67% of cadavers, with a higher occurrence in females (three cases) than males (one case). Overall, the findings indicate a gender-based disparity, with females showing a greater frequency of these variations.

Conclusion: Morphological variations in foot lumbricals variations have potential implications in conditions like claw toe deformity and altered gait mechanics and may influence foot biomechanics and surgical outcomes. Recognizing these anomalies is essential for clinicians and surgeons to enhance diagnostic accuracy and optimize therapeutic interventions.

Background: Pregnancy-related acute kidney injury (PRAKI) may occur due to various causes from conception to puerperium. This study was undertaken to determine the incidence and associated risk factors and evaluate fetomaternal outcomes in PRAKI at tertiary care institution.

Materials and methods: A prospective longitudinal study was conducted with enrollment of pregnant females with PRAKI, ≥28 weeks, and up to 7 days of puerperium, diagnosed as per the Kidney Disease Improving Global Outcomes (KDIGO) criteria - serum creatinine >1.3 mg/dl at admission or increased by 0.3 mg/dL within 48 h or >1.5 times within 7 days or urine output <0.5 ml/kg/h. A detailed history including sociodemographic factors, obstetric history, and underlying medical disorders with primary cause and obstetric precipitating factors of PRAKI was noted. The sample size was 184 patients and followed up with serial renal function test, serum electrolytes, input/urine output monitoring, and dialysis, on nephrologist advice. Complete renal recovery was considered if serum creatinine <1.3 mg/dl at discharge.

Results: In the present study, the incidence of PRAKI was 3.16%, the mean age was 25.36 ± 5.13 years, and 76.08% of patients were antenatal, mostly primigravida. Primary causes were hypertension (57.06%), hemorrhage (20.65%), multiorgan failure (MOF), sepsis, and other causes. Obstetric complications which precipitate PRAKI were eclampsia (antepartum [52.38%], severe preeclampsia [44.77%], and postpartum [2.86%]), hemorrhage (antepartum [28.59%] and postpartum [23.68%]), hemolysis, elevated liver enzymes, and low platelet count syndrome (3.8%), and acute fatty liver of pregnancy (2.71%). The mean serum creatinine (mg/dL) at admission, after 48 h, and at discharge were 1.92 ± 0.87, 2.69 ± 1.33, and 1.09 ± 0.32, respectively (P = 0.0001). The mean blood urea (mg/dL) at admission and at discharge were 83.9 ± 30.42 and 37.2 ± 7.12, respectively (P = 0.0001). Hemodialysis was performed in 42 (22.83%) patients; 142 patients (77.17%) were managed conservatively. Complete recovery in 137 (74.46%), 19 (10.33%) maternal mortality, 5 (11.9%) patients progressed to chronic kidney disease, median hospital stay 10 days, intensive care unit (ICU) stay 8 days (P = 0.0001). Live birth, intrauterine death, and neonatal ICU admission were in 128 (69.57%), 56 (30.43%), and 42 (32.81%) patients, respectively.

Conclusion: Proper antenatal care, timely referral, and early detection and management of PRAKI may minimize fetomaternal morbidity and mortality.

Aim: To find out the prevalence of asymptomatic pulmonary hypertension (PHT) in metabolic syndrome patients who have obstructive sleep apnea (OSA).

Objectives: To find out the presence of asymptomatic PHT by two-dimensional echocardiography (2D ECHO) who have metabolic syndrome by WHO diagnostic criteria and OSA done by polysomnography. In this study, we also assessed the glycemic status in patients with metabolic syndrome with OSA and asymptomatic PHT.

Materials and methods: Study population: All patients attending tertiary care outpatient department for type 2 diabetes/prediabetes/dyslipidemia/hypertension/obesity were screened for metabolic syndrome features.

Results: In a pilot study, 34 consecutive patients were found to have metabolic syndrome by the WHO diagnostic criteria. 28 (82%) of metabolic syndrome patients had OSA. 14 out of 28 patients (50%) had PHT by 2D ECHO. Prediabetes was more prevalent, 22 (65%) among patients with metabolic syndrome than diabetes (32%). All but one patient who had no OSA was found to have moderate PHT. Asymptomatic PHT was found in 6/12 (50%) of diabetics and in 8/22 (36%) in prediabetes. Except for one, diabetes duration of all was <10 years and all prediabetes were recently detected within 1 year.

Conclusion: Our findings suggest that PHT is associated with a 4-fold higher occurrence of metabolic syndrome than patients with OSA. It is more prevalent in prediabetes and diabetes. The detection of the association of diabetes mellitus, OSA, and asymptomatic PHT in the pathophysiology of heart failure with preserved ejection fraction requires further longitudinal studies. The prevalence of PHT increases with increasing severity of OSA; therefore, early detection is beneficial.