Annals of African Medicine最新文献

Background: Tennis elbow is common in female elderly patients due to overuse of the forearm and wrist extensors. Platelet-rich plasma (PRP) is a safe, noninvasive modality by which growth factors are produced from platelet concentrates, which helps in the regeneration of damaged tendons.

Materials and methods: This prospective observational study assessed leukocyte-poor PRP for lateral epicondylitis in 50 patients unresponsive to conservative treatment. PRP was prepared using a standardized protocol and injected under aseptic conditions. Outcomes were evaluated at baseline, three and 6 months using a Visual Analog Scale (VAS) for pain and patient-related tennis elbow evaluation (PRTEE) for function.

Results: The mean VAS score improved from 8.8 to 1.7, and the mean PRTEE score improved from 74 to 12.

Conclusion: Leukocyte poor PRP injection is a minimally invasive, effective and safe outpatient procedure in treating tennis elbow patients with severe pain. Who do not respond to the conservative method.

Aim: Nosocomial infections are the most important cause of mortality and morbidity of the intensive care units (ICUs). In this study, we evaluated that developed infections in neurosurgery care unit.

Materials and methods: Twenty-seven cases with the diagnosis of nosocomial infection out of 132 patients followed up in the neurosurgical ICUs of our center between October 2022 and September 2024 were prospectively evaluated.

Results: In our center, infection rate was 20.45%. Pneumonia was the most frequently seen type of infection followed by urinary tract infection. Most frequently Staphylococcus aureus (32.15%) and Pseudomonas aeruginosa (24.52%) were detected. Overall mortality rate of the patients who became infected was 22.7%. However, mortality rate of the patients without infection was 6.6%. In 14 patients more than one episode of infection developed which resulted in death of 12 (85.7%) cases.

Conclusion: During monitorization in the ICU, one of the important factors which effect morbidity and mortality is nosocomial infections. In order to be able to prevent infections, routine surveillance studies should be performed and infection control measures should be evolved.

Background: The patella plays a crucial role in the extensor mechanism of the knee joint, significantly enhancing the efficiency of the quadriceps muscle. The alignment and height of the patella are critical for maintaining knee joint functionality and preventing knee-related disorders. The Patellotrochlear Index (PTI) is a novel measurement method that provides a more accurate assessment of patellar height and its relationship with the femoral trochlea, particularly in the North Indian population.

Objective: This study aims to establish normal PTI values in the North Indian population and evaluate the PTI as a reliable method for measuring patellar height.

Materials and methods: A cross-sectional study was conducted at King Georges Medical University, Lucknow, involving 80 patients with suspected ligamentous knee injuries. Patients underwent magnetic resonance imaging examinations, and PTI measurements were obtained. Data analysis was performed using SPSS version 22, with statistical significance set at P < 0.05.

Results: The mean age of the patients was 31.6 years (±5.6), with 66.3% males and 58.7% having the condition on the right side. The mean PTI was 0.52 (±0.12). PI values increased significantly with age ( P = 0.034) and were higher in females (0.56 ± 0.11) compared to males (0.50 ± 0.11) ( P = 0.024). Significant differences in PI values were also observed between the right (0.48 ± 0.10) and left (0.58 ± 0.11) sides ( P < 0.001).

Conclusion: The PTI is a dependable and repeatable indicator of patellar height, reflecting the true relationship between the patellar and trochlear articular surfaces. This index can be effectively used to diagnose and manage patellofemoral pain syndrome and other knee disorders, emphasizing its clinical relevance in the North Indian population.

Background: Artificial intelligence (AI) is transforming pharmacology by enhancing drug discovery, clinical trials, pharmacovigilance, and medical education. However, concerns about data security, job displacement, and ethical implications hinder its widespread adoption. This study assesses the perception of AI's scope, threats, challenges, and acceptance among pharmacologists in India.

Methodology: A cross-sectional, survey-based study was conducted among pharmacologists working in academia and the pharmaceutical industry in India between February 2024 and January 2025. A validated self-administered questionnaire was distributed through online platforms, collecting responses on AI awareness, perceived threats, benefits, challenges, and use. Data were analyzed using descriptive statistics, and categorical variables were compared using the Chi-square test.

Results: A total of 104 pharmacologists participated, with 64 from academia and 40 from the industry. While 68.26% were familiar with AI tools, industry professionals (82.5%) exhibited higher awareness than academicians (59.37%, P = 0.017). Most respondents recognized AI's significant role in drug discovery (77%), pharmacovigilance (73.07%), and clinical trials (69.23%). Major concerns included job displacement (62.5%), skill loss (63.46%), and algorithmic biases (64.42%). 33.65% pharmacologists never used AI-based tools in their professional careers. This number is significantly higher among academicians as compared to pharma people ( P = 0.03). Limited access to AI tools, expertise, and training (79.8%) and lack of standardized data format/interoperability issues (66.34%) were key barriers to adoption.

Conclusion: AI is perceived as a valuable tool in pharmacology, but challenges such as skill gaps, ethical concerns, and infrastructural limitations hinder its adoption. Addressing these barriers through targeted training, regulatory frameworks, and interdisciplinary collaborations will be crucial for AI's seamless integration into the Indian pharmacology sector.

Background: Laparoscopic cholecystectomy (LC) is the most effective treatment for gallstones. Anomalies in the biliary tree provide a risk and increase the probability of bile duct injury. The use of methylene blue for bile duct mapping may enhance intraoperative visibility; nevertheless, its efficacy and feasibility remain uncertain.

Aim: The aim of this study was to evaluate intraoperative findings during LC and assess the role of biliary mapping using methylene blue in identifying biliary anatomy and reducing complications.

Materials and methods: A total of 84 gallstone patients scheduled for LC were included. After obtaining informed consent from the patients, methylene blue was injected into the gallbladder to visualize the architecture of the bile ducts. The intraoperative results, anatomical changes, and complications were analyzed.

Results: The majority of intraoperative findings consisted of short cystic ducts (55.95%), followed by normal ducts (13.10%) and elongated ducts (8.33%). Uncommon observations included intrahepatic gallbladder (4.76%), colonic adherent gallbladder (2.38%), and twisted common bile duct. No significant adverse effects of methylene blue were noted. Methylene blue bile mapping enhanced the visibility of the bile duct architecture, particularly in cases with anatomical anomalies, and reduced the likelihood of bile duct injury.

Conclusion: Methylene blue bile mapping is a cost-effective and practical tool for LC that identifies bile duct architecture and reduces problems. This study suggests that it may be safer than intraoperative cholangiography in resource-limited situations.

Abstract: Spontaneous closure (SC) of a macular hole (MH) is a rare but well-documented phenomenon, particularly in small, early-stage holes. The exact mechanisms underlying SC remain unclear, but it is hypothesized to involve the interplay of vitreoretinal dynamics, glial cell proliferation, and the natural healing processes of the retina. Our study reports clinical features of two cases of full-thickness MHs (FTMHs) that closed spontaneously under different circumstances, as well as their optical coherence tomography (OCT) characteristics and effect on visual acuity, thus emphasizing the role of OCT in understanding this uncommon event. By documenting this rare outcome, we aim to contribute to the growing body of knowledge on FTMH and the potential for nonsurgical resolution in certain cases.

Background: This study aims to find the correlation between risk factors and the incidence of postpartum hemorrhage (PPH) in normal vaginal deliveries.

Materials and methods: The present research is an observational cohort study. Two hundred and thirty-nine women undergoing normal labor who delivered vaginally were given 0.2 mg of Ergometrine or 600 μg of Misoprostol at the delivery of the anterior shoulder, as a prophylaxis to prevent PPH. The blood loss was estimated by the use of blood collection drapes during delivery. All statistical analyses were conducted through SPSS version 27. The risk factors were compared between the groups with or without PPH.

Results: The majority 87 (36.4%) of the participants were in the 25-29 years' age group, 113 were nullipara (47.3%), and 93 (38.9%) were primigravida. The prevalence of PPH was 4.6% (11/239). Almost half of the cases of PPH (5/11, 45.5%) had no risk factors, whereas those with risk factors had twin pregnancy (25%), low-lying placenta (50%), grand multipara (33.3%), and previous history of PPH (33.3%). Furthermore, a moderate positive correlation between the risk factors and the incidence of PPH was observed ( R = 0.512).

Conclusions: In this study, women with risk factors such as twin pregnancy, low-lying placenta, grand multipara, and previous history of PPH developed PPH despite prophylaxis and close monitoring. However, almost half of the cases of PPH occurred in people where there was no risk factor. It is recommended that vigilance for the early detection and appropriate preparation for the management of PPH should be followed even in low-risk women undergoing vaginal delivery.

Background: Ensuring proper endotracheal tube (ETT) placement is crucial during general anesthesia. Traditional confirmation methods include capnography and chest auscultation, but each has limitations. Ultrasound (USG) offers real-time visualization of ETT placement, potentially improving confirmation speed and accuracy.

Objectives: To compare the feasibility of USG for early detection of esophageal intubation against capnography and chest auscultation in trainees.

Methodology: This comparative observational study assessed the time for ETT placement confirmation using USG, capnography, and chest auscultation in 90 patients undergoing general anesthesia. Patients were divided into three groups: USG confirmation (Group A), capnography confirmation using the first or sixth waveform (Group B), and chest auscultation confirmation (Group C).

Results: Group A had the fastest confirmation time (32.1 s), followed by Group C (bilateral: 46.97 s), and Group B (6th waveform: 48.23 s). Statistically significant differences were observed between Group A and Group B (6 th waveform), and Group A and Group C (bilateral). Hemodynamic parameters showed significant changes during and after intubation compared to baseline.

Conclusions: USG emerged as a faster and potentially more reliable method for ETT placement confirmation compared to capnography and chest auscultation. The real-time visualization offered by USG is valuable for novice trainees, enabling rapid confirmation, and potentially improving patient safety by facilitating early detection of misplacement.

Background and aim: Total knee arthroplasty (TKA) is a common procedure for severe knee joint conditions, requiring effective postoperative pain management to improve outcomes and minimize side effects. This study aims to compare the analgesic efficacy and safety of 0.1% ropivacaine versus 0.125% bupivacaine, each combined with dexmedetomidine, for femoral nerve block in TKA.

Methods: This comparative observational study was conducted at KMC Hospitals, Mangalore, from September 2022 to January 2024. Seventy-two patients undergoing spinal anesthesia for unilateral TKA were included, with 36 in each group. Group R received 0.1% ropivacaine with 0.75 μg/kg dexmedetomidine and Group B received 0.125% bupivacaine with 0.75 μg/kg dexmedetomidine. Pain was assessed using the Visual Analog Scale (VAS) at various time points postoperatively. Other outcomes included SPO2 levels, blood pressure, nausea, vomiting, and time to rescue analgesia.

Results: Both groups showed comparable pain relief, with no significant differences in VAS scores at rest or during motion at 24 h postoperation. SPO2 levels were similar across groups, with a significant difference only at 10 min postoperation. Blood pressure measurements showed no significant differences. Nausea and vomiting rates were high but similar between groups. The time to first rescue analgesia was slightly longer for the bupivacaine group (318 min vs. 305 min).

Conclusion: Both 0.1% ropivacaine and 0.125% bupivacaine, each with dexmedetomidine, provide effective analgesia for TKA with minimal impact on vital signs. Bupivacaine showed a trend toward lower blood pressure, which may benefit cardiovascular patients. Further research with larger cohorts and extended monitoring is recommended.

Objectives: Clarify the distinctive characteristics of avascular necrosis of the femoral head (AVNFH) in relation to coronavirus disease 19 (COVID-19) and report the successive individuals who were identified with the condition after recovering from COVID-19.

Materials and methods: From August 2023 to July 2024, we examined 24 successive patients (35 hips) prospectively who received an AVNFH diagnosis after recovering from COVID-19. Twenty patients were on corticosteroids for the treatment of COVID-19. The staging of AVNFH was decided by plain radiographs and magnetic resonance imaging. An association between the stage with the dosage of steroids and the comorbidities was evaluated.

Results: After COVID-19, hip symptoms took a mean of 6.13 months to manifest. In Methylprednisolone equivalent, the average steroid dosage was 713.2 mg. For those on steroid medication, the mean time for COVID-19 before hip complaints was 5.95 months. It was discovered that the mean COVID-19 period before the onset of hip symptoms was 7.125 months for individuals without comorbidities and 3 months for those with both diabetes and hypertension.

Conclusion: There has been an increase in AVN during the pandemic. This rise is probably because patients with COVID-19 pneumonia were receiving severe doses of corticosteroids. There is also an increase in severity and decrease in the duration of COVID-19 before hip symptoms in patients with comorbidities like diabetes. Given the minimal total amount of steroids taken by our patients, it is possible that vasculitis-associated COVID-19 contributes to the pathophysiology of AVN of the femur head.