Annals of African Medicine最新文献

Background: Acute encephalitis (AE) is associated with a high burden of mortality and permanent disability and has a spectrum of underlying etiologies. The prognosis of encephalitis is difficult and almost all the patients seem to be at a high risk of poor outcomes. A number of physiological changes take place during encephalitis and have been evaluated for their prognostic value. Platelet count, which has been recognized as a surrogate prognostic marker in various viral illnesses, has recently been recognized to have a prognostic value in AE too. In the present study, we attempted to study the role of thrombocytopenia in the prognosis of AE.

Methods: Total of 98 cases based on clinical, cerebrospinal fluid, and radiological profiles consistent with the diagnosis of AE were enrolled in the study. A clinical profile was noted, and platelet count was assessed. Thrombocytopenia was defined as platelet count <150,000/mm3. Platelet count 100,000-150,000, 50,000-99,999, and <50,000/mm3 were considered mild, moderate, and severe thrombocytopenia. The underlying etiology was explored, and patients were followed till discharge/outcome. The outcome was noted in terms of the Modified Rankin score (MRS). MRS 0-2 was considered good, 3-4 fair, and 5-6 as poor outcome.

Results: The mean age of patients was 34.06 ± 18.76 years. Majority of patients were women (54.1%). Prevalence of thrombocytopenia was 75.5%. A total of 34 (45.9%) had mild, 30 (40.5%) had moderate, and 10 (13.5%) had severe thrombocytopenia. Acute viral encephalitis (unclassified) was the most common etiology (33.7%), followed by scrub meningoencephalitis (24.5%) and Japanese encephalitis (12.2%), respectively. Good, fair, and poor outcomes were noted in 48 (49%), 21 (21.4%), and 29 (29.6%) cases. On univariate analysis, no significant association of poor outcome was seen with age, sex, duration of fever, and mechanical ventilation need (P > 0.05). Low Glasgow Coma Scale (GCS), splenomegaly, low platelet count, and Japanese encephalitis virus/scrub typhus etiologies were found to be significantly associated with poor outcomes (P < 0.05). Thrombocytopenia compared to normal platelet count and severe thrombocytopenia compared to mild and moderate thrombocytopenia were significantly associated with poor outcomes (P < 0.05). On multivariate analysis, GCS <8 (odds ratio [OR] =4.52; 95% confidence interval [CI] =1.56-13.20) and thrombocytopenia (OR = 11.92; 95% CI = 1.38-103.32) emerged as independent predictors of poor outcome.

Conclusions: The findings of the study showed that low GCS and thrombocytopenia could be used as predictors of poor outcomes in AE cases.

Background: Metopic suture is a dense fibrous joint extending from nasion to bregma. Normally, closure of this suture takes place between 1-8 years of age. Failure of this closure beyond 8 years leads to persistent metopic suture. Persistent metopic suture may mimic skull fracture.

Aim and objective: To differentiate metopism from frontal bone fracture.

Material and method: 54 dry skull of adult humans in were studied. These skulls were observed for the presence (complete or incomplete suture) or absence of metopic suture.

Result: Metopic suture was found in 3.7% skulls. Both complete and incomplete metopic suture were found in 1.85% of the dry skulls.

Conclusion: Neurosurgeons, radiologists, otorhinolaryngologists, physicians, anatomists, forensic specialists, anthropologists and evolutionary biologists should have knowledge of this anatomical variation. This case series focusses on the importance of metopism. Metopism is a topic, which has not been much studied.

Objectives: The novel SARS-CoV-2 outbreak disrupted businesses globally and created fears in the general public and among health-care professionals. Almost universally, considerations about the coronavirus pandemic and its effects became priority in the daily operations of businesses, leaving hitherto pressing concerns in the back stage. Early in the pandemic, the management of University of Benin Teaching Hospital set up a Business Continuity Team which undertook an evaluation of the perceptions of mid-level hospital managers about their departments' and units' risks and vulnerabilities in the face of the ongoing pandemic.

Methods: A modified International Labour Organization (ILO) risk profile self-assessment tool which focused on "people," "processes," "profits," and "partnerships" was used to assess mid-level managers' perceptions of their respective departments' and units' risks and vulnerabilities, consequent on the COVID-19 pandemic. Responses were obtained from heads of departments and units using an online survey. Final scores were divided into terciles (three equal groups) in respect of perceived risks and adverse outcomes of the COVID-19 pandemic. Scores in the lower tercile were grouped as low risk/vulnerability, the middle group of scores as medium risk/vulnerability, and scores in the upper tercile as high risk/vulnerability.

Results: Responses were obtained from 35 (49.3%) of the 71 clinical and nonclinical departments and units in the hospital. Fifteen of these (42.9%) were clinical. Nineteen (54.2%) departments were assessed to be at high risk/vulnerability, 9 (47.4%) of which were clinical. Twelve (34.3%) departments were assessed to be at medium risk/vulnerability - 4 (33.3%) of them, clinical. No department was assessed to be at low risk. The highest risk ratings were in the domains of "profits" and "partnerships:" 54 (84.4%) mid-level managers assessed their departments and units to be at high risk of the negative impacts of the coronavirus pandemic with respect to "profits" and 51 (79.7%) with respect to "partnerships."

Conclusion: Mid-level managers in clinical and nonclinical departments and units assessed their departments and units to be at medium and high risk of the negative impacts of the COVID-19 pandemic, using the ILO's modified tool. Our findings enabled the management of the hospital and the Business Continuity Team to address the specific areas of concerns that were highlighted, develop contingency plans, and frame risk communication during the pandemic, with a view to fostering increased sense of safety in the workforce. This approach to risk assessment is repeatable, and we recommended it to other hospitals in Africa.

Background: Hepatitis B virus (HBV) and neonatal tetanus infections remain endemic in Nigeria despite the availability of safe, effective vaccines. We aimed to determine health facilities' capacity for hepatitis B vaccine birth dose (HepB-BD) and maternal tetanus-diphtheria (Td) vaccination and to assess knowledge, attitudes, and practices of HepB-BD and maternal Td vaccine administration among health facility staff in Nigeria.

Materials and methods: This was a cross-sectional study assessing public primary and secondary health facilities in Adamawa and Enugu States. A multistage sampling approach was used to select 40 facilities and 79 health-care workers (HCWs) from each state. A structured facility assessment tool and standardized questionnaire evaluated facility characteristics and HCW knowledge, attitudes, and practices related to HepB-BD and maternal Td vaccination. Frequencies and proportions were reported as descriptive statistics.

Results: The survey of 80 facilities revealed that 73.8% implemented HepB-BD and maternal Td vaccination policies. HepB-BD was administered within 24 h of birth at 61.3% of facilities and at all times at 57.5%. However, administration seldom occurred in labor and delivery (35%) or maternity wards (16.3%). Nearly half of the facilities (46.3%) had HCWs believing there were contraindications to HepB-BD vaccination. Among 158 HCWs, 26.5% believed tetanus could be transmitted through unprotected sex, prevented by vaccination at birth (46.1%), or by avoiding sharing food and utensils. 65% of HCWs knew HBV infection had the worst outcome for newborns.

Conclusions: The limited implementation of national policies on HepB-BD and maternal Td vaccination, coupled with knowledge gaps among HCWs, pose significant challenges to timely vaccination, necessitating interventions to address these gaps.

Aims: We have compared sealing pressure, usability, and complications of two second-generation supraglottic airway devices-Baska® mask and I-gel.

Settings and designs: The study design involves prospective randomized controlled trial.

Materials and methods: The study was undertaken involving 44 patients of the American Society of Anesthesiologists physical status I and II, aged 20-70 years, who underwent surgical procedures of short duration under general anesthesia. Patients were randomly categorized into two groups of 22 each: Group B (Baska® mask) and Group I (I-gel). The main objective was to compare oropharyngeal leak pressure (OLP).

Statistical analysis: Continuous variables were compared between the two groups using an unpaired t-test. Categorical variables were compared using the Chi-square test and insertion attempts using Fisher's exact test.

Results: Group B had significantly higher mean OLP (32.22 ± 2.52 cmH2O vs. 26.18 ± 2.42 cmH2O, P < 0.001). In Group I, 97.1% of patients had very easy insertion (Grade 1), 2.9% had easy insertion (Grade 2) and Group B had very easy insertion in 50% of patients, easy in 36.4%, and difficult in 13.6% of patients (P = 0.009). Group B took a longer time for successful insertion than Group I (39.89 ± 7.15 s vs. 28.19 ± 3.29 s, P < 0.001).

Conclusion: For positive pressure ventilation, both I-gel and Baska® masks proved to be successful, with I-gel being easier and quicker to insert. It is possible to employ the Baska® mask with superior seal pressures as an alternative to endotracheal intubation in elective surgeries if there are no patient contraindications.

Introduction: The reliability of the diaphragm thickening fraction in predicting weaning failure in mechanically ventilated patients in the intensive care unit (ICU), as well as the relationship between the patients' diaphragmatic inspiratory excursion and diaphragmatic thickness.

Materials and methods: Fifty mechanically ventilated patients participated in this hospital-based cross-sectional prospective study in a tertiary care teaching hospital. Patients who had been on a mechanical ventilator for at least 7 days and whose legal guardian was willing to provide consent were also included in the research. People with hemodynamic instability and those whose legal guardians were reluctant to comply were excluded.

Results: Using diaphragmatic thickening fraction as a diagnostic criterion, the weaning failure group consisted of 24 patients, out of which we predicted diaphragmatic dysfunction (DD) in 19 patients. The weaning success group consisted of 26 patients, of which we predicted no DD in 21 patients. Weaning success or failure was predicted by diaphragmatic thickening fraction with a sensitivity of 79.16% and a specificity of 80.76%, diaphragm excursion with a sensitivity of 70.8% and an 80.7%, and diaphragmatic thickness with a sensitivity of 66.66% and a specificity of 73.91%, respectively.

Conclusion: Diagnosing DD in mechanically ventilated, figuring out if extubation would be effective or not, monitoring respiratory effort, and assessing atrophy in ICU patients, ultrasonography may be an effective and accurate technique for mechanical ventilation patients, and it provides a convenient, noninvasive, affordable, and secure way to assess DD.

Background: In our routine pediatric dental practice, many of us encounter parents and caretakers of Children with Special Health Care Needs (CSHCN) who complain about the difficulties they face in daily tooth brushing of their children. Some parents may have to accept defeat as their children face overwhelming medical conditions to cater to; ultimately leading to paradigm shift of oral hygiene leading to increase of dental caries and gingival problems.

Aims and objectives: To develop and validate a comprehensive tool that can help us in assessing parent related stressors and coping factors with regard to maintenance of oral hygiene of their children.

Materials and methods: Data related to stress and coping factors encountered during maintenance of oral hygiene of their children and their experiences during the child's dental treatment (if any) were collected from parents of CSHCN. Validation and feedback from content evaluation panel experts were done.

Results: A comprehensive assessment tool with 45 items (29 stresses related items and 16 coping related items) was developed after validation.

Conclusion: We could develop and validate a 'Stress and Coping Assessment Tool associated with maintaining Oral health among Children with Special health care needs' - abbreviated as "SCATOCS" with a hope to benefit and manage oral health care to the referred population.

Background: Poisoning is a significant health hazard and a leading cause of morbidity and mortality worldwide. India, being a predominantly agrarian country, routinely employs organophosphate (OP) pesticides in farming, and they are readily available "over the counter." OPs exert their toxicity by interfering with the normal function of acetylcholine, an essential neurotransmitter throughout the autonomic and central nervous systems. Due to the limited availability of facilities and resources in health-care systems, and economically restraining patients, it is necessary to rely more on clinical features to assess the severity of poisoning and manage the condition properly.

Methodology: It was a hospital-based prospective observational study that included patients aged >13 years in a tertiary care hospital. All patients were clinically evaluated based on their history and examination. The diagnosis was made based on characteristic clinical manifestations or evidence of exposure to organophosphorus compounds (corroborative evidence such as empty containers and the odor of gastric aspirates). Clinical severity was assessed and categorized according to the Peradeniya Organophosphorus Poisoning Scale (POP scale). A score of 0-3 is considered mild poisoning, 4-7 as moderate poisoning, and 8-11 as severe poisoning.

Results: Out of the 50 patients enrolled in the study, 17 (34.00%) were aged <20 years, 19 (38%) were in the 20-30 years age group, and 14 (28%) were aged >30 years. Ingestion is the only mode of exposure to poisoning. None of the patients had history of contact or inhalational exposure. Of the 50 cases, 12 (24.0%) were in the mild category, 26 (52.0%) in the moderate category, and 12 (24%) in the severe category on the POP grading. A comparison of the mean serum pseudocholinesterase, troponin-T, and pro-BNP levels with severity was performed. In mild OP poisoning, the mean serum PChE level was 2766.58 ± 1120.44; in moderate, it was 1969.35 ± 1330.07, and in severe, it was 701.83 ± 961.17. Pseudocholinesterase levels decreased progressively with increasing clinical severity from mild-to-severe cases, and this association was statistically significant (P < 0.001). Two-dimensional echocardiography screening done in all patients did not show any significant abnormalities.

Conclusion: This study shows that serum PCE is reduced in OP poisoning and correlates with the clinical severity grading done by the POP scale and is also associated with an increase in the duration of intensive care unit stay. No significant evidence of direct cardiac injury was observed in this study. A low Glasgow Coma Scale score and an increased respiratory rate at presentation are associated with poor outcomes.

Background: Activation procedures (APs) are adopted during routine electroencephalography (rEEG) to provoke interictal epileptiform abnormalities (EAs). This study aimed to observe interictal and ictal (EAs) of different EEG patterns, provoked by various APs.

Methodology: This cross-sectional study was performed in the neurology department of King Fahd hospital of university, Saudi Arabia. The EEGs and medical records of patients who presented for EEG recordings were screened initially, then 146 EEGs provoked EAs due to utilization of APs, were included for analysis.

Results: Among all EEGs with provoked EAs, Non-rapid eye movement sleep (NREM) provoked EAs in 93 (63.7%) patients with following patterns, focal spike wave discharges (FSWDs) 45 (P= 0.01), focal spike wave discharges with bilateral synchrony (FSWDBS) 27 (P=0.03) and generalized spike wave discharges (GSWDs) 46 (P=0.01). Intermittent photic stimulation (IPS) most significantly provoked FSWDs in 07 patient (P =0.01) and GSWDs in 30 patients (P=<0.001) 7 patients (P = 0.01) and GSWDs in 30 patients (P < 0.001). Hyperventilation (HV) was associated with a higher occurrence of GSWDs in 37 patients (P =0.01). Female sex 7 (P = 0.02), provoked GSWDs 3 (P = 0.03), NREM sleep 8 (P = 0.04), prolonged EEG record 3 (P = 0.02), clinical events during recording 5 (P ≤ 0.01), diagnosis of genetic 05 (P = 0.03), and immune-mediated epilepsies 2 (P = 0.001) were associated with the provocation of ictal EAs; however, in multiple logistic regression analysis, no statistically significant association of these variables (P ≥ 0.05 each) was noted.

Conclusion: The provocation of EAs in rEEG with different APs varies according to circumstances, including seizure types, epilepsy etiology, and the type of AP applied. These clinical and procedural parameters affect the diagnostic yield of rEEG and need careful consideration during rEEG recordings. APs adopted during rEEG recording can induce FSWDs, FSWDBS, and GSWDs in the form of either interictal or ictal EAs in various etiologies of epilepsy. Ictal EAs may appear in the form of GSWDs, during NREM sleep, in prolonged EEG records; however, their independent association needs to be evaluated in larger sample studies. Further, prospective cohort studies with adequate sample sizes are warranted.

Background: Primary esophageal motility disorders present with a spectrum of symptoms where manometry plays an important role. We designed this study to evaluate the utility of esophageal manometry among various symptoms.

Materials and methods: This is a single-center observational study conducted over 5 years in a tertiary referral center. A total of 564 patients who underwent high-resolution esophageal manometry (HREM) using a 16-channel water perfusion system were included in the study. Their clinical profile and manometric findings, as per the Chicago classification version 4.0, were recorded, and the diagnostic utility of HREM with respect to symptoms was studied.

Results: Motility disorders were identified in 48.8% of patients, the most common being Achalasia cardia (32.4%). Dysphagia (55.5%) was the most common indication of manometry, followed by gastroesophageal reflux disease (GERD) (34.9%), chest pain (6.2%), and symptoms such as belching, globus, and hiccoughs (3.4%). Among those who were re-classified from Chicago classification v3.0 to v4.0, 21.2% had a newer diagnosis. Among the patients with dysphagia, HREM revealed the highest yield of detecting an abnormal esophageal motility test (70.6%); meanwhile, this yield was much lower in those with GERD (21.8%), chest pain (22.8%), and other symptoms (15.7%). The most common finding among those with dysphagia was Achalasia cardia (55.9%), while the study was normal among those with GERD (78.1%), chest pain (77.1%), and other symptoms (84.2%). The sensitivity and specificity of dysphagia for major motility disorders were 65% and 91%, respectively, with a positive predictive value of 90%.

Conclusion: HREM has high accuracy and a good diagnostic yield among patients with dysphagia, with the most common finding being Achalasia cardia.