Annals of African Medicine最新文献

Background: Cardiovascular diseases (CVDs) remain the leading cause of death globally. Statin therapy significantly reduces cardiovascular risk in both primary and secondary prevention; however, real-world implementation of guideline-directed therapy and achievement of target low-density lipoprotein cholesterol (LDL-C) levels remain suboptimal, especially in low- and middle-income settings.

Materials and methods: This cross-sectional observational study was conducted at the Hospital and Research Centre, including 198 adults (≥25 years) eligible for statin therapy based on atherosclerotic CVD (ASCVD) risk assessment or established CVD. Patients were categorized into primary or secondary prevention groups. Lipid profiles were assessed to determine LDL-C target attainment (<70 mg/dL) after at least 3 months of statin therapy. Factors contributing to nonachievement of the target LDL-C were analyzed descriptively.

Results: Of 198 patients, 67.7% were eligible for primary prevention, yet only 3.7% were initiated on statins. All secondary prevention patients received statins, but only 4.7% achieved the target LDL-C. The most frequent reasons for nonattainment included inadequate dose escalation (59.0%), low patient perception of therapy importance (52.5%), financial barriers (49.2%), and pill burden (39.3%). True statin intolerance was rare (3.3%). Demographic analysis revealed a mean age of 62.18 ± 12.84 years and a male predominance (80.3%).

Conclusion: This study highlights critical gaps in statin use and LDL-C target attainment in both primary and secondary prevention. Systematic incorporation of ASCVD risk calculators, regular follow-up lipid profiling, structured dose optimization, patient education, and enhanced medication affordability are essential to improving real-world cardiovascular risk reduction and achieving global prevention targets.

Background: In India, maternal mortality has reduced to 97 per 100,000 live births, marking progress, though concerns remain about the overall quality of antenatal care (ANC). Evidence from resource-constrained regions is limited, but it is well established that women's satisfaction with ANC plays a critical role in shaping how effectively these services are used and the outcomes they produce.

Objective: The objective of the present study is to assess satisfaction with ANC services among recently delivered women and identify associated factors.

Materials and methods: A cross-sectional survey was conducted among 511 women, multi-stage random sampling was used to obtain participants from an urban slum and one rural area of the district Lucknow, India. A pretested Hindi questionnaire was used to assess ANC use and satisfaction across four domains. Satisfaction was classified as satisfied (>95% score), moderately satisfied (95%-80% score), or dissatisfied (<80% score). Descriptive statistics, Chi-square, correlation, and ordinal logistic regression were used to describe and identify factors associated with satisfaction with ANC.

Results: Overall, 11.1% of women were satisfied and 20.4% dissatisfied, with higher dissatisfaction in urban slums than in rural areas (P = 0.004). Dissatisfaction was associated with urban residence (odds ratio (OR) = 0.54), age <25 years (OR = 0.50), lack of Accredited Social Health Activist (ASHA) contact (OR = 0.48), no advice (OR = 1.89), untimely visits (P = 0.018), and incomplete care (P = 0.005). The barriers included lack of time, lack of accompaniment, and distance.

Conclusion: ANC satisfaction was moderate. Younger age, urban residence, and service gaps were predictors of dissatisfaction. Strengthening ASHA roles, improving facilities, and encouraging timely ANC may enhance satisfaction and maternal outcomes.

Background: Diabetic nephropathy is the most serious complication associated with diabetes mellitus and the diagnosis typically relies on the identification of albuminuria. However, there are cases of renal insufficiency without albuminuria reported in diabetic patients. This study aimed to evaluate the association between microalbuminuria and serum cystatin C, as well as to assess the clinical usefulness of cystatin C in predicting the renal impairment in diabetic patients.

Materials and methods: It was a cross-sectional study conducted on type 2 diabetic patients and healthy controls, who were categorized into four groups based on their albuminuria levels. All the participants were investigated for serum cystatin C, albuminuria, and traditional markers of nephropathy.

Results: The level of cystatin C was significantly elevated in diabetic patients as compared to healthy individuals. The mean ± standard deviation progressively raised among the normoalbuminuric diabetic patients (1.32 ± 0.32 mg/L) and reached the peak in nephropathy patients (1.86 ± 0.25 mg/L). There was a significant positive correlation of cystatin C with albuminuria (P < 0.001). Receiver operating characteristic analysis of cystatin C showed an area under the curve of 0.881 (95% confidence interval, 0.832-0.930) with a sensitivity of 80.83% and a specificity of 86.67%, demonstrating the diagnostic efficacy of cystatin C (P < 0.001).

Conclusion: Elevated serum cystatin C level was observed in type 2 diabetic patients before the development of notable albuminuria, and its concentration rises as nephropathy advances, indicating that cystatin C could serve as a potential and earlier marker of renal dysfunction compared to albuminuria.

Background: Meconium-stained amniotic fluid (MSAF) is a commonly encountered finding during labor, particularly in term and postterm pregnancies, and is frequently associated with increased maternal and perinatal morbidity. The presence of meconium in the amniotic fluid is often viewed as a marker of fetal compromise, especially when thick or associated with abnormal fetal heart rate patterns. Timely identification and appropriate obstetric interventions are essential to mitigate adverse outcomes for both the mother and the neonate.

Aim: The aim of the study was to evaluate the maternal and perinatal outcomes associated with MSAF and to compare clinical parameters between thin and thick meconium consistency.

Methodology: This hospital-based observational study was conducted in the Department of Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College, Pimpri, Pune, over a period of 12 months from January 2023 to December 2023. A total of 100 term pregnant women with singleton pregnancies in labor and documented MSAF were included. Patients were grouped based on meconium consistency into thin (n = 53) and thick (n = 47) MSAF categories. Maternal variables assessed included mode of delivery, duration of labor, and intrapartum complications. Neonatal outcomes evaluated were birth weight, Apgar score, neonatal intensive care unit (NICU) admission, and presence of meconium aspiration syndrome (MAS). Data were analyzed using SPSS version 22, and P < 0.05 was considered statistically significant.

Results: Among the 100 cases, 53% had thin meconium and 47% had thick meconium. Thick MSAF was significantly associated with higher rates of cesarean section, fetal distress, MAS, and NICU admissions compared to the thin MSAF group. A lower Apgar score at 1 and 5 min was also more frequently observed in the thick MSAF group. Instrumental deliveries were more common in the thin MSAF, while spontaneous vaginal delivery rates were lower in the thick MSAF subgroup.

Conclusion: The presence and consistency of meconium in amniotic fluid are important indicators of fetal compromise. Thick meconium, in particular, is significantly associated with adverse perinatal outcomes and a higher rate of obstetric intervention. Careful monitoring during labor and timely decision-making regarding the mode of delivery can help reduce maternal and neonatal complications associated with MSAF.

Background: Traditional rotating drills can cause bone overheating and damage to adjacent tissues. Piezoelectric osteotomy, a nonrotational alternative, has been suggested to overcome these limitations.

Aim: To evaluate the implant stability quotient (ISQ) values at 0, 2, 4, 8, and 12 weeks using a resonance frequency analyzer and to assess crestal bone loss at 3 and 6 months via periapical radiographs obtained using the paralleling cone technique.

Materials and methods: A total of 10 participants, each with at least two missing teeth in the maxillary anterior or premolar region (D2 or D3 bone quality), were enrolled in the study. Participants were randomly assigned to one of the two groups. Group 1 underwent osteotomy preparation using the piezoelectric osteotomy technique, whereas Group 2 received the conventional drilling technique. Implant stability was measured at baseline and at 2, 4, 8, and 12 weeks postsurgery, and crestal bone loss was evaluated at 3 and 6 months postimplantation.

Results: The analysis showed a statistically significant difference in implant stability between the two groups. At 12 weeks, the mean ISQ value in the piezoelectric group was 76.6 (±4.5) compared to 73.9 (±5.1) in the conventional group (P = 0.03). Secondary stability continued to improve in the piezoelectric group, whereas no significant change was observed in the conventional group. For crestal bone loss, no significant difference was found between the groups at 3 or 6 months (P = 0.25 and P = 0.18, respectively).

Conclusion: Piezoelectric osteotomy demonstrated a significant increase in implant stability up to 12 weeks postsurgery. This technique can be a reliable alternative to conventional drilling for osteotomy preparation.

Background: Acute cholecystitis (AC) is a common surgical emergency that can be managed either surgically or conservatively. However, identifying reliable predictors for treatment modalities is crucial in the clinical settings to optimize the patient outcomes. This study aimed to analyze risk factors, clinical presentation, and management modalities in patients with AC.

Materials and methods: This prospective observational study conducted over 2 years (January 2023-March 2025) enrolled 100 patients diagnosed with AC. Based on the treatment received, patients were categorized: Surgical (n = 42) and conservative treatment (n = 58) groups. Demographic, clinical, and laboratory data were collected and analyzed. Logistic regression was utilized to evaluate the predictive value of age, body mass index (BMI), leukocyte count, and total bilirubin levels for determining treatment modality and the need for surgery.

Results: The patients were predominantly females (59.0%) and mainly presented with abdominal pain (95.0%) and fever (90.0%). Age and BMI had no significant correlation (r = -0.0346, P = 0.733). The patients with treatment failure had significantly higher mean total bilirubin (P = 0.031) and leukocyte count (P = 0.022) compared to those with treatment success. Age (P = 0.719) and BMI (P = 0.506) were not the significant predictors of treatment modality. However, leukocyte count (P = 0.001) and total bilirubin levels (P = 0.006) were the significant predictors of the need for surgical intervention.

Conclusion: Demographic factors such as age and BMI are not significant predictors of treatment choice in AC, while high leukocyte counts and raised total bilirubin levels are significant predictors of need for surgery.

Abstract: Cervical swellings in adults are commonly evaluated for metastatic or infective etiologies. Vascular lesions such as cavernous hemangiomas are extremely rare in the carotid region and can pose significant diagnostic challenges. We report a 63-year-old female presenting with a left-sided neck swelling, clinically and radiologically suspected to be cervical lymphadenopathy. Fine-needle aspiration cytology was inconclusive. Intraoperatively, the lesion was identified as a pulsatile vascular mass near the carotid bifurcation. Complete excision was performed, and histopathological examination confirmed a cavernous hemangioma. Nontraumatic cavernous hemangioma of the carotid region is an exceptionally rare entity that can closely mimic lymphadenopathy. A high index of suspicion, careful intraoperative assessment, and histopathological confirmation are essential for accurate diagnosis and safe management.

Abstract: Families caring for children with autism spectrum disorder (ASD) often encounter persistent stress, stigma, and limited support systems. Despite these challenges, many demonstrate resilience-the capacity to adapt and sustain well-being under adversity. This integrative review synthesizes conceptual frameworks and interventions designed to strengthen family resilience in ASD caregiving. A systematic search across PubMed, Scopus, CINAHL, and Google Scholar (2000-2025) yielded 55 eligible studies. Seven resilience models were identified: protective factors, transactional, ecological systems, CARE, mindfulness-based stress reduction, Triple-A, and strengths-based approaches. Interventions informed by these models produced measurable benefits, including reductions in parental stress and caregiver burden, alongside gains in family cohesion, psychological health, and quality of life. The review underscores the importance of culturally adapted, multidisciplinary, and scalable resilience-building strategies, while calling for standardized evaluation tools and policy integration to ensure sustainable support for families raising children with ASD.

Introduction: Monitored anesthesia care (MAC) combines local anesthesia with sedoanalgesia to maintain patient comfort and hemodynamic stability. This study aimed to compare the analgesic efficacy, sedation quality, and hemodynamic changes between clonidine and midazolam-fentanyl combinations during varicose vein surgery and to assess the effect of catechol-O-methyltransferase (COMT) gene polymorphism (rs4680) on postoperative pain modulation.

Materials and methods: In this prospective, randomized controlled trial, 50 American Society of Anesthesiologists I-II patients were equally divided into two groups. Group I (clonidine) received 2 μg/kg bolus followed by 0.2 μg/kg/h infusion, while Group II (midazolam-fentanyl) received 0.06 mg/kg midazolam and 1 μg/kg fentanyl followed by 0.2 mL/kg/h infusion. Hemodynamic variables, pain scores (Visual Analog Scale [VAS]), sedation (Ramsay and Observer's Assessment of Alertness/Sedation), and recovery (Aldrete) were assessed. The COMT rs4680 polymorphism was genotyped using polymerase chain reaction-restriction fragment length polymorphism.

Results: Baseline characteristics were comparable (P > 0.05). Mean heart rate (HR), systolic, diastolic, and mean arterial pressures (MAPs) were significantly lower in the clonidine group at 10-60 min intraoperatively (e.g. HR: 70.04 ± 3.77 vs. 78.60 ± 2.97 beats/min; P < 0.001; MAP: 79.88 ± 7.48 vs. 91.29 ± 4.88 mmHg; P < 0.001). Postoperative VAS scores were consistently lower in the clonidine group at 6 h (0.44 ± 0.87 vs. 2.84 ± 1.43; P < 0.001), 12 h (0.00 ± 0.00 vs. 1.60 ± 1.26; P < 0.001), and 18 h (0.00 ± 0.00 vs. 0.84 ± 0.90; P < 0.001). Rescue analgesia was required in 32% versus 56% of patients, respectively (P = 0.114). Respiratory distress occurred only in the midazolam-fentanyl group (16%; P = 0.037). COMT genotypes (CT = 54%, TT = 46%) showed no significant association with pain intensity (P > 0.05).

Conclusion: Clonidine-based MAC provided better intraoperative hemodynamic stability, prolonged analgesia, and reduced postoperative pain compared with midazolam-fentanyl, with minimal respiratory complications. The COMT rs4680 polymorphism did not significantly influence pain perception, highlighting the multifactorial nature of postoperative analgesic response.

Abstract: A 45-year-old woman who comes with complains of recurrent paradoxical loose stools and abdominal distension for 3 days. She had type II diabetes, schizophrenia, and a history of left below-knee amputation. While there was no indication of a mechanical blockage, imaging tests revealed paralytic ileus. A potentially fatal gastrointestinal side effect that is frequently associated with anticholinergic drugs, such as clozapine, is paralytic ileus. Full recovery was achieved with conservative treatment and a reduction in the dosage of clozapine. This instance highlights how important it is to identify and treat drug-induced gastrointestinal dysmotility as soon as possible.