Annals of African Medicine最新文献

Background: The incidence of postoperative urinary retention (POUR) may also vary based on the type of anesthesia provided to the patient. This study aims to evaluate the occurrence of POUR developing following unilateral and bilateral spinal anesthesia.

Methods: The analysis was summarized by frequency, percentage, mean, and standard deviation. The demographic data and the contributing factors between the two groups were analyzed by Student's t -test. The symptoms of retention were compared using the Chi-square test, and the rescue intervention used between the two groups was studied using the Fisher's exact test. Statistical significance was established with P < 0.05.

Results: The patients were sorted into two groups: Unilateral and bilateral spinal anesthesia groups. Two patients who underwent orthopedic procedures under unilateral spinal anesthesia and eight patients under bilateral spinal anesthesia developed POUR. The mean age, duration of surgery, the intravenous fluids administered, symptoms of retention, need for rescue intervention, and the presentation of symptoms of retention were nil significant between the two groups. The presentation of symptoms of retention was significant with respect to the time taken to void in both the groups.

Conclusion: There is a similar proportion of occurrence of POUR between unilateral and bilateral spinal anesthesia in patients undergoing orthopedic procedures.

Abstract: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide with a substantial economic burden. It is driven by the intricate pathophysiology of insulin resistance (IR), which has been shown to disrupt glucose and lipid metabolism, vascular function, and drive inflammatory pathways, further accelerating the development and progression of CVD. The triglyceride-glucose (TyG) index, which was first proposed in 2008, has demonstrated strong correlations with the more traditional markers reserved for research settings, namely the hyperglycemic-euglycemic clamp and the homeostatic model assessment of IR. Studies have shown that the TyG index independently predicts cardiovascular outcomes in diabetic and nondiabetic individuals, supporting its potential as a practical tool for cardiovascular risk assessment in patients with or without known metabolic disorders and those that existing risk stratification models would otherwise miss. Several randomized control trials, cohort studies, and meta-analyses performed to date have identified the value of this index in identifying coronary artery calcification, acute coronary syndromes, major adverse cardiovascular and cerebral events and heart failure risk. In this summative review, we explore how incorporating the TyG index into general clinical practice would help identify high-risk individuals more effectively and earlier in the course of their disease, and consequently improve patient outcomes.

Background: Choosing a medical specialty is a crucial decision influenced by factors such as personal interest, job opportunities, stability, patient variety, lifestyle, and financial incentives, with gender also playing a role. This study explores factors affecting Arab medical students' preference for cardiology, aiming to address the shortage of cardiologists amidst a high prevalence of cardiovascular diseases in the region and to promote interest in this specialty.

Methods: A cross-sectional study was conducted across Saudi Arabia, Sudan, Egypt, Syria, Jordan, and Algeria. A total of 391 clinical-year medical students completed a structured questionnaire covering demographics, specialty preferences, and influencing factors. Data were analyzed using SPSS.

Results: Participants were predominantly aged 18-24 (68.5%) with a balanced gender distribution (57.5% males). While many had completed rotations in internal medicine (81.8%), fewer had done so in cardiology (45.3%). About 47.1% expressed interest in cardiology. Key factors influencing interest included intellectual appeal, salary, national need, scholarship opportunities, and hands-on work. Significant predictors of cardiology interest were completing a cardiology rotation and valuing long-term patient relationships, hands-on work, and intellectual challenges ( P < 0.001, P = 0.02, P = 0.04, respectively). Gender, marital status, and children were not significant predictors.

Conclusions: Despite the high prevalence of cardiovascular diseases and the shortage of cardiologists, interest in cardiology among Arab students is promising, exceeding some global trends. Enhancing hands-on experiences, promoting cardiology rotations, and emphasizing cardiology's intellectual and practical aspects may further boost interest. Future research should investigate educational strategies to promote pursuing a career in cardiology.

Background: Laryngoscopy and endotracheal intubation are essential for airway management but provoke a transient pressor response characterized by hypertension and tachycardia. This reflex sympathetic stimulation can pose significant risks to patients with cardiovascular comorbidities.

Objectives: To evaluate the efficacy of ultrasound-guided bilateral superior laryngeal nerve block (SLNB) using 2% lidocaine in attenuating hemodynamic responses and reducing postoperative airway complications during elective surgeries under general anesthesia.

Methodology: This randomized double-blind controlled study included 234 adult patients aged 18-60 years with American Society of Anesthesiologists I and II physical status, divided into Group-L (lidocaine, n = 117) and Group-N (normal saline, n = 117). Hemodynamic parameters-heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)-were recorded at baseline, postinduction, and at defined intervals postlaryngoscopy and intubation. Postextubation complications, including cough, hoarseness, and sore throat, were assessed at 0, 2, 6, and 24 h.

Results: Group-L showed significantly attenuated HR, SBP, DBP, and MAP compared to Group-N ( P < 0.001 at all-time points). Postoperative airway complications were significantly lower in Group-L immediately postextubation ( P < 0.05) but comparable between groups at 6 and 24 h.

Conclusions: Ultrasound-guided SLNB effectively attenuates the pressor response to laryngoscopy and intubation and reduces immediate postoperative airway complications. This technique offers a safe and effective strategy for haemodynamic stability in perioperative care.

Background: The admission of a newborn to the neonatal intensive care unit (NICU) is a highly emotional and challenging experience for parents, often leading to significant stress, delayed parent-infant bonding, and emotional strain.

Materials and methods: A cross-sectional study was conducted at a tertiary hospital to assess stress levels and coping strategies among 130 parents of neonates admitted to the NICU for more than 2 days. An enumerative sampling technique was used to select participants. Stress was assessed using a three-point Likert scale (25 items) and coping strategies were assessed using a similar three-point Likert scale (30 items). Data were collected through face-to-face interviews.

Results: The study found that 53.1% of parents reported mild stress, 35.4% experienced moderate stress and 11.5% reported severe stress, with an overall mean stress score of 18.85 ± 8.25. The emotional and socioeconomic domains had the highest stress scores. Regarding coping strategies, 71.5% used partially adaptive strategies, 16.9% used adaptive strategies and 11.5% used maladaptive strategies, with an overall mean score of 28.40 ± 2.5. A significant positive correlation ( r = 0.811, P = 0.001) was found between stress and coping scores. Parental occupation was significantly associated with stress levels and religion was significantly associated with coping strategies at the 0.05 level.

Conclusion: The study highlights the stress experienced by NICU parents, with emotional and socioeconomic stressors being most prominent. Emotional and spiritual coping strategies were most common, emphasizing the need for targeted interventions by healthcare professionals.

Introduction: Diabetic peripheral neuropathy (DPN) is one of the most common and debilitating complications of diabetes mellitus, affecting approximately 50% of patients with long-standing disease. While hyperglycemia is the primary driver of nerve damage, emerging evidence suggests that dyslipidemia may also contribute significantly to the development and progression of neuropathy. This study aimed to evaluate the clinical profile, lipid abnormalities, and nerve conduction patterns in patients with DPN and to explore the potential correlations between these parameters.

Methodology: This cross-sectional study included 100 diabetic patients with clinical evidence of peripheral neuropathy. Comprehensive assessment included demographic data, diabetes history, clinical examination, metabolic parameters (fasting and postprandial blood glucose, glycated hemoglobin [HbA1c], and complete lipid profile), and nerve conduction studies of upper and lower limb nerves. Neuropathy was classified as motor, sensory, or sensorimotor based on clinical and electrophysiological findings, and severity was assessed using the Toronto Clinical Neuropathy Scale.

Results: The study population had a slight female predominance (54%) and uniform distribution across age groups. Type 2 diabetes constituted 88% of cases, with diabetes duration ranging from <5 to 20 years. Metabolic assessment revealed poor glycemic control in most patients (99% with fasting blood sugar >126 mg/dL, 100% with postprandial blood sugar >180 mg/dL, and 84% with HbA1c >7%) and high prevalence of lipid abnormalities (88% with hypertriglyceridemia and 90% with elevated low-density lipoprotein-cholesterol). Sensory symptoms (numbness 71% and tingling 62%) predominated over motor symptoms. Sensory neuropathy was the most common type (45%), followed by sensorimotor (32%) and motor neuropathy (23%). Nerve conduction studies showed greater involvement of sensory nerves, with upper limb nerves (median and ulnar) being more frequently affected than lower limb nerves. No statistically significant associations were found between lipid parameters and neuropathy types or severity, although trends were observed.

Conclusion: This study demonstrates a high prevalence of dyslipidemia and poor glycemic control in patients with DPN, with sensory neuropathy being the predominant type. While statistical associations between specific lipid abnormalities and neuropathy characteristics were not established, the remarkably high prevalence of lipid derangements suggests that they may contribute to the pathogenesis. A multifactorial approach to neuropathy management, addressing both glycemic control and lipid abnormalities, may be beneficial in reducing the burden of this complication.

Abstract: Tracheoesophageal fistula (TEF) is a rare yet severe complication of tuberculosis (TB), often leading to persistent symptoms, recurrent infections, and treatment failure. Its early recognition and appropriate management are crucial to improving patient outcomes. We report the case of a 24-year-old woman with pulmonary TB who presented with persistent fever, copious expectoration, and progressive weight loss despite receiving anti-tubercular therapy (ATT) for 3 months. She developed a right pneumothorax, requiring Malecot catheter insertion, and was referred to our institute due to poor treatment response. Differential diagnoses, including drug-resistant TB and malabsorption, were ruled out. Clinical suspicion of TEF arose due to worsening cough on swallowing. Bronchoscopy confirmed a TEF, five tracheal rings above the carina, measuring 7-8 mm in diameter. A computed tomography scan delineated its extent, and bronchoalveolar lavage analysis confirmed Mycobacterium TB. The patient was managed with nasogastric feeding, intravenous antibiotics, and ATT continuation. Her condition improved significantly within 10 days. TEF is a rare but serious complication of pulmonary TB that can significantly impact treatment success. Early recognition, nutritional support, and ATT continuation are crucial for improved outcomes and preventing complications this case underscores the importance of considering TEF in patients with persistent symptoms despite standard TB treatment.

Abstract: Dengue fever presents with a wide spectrum of clinical manifestations ranging from fever, rash, myalgia to myocarditis, encephalitis, etc. However, severe ocular involvement in dengue is less frequent, but if it occurs it can have devastating and long-lasting effects such as permanent vision loss. We present the case of a 35-year-old male with dengue fever complicated by acute, painful vision loss in the right eye and was diagnosed with acute congestive glaucoma leading to panophthalmitis. Timely diagnosis and prompt intervention in the form of enucleation of the affected eye saved his vision in the unaffected left eye.

Abstract: Filicide refers to an act in which a parent kills their child. It is a complex and multifaceted phenomenon observed globally. Despite widespread occurrence, the psychodynamics of filicides remain largely unexplored. Several aspects of this phenomenon are not always found in medical textbooks or journals. This case report intends to contribute to the patterns and findings of maternal filicides. Herein, we present a case of maternal filicide followed by suicide in a state in India. The mother smothered her son using a pillow before taking her own life. Therefore, the cause of death for both the mother and her child was associated with asphyxiation. This case emphasizes the integration of autopsy findings, crime scene analysis, and psychological evaluation of the deceased mental state before death for determining the cause and manner of death in these cases. Fibers obtained from the child's body on analysis matched with a pillow found at the crime scene. The presence of a suicide note provided a great insight into the mother's psychological state in this case. It is our opinion that reporting these events that occurred within the family leads us to understand the motivations and warning signs of maternal filicide and could prove beneficial in the pursuit of preventive child protection measures, as well as help provide early mental health intervention aside from aiding in the investigation into the cause and manner of such deaths.

Introduction: Chronic kidney disease (CKD) affects up to 15% of the global population, with cognitive impairment frequently reported in patients, particularly those undergoing hemodialysis (HD). The study aims to analyze cognitive performance differences between patients receiving conservative management and those on HD in India.

Materials and methods: This observational cross-sectional study was conducted between September 2021 and April 2023, involving 1214 end-stage CKD patients - 604 on conservative therapy and 610 on HD. Neurocognitive assessment tools included the abbreviated mini-mental state examination (MMSE), Addenbrooke's cognitive examination III (ACE-III), Grober and Buschke Test, Trail Making Tests, Stroop Test, and Boston Naming Test. Statistical analysis utilized the Wilcoxon and Chi-square tests for group comparisons.

Results: The HD group demonstrated significantly lower scores in the ACE-III visuospatial domain ( P = 0.00685) and verbal inhibitory control ( P = 0.011) assessed by the INECO frontal screening test. No significant differences were observed in global cognitive performance based on MMSE or other ACE-III domains. In addition, 16.7% of HD patients had deficient Stroop test scores, and 33.3% were unable to complete it due to visual difficulties.

Discussion: The findings highlight selective deficits in frontal-executive functions among HD patients, potentially reflecting subcortical and vascular pathophysiology due to hemodynamic stress and cerebral hypoperfusion. These results underscore the need for routine cognitive screening in CKD patients to guide treatment strategies.

Conclusion: Patients with end-stage CKD on HD exhibited significant impairments in executive function compared to those under conservative management. Incorporating neurocognitive evaluations into clinical practice can enhance treatment decision-making and improve patient outcomes.