Annals of African Medicine最新文献

Background: Laparoscopic surgery, a minimally invasive technique, is preferred due to its rapid recovery and minimal incisions. However, postsurgery port site infection (PSI) is a rare complication that can increase patient morbidity and damage the surgeon's reputation. The effectiveness of laparoscopic surgery depends on advancements in sterilization and surgical techniques. This current study aimed to evaluate the port site infections after laparoscopic cholecystectomy, identify contributing variables, and ascertain which factors are amenable to modification to avoid infections and optimize the benefits of laparoscopic surgery, thereby improving patient outcomes.

Methodology: This prospective observational study, including 138 participants having elective laparoscopic cholecystectomy, was done over 1 year, from January 1 to December 31, 2021, at a tertiary care hospital.

Results: We observed the port site infection rate in 6 of 138 participants (4.3%). Male patients showed increased rates, with infections occurring in three of 13 (23%, χ² =0.218; P = 0.641) cases when bile, stones, or pus spilled, and in 4 of 6 (66.7%, χ² =012.105; P = 0.001, a significant association) cases at the epigastric port. The majority of the port site infection (PSI) were superficial, accounting for 83.3%, with nonspecific bacteria identified in 5 out of 6 cases (83.3%).

Conclusion: The majority of PSIs were superficial and more common in males; one participant experienced a mycobacterial infection; there is a significant association between port site infection and pus, stones, or bile spilling through the port used for gallbladder extraction. Chronic deep surgical site infections require special consideration because Mycobacterium tuberculosis may be the cause.

Aim: The aim of the study was to evaluate the efficacy of cognitive-behavioral play therapy (CBPT) and Tell-Show-Do (TSD) technique in the behavior modification of uncooperative children during restorative procedures using airotor.

Materials and methods: Sixty-two children (6-11 years) with dental caries (international caries detection and assessment system score 3) requiring restorations without local anesthesia, were divided into two groups: Group I - CBPT, and Group II - TSD. Children in Group I were introduced to the dental instrument using verbal explanations and a demonstration on a customized toy. They were then allowed to role-play as the dentist on the customized toy. Children in Group II received an explanation and a demonstration of the procedure before undergoing it. The behavior and anxiety levels of the children were assessed at three different points during the course of the trial. Pulse rate record served as an objective measure of anxiety.

Results: The intergroup comparison of the behavior and anxiety scores between Group 1 and Group 2 exhibited a significant difference in the posttreatment scores. Group 1 showed a greater improvement in the behavior and anxiety scores in comparison to Group 2.

Conclusion: The CBPT by way of role-play promotes a change in the cognitive and behavioral patterns of children in the dental clinic.

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.

Background: Hypothyroidism in mothers can lead to premature labor and problems in the newborn. However, the impact on neonatal outcomes, including respiratory distress syndrome (RDS) and hospitalization, is unclear.

Objective: To investigate the association between maternal hypothyroidism and preterm labor and its impact on neonatal outcomes, particularly RDS and neonatal health, in a group of pregnant women with spontaneous preterm labor.

Materials and methods: This prospective case-control study at King George's Medical College, Lucknow, studied 509 pregnant women with spontaneous preterm labor between 28 and 37 weeks for 1 year and 6 months. The study included 69 hypothyroid women and 431 euthyroid women as a control group. Maternal thyroid function was measured by measuring thyroid-stimulating hormone (TSH), T3, T4, and anti-thyroid peroxidase (anti-TPO) antibodies. Neonatal outcomes included birth weight, gestational age, RDS, and cord blood TSH. SPSS 25.0 was used for t -tests, Chi-square tests, correlation analyses, and logistic regression.

Results: Preterm labor was more likely in hypothyroid mothers than in euthyroid mothers. The newborns of hypothyroid mothers, especially those with subclinical hypothyroidism, were more likely to have RDS, require treatment in the neonatal intensive care unit (NICU), and need advanced ventilatory support. Babies born to hypothyroid mothers had a higher TSH level in the umbilical cord blood. Thyroid dysfunction in mothers was associated with longer hospital stays in the NICU and a higher need for oxygen treatment in babies.

Conclusion: Preterm labor and poor neonatal outcomes are associated with maternal hypothyroidism, especially with subclinical levels. Recognizing and treating maternal thyroid dysfunction during pregnancy may improve neonatal health and reduce RDS and intensive care unit stays.

Abstract: Although gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal tract, they are the most common mesenchymal tumors of the gastrointestinal tract. The majority of these tumors occur in the stomach, but they could be found anywhere along the gastrointestinal tract. A 72-year-old man presented with a large intra-abdominal mass. A Tru cut biopsy revealed features of a GIST. He underwent a resection of the intra-abdominal mass along with a partial gastrectomy and splenectomy. His postoperative course was uneventful.

Abstract: Malignancy at the gastrojejunostomy site, though rare, is a recognized long-term risk factor of the procedure. Such malignancies, though uncommon, pose diagnostic and therapeutic challenges. We report a case of a 63-year-old male presenting with a rare complication of gastric carcinoma at the loop gastrojejunostomy site 30 years after surgery for duodenal ulcer-induced gastric outlet obstruction. The patient's symptoms included chronic intermittent upper abdominal pain, postprandial bilious vomiting, significant weight loss, and anorexia. The diagnosis was established through imaging and endoscopic biopsy, revealing a poorly differentiated carcinoma. Following preoperative optimization, the patient underwent subtotal radical gastrectomy with Roux-en-Y reconstruction with D2 lymphadenectomy. Histopathology confirmed poorly cohesive gastric carcinoma (signet ring cell type) with extensive lymph node metastasis (pT4a pN3a M0). Postoperative recovery was uneventful, and the patient was discharged on a CAPEOX regimen for adjuvant chemotherapy. This case highlights the importance of vigilance in patients with long-standing gastrojejunostomy, given the risk of malignancy at the anastomotic site.

Background: Tuberculosis (TB) remains a significant global public health issue. In Tanzania, TB prevalence and incidence rose by 2.1% and 2.3%, respectively, from 2020 to 2021. Current public health strategies focus mainly on HIV/AIDS-related TB, often neglecting other immunosuppressive conditions. This study aimed to assess the prevalence of immunosuppressive conditions beyond HIV in TB patients and explore their interactions.

Materials and methods: A retrospective observational study was conducted among TB patients admitted to or attending the TB clinic at Mbeya Zonal Referral Hospital, Mbeya City, southwestern Tanzania, from January 1, 2021, to February 29, 2024. Data were collected through comprehensive medical history reviews. Immunosuppressive factors were assessed in confirmed TB cases, particularly those present before TB diagnosis. Statistical analyses were performed using STATA version 17, with significance set at P ≤ 0.05 and a 95% confidence interval.

Results: A total of 322 TB patients with a mean age of 48 ± 20.8 years (range 2-92) were included. Among them, 38.2% were diagnosed with HIV/AIDS, 20.2% had type 2 diabetes (T2D) mellitus, 5% were malnourished, 3.7% had a history of prolonged corticosteroid use (>6 weeks), and 3.1% had cancer or were undergoing chemotherapy before TB diagnosis. HIV infection was significantly associated with T2D (χ 2 = 50.17, P < 0.001), cancer (χ 2 = 6.25, P = 0.01), prolonged corticosteroid use (χ 2 = 3.82, P = 0.05), and malnutrition (χ 2 = 3.73, P = 0.05). A total of 74.2% of TB patients had one or more immunosuppressive conditions prior to TB diagnosis, with 36% having additional factors beyond HIV/AIDS.

Conclusions: HIV/AIDS is still a major immunosuppressive factor associated with TB development. However, other immunosuppressive conditions also contribute significantly to TB risk. Public health strategies should address these factors alongside HIV/AIDS to reduce the TB burden.

Background: Subaxial cervical spine injuries (C3-C7) are common and often require stabilization due to their proximity to vital neurovascular structures. Posterior cervical spine surgery now commonly uses a lateral mass screw and rod fixation because of its biomechanical stability and versatility. This study aims to evaluate the long-term outcome and complications of this technique in tackling subaxial cervical spine pathologies.

Materials and methods: A 3-year prospective observational study conducted at our hospital on 50 adult patients with subaxial cervical spine instability was carried out. The parameters recorded included preoperative, intraoperative, and postoperative information, and results obtained regarding fusion and hardware placement were assessed at 3 and 6 months post surgery. The Frankel grading system was used for neurologic assessment; the radiologic outcomes were fusion rates and placement of the hardware.

Results: The mean age of the patients was 47 years (68% of males), and a majority of cases (56%) were from trauma. At 6 months, 62% of the patients showed improvement in neurological condition - 20% in fully recovered (Grade E) condition. The overall fusion and success rates of hardware position were 88% and 96%, respectively. The complications included 4% with superficial infection and 6% transient radiculopathy, which were rare. Misplacement of screws occurred in 2%, and all caused minor neurological deficiencies.

Conclusion: Our study has supported lateral mass screw and rod fixation as an effective and reliable technique of stabilization of the subaxial cervical spine with substantial neurological recovery and a very low complication rate.

Background: Neglected hip dislocation in adult is relatively a rare entity but not so uncommon in the developing world due to many factors including lack of awareness, poor socioeconomic status, illiteracy, poor transportation, distant location from towns, lack of well-equipped hospitals, and skilled medical personnel. Its management becomes challenging as close reduction becomes almost impossible and there are increased chances of avascular necrosis (AVN) of the femoral head and so arthritis of hip joints later on. There is no clear-cut management protocol available in the literature regarding it. Some orthopedician prefer open reduction of hip joint and some prefer total hip arthroplasty (THA).

Case characteristics: In our series of 3 cases, One patient who had neglected hip dislocation of 2 months duration without AVN changes in magnetic resonance imaging (MRI) underwent open reduction, whereas another two cases with neglected hip dislocation of more than 3 months durations (12 months and 6 months) undergone primary THA.

Conclusion: Primary THA should be done in neglected hip dislocation of duration more than 3 months but the open reduction of the hip joint can be tried if the duration of dislocation is <3 months without AVN changes of the femoral head in MRI.

Abstract: Skeletal tuberculosis (TB) accounts for only 10% of extrapulmonary TB and predominantly involves the spine and joints. Sternal involvement in TB is a rare clinical occurrence. The clinical presentation is indolent with localized swelling and pain over the sternum. Other less common manifestations are discharging sinuses, ulcers, and bone deformities. Magnetic resonance imaging can delineate the extent of bone and soft tissue involvement well. The diagnosis is established by cytopathological or histopathological examination along with microbiological evidence of Mycobacterium tuberculosis . Treatment with a standard anti-TB regimen provides excellent outcomes. Here, we report a case of primary tubercular osteomyelitis of the sternum that presented as a chronic ulcer over the suprasternal notch.