Annals of African Medicine最新文献

Abstract: The coexistence of multiple complex congenital cardiac anomalies in a single infant - particularly unbalanced Atrioventricular Septal Defect; Double Outlet Right Ventricle; Infracardiac Total Anomalous Pulmonary Venous Connection, situs inversus, and pulmonary hypertension - is exceptionally rare and presents significant surgical and physiological challenges. A full-term male neonate was diagnosed at 25 days of age with this rare combination of defects. Despite low-flow oxygen, the baseline oxygen saturation remained at 60%-65%, and growth was severely impaired. Initial management at a tertiary center included diuretics, captopril, and high-calorie feeding, with discharge on home oxygen therapy. Recurrent cyanotic spells worsened, leading to readmission at 7 months due to profound hypoxemia (SpO2 35%). Escalated respiratory and nutritional support, along with optimized heart failure therapy, achieved only transient stability. Two multidisciplinary teams concluded that local surgical or palliative options were infeasible and recommended urgent referral to a supraregional center for treatment. Before transfer could occur, the infant suffered a terminal cyanotic spell at 8 months. Resuscitation efforts were unsuccessful, and the infant succumbed to death at 8 months of age. This case illustrates how anatomical and physiological complexity, coupled with limited regional surgical infrastructure, can preclude curative repair. Early antenatal or neonatal detection, rapid multidisciplinary coordination, and timely transfer to specialized cardiac centers are essential for improving survival in such cases.

Abstract: Brucellosis is a common zoonotic disease, yet pulmonary involvement is rare and often mimics tuberculosis or malignancy. We report the case of a 62-year-old woman with diabetes and chronic hookah use presented with persistent fever and cough. Imaging revealed right lower lobe cavitary consolidation with bilateral nodules. Even after extensively investigating, her diagnosis was inconclusive. A detailed dietary history revealed raw milk consumption, while serology confirmed brucellosis. She improved with doxycycline, rifampicin, and streptomycin therapy. This case highlights the diagnostic challenge of pulmonary brucellosis in nonendemic areas and underscores the importance of thorough history and appropriate serological testing.

Context: Triglyceride (TG) accumulation and insulin resistance (IR) are the hallmarks of nonalcoholic fatty liver disease (NAFLD). The triglyceride glucose (TyG) index may serve as an important risk factor for both hepatic steatosis and liver fibrosis in individuals with NAFLD.

Aims: This study was undertaken to assess the TyG index in patients with NAFLD and to study its correlation with the disease severity.

Settings and design: This cross-sectional study spanning over 18 months was conducted in the department of Medicine at a tertiary care teaching hospital.

Materials and methods: The study enrolled 105 adult NAFLD patients in whom the TyG index was calculated and correlated with serum transaminases and liver elastography measurements.

Statistical analysis used: Descriptive statistics were calculated for all variables, including mean and standard deviation for continuous variables, and frequency and percentage for categorical variables. Pearson or Spearman correlation coefficients were computed to evaluate the relationships between the TyG index and continuous variables such as liver elastography and transaminases.

Results: The mean TyG index was 9.34 ± 0.41. A significant and positive correlation was observed between TyG and liver transaminases (aspartate transaminase: r = 0.53 and alanine transaminase: r = 0.46). The mean liver stiffness measurement (LSM) on liver elastography was 6.04 ± 2.54 kPa. A significant positive correlation was observed between TyG and LSM ( r = 0.71).

Conclusions: TyG is an inexpensive, simple, and easily available surrogate marker of IR, which has statistically significant positive correlation with both serum transaminases and LSM. Thus, TyG may serve as a novel biomarker for predicting disease severity in NAFLD patients.

Background: Acute pancreatitis (AP) is a common gastrointestinal emergency with variable outcomes. Early prediction of severity is essential for triage and timely intervention. Among scoring systems, the Bedside Index of Severity in Acute Pancreatitis (BISAP) and Ranson's criteria are widely validated, but their comparative performance in Indian cohorts requires further evaluation.

Aims and objectives: To assess the clinical profile of AP in a tertiary care hospital and to compare the efficacy of BISAP and Ranson's scores in predicting severity, complications, and mortality.

Materials and methods: This hospital-based prospective observational study was conducted between September 2024 and March 2025, including 100 consecutive AP patients. Etiological factors, clinical features, complications, and outcomes were recorded. BISAP and Ranson's scores were calculated within 24 h of admission. Statistical analysis determined sensitivity, specificity, predictive values, and diagnostic accuracy for organ failure, necrosis, and mortality.

Results: Alcohol (48%) and gallstones (32%) were the leading causes. Complications included necrosis (12%), acute renal failure (8%), and MODS (5%). Mortality was 4%. BISAP ≥3 predicted organ failure with sensitivity 82.14% and specificity 88.37%, while Ranson's >3 had sensitivity 78.57% and specificity 82.56%. BISAP also demonstrated higher positive predictive value (65.22% vs. 55%) and diagnostic accuracy (86% vs. 81%).

Conclusion: BISAP score is a reliable, simple, and early prognostic tool with modestly better sensitivity and specificity than Ranson's score. BISAP ≥3 identified all deaths and most necrosis cases, suggesting its utility for early risk stratification and intensive monitoring in Indian clinical settings.

Abstract: This case report presents an emergency surgical technique for managing a traumatic sealed corneal perforation in a young adult male, utilizing a sterile polydrape patch and cyanoacrylate glue. The objective was to showcase a straightforward, low-cost solution that can be especially useful in situations where donor corneal tissue is not readily available, such as in resource-limited environments or urgent care scenarios. A 22-year-old male sustained an ocular injury at his workplace following an accident involving a hand saw machine. He arrived with complaints of sudden visual decline, ocular pain, redness, and excessive tearing in his left eye. On clinical examination, a 4 mm × 3 mm sealed corneal perforation with pseudocornea was identified in the inferior quadrant, accompanied by a shallow anterior chamber and hypotony. Given the emergency and lack of access to corneal graft material, a temporary globe-sealing procedure was undertaken. A section of sterile surgical polydrape was punched into a 4 mm circular patch and carefully positioned over the perforation site. It was secured using N-butyl-cyanoacrylate glue, followed by the application of a bandage contact lens to enhance patient comfort and protect the surgical site. The patient's recovery was uneventful. At the 1-month review, the cornea had healed with a leucomatous scar at the perforation site. The anterior chamber was well maintained, and there were no signs of infection or persistent inflammation. In emergency settings or regions with limited access to donor corneas, the combination of a sterile polydrape patch and cyanoacrylate adhesive provides an effective and accessible method to restore globe integrity. This approach not only stabilizes the eye but also creates a critical window for healing or referral for definitive surgical management. It is a valuable interim solution, particularly in rural or under-resourced healthcare environments.

Introduction: Diabetes mellitus is a metabolic syndrome characterized by hyperglycemia and disturbances in the metabolism of carbohydrates, proteins, and lipids. Taste and smell may influence the acceptance or rejection of food, and abnormalities in taste and smell receptors are known to influence the intake of specific foods, thus increasing the risk of obesity, diabetes, and metabolic syndrome.

Aim: To estimate the random blood sugar (RBS) levels, assess the taste and smell perception in type II diabetic patients and healthy individuals.

Materials and methods: This study was carried out in 120 individuals (Group A-60 type II diabetics and Group B-60 healthy individuals). Blood samples of 120 participants were collected, and RBS levels were measured. The smell test was conducted by Sniffin's sticks test using six commercially available scent-tip pens. The taste test was conducted by soaking sterile cotton pads in 4 different solutions (quinine sulfate, sucrose, sodium chloride, and citric acid) and applying them over the dorsum of the tongue one after the other, and the results were recorded.

Results: Among the 120 subjects, Group A subjects showed reduced taste identification than the Group B subjects. A highly statistically significant difference was found in age, smell, and RBS (mg%) between Group A and Group B. Furthermore, among the two groups, impairment of taste identification was higher in the group A subjects. There was a statistically significant association in the identification of sweet, salt, and sour taste among the Group A and Group B subjects.

Conclusion: From the results of the study, we infer that the identification of smell, salty, sweet, and sour taste was impaired in type II diabetic patients.

Background: Parturients are concerned regarding the method of delivery. In this study, we are comparing the serum interleukin-6 (IL-6) levels and maternal and neonatal infection rate between parturients undergoing vaginal or cesarean delivery.

Methods: This prospective study was conducted on 60 parturients undergoing normal delivery or elective cesarean delivery. Parturients were delivered as per institutional protocol. Maternal blood samples for assessment of serum IL-6 were collected within 10 min of delivery of the baby.

Results: On comparing the serum IL-6, there was a significant difference with parturients undergoing normal delivery having higher values than cesarean delivery (73.35 ± 52.29 vs. 9.97 ± 26.49, P < 0.001). On comparing the incidence of maternal infection, cesarean section parturients had a higher incidence (10.0%) than vaginal delivery (3.3%), with P = 0.612, which is not statistically significant. When neonatal infection was compared, 6.7% in the normal delivery group and 16.7% in the cesarean group had infection, which was not statistically significant with P = 0.424.

Conclusion: Our study demonstrates that vaginal delivery is associated with significantly higher serum IL-6 levels compared to cesarean delivery. While we did not find a statistically significant difference in the incidence of maternal or neonatal infections, the numerically higher rate of infection in the cesarean group was noted. The higher IL-6 levels in vaginal delivery may be beneficial for both parturients and newborns. Further research is warranted to fully elucidate the long-term significance of these observed differences and their impact on maternal and child health.

Introduction: Lateral epicondylitis, commonly known as tennis elbow, is a prevalent musculoskeletal condition affecting 1%-3% of the population, with a higher incidence among athletes and manual laborers. It impairs quality of life, reduces productivity, and imposes economic burden on healthcare systems.

Aim: This study aimed to compare the efficacy of dry needling after lignocaine infiltration versus local corticosteroid injection in managing lateral epicondylitis.

Methodology: This hospital-based, prospective, randomized comparative study was conducted over 18 months in the orthopedics department of a tertiary care hospital. Forty-five patients over 18 years with lateral epicondylitis unresponsive to 3 weeks of conservative treatment were randomized into two groups. Group A (n = 21) received dry needling after lignocaine infiltration with 2-3 sterile needles inserted at the point of maximum tenderness, administered twice weekly for four sessions. Group B (n = 24) received a single injection of 40 mg triamcinolone acetate with 2% lignocaine. Outcome measures included patient-rated tennis elbow evaluation (PRTEE) scores, grip strength, numeric pain rating scale, and pain pressure threshold (PPT), assessed at baseline, 1 month, and 3 months.

Results: Baseline characteristics were comparable. At 3 months, Group A showed significantly better outcomes: lower PRTEE scores (27.1 vs. 37.1, P < 0.001), higher grip strength (49 kg vs. 40.8 kg, P < 0.001), lower pain scores (2.1 vs. 3.1, P < 0.001), and higher PPT (5.6 vs. 4.7 kg/cm2, P < 0.001). Recurrence occurred in 8.3% of Group B, with none in Group A.

Conclusion: Dry needling after lignocaine infiltration is superior to steroid injection in lateral epicondylitis, with better clinical outcomes and lower recurrence at 3-month follow-up.

Purpose: To evaluate the demographic profile, clinical presentation, type of retained nonmetallic periocular foreign bodies (FBs), and treatment outcomes.

Methods: This retrospective observational study reviewed the hospital records of 23 patients who presented with periocular nonmetallic FBs between January 2021 and December 2024. Data collected included demographic details, etiology, type and location of foreign body, clinical presentation, microbiological culture results, surgical approach, and outcomes. Descriptive statistics were used for the analysis.

Results: The majority of patients were males accounting for 73.9%, with a mean age of 29.5 years. The right eye was more commonly involved, with no bilateral cases. Wooden sticks were the most common foreign body observed in 60.86%, followed by stone, plastic, and glass. The most frequent clinical presentation was lacerated lid injury in 47.8%. Culture was positive in 39.1% and was dominated by Gram-positive cocci. Only two patients developed scarring on long term, otherwise no major complications were noted.

Conclusions: Nonmetallic periocular FBs, especially organic ones such as wood, can pose a high risk of infection but generally have a favorable prognosis if managed early. Early diagnosis remains crucial to prevent rare but serious complications.

Background: Isolated greater tuberosity (GT) fractures constitute approximately 20% of proximal humeral fractures and predominantly affect younger, active individuals. While minimally displaced fractures respond well to conservative treatment, displacement exceeding 5 mm often results in subacromial impingement and rotator cuff dysfunction, necessitating surgical intervention. Despite various fixation techniques available, optimal management remains debated. This study evaluates the functional and radiographic outcomes of a low-profile anatomical locking plate specifically designed for GT fractures.

Methodology: This prospective study, conducted from June 2023 to November 2024, included 30 patients with displaced isolated GT fractures treated surgically using a low-profile anatomical proximal humerus GT plate via a deltoid-splitting approach. Patients were followed clinically and radiographically at regular intervals up to 6 months. Functional outcomes were assessed using the Constant-Murley Score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) score, and Visual Analog Scale (VAS) for pain. Range of motion and complications were documented.

Results: The mean patient age was 42.6 ± 10.3 years with male predominance (60%). Mean fracture displacement was 6.7 ± 1.5 mm superiorly and 7.9 ± 1.8 mm posteriorly. Surgery was performed at a mean of 4.6 ± 1.2 days postinjury with an operative time of 65.2 ± 8.5 min. At final follow-up (mean 17.2 ± 4 months), the mean ASES score was 81.3 ± 9.4, constant score improved from 41.6 at 1 month to 75.8 at 6 months, DASH score decreased from 48.5 to 14.2, and VAS reduced from 5.8 to 1.8. All fractures achieved union. Complications included restricted abduction in 10% and superficial infection in 3.3%, with no implant failures.

Conclusion: Low-profile anatomical locking plates provide excellent functional outcomes, reliable fracture healing, and minimal complications in displaced GT fractures, representing a dependable surgical option facilitating early mobilization and functional recovery.