Annals of African Medicine最新文献

Abstract: Endogenous endophthalmitis is an intraocular inflammation caused by the hematogenous spread of microorganisms from distant foci. Streptococcus mitis is a low-virulence organism that inhabits the oral cavity; however, it has rarely been reported to cause endogenous endophthalmitis. In this case report, we present a 63-year-old woman with bilateral asymmetrical endogenous endophthalmitis and a severely affected right eye, with light perception vision, hypotony, and severe anterior and posterior segment inflammation. The left eye exhibited intraretinal infectious infiltrates and minimal vitritis. However, the cause of the S. mitis bacteremia was unclear. Considering the patient's recent dental implant procedure, we hypothesized that the bacteria may have entered the bloodstream through the oral cavity. The patient received intravitreal and systemic antibiotics and underwent pars plana vitrectomy for the right eye. In conclusion, we present a case of endogenous endophthalmitis, presumed following a dental implant procedure. S. mitis may invade the bloodstream following an uncomplicated dental procedure, leading to bilateral endogenous endophthalmitis. Early detection, prompt management with systemic and intravitreal antibiotics, and early vitrectomy may potentially preserve the patient's globe and vision.

Introduction: Peptic ulcer disease (PUD) is a condition characterized by discontinuity in the gastrointestinal (GI) tract's inner lining, often caused by factors such as Helicobacter pylori infection and NSAID consumption. PUD can lead to various symptoms, but up to 70% of patients may not experience any symptoms. Diagnosing PUD can be challenging due to the unreliability of individual symptoms and signs. PUD can have serious complications if left untreated. Despite its significance, there is a lack of studies measuring the awareness of PUD among the population in Al-Ahsa, Saudi Arabia. Therefore, this study aimed to assess the level of awareness of PUD among the general population in Al-Ahsa.

Methodology: A cross-sectional study was conducted in Al-Ahsa, Saudi Arabia, from September to December 2023. The study included 399 adult residents of Saudi Arabia who agreed to participate. A convenient nonprobability sampling technique was used to collect data. An online self-administered questionnaire, distributed through social media platforms, was used to gather information on participants' awareness of PUD. The questionnaire included sociodemographic characteristics and questions related to PUD awareness. Data were analyzed using SPSS, and qualitative data were presented as numbers and percentages. The Chi-square test was used to examine qualitative data between the two groups.

Results: Of the 399 participants, 71.4% demonstrated a good level of knowledge regarding PUD, whereas 28.6% had a low level of knowledge. The sample consisted of nearly equal numbers of males and females, with participants aged 18-55+ years. The majority of participants had attained a bachelor's degree and were employed. The findings suggest a relatively high level of education among the study population.

Conclusion: The study highlights the need for increased public awareness of PUD in Al-Ahsa, Saudi Arabia. While some participants showed good knowledge of PUD, a significant number had low awareness. Educational initiatives are essential to improve understanding and knowledge of PUD among the community. By enhancing awareness, early detection and appropriate management of PUD can be promoted, resulting in improved health outcomes for individuals in Al-Ahsa.

Abstract: Postpartum pubic symphysis diastasis is a relatively rare entity. It is usually associated with cephalopelvic disproportion, macrosomia, multiparity, precipitate labor, difficult labor, difficult forceps delivery, any other pelvic bone pathologies, and underlying connective tissue disorders. Management is typically conservative in most cases, but surgical intervention is sometimes required in cases where pubic symphysis is >4 cm and not responding to conservative management. Case with more than 4 cm of pubic diastasis is usually associated with disruption of the symphyseal ligament, sacroiliac joint capsule, and ligaments. Surgical management promotes early ambulation with good functional recovery and decreases the chances of symphyseal sclerosis, functional disability, and chronic pain. Four female patients with postpartum pubic diastasis of more than 7 cm with an age ranging from 20 to 30 years underwent open reduction and internal fixation using plates and screws.In all four cases, the patient got early ambulation and full functional recovery without any pain, discomfort, and disability at 3 months of follow up. Although conservative management has been advocated for postpartum pubic diastasis typically, surgical intervention should be sought for significant pubic diastasis (more than 4 cm) to promote early full functional recovery and avoid chronic pain, functional disability, and symphyseal sclerosis.

Background: Successful weaning is a crucial element in care toward critically ill patients on mechanical ventilation. An attempt was made to propose and assess a reliable predictor of weaning outcome.

Materials and methods: A prospective observational study was conducted on 76 patients on mechanical ventilation, assessed by Acute Physiology and Chronic Health Evaluation II (APACHE II) score. For all these patients we calculate Rapid shallow breathing index (RSBI), Ultrasonographic diaphragmatic parameters namely diaphragmatic excursion (DEx), diaphragmatic thickening fraction (DTF) and diaphragmatic contraction velocity (DCV). Values were compared among patients with two groups of successful and failed weaning outcomes, respectively, and statistically analyzed.

Results: Of 76 patients included in the study, with ultrasonographic diaphragmatic parameters being measured 30 min into SBT, 71 patients tolerated spontaneous breathing test (SBT) for 2 h and were extubated. Of these, 61 patients did not require reintubation or any form of ventilatory support within 48 h after extubation. There was a statistically significant difference in APACHE II scores, duration of ventilation, oxygen saturation levels, RSBI, DEx, DTF, and DCV between groups of patients who showed successful and failed weaning from mechanical ventilation. There were a significant positive correlation between the duration of ventilation and the RSBI and a significant negative correlation between DEx, DCV, DTF, and duration of ventilation. As predictors of weaning outcome, RSBI showed the best validity, followed by DCV, DTF, and DEx.

Conclusion: RSBI can be reliably used as a predictor of weaning outcome in critically ill patients on mechanical ventilation.

Introduction: Airway management is an integral part of general anesthesia, allowing ventilation and oxygenation and working as a mode for delivering anesthetic gases. Awake fiber-optic-guided intubation is an essential component of airway management in difficult cases. We aim to study the benefits of nebulized dexmedetomidine with lignocaine over lignocaine alone for anesthetizing the airway for flexible fiber-optic bronchoscopy.

Materials and methods: In the study, after written informed consent, 50 patients were randomly allocated into two equal groups of 25 each. The intervention group received dexmedetomidine with lignocaine nebulization, while the control group received lignocaine nebulization alone. Baseline pulse rate, blood pressure, and, at regular intervals, cough, sedation, and pain scores were recorded along with the patient satisfaction score. Parametric data were analyzed by the Student's t-test, while nonparametric data were analyzed by the Wilcoxon Mann-Whitney U test.

Results: Out of a total of 54 patients, 4 patients did not give consent to participate in the study. The demographic profile was comparable in both groups. The pulse rate was comparable in both groups throughout the procedure; however, 10 min after the procedure, the pulse rate in the lignocaine group was (mean ± standard deviation) 114.2 ± 11.52, while in the intervention group, it was 87.32 ± 7.24 with a P = 0.027. The mean blood pressure was comparable throughout the procedure. The cough score yielded a Z-score of -5.12 and a P < 0.00001 favoring the dexmedetomidine group. Similarly, Richmond agitation-sedation score and Visual Analog Scale (VAS) also favored the intervention group, with P < 0.00054 and P < 0.00001 in RASS and VAS, respectively. Patient satisfaction score analysis found a Z-score of -5.29 and a P < 0.00001.

Conclusion: The overall results favored dexmedetomidine with lignocaine nebulization over lignocaine alone for anesthetizing airways for flexible fiber-optic bronchoscopy.

Abstract: Thyroid abscess is a very rare clinical entity, but potentially fatal emergency in the pediatric age group, with a mortality of 3.7%-9% in acute suppurative thyroiditis (AST), it is imperative to make a timely diagnosis and start treatment accordingly, it represents 0.1% of surgical pathologies of the thyroid. The anatomical and physiological characteristics of the gland provide it with resistance to pathogens. Recurrence is still exceptional. In this case report, we discuss a rare case of thyroid abscess in a 7-year-old girl revealing a piriform sinus fistula. Through this article, we attempt to stress the need for quick and accurate diagnosis and timely intervention to prevent complications as the condition is rare and unusual. The child presented to the pediatric emergency in January 2023 for a first episode of febrile torticollis the exploration objectified a thyroid abscess treated by probabilistic antibiotic therapy with good clinical and biological evolution, 6 months later, the child consulted again for the same symptomatology with febrile torticollis, dysphagia without signs of dysthyroidism, fever, and night sweats. Cervical computed tomography showed a mass occupying the left thyroid lobe. A cervical ultrasound showed heterogeneous hypoechoic collection; poorly limited. The biological assessment objectified a hyperleukocytosis in 19090 with a predominance of neutrophils with a C-reactive protein at 150 mg/l. The management was medical including intravenous antibiotic therapy based on amoxicillin-clavulanic acid and exploration by nasofibroscopy completed by hypopharyngoscopy showed a fistula of the piriform sinus. The treatment is based on surgery by cauterization of the sinus.

Background: The effect of the progressive utilization of virtual learning (VL) in postgraduate medical education (PGME) is contentious. During the COVID-19 pandemic, VL was up-scaled to bridge the education delivery gap. How this impacted learning experiences in PGME is an area that needs to be explored for the progressive context-specific application of VL.

Objective: This phenomenological study aimed to explore the postgraduate medical faculty's and residents' experiences with the rapid shift to VL.

Methods: Through an interpretivist paradigm, this study used in-depth individual semi-structured interviews and prompts to explore the full breadth of the participants' experiences. A purposive sampling method was used, and qualitative content analysis was employed in an iterative process until data saturation. Data was collected between January 2021 and July 2021. Member checking was done to ensure validity. The AKU-ERC granted ethical approval, with reference AKU/2020/098/fb.

Results: Ten participants were recruited for the study. Positive experiences were greater access to learning materials and improved learner confidence. In contrast, limited supervision, and lack of assurance of participants' engagement emerged as a negative VL experience. The components of critical thinking and problem-solving skills were unaffected by virtual case-based learning. However, the aspects of acquiring clinical and surgical skills emerged as a difficulty in accepting VL as a valid mode for attaining these competencies.

Conclusions: To improve experiences of VL, participants' drive, engagement, technological inadequacies, and instructional design should be optimized.

Background: Sleep disruptions are common among cancer patients, adversely affecting their quality of life and treatment outcomes. Warm foot baths have emerged as a potential intervention to improve sleep quality in this population, offering a noninvasive and holistic approach.

Materials and methods: A quasi-experimental study was conducted on 200 cancer patients in Rajasthan, India, with 100 participants in experimental and control groups. The hot water footbath intervention was administered to the experimental group, while the control group received standard care. Data were collected using demographic pro forma and the Groningen Sleep Quality Scale.

Results: Baseline comparison revealed similar sleep quality levels between groups, but postintervention analysis showed significant differences. The experimental group exhibited higher proportions of disturbed and poor sleep, indicating a nuanced response to footbath intervention. However, the experimental group demonstrated a significantly higher mean sleep quality score (9.85 ± 2.47) compared to controls (8.97 ± 2.44). Statistical analysis confirmed the effectiveness of footbath therapy in improving sleep quality among cancer patients.

Conclusion: Hot water footbath therapy effectively improved sleep quality among cancer patients despite varied responses within the experimental group. Integrating footbath therapy into cancer care regimens is recommended to alleviate sleep disturbances and enhance overall well-being during chemotherapy. Further research should explore additional nonpharmacological interventions to alleviate the challenges faced by cancer patients, aiming to optimize their quality of life.

Abstract: This case report aims to document a case of bilateral endotheliitis occurring shortly after riboflavin-assisted cross-linking (CXL) in a young male patient with progressive keratoconus. The objective is to identify potential risk factors, treatment strategies, and outcomes while considering relevant literature on similar cases. A male in his late adolescence with bilateral progressive keratoconus underwent bilateral CXL using riboflavin and ultraviolet A light exposure. Postoperatively, the patient received moxifloxacin drops, prednisolone acetate drops, and artificial tears. Seven days later, the patient presented with decreased vision, photophobia, and corneal findings consistent with endotheliitis. Treatment with prednisolone acetate and moxifloxacin eye drops was initiated. Two months later, visual acuity deteriorated, but anterior slit-lamp findings improved, and the intraocular pressure measurement was high. Prednisolone acetate was tapered, whereas loteprednol etabonate gel, brimonidine eye drops, and cyclosporine eye drops were initiated. After 7 months, visual acuity improved, and endotheliitis resolved, although mild residual central haze persisted. This case highlights the occurrence of acute idiopathic endotheliitis following routine CXL and its successful management. Although limited cases have been reported, a standardized treatment protocol is lacking. In our patient, the utilization of loteprednol etabonate gel, cyclosporine eye drops, brimonidine eye drops, and regular follow-up examinations led to improved clinical findings and visual acuity. Further studies are warranted to establish optimal treatment approaches for similar cases of endotheliitis following CXL.