Annals of African Medicine最新文献

Abstract: Alveolar sarcoidosis is an uncommon radiographic phenotype that can closely mimic infection, organizing pneumonia, and malignancy. We report a 44-year-old nonsmoker with 1 month of dyspnea, fever, and cough. Computed tomography of the chest showed patchy subpleural consolidations with perilymphatic nodules and interstitial thickening. Microbiologic testing, including bacterial and fungal cultures, and GeneXpert MTB, were negative; autoimmune serologies were unremarkable. Pulmonary function tests revealed a restrictive pattern. Bronchoalveolar lavage was lymphocytic, and transbronchial lung biopsy demonstrated noncaseating granulomas with elevated serum ACE levels that was suggestive of acute alveolar sarcoidosis. After initiating the treatment with prednisone, symptomatic, functional, and radiographic improvements were noticed. This case underscores the need for integrated clinical, imaging, and histologic assessment to identify sarcoidosis presenting as acute hypoxemic respiratory failure with an alveolar pattern.

Abstract: Refractory hypertension in young adults warrants evaluation for secondary causes. Chronic nonsteroidal anti-inflammatory drug (NSAID) use, though common, is an underrecognized cause of chronic kidney disease that may lead to biochemical abnormalities, including electrolyte disturbances and hormonal dysregulation. A 37-year-old male presented with headache, vomiting, and abdominal pain. Examination revealed severe hypertension (210/190 mmHg) with epigastric tenderness. Electrocardiography (ECG) showed a Wellens type A pattern with Q waves. Initial laboratories revealed hyponatremia, hypokalemia, and deranged renal function. Despite correction of hyponatremia by day 4, hypokalemia persisted. Investigations revealed elevated aldosterone (37.4 ng/dL) with normal renin (16.9 ng/mL), significant proteinuria (24-h urinary protein: 2.58 g/day), and low creatinine clearance (27 mL/min/1.73 m2). Imaging showed bilaterally small kidneys with loss of corticomedullary differentiation, ruling out renal biopsy. Persistent hypokalemia was refractory to supplementation due to NSAID-induced gastritis. Elevated intact parathyroid hormone (193 pg/mL) and Vitamin D deficiency indicated secondary hyperparathyroidism. Upon detailed history, the patient admitted to chronic NSAID use. A diagnosis of NSAID-induced acute-on-chronic interstitial nephritis with secondary hyperaldosteronism and hyperparathyroidism was made. Management included antihypertensives (labetalol, nicardipine, and prazosin), potassium correction, and withdrawal of NSAIDs. This case highlights the importance of thorough history taking and evaluation of secondary causes in young-onset refractory hypertension. Chronic NSAID use can precipitate progressive renal dysfunction, leading to complex metabolic and endocrine complications, including secondary hyperaldosteronism and hyperparathyroidism.

Abstract: Multicystic encephalomalacia (MCE) is an uncommon but severe consequence of perinatal hypoxic-ischemic injury in neonates. We report a 1.5-month-old male infant presenting with fever and focal seizures, with a prior history of birth asphyxia and prolonged neonatal intensive care unit stay. Neurosonography and magnetic resonance imaging revealed extensive bilateral cortical and subcortical cystic changes with cerebral atrophy consistent with MCE. This case highlights the importance of early neuroimaging to identify characteristic patterns of extensive cystic degeneration, enabling timely prognostication, seizure management and counseling of caregivers regarding long-term neurodevelopmental outcomes.

Background: Nonalcoholic fatty liver disease (NAFLD) represents a histological spectrum of liver damage ranging from simple steatosis to progressive fibrosis and cirrhosis in individuals without adequate alcohol intake (<20 g/day). The metabolic syndrome is characterized by a glucose intolerance/insulin resistance, abdominal obesity, dyslipidemia, hypertension, pro-inflammatory and thrombotic disorders, attributed to poor eating habits, and lack of exercise. Obesity, type 2 diabetes, dyslipidemia, and arterial hypertension are frequently paired with these illnesses, are together referred to as insulin resistance syndrome and are associated with an increased risk of cardiovascular diseases. The purpose of this study was to assess the relationship between NAFLD and metabolic syndrome, as well as its constituent parts, using a modified definition based on the National Cholesterol Education Program Adult Treatment Panel III.

Materials and methods: An Observational Cross-sectional Analytical Study with 100 patients was carried out at a tertiary care hospital in Western Maharashtra. Data were collected and tabulated, and statistical analysis was done.

Results: The incidence of metabolic syndrome was 61% among study subjects. Out of 100 subjects, 55 had grade 1 fatty liver, 34 had grade 2 fatty liver, and 11 had grade 3 fatty liver.

Conclusion: From our study, higher prevalence of all the components of metabolic syndrome in cases of NAFLD was observed. The available literature on metabolic syndrome may indicate undiscovered heart disease, which may merit additional screening of NAFLD patients for the same, even though this study did not find a direct association between cardiovascular illness and NAFLD.

Abstract: Third and fourth branchial cleft anomalies are rare congenital defects affecting children. They arise due to the incomplete obliteration of branchial clefts during embryogenesis. Nearly 90% of the third or fourth branchial pouch sinus tracts are situated on the left side of the neck. It is difficult to differentiate the third and fourth branchial cleft anomalies on radiological imaging due to their close proximity; hence, they may be treated as the same disease. In this report, we describe the case of a 17-year-old male patient with a persistent branchial cleft sinus tract and its clinical presentation, diagnostic evaluation, and surgical management and discuss the preoperative evaluation, pitfalls in diagnosis, and surgical management, including strategies for the management of third or fourth branchial cleft sinus.

Aim: This study aimed to evaluate the immunohistochemical co-expression of MUC1 and MUC4 in oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC) and assess their potential as biomarkers for diagnosing and prognosticating oral malignancies.

Materials and methods: A retrospective observational study was conducted on formalin-fixed, paraffin-embedded tissue specimens from the archives of the Department of Oral Pathology and Microbiology. A total of 80 histopathologically confirmed cases, consisting of 40 OL and 40 OSCC cases, were selected. Immunohistochemical staining for MUC1 and MUC4 was performed using specific monoclonal antibodies, and the expression was evaluated based on localization, intensity, and extent of staining. Statistical analysis was performed using SPSS, with P < 0.05 considered statistically significant.

Results: The study found that MUC1 and MUC4 expression were significantly higher in OSCC compared to OL. High MUC1 expression was observed in 82.5% of OSCC cases versus 30% in OL cases (P < 0.001), and high MUC4 expression was found in 70% of OSCC cases versus 30% in OL (P = 0.002). Co-expression of MUC1 and MUC4 was seen in 90% of OSCC cases and 65% of OL cases (P = 0.027). Logistic regression analysis confirmed that OSCC diagnosis was a strong predictor of high MUC1 and MUC4 expression (P < 0.001).

Conclusion: The findings suggest that MUC1 and MUC4 are significantly overexpressed in OSCC compared to OL, and their co-expression may serve as a valuable biomarker combination for early diagnosis and prognosis. Elevated expression of both mucins is associated with poor prognosis, indicating their potential for use in clinical practice for risk stratification and personalized treatment in OSCC patients.

Abstract: Snakebite-induced acute kidney injury (AKI) is a severe, potentially fatal complication driven by venom's direct toxicity, inflammation, and complex mechanisms such as intravascular hemolysis, rhabdomyolysis, and coagulation disorders. While early antivenom administration and supportive care are crucial, many survivors may face long-term renal dysfunction, emphasizing the need for advanced understanding to prevent severe outcomes and improve patient management. We present a case of an 81-year-old farmer who sustained a snakebite injury and developed local and systemic features of envenomation and subsequent AKI. He was managed with supportive care and administration of polyvalent antivenom in an inpatient setting and discharged with complete recovery of kidney function. This report became necessary to draw attention to this tropical cause of nephropathy and highlight that early diagnosis and intervention with antivenom are crucial for preventing kidney damage and improving outcomes.

Background: Propofol, an induction agent for general anesthesia (GA), is associated with a significant risk of hypotension. Perfusion index (PI) is known to predict vascular responses in various situations; however, its utility in the prediction of hypotension postpropofol administration is not fully established.

Aim: To evaluate the performance of PI in the prediction of hypotension postinduction with propofol.

Methods: This observational, prospective study involved 120 adult patients who underwent elective surgeries under GA. The PI, heart rate, systolic blood pressure (SBP), diastolic blood pressure, mean arterial pressure (MAP), and oxygen saturation were recorded at baseline, postinduction (every minute for the first 5 min), and postintubation (every minute for the first 10 min and then at 5-min interval till a total of 20-min). Hypotension was defined as a fall in SBP by >20% of baseline or MAP <60 mmHg.

Results: As per SBP and MAP criteria, the incidence of hypotension during induction was 28.3% and 35.8%, respectively, with corresponding values during postintubation period being 22.5% and 29.2%, respectively. Based on the SBP and MAP criteria (area under the curve [AUC]: 0.810 and 0.76, respectively; cutoff: 1.08), at 5 min, PI had sensitivity of 73% and 71%, and specificity of 74% and 69%, respectively. At 10 min, based on the SBP (AUC: 0.66, cutoff: 1.15) and MAP (AUC: 0.77, cut-off: 1.17) criteria, PI had a sensitivity and specificity of 65% and 52%, and 71% and 65%, respectively.

Conclusions: The baseline PI is a useful noninvasive tool for the prediction of hypotension, with MAP criterion performing slightly better than SBP criterion.

Abstract: Acute methotrexate toxicity represents a serious medical emergency with significant morbidity and mortality. This case series aims to characterize clinical presentations, risk factors, and outcomes of patients with acute methotrexate toxicity admitted to a tertiary care hospital. We retrospectively analyzed six patients who presented with acute methotrexate toxicity. Clinical presentations, laboratory parameters, management strategies, and outcomes were evaluated. All patients received leucovorin rescue therapy and supportive care. The cohort comprised six patients (median age 63 years, range 54-96 years) with 67% female predominance. All patients presented with mucocutaneous manifestations, predominantly oral ulcers (100%). Pancytopenia was observed in all cases with available complete blood counts. Dosing errors were the primary etiology in 67% of cases, with patients erroneously taking weekly doses daily. Additional risk factors included advanced age and chronic kidney disease. Laboratory findings revealed severe neutropenia (median total leukocyte count range 480-5300 cells/mm 3 ), with progressive hematological deterioration requiring intensive monitoring. Treatment consisted of immediate methotrexate discontinuation, leucovorin rescue therapy (15 mg IV), granulocyte colony-stimulating factor in severe cases, and supportive care. Five patients (83%) recovered completely within 5-14 days, while one elderly patient with chronic kidney disease died from complications, yielding a 17% mortality rate. Acute methotrexate toxicity results primarily from dosing errors. Mucocutaneous ulcers serve as early warning signs of systemic toxicity. Early recognition, prompt leucovorin rescue therapy, and aggressive supportive care are crucial for favorable outcomes. Enhanced patient education and monitoring protocols are essential for prevention.

Background: Attention deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in childhood, marked by inattention, hyperactivity, and impulsivity. In India, limited awareness and variable access to diagnosis result in underidentification, particularly across socio-geographic divides.

Objectives: To estimate the prevalence of ADHD among children aged 6-11 years in selected urban and rural schools of Mysuru District, Karnataka and to analyze the subtype distribution and gender-based differences.

Methodology: A community-based, cross-sectional study was conducted among 739 schoolchildren selected by the simple random sampling. ADHD symptoms were assessed using the Vanderbilt ADHD Diagnostic Rating Scales - Teacher and Parent versions - based on Diagnostic and Statistical Manual of Mental Disorder-5 criteria. Data were analyzed using SPSS v28; P < 0.05 was considered statistically significant.

Results: The overall prevalence of ADHD was 13.8%, with the combined subtype being most common (52%), followed by inattentive (27%) and hyperactive (21%). The prevalence was higher in boys (15.86%) than girls (10.86%) and significantly higher in urban schools (16.2%) compared to rural (9.7%) ( P = 0.01). Over 87% of affected children exhibited moderate to severe functional impairment, particularly in the combined group. Teachers reported more hyperactivity, while parents noted inattentiveness. Notably, 56% of cases had not been previously identified.

Conclusion: ADHD is common yet underdiagnosed among Indian schoolchildren. Subtype-specific impairments and urban-rural disparities highlight the need for early screening, multi-informant assessments, and equitable, school-based interventions. Collaborative efforts among educators, parents, and healthcare providers are essential to improve the diagnosis and outcomes.