Annals of African Medicine最新文献

Background: Inguinal hernia repair is a common surgical procedure, with laparoscopic techniques offering advantages over open surgery. The extended Totally Extraperitoneal (eTEP) technique provides a larger working space compared to the traditional Totally Extraperitoneal (TEP) approach, potentially improving outcomes.

Material and methods: A prospective study was conducted comparing eTEP and TEP techniques for inguinal hernia repair at Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune. Forty patients (20 in each group) aged 15-65 with uncomplicated inguinal hernias were included. Surgical procedures were performed based on patient preference. Data on surgical duration, pain scores, hospital stay, and complications were collected and analyzed using statistical methods.

Results: eTEP surgery had a significantly shorter mean duration (48.70 ± 7.505 minutes) compared to TEP surgery (74.20 ± 7.78 minutes; P = 0.00). Patients undergoing eTEP experienced lower mean pain scores (3.75 ± 0.55) compared to those undergoing TEP (5.15 ± 0.745; P = 0.00). Hospital stay following eTEP surgery was shorter (1.70 ± 0.657 days) than following TEP surgery (3.65 ± 1.137 days; P = 0.00). eTEP had lower incidences of hematoma and surgical emphysema but higher seroma complications. TEP surgeries were associated with more post-operative complications and a higher likelihood of requiring conversion to open surgery.

Discussion: The eTEP technique offers several advantages over TEP, including shorter surgical duration, less post-operative pain, and shorter hospital stays. However, TEP had more complications related to seroma. Individual patient factors and surgeon experience should guide the choice of technique.

Conclusion: The eTEP technique appears to be a promising option for inguinal hernia repair, offering advantages over TEP in terms of surgical outcomes. However, further studies are needed to evaluate long-term outcomes and complication rates comprehensively.

Abstract: Malaria is a severe health issue in India despite government efforts. Malaria has many complications, some of which can be life-threatening. Disseminated intravascular coagulation (DIC) is a prominent malaria complication, besides renal failure, cerebral malaria, pulmonary edema, and anemia. We report a young man with Plasmodium vivax malaria who developed septic shock due to DIC. A 25-year-old male had a fever, abdominal pain, vomiting, and nausea for 5 days. On clinical examination, the patient was in distress and had a fever of 102.6°F with a blood pressure of 86/46 mmHg. A complete blood count revealed anemia, leukocytopenia, and severe thrombocytopenia. Peripheral blood smear findings showed a P. vivax parasite in red blood cells with the presence of a few schistocytes. Further coagulation tests showed raised prothrombin, partial thromboplastin time, and d-dimer. DIC and septic shock required critical care unit admission. Conservative treatment with artesunate and lumefantrine completely cured him. This unusual case shows that P. vivax causes severe malaria and its morbid consequences. It stresses early diagnosis and treatment to prevent mortality and morbidity.

Background: One of the major inflammatory markers, C-reactive protein (CRP), is often elevated in people who have had a heart attack, vascular problems, stroke, or sudden cardiac death. Obesity is associated with higher CRP levels because adipose tissue activates cytokines. Obesity and overweight increase the risk of heart disease, as does an elevated CRP level.

Purpose: The purpose of this study was to evaluate the association of high-sensitivity CRP (hs-CRP) level with obese normal individuals in North Indian population.

Materials and methods: This cross-sectional study included 50 individuals between the ages of 18 and 50 years who were overweight or obese. The degree of obesity was determined by anthropometric measurements. The patients' height, weight, waist circumference (WC), hip circumference, and blood pressure were measured. Enzyme-linked immunosorbent assay-based CRP level was determined from the blood.

Results: The mean WC (cm) was significantly higher in the obese (103.42 ± 9.79) than in the overweight (89.00 ± 8.72). The mean hip circumference (cm) was also significantly smaller in the obese group (99.95 ± 8.07) than in the overweight group (131.29 ± 15.82). The waist-to-hip ratio (WHR) was significantly more in the obese group (88.37%) than in the overweight group (0.00%). WC (cm), hip circumference (cm), WHR, systolic blood pressure (mmHg), and diastolic blood pressure (mmHg) were not significantly correlated with hs-CRP in overweight and obese participants.

Conclusion: Compared with obesity, hs-CRP was not related to obesity. A relationship between hs-CRP and WC, hip circumference, and WHR was not found.

Background: Tyrosine kinase inhibitors improve chronic myeloid leukemia (CML) outcomes. Dasatinib inhibits breakpoint cluster region-Abelson 1 proto-oncogene tyrosine kinase better than imatinib in CML. T-regulatory cells prevent autoimmune diseases and aberrant immune responses by reducing oncoprotein antigen reactivity. They also reduce self-antigen-induced immune responses to maintain peripheral tolerance. In this study, T-regulatory cells in peripheral blood of chronic myeloid leukemia-chronic phase patients were measured, together with serum levels of cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) and transforming growth factor (TGF)-β1 at diagnosis and 3 months postdasatinib therapy.

Materials and methods: The Pathology and Clinical Haematology Departments at King George's Medical University, Lucknow, India, conducted this prospective analytical study. Forty CML-chronic patients and 10 healthy controls were analyzed. Flow cytometry was used to determine T-regulatory cell percentage in peripheral blood mononuclear cells of newly diagnosed CML patients before and after 3 months of dasatinib treatment; ELISA was used to measure serum levels of CTLA-4 and TGF-β1.

Results: T-regulatory cells, CTLA-4, and TGF-β1 significantly decreased in CML-chronic phase patients after 3 months of dasatinib therapy compared to the initial diagnosis. No significant change in T-regulatory cell, CTLA-4, or TGF-β1 percentages were seen between responders and poor responders. However, responders had a lower percentage of T-regulatory cells than suboptimal responders.

Conclusions: The study concluded that dasatinib treatment improved response in CML patients with decreased Treg cells. Dasatinib reduces Treg-mediated immunological suppression, reducing CTLA-4 and TGF-β1 levels.

Objectives: To highlight the significance of various clinical and radiological parameters in association with specific electroencephalographic (EEG) patterns in order to prioritize EEG referrals.

Method: This retrospective, cross-sectional study was conducted in the neurology department of King Fahad University Hospital, Alkhobar, and involved a review and analysis of EEG and medical records pertaining to 604 patients referred for routine EEG. The data were analyzed using SPSS version 22. An association between various parameters and EEG yield was established.

Results: Factors associated with the yield of abnormal EEG patterns were diverse, like generalized tonic-clonic seizures (GTCs) (P =.05), status epilepticus (SE) (P =.05), altered level of consciousness (ALC) (P =.00), abnormal movement (P =.00), cardiac arrest (P =.00), prior history of epilepsy (P =.04), chronic renal disease (CRD) (P =.03), abnormal neurological exam (P =.00), and cortical lesions on brain imaging (P =.00). Among the abnormal EEG patterns, epileptiform activity (EA) in EEG was associated with focal seizures (P =.03), GTCs (P =.00), falls (P =.05), cardiac arrest (P =.00), a history of epilepsy (P =.00), and hypoxic ischemic injury (P =.03). Encephalopathy in EEG was also associated with focal sz (P =.02), GTCs (P =.00), SE (P =.01), ALC (P =.00), cardiac arrest (P =.00), history of stroke (P =.01), and epilepsy (P =.00).

Conclusion: Among the studied parameters, patient level of consciousness, neurological exam findings, and neuroimaging findings, with some discrepancies, were found to be the most consistent in predicting the EEG yield. The study demonstrated the value of a proper neurological exam and careful selection of patients to gain the optimum benefit from the routine EEG.

Background: Acute encephalitis (AE) is associated with a high burden of mortality and permanent disability and has a spectrum of underlying etiologies. The prognosis of encephalitis is difficult and almost all the patients seem to be at a high risk of poor outcomes. A number of physiological changes take place during encephalitis and have been evaluated for their prognostic value. Platelet count, which has been recognized as a surrogate prognostic marker in various viral illnesses, has recently been recognized to have a prognostic value in AE too. In the present study, we attempted to study the role of thrombocytopenia in the prognosis of AE.

Methods: Total of 98 cases based on clinical, cerebrospinal fluid, and radiological profiles consistent with the diagnosis of AE were enrolled in the study. A clinical profile was noted, and platelet count was assessed. Thrombocytopenia was defined as platelet count <150,000/mm3. Platelet count 100,000-150,000, 50,000-99,999, and <50,000/mm3 were considered mild, moderate, and severe thrombocytopenia. The underlying etiology was explored, and patients were followed till discharge/outcome. The outcome was noted in terms of the Modified Rankin score (MRS). MRS 0-2 was considered good, 3-4 fair, and 5-6 as poor outcome.

Results: The mean age of patients was 34.06 ± 18.76 years. Majority of patients were women (54.1%). Prevalence of thrombocytopenia was 75.5%. A total of 34 (45.9%) had mild, 30 (40.5%) had moderate, and 10 (13.5%) had severe thrombocytopenia. Acute viral encephalitis (unclassified) was the most common etiology (33.7%), followed by scrub meningoencephalitis (24.5%) and Japanese encephalitis (12.2%), respectively. Good, fair, and poor outcomes were noted in 48 (49%), 21 (21.4%), and 29 (29.6%) cases. On univariate analysis, no significant association of poor outcome was seen with age, sex, duration of fever, and mechanical ventilation need (P > 0.05). Low Glasgow Coma Scale (GCS), splenomegaly, low platelet count, and Japanese encephalitis virus/scrub typhus etiologies were found to be significantly associated with poor outcomes (P < 0.05). Thrombocytopenia compared to normal platelet count and severe thrombocytopenia compared to mild and moderate thrombocytopenia were significantly associated with poor outcomes (P < 0.05). On multivariate analysis, GCS <8 (odds ratio [OR] =4.52; 95% confidence interval [CI] =1.56-13.20) and thrombocytopenia (OR = 11.92; 95% CI = 1.38-103.32) emerged as independent predictors of poor outcome.

Conclusions: The findings of the study showed that low GCS and thrombocytopenia could be used as predictors of poor outcomes in AE cases.

Objectives: The novel SARS-CoV-2 outbreak disrupted businesses globally and created fears in the general public and among health-care professionals. Almost universally, considerations about the coronavirus pandemic and its effects became priority in the daily operations of businesses, leaving hitherto pressing concerns in the back stage. Early in the pandemic, the management of University of Benin Teaching Hospital set up a Business Continuity Team which undertook an evaluation of the perceptions of mid-level hospital managers about their departments' and units' risks and vulnerabilities in the face of the ongoing pandemic.

Methods: A modified International Labour Organization (ILO) risk profile self-assessment tool which focused on "people," "processes," "profits," and "partnerships" was used to assess mid-level managers' perceptions of their respective departments' and units' risks and vulnerabilities, consequent on the COVID-19 pandemic. Responses were obtained from heads of departments and units using an online survey. Final scores were divided into terciles (three equal groups) in respect of perceived risks and adverse outcomes of the COVID-19 pandemic. Scores in the lower tercile were grouped as low risk/vulnerability, the middle group of scores as medium risk/vulnerability, and scores in the upper tercile as high risk/vulnerability.

Results: Responses were obtained from 35 (49.3%) of the 71 clinical and nonclinical departments and units in the hospital. Fifteen of these (42.9%) were clinical. Nineteen (54.2%) departments were assessed to be at high risk/vulnerability, 9 (47.4%) of which were clinical. Twelve (34.3%) departments were assessed to be at medium risk/vulnerability - 4 (33.3%) of them, clinical. No department was assessed to be at low risk. The highest risk ratings were in the domains of "profits" and "partnerships:" 54 (84.4%) mid-level managers assessed their departments and units to be at high risk of the negative impacts of the coronavirus pandemic with respect to "profits" and 51 (79.7%) with respect to "partnerships."

Conclusion: Mid-level managers in clinical and nonclinical departments and units assessed their departments and units to be at medium and high risk of the negative impacts of the COVID-19 pandemic, using the ILO's modified tool. Our findings enabled the management of the hospital and the Business Continuity Team to address the specific areas of concerns that were highlighted, develop contingency plans, and frame risk communication during the pandemic, with a view to fostering increased sense of safety in the workforce. This approach to risk assessment is repeatable, and we recommended it to other hospitals in Africa.

Background: Metopic suture is a dense fibrous joint extending from nasion to bregma. Normally, closure of this suture takes place between 1-8 years of age. Failure of this closure beyond 8 years leads to persistent metopic suture. Persistent metopic suture may mimic skull fracture.

Aim and objective: To differentiate metopism from frontal bone fracture.

Material and method: 54 dry skull of adult humans in were studied. These skulls were observed for the presence (complete or incomplete suture) or absence of metopic suture.

Result: Metopic suture was found in 3.7% skulls. Both complete and incomplete metopic suture were found in 1.85% of the dry skulls.

Conclusion: Neurosurgeons, radiologists, otorhinolaryngologists, physicians, anatomists, forensic specialists, anthropologists and evolutionary biologists should have knowledge of this anatomical variation. This case series focusses on the importance of metopism. Metopism is a topic, which has not been much studied.

Background: Hepatitis B virus (HBV) and neonatal tetanus infections remain endemic in Nigeria despite the availability of safe, effective vaccines. We aimed to determine health facilities' capacity for hepatitis B vaccine birth dose (HepB-BD) and maternal tetanus-diphtheria (Td) vaccination and to assess knowledge, attitudes, and practices of HepB-BD and maternal Td vaccine administration among health facility staff in Nigeria.

Materials and methods: This was a cross-sectional study assessing public primary and secondary health facilities in Adamawa and Enugu States. A multistage sampling approach was used to select 40 facilities and 79 health-care workers (HCWs) from each state. A structured facility assessment tool and standardized questionnaire evaluated facility characteristics and HCW knowledge, attitudes, and practices related to HepB-BD and maternal Td vaccination. Frequencies and proportions were reported as descriptive statistics.

Results: The survey of 80 facilities revealed that 73.8% implemented HepB-BD and maternal Td vaccination policies. HepB-BD was administered within 24 h of birth at 61.3% of facilities and at all times at 57.5%. However, administration seldom occurred in labor and delivery (35%) or maternity wards (16.3%). Nearly half of the facilities (46.3%) had HCWs believing there were contraindications to HepB-BD vaccination. Among 158 HCWs, 26.5% believed tetanus could be transmitted through unprotected sex, prevented by vaccination at birth (46.1%), or by avoiding sharing food and utensils. 65% of HCWs knew HBV infection had the worst outcome for newborns.

Conclusions: The limited implementation of national policies on HepB-BD and maternal Td vaccination, coupled with knowledge gaps among HCWs, pose significant challenges to timely vaccination, necessitating interventions to address these gaps.

Aims: We have compared sealing pressure, usability, and complications of two second-generation supraglottic airway devices-Baska® mask and I-gel.

Settings and designs: The study design involves prospective randomized controlled trial.

Materials and methods: The study was undertaken involving 44 patients of the American Society of Anesthesiologists physical status I and II, aged 20-70 years, who underwent surgical procedures of short duration under general anesthesia. Patients were randomly categorized into two groups of 22 each: Group B (Baska® mask) and Group I (I-gel). The main objective was to compare oropharyngeal leak pressure (OLP).

Statistical analysis: Continuous variables were compared between the two groups using an unpaired t-test. Categorical variables were compared using the Chi-square test and insertion attempts using Fisher's exact test.

Results: Group B had significantly higher mean OLP (32.22 ± 2.52 cmH2O vs. 26.18 ± 2.42 cmH2O, P < 0.001). In Group I, 97.1% of patients had very easy insertion (Grade 1), 2.9% had easy insertion (Grade 2) and Group B had very easy insertion in 50% of patients, easy in 36.4%, and difficult in 13.6% of patients (P = 0.009). Group B took a longer time for successful insertion than Group I (39.89 ± 7.15 s vs. 28.19 ± 3.29 s, P < 0.001).

Conclusion: For positive pressure ventilation, both I-gel and Baska® masks proved to be successful, with I-gel being easier and quicker to insert. It is possible to employ the Baska® mask with superior seal pressures as an alternative to endotracheal intubation in elective surgeries if there are no patient contraindications.