Annals of African Medicine最新文献

Abstract: Chronic pancreatitis (CP) is a progressive inflammatory disorder of the pancreas characterized by irreversible fibrosis and intraductal calculi, leading to recurrent abdominal pain and functional impairment. Here, we present the case of a 37-year-old female, 2 months postpartum with a history of gestational diabetes, who presented with 1 month of worsening epigastric pain radiating to the back, aggravated after meals, and associated with nausea and nonbilious vomiting. Laboratory investigations were unremarkable except for mildly elevated HbA1c, while imaging revealed multiple large calculi within the main pancreatic duct, confirming chronic calcific pancreatitis. Conservative management failed to relieve symptoms, necessitating surgical intervention. She underwent lateral pancreaticojejunostomy (Partington-Rochelle procedure) with intraoperative extraction of ductal calculi. Postoperative recovery was uneventful, and at 6-week follow-up, she reported complete resolution of symptoms with improved quality of life. This case emphasizes the importance of timely diagnosis and surgical management in CP with ductal obstruction.

Abstract: Excessive prescription of antifungal medications heightens the risk of adverse effects and drug interactions for patients while also fostering the development of resistant fungal strains. Moreover, antifungal agents rank among the most expensive antimicrobial drugs in hospital inventories, and the populations vulnerable to invasive fungal diseases are expanding. These factors collectively contribute to elevated mortality rates and extended hospital stays among affected populations. While the global community has placed a growing emphasis on the significance of antibiotic stewardship to combat the rise of the growing antibiotic resistance threat in the past few years, antifungal stewardship (AFS) has garnered comparatively less attention. The present review article focuses on the essential elements of AFS in three common invasive fungal infections: candidemia, aspergillosis, and mucormycosis.

Abstract: Methemoglobinemia represents a rare blood disorder which occurs through the oxidation of hemoglobin (Hb) from its ferrous (Fe 2+ ) to ferric (Fe 3+ ) state, thus disabling its oxygen transport function. The condition leads to functional hypoxia which manifests as cyanosis that does not respond to oxygen therapy. The condition affects neonates most severely because their enzymatic systems are not fully developed and their fetal Hb has a tendency to become oxidized. We report a case of a 4-week-old male term infant who developed severe cyanosis after receiving excessive EMLA cream (lidocaine/prilocaine) for circumcision pain relief. The methemoglobin level reached 52% which established the diagnosis. The administration of methylene blue brought about a quick clinical recovery of the patient. The case demonstrates the difficulties in diagnosis and potential dangers of using topical anesthetics in newborns while showing why early detection and proper treatment and parental education remain crucial.

Background: The most resilient structures to mechanical, thermal, and chemical changes are teeth. Both metric and nonmetric techniques may be used on the teeth to determine dental gender. Several odontometric investigations were conducted in various Indian demographic groups. The Maharashtrian population was not studied for sexual dimorphism using linear odontometric analysis.

Aim: This study aims to determine sexual dimorphism using linear odontometric analysis in a sample of the Maharashtrian population.

Materials and methods: One hundred and sixty individuals, including patients and students, participated in cross-sectional research. Dental alginate was used to take impressions of the maxillary and mandibular arches from undergraduate students and patients at our institution after the participants gave their written permission. Dental stone was then used to pour the castings. A digital caliper calibrated to 0.01 mm was used to measure the mesiodistal (MD) and buccolingual (BL) dimensions of every tooth, with the exception of third molars, on the castings, and all the measurements were recorded.

Results: Male canine BL and first premolar MD dimensions in the maxillary arch are substantially larger than those of females. The mandibular first premolar MD measures and the maxillary lateral incisor BL measurements were significantly bigger than the mandibular arch when comparing the two arches. Using MD and BL measures, the Maharashtrian population's overall sex determination accuracy rate was 73%.

Conclusion: The most accurate markers of sexual dimorphism in the Maharashtrian population are maxillary canines and maxillary first premolars. These results draw attention to population-specific differences that may have an impact on anthropological and forensic research.

Background: Antenatal depression is a significant but often overlooked complication of pregnancy, particularly in women with metabolic comorbidities such as gestational diabetes mellitus (GDM). This study aimed to assess the prevalence of antenatal depression and its association with GDM and other risk factors among pregnant women in eastern India.

Materials and methods: A cross-sectional and observational study was conducted among 360 pregnant women attending two tertiary care hospitals. Data on sociodemographic and obstetric variables were collected through structured interviews. Depression was screened using the Edinburgh Postnatal Depression Scale (EPDS), with a score of ≥ 12 indicating depression. Statistical analysis included Chi-square and Mann-Whitney U-tests, with P < 0.05 considered statistically significant.

Results: The overall prevalence of antenatal depression was 27.5%. Depression was significantly more common in women with lower education (≤10th standard), rural residence, joint family setting, unplanned pregnancies, and irregular sleep patterns (P < 0.05 for all). Obstetric factors such as multigravidity, past abortion, and both history and current diagnosis of GDM were significantly associated with higher depression rates. Women with GDM had significantly higher mean EPDS scores (11.63 ± 4.1) and nearly double the prevalence of depression compared to non-GDM women (37.2% vs. 18.9%, P < 0.001).

Conclusion: GDM significantly increases the risk of antenatal depression. Integrated antenatal care models should incorporate routine screening for depression, especially in women with metabolic or obstetric risk factors, to improve the maternal and fetal outcomes.

Abstract: Giant cell tumors (GCTs) of bone are rare, locally aggressive neoplasms, with metacarpal involvement being particularly uncommon. They present unique challenges due to the need for both oncological clearance and preservation of hand function. We report the case of a 19-year-old female who presented with swelling and pain over the head of the fourth metacarpal following trauma. Imaging and biopsy confirmed GCT. She was treated with intralesional curettage, chemical cauterization using hydrogen peroxide, reconstruction with tricortical iliac crest autograft, and fixation with an intramedullary Kirschner wire. Follow-up at 3, 6, and 12 months showed progressive graft incorporation, restoration of function, and absence of recurrence. This case demonstrates a rare and effective treatment strategy combining adjuvant hydrogen peroxide cauterization with tricortical iliac crest graft and intramedullary fixation in a metacarpal GCT.

Background: Traditional "nil per oral after midnight" fasting practices often result in unnecessarily prolonged fasting before surgery, which may adversely affect metabolic stability and patient comfort. Updated American Society of Anesthesiologists (ASA) guidelines recommend shorter, evidence-based fasting durations; however, adherence remains inconsistent in many healthcare settings.

Objectives: This study aimed to assess the association between actual preoperative fasting duration and perioperative blood glucose levels in nondiabetic patients, to determine the prevalence of perioperative hypoglycemia and hyperglycemia in relation to ASA fasting guideline compliance, to evaluate patient-reported symptoms such as thirst, tiredness, and anxiety in relation to fasting duration, and to qualitatively explore patients' perceptions of prolonged fasting and its psychological effects.

Materials and methods: A mixed-method, prospective observational study was conducted among 130 nondiabetic adult patients (ASA I and II) undergoing elective surgeries under general anesthesia. Fasting durations for solids and clear fluids were recorded and compared with ASA recommendations. Capillary blood glucose was measured preoperatively and postoperatively using a standardized glucometer. Quantitative data were analyzed using Chi-square and t-tests to assess associations between fasting duration and glycemic status.

Results: The mean fasting duration was 8.7 ± 1.2 h for solids and 3.4 ± 0.7 h for clear fluids, exceeding ASA recommendations in 27.7% of patients. The mean preoperative blood glucose was significantly lower in patients fasting beyond recommended duration (79.8 ± 9.5 mg/dL) compared to those within guidelines (93.4 ± 8.1 mg/dL, P < 0.001). Mild hypoglycemia (<70 mg/dL) occurred in 10.8% of cases, predominantly among the prolonged fasting group (P = 0.0002). Symptoms such as thirst (68.5%), tiredness (61.5%), and anxiety (54.6%) were significantly higher in the prolonged fasting cohort (P < 0.01). Qualitative findings highlighted discomfort, irritability, and apprehension linked to long fasting times, with many participants expressing a preference for shorter, guideline-based fasting periods.

Conclusion: Adherence to ASA fasting guidelines (6 h for solids, 2 h for clear fluids) maintains euglycemia and improves patient comfort in nondiabetic individuals undergoing elective surgeries. Prolonged fasting increases the risk of mild hypoglycemia and perioperative discomfort.

Background: A disadvantage of regional blocks is their limited period of efficacy. One of the medications that has been found to have the ability to extend the duration of effect is dexamethasone. For the purpose of determining the duration of analgesia after administration of 4 mg of dexamethasone via the intravenous and perineural routes following an ultrasound (USG)-guided supraclavicular brachial plexus block.

Objective: To compare the duration of analgesia between perineurial and intravenous dexamethasone when giving supraclavicular USG-guided brachial plexus block, time of administering rescue analgesia, and any adverse events like postoperative nausea and vomiting (PONV).

Methods: This comparative observational study involved 100 adults, aged 18-70 years, with ASA physical status between I and III, who were scheduled to undergo elective procedures of the upper limb under USG-guided supraclavicular brachial plexus block, and were assigned to either the perineural group or intravenous group. Patients in the perineural group (n = 50) were given 10 mL of 0.5% bupivacaine hydrochloride, 10 mL of 2% lidocaine hydrochloride with adrenaline 1:200,000 (5 μg/mL), and 4 mg of dexamethasone. Patients in the intravenous group (n = 50) were given an additional 4 mg of dexamethasone intravenously just before giving the local anesthetic mixture into the brachial plexus. The extent of analgesia, pain, adverse effects like PONV, and rescue analgesia required were recorded.

Results: Up to 24 h after the procedure, a greater segment of patients in the perineural group reported analgesia (72% vs. 24%; P = 0.001) and a reduction in pain (76% vs. 36%; P = 0.001). Adverse effects like PONV were minimal and comparable. Patients in the intravenous group received rescue analgesia with paracetamol 1 g intravenous repeated every 6 h when VAS score is 3 or more. Patients with VAS score of 1 or 2 did not receive any rescue analgesics. Second rescue analgesic is injection diclofenac 75 mg intramuscular repeated every 6 h if paracetamol fails.

Conclusion: When compared to the intravenous route, the perineural route of dexamethasone was shown to be beneficial in extending the duration of anesthesia for up to 24 h, which resulted in prolonged pain-free and a reduced need for rescue analgesia. Furthermore, enhanced recovery was noted in patients when dexamethasone was given via the perineural route due to the extended duration of pain relief.

Abstract: External brain tamponade is an uncommon but serious postoperative complication of decompressive craniectomy, characterized by the accumulation of subgaleal cerebrospinal fluid causing mass effect on the brain. We report the case of a 45-year-old woman with previously resected right frontotemporal glioblastoma who underwent repeat craniectomy for tumor recurrence. Twenty-five days later, she developed sudden swelling at the operative site along with acute neurological deterioration. Computed tomography revealed a large subgaleal fluid collection compressing the underlying brain parenchyma, consistent with external brain tamponade. The patient underwent urgent drainage of the collection along with ventriculoperitoneal shunt placement, resulting in rapid clinical and radiological improvement. This case underscores the importance of recognizing delayed postoperative complications after craniectomy and highlights the need for prompt imaging and intervention to prevent irreversible neurological damage.

Introduction: Birth preparedness and complication readiness (BPCR) is a critical strategy to improve maternal and neonatal outcomes by reducing delays in accessing skilled care. Despite its importance, knowledge levels remain inadequate, particularly among primigravid women. This study evaluated the effectiveness of a companion-integrated BPCR (CI-BPCR) awareness package in improving knowledge and childbirth experience among primigravid women in Eastern India.

Methods: A quasi-experimental study was conducted at two tertiary care hospitals serving comparable demographic populations. Eighty primigravid women (40 per group) were enrolled through purposive sampling. The intervention group received a structured CI-BPCR awareness package at 28-32 weeks of gestation, incorporating education on birth preparedness, danger sign recognition, and birth companion training through interactive sessions. The control group received standard antenatal care. Knowledge was assessed at baseline and 2 weeks postintervention using a validated questionnaire adapted from the JHPIEGO tool. Childbirth experience was evaluated 24-48 h postpartum using the Childbirth Experience Questionnaire. Thirty-five participants per group completed the study.

Results: The intervention group demonstrated significant improvements in knowledge across all domains: birth preparedness, danger signs in pregnancy, labor, puerperium, and newborn ( P < 0.001). Childbirth experience was significantly better in the intervention group across dimensions of own capacity ( P < 0.001), professional support ( P < 0.001), perceived safety ( P = 0.003), participation ( P = 0.001), and sense of security ( P < 0.001). Pain levels showed no significant difference ( P = 0.607).

Conclusion: The CI-BPCR awareness package significantly improved knowledge and childbirth experience among primigravid women, demonstrating its potential for integration into routine antenatal care in resource-limited settings.