Annals of African Medicine最新文献

Abstract: Scrub typhus, caused by Orientia tsutsugamushi, is an emerging zoonotic infection that typically presents as an acute febrile illness. While neurological manifestations are increasingly recognized, cerebellar involvement remains exceedingly rare. We report the case of a 42-year-old man from Uttar Pradesh who presented with high-grade fever, followed by slurred speech and gait ataxia. Clinical examination revealed cerebellar signs, including dysmetria and dysdiadochokinesia. Laboratory testing confirmed scrub typhus via a positive immunoglobulin M enzyme-linked immunosorbent assay, and other infectious and autoimmune etiologies were excluded. Magnetic resonance imaging of the brain and cerebrospinal fluid analysis were normal. The patient was treated successfully with intravenous doxycycline and methylprednisolone, resulting in rapid clinical improvement. This case highlights acute cerebellitis as an atypical but important complication of scrub typhus, underscoring the need for heightened clinical suspicion in endemic areas.

Background: Dentinal hypersensitivity (DH) is a frequent condition producing sharp, transient pain in response to external stimuli. Conventional desensitizing agents often provide only partial or short-term relief. This study evaluated the effectiveness of combining ozone therapy with desensitizing toothpaste compared with toothpaste alone in DH management.

Methods: A randomized controlled trial was conducted on 80 patients aged 18-65 years with moderate-to-severe DH at the Department of Oral Medicine and Radiology, Kalinga Institute of Dental Sciences, Bhubaneswar. Patients were allocated into two groups: the test group ( n = 40) received ozone therapy (ozonated olive oil and ozone gas) plus desensitizing toothpaste, and the control group ( n = 40) received 5% potassium nitrate toothpaste. Sensitivity was assessed at baseline and follow-up intervals (1 week, 2 weeks, 1 month, 3 months, and 6 months) using the Visual Analog Scale (VAS), Air Blast Sensitivity Test, and Sensitivity Clinical Assessment Scale (SCASS). Scanning electron microscopy was performed to assess dentinal tubule occlusion.

Results: Both the groups showed significant sensitivity reduction. The test group achieved greater mean decreases in VAS (5.05 ± 1.11) and SCASS (5.23 ± 1.10) compared with the control group (VAS: 2.35 ± 1.03 and SCASS: 2.28 ± 0.88). Improvements in the test group were sustained for 6 months, whereas control results plateaued. No adverse effects were reported.

Conclusion: Ozone therapy with desensitizing toothpaste offers enhanced, long-lasting relief of dentinal hypersensitivity. Its antimicrobial, anti-inflammatory, and remineralizing actions support dentinal repair and patient comfort, representing a safe and effective adjunct to standard care.

Introduction: Robotic surgery enables surgeons to perform complex procedures with greater precision, flexibility, and control than traditional methods. The surgeon operates robotic arms from a computer console near the patient, viewing the surgical site in high-definition 3D. Despite its advantages, many medical students lack adequate knowledge of robotic surgery, which could influence patient choices regarding surgical treatments.

Materials and methods: A predesigned and pre-validated questionnaire on demographics, knowledge, and attitudes toward robotic surgery was distributed to all MBBS students through email. In addition, a print version was provided to collect responses from those who missed the online form. The data gathered were analyzed using SPSS 23 software to calculate percentages.

Results: A total of 192 medical students of all three clinical years responded to the questionnaire. 38.5% of students were interested in the surgical field, 53.2% considered themselves tech savvy, and 47.9% of students had a clear understanding of robotic surgery. Many (64.6%) students believed robots would improve surgical outcomes. 60.4% of students disagreed that robots will replace surgeons, 34.4% of students disagreed that patients have a positive attitude toward robotic surgery, and many (71.1%) believe that the UAE should invest and expand in robotic surgery.

Discussion and conclusion: Most medical students have a clear understanding of robotic surgery, with a strong belief that robots will improve surgical outcomes, but at the same time, they strongly feel that patients do not have a positive attitude toward robotic surgery.

Abstract: Complete loss of both endocrine and exocrine functions of the pancreas results in the lifelong necessity for enzyme and insulin therapy, coupled with the possibility of immunosuppressant side effects following transplantation, representing the future for patients with hereditary pancreatitis (HP) after routine surgical intervention. One possible method for regenerating pancreatic cells and restoring their functioning is the application of stem cell therapy. The purpose of this narrative review is to compile the body of research on the application of stem cell therapy as a regenerative treatment for postpancreatectomy HP. Many pluripotent stem cells (PSCs), such as human embryonic stem cell-derived, and bone marrow (BM)-derived mesenchymal cells, are in different phases of study. These studies led to the creation of CRISPR VCTX210, VC-02 implants by ViaCyte. VX-880 by Vertex, in its phase 3 trial, used fully differentiated, allogenic pluripotent-stem-cell-derived islet therapy as a functional cure for type 1 diabetes. An allogeneic BM-derived mesenchymal stem cell (MSC), STEMCAP-1, developed by the Medical University of South Carolina (MUSC), is currently in its initial phase of trial. The terms "Hereditary Pancreatitis," "Pancreatectomy and insulin," and "Stem cell therapy" were used in a thorough search of PubMed, Google Scholar, and NIH. Thematic discussion and identification of pertinent material were conducted. Significant areas of divergence in the literature encompass the conventional management of HP, the justification for using Stem Cell Therapy, diverse clinical studies of beta-cell therapies, its burgeoning application in biotechnology and academic institutions, along with the implications for accessibility and economic factors. The enduring risk of insulin-dependent diabetes associated with HP can be mitigated through the regeneration of function with PSC-derived implants and MSC co-transplantation after pancreatectomy. Researchers may find this review useful in developing procedures for patient selection and monitoring, and clinicians may find it helpful in incorporating new treatments into patient care for HP.

Background: Anterior cruciate ligament (ACL) injuries are common among active individuals and often require surgical reconstruction. The position of the interference screw during tibial tunnel fixation may influence graft orientation and postoperative outcomes.

Objectives: To evaluate the correlation between interference screw position in the tibial tunnel, graft inclination, and functional outcomes following single-bundle ACL reconstruction.

Methodology: This prospective observational study included 47 patients aged 16-66 years with isolated ACL tears. All patients underwent single-bundle ACL reconstruction using a standardized technique. Interference screws were placed either anterior or posterior to the graft within the tibial tunnel. Graft inclination was measured via postoperative magnetic resonance imaging. Functional outcomes were assessed using Lysholm and IKDC scores pre- and postoperatively. Statistical analyses included t-tests, Pearson's correlation, and Chi-square tests.

Results: Posterior screw placement was significantly associated with better functional outcomes (Lysholm: P <0.001; IKDC: P <0.001). The inclination angle of the graft negatively correlated with both Lysholm (r = -0.381, P = 0.008) and IKDC (r = -0.366, P = 0.011) scores, indicating that steeper graft angles were linked to poorer outcomes. No significant correlation was found between screw angle and postoperative scores.

Conclusion: Posterior placement of the interference screw improves graft alignment and functional outcomes after ACL reconstruction. Accurate screw and graft positioning are vital for optimal surgical success.

Objectives: This study aimed to determine the effectiveness of intrawound vancomycin in preventing surgical site infection (SSI) in major cranial surgeries.

Materials and methods: It was a prospective, randomized controlled, interventional study conducted in the neurosurgery department of our institution on all adult patients who had major cranial surgeries over 12 months. The consented patients were randomized into either Vancomycin group or control. A predesigned study pro forma was used to collect patients' clinical data including risk factors for SSIs, clinical presentation, indication for surgery, type of surgical intervention and postoperative wound findings. Patients were followed up for 3 months postoperatively.

Results: A total of 104 patients were studied with equal numbers in each group. The incidence of SSI was 10.6% with no significant difference between the two groups. There was however a 17% relative risk reduction in SSI in Vancomycin group. Only two organisms were responsible for SSI: Staphylococcus aureus (91%) and enterococcus (9%).

Conclusion: This study showed that intrawound vancomycin use does not significantly reduce incidence of SSI post major cranial surgery, however the 17% relative risk reduction suggests a potential clinical utility of topical vancomycin for SSI prophylaxis.

Abstract: Tropical tourist destinations frequently encounter marine injuries. Sea urchin stings are commonly seen, but injuries with coral fragments can simulate their presentation, leading to diagnostic dilemmas. We report a case of a 36-year-old male Indian tourist who sustained a puncture wound over the plantar aspect of the foot while walking barefoot in shallow waters of Mauritius. The wound clinically resembled a sea urchin sting. However, wound exploration under aseptic precautions revealed a fragment of coral as the causative foreign agent. The wound was managed with removal of the fragment, irrigation, a compression bandage, tetanus prophylaxis, and oral antibiotics. Radiologic investigations following the procedure were negative for any retained foreign body. Follow-up showed satisfactory wound healing; nevertheless, the patient had local tenderness at the injury site and pain while walking, which was due to granuloma formation as revealed on an ultrasound without any signs of infection. The pain eventually subsided after 2 months. Coral injuries can mimic sea urchin stings clinically. Awareness of this possibility, careful wound exploration, and accurate diagnosis are critical to avoid misdiagnosis and complications. Tourists visiting the island countries should be aware of the dangers of aquatic wildlife and should be vigilant while taking part in water activities.

Abstract: Femoral neck fractures in the elderly are a significant health concern, particularly in low-income settings where total hip arthroplasty may not be feasible. Bipolar hemiarthroplasty is a preferred treatment, but the absence of a supportive calcar can compromise implant stability, leading to complications such as subsidence and periprosthetic fractures. This study evaluates the efficacy of calcar reconstruction using an autologous bone graft in geriatric patients undergoing bipolar hemiarthroplasty. A prospective case series was conducted on 20 patients (aged > 65 years) with displaced femoral neck fractures. During bipolar hemiarthroplasty, the calcar was reconstructed using an autologous femoral head graft. Functional and radiological outcomes were assessed at 6 and 12 months postoperatively using the Harris Hip Score (HHS) and implant stability parameters. At 6 months, the mean HHS was 85.2 ± 7.1, improving to 89.4 ± 6.3 at 12 months. Only one case (5%) of implant subsidence (>3 mm) was noted. There were no dislocations, and 80% of patients regained independent ambulation within 6 months. Calcar reconstruction with an autologous bone graft improves implant stability, enhances functional recovery, and reduces complications, making it a cost-effective alternative in resource-limited settings..

Abstract: Autoimmune adrenalitis is an under-recognized cause of primary adrenal insufficiency in young individuals. Its nonspecific presentation can often mimic gastrointestinal or psychiatric conditions, leading to delayed diagnosis and life-threatening adrenal crisis. We report the case of a 23-year-old male having known treated tuberculous meningitis history who presented with recurrent episodes of vomiting, generalized weakness, and altered behavior. He was hypotensive, drowsy, and had metabolic derangements, including hyponatremia and hyperkalemia. Laboratory investigations revealed low serum cortisol with elevated ACTH levels. Imaging ruled out tuberculous adrenal involvement, and the diagnosis of autoimmune adrenalitis causing primary adrenal insufficiency (Addisonian crisis) was made. The individual was handled using intravenous hydrocortisone, fluids, and supportive care, followed by oral steroid replacement. His condition improved markedly, and he was discharged on maintenance steroid therapy. Primary care physicians should consider adrenal insufficiency in young patients presenting with unexplained vomiting, weakness, or behavioral changes, especially those with a history of central nervous system tuberculosis. Early recognition and steroid replacement are critical to prevent adrenal crises and reduce morbidity.

Introduction: Infertility, defined as the inability to conceive after 1 year of unprotected intercourse, affects 15% of couples globally and is a significant source of psychological distress, especially in women undergoing in vitro fertilization (IVF). This study investigates whether psychotherapeutic interventions reduce distress and improve embryo implantation rates in IVF patients.

Materials and methods: A randomized controlled trial was conducted at two IVF centers in Chandigarh Tricity, India, between June 2023 and April 2024. Three hundred women, aged 21-45 years, were assigned to an experimental and a control group. The experimental group received a structured four-session psychotherapeutic intervention targeting stress, uncertainty, and anxiety, measured using validated scales before and after the intervention. Embryo implantation rates were also recorded. Data collection was followed by entry into Excel and analysis with IBM SPSS 27.

Results: Compared to the control group, the experimental group showed significant reductions in stress, anxiety, and uncertainty. Embryo implantation was successful in 71.3% of the experimental group and 52.7% of the control group (P = 0.001). The intervention also significantly lowered state and trait anxiety (P < 0.001).

Conclusion: Structured psychotherapeutic intervention effectively reduced psychological distress and improved IVF outcomes. These results suggest that psychotherapeutic support should be integral to IVF treatment for better emotional well-being and clinical success.