Annals of African Medicine最新文献

Background: Fractures of the metacarpal bones are common injuries of the hand that can be managed surgically with K-wire, intramedullary screws or plates. The study aimed to compare the radiological and functional outcomes of metacarpal shaft fractures treated with K-wire and plate fixation.

Methodology: A prospective study comprising 100 patients with metacarpal shaft fractures was recruited in a nonrandomized manner and divided into two groups ( n = 50 per group) and followed up for 9 and 14 months. Participants in one group were fixed using K-wire, while fractures in the other group were fixed using plates. The outcome variables included time for union, functional outcomes (Disability of the Shoulder, Arm, and Hand scores), pain scores (Visual Analogue Scale [VAS]), metacarpophalangeal joint-range of motion (MCPJ-ROM) (using single-axis manual goniometry), and possible complications.

Results: The median time of union was around 14 weeks in the plate group when compared to 17 weeks in the K-wire group ( P = 0.001). Overall functional outcomes were significantly better among participants in the plate group after 9 and 14 months, respectively ( P = 0.001). However, the median MCP joint active ROM (A-ROM) was found to be around 79.2° (88%) and 84.6° (94%) in the plating group and the K-wire group, respectively, at the end of 14 months. Median pain score was around 2 and 3 in the K-wire and the plating groups at the end of 9 months, respectively ( P = 0.001), but were the same at the end of 14 months. Median flexion MCPJ-AROM was better among participants fixed with K-wire both after 9 months (73.8° vs. 64.8°) and 14 months (84.6° vs. 79.2°), respectively. In terms of complications, there were 3 (6%) nonunion rates and 6 (3%) pin tract infections among the K-wire group, whereas there was only one case of nonunion among the plating group at the 14 th month ( P = 0.041).

Conclusions: Fixing metacarpal fractures using plates resulted in better overall functional outcomes with early union of fracture segments. However, pain scores were less in the K-wire group with better MCPJ-ROM among participants.

Background: Opportunistic mycosis such as candidiasis are those fungal infections that are found in patients with underlying predisposing conditions such as old age, immunosuppressive therapy, HIV, tuberculosis, and pregnancy. Urinary tract infection (UTI) is a major source of morbidity in women of all ages, older men and infant boys caused by bacterial as well as fungal agents. Fungal infections, especially Candida species are found to cause candidiasis in pregnant women causing various complications such as urethritis, pelvic inflammatory disease, infertility, ectopic pregnancy, and chronic pelvic pain.

Materials and methods: The samples of genitourinary tract such as urine, high vaginal swabs, vaginal discharge, and catheter tips were examined for isolation and identification of Candida species.

Results: A total of 498 samples were processed, of which 55 Candida species were obtained from urine, HVSs, vaginal discharge, and catheter tips. The most prevalent species were Candida albicans (63.64%), followed by Candida tropicalis (12.73%) and Candida glabrata (10.90%). The most effective drug against all the Candida species isolates was Caspofungin showing 100% sensitivity.

Conclusions: Maximum number of Candida species was obtained from the urine samples among pregnant female patients aged between 21 and 40 years with C . albicans being the most predominant fungus causing opportunistic fungal infections. Caspofungin was the most effective drug in these isolates. The study emphasizes the need for species-specific therapy and routine screening, especially in pregnant women.

Abstract: Macrophage activation syndrome (MAS) is part of a spectrum of cytokine storms. This case report describes a presentation of an 18-year-old female with systemic lupus erythematosus (SLE) complicated by MAS. The patient, previously healthy, presented with a 3-week history of high-grade intermittent fever, abdominal pain, nausea, and loss of appetite. Clinical examination revealed fever, tachycardia, and normal blood pressure without signs of lymphadenopathy or organomegaly. Laboratory tests indicated anemia, thrombocytopenia, leukopenia, neutropenia, elevated liver enzymes, hyperferritinemia, hypofibrinogenemia, and hypertriglyceridemia. Despite broad-spectrum antimicrobial therapy, the patient's fever persisted, prompting bone marrow aspiration, which showed hemophagocytosis. Immunological testing revealed elevated antinuclear antibodies, anti-double-stranded DNA, and anti-Smith antibodies, confirming a diagnosis of SLE. Further analysis using the Modified Histocyte score and hemophagocytic lymphohistiocytosis-2004 criteria supported a diagnosis of MAS associated with SLE. The patient was treated with intravenous methylprednisolone, followed by oral prednisolone and monthly cyclophosphamide. The patient showed significant clinical improvement with the resolution of fever and hematological abnormalities. MAS is a rare but severe complication of SLE, requiring early recognition and treatment to prevent life-threatening complications like multiorgan failure. This case highlights the importance of considering MAS in young females with SLE presenting with systemic symptoms and emphasizes using diagnostic scoring systems to guide management. Early intervention and careful monitoring are crucial to improving patient outcomes.

Background: Serum albumin is generally considered to be a predictor of a patient's nutritional status. Hypoalbuminemia is associated with increased mortality and morbidity in postoperative patients. In this study, we used preoperative serum albumin levels and a drop in postoperative albumin levels to assess various postexploratory laparotomy complications.

Aim: This study aims to evaluate the role of preoperative albumin levels and their postoperative drop in the incidence and severity of outcomes in exploratory laparotomies.

Study design: Prospective observational.

Materials and methods: Preoperative and postoperative serum albumin level was observed in 52 patients who underwent exploratory laparotomy for various pathological conditions and were divided into ten groups based on the specific outcomes observed, such as surgical site infections (SSIs), delayed wound healing (DWH), or acute respiratory distress syndrome. Within each group, the relationship between the preoperative albumin levels, their postoperative drop, and the severity of the outcomes was analyzed. The study was conducted over a period from August 2022 to July 2024.

Results: Among ten outcomes, four outcomes showed significant results. Patients with SSI and DWH showed significant differences in drop-in postoperative albumin levels ( P = 0.005), with a mean difference of 0.64810 g/dL. Among anastomotic leak (AL) patients, Out of 52 patients who underwent exploratory laparotomy due to various indications, only 32 had bowel anastomosis, with significant value for AL when equal variances are assumed ( P = 0.039) noted. In the mortality category, for preoperative albumin, there is a significant mean difference of 1.2970 ( P = 0.001), with higher levels in survivors compared to nonsurvivors. Similarly, postoperative albumin levels show a significant mean difference of 1.18085 ( P = 0.002), again favoring survivors.

Conclusion: Preoperative hypoalbuminemia <3.0 g/dl is a strong and independent risk factor for postoperative morbidity and mortality in gastrointestinal surgeries. Preoperative improvement of nutritional status must be done before undertaking surgery.

Introduction: The purpose of the study was to determine the spectrum of diseases of surgical acute abdomen by ultrasonography and comparing the ultrasound diagnosis with the surgical diagnosis of acute abdominal conditions in a low-income resource setting.

Materials and methods: A prospective observational study was conducted on consecutive patients presenting with acute abdomen to the radiology department for abdominal ultrasonography. The ultrasound diagnosis was compared with the surgical diagnosis. Chi-square and Fisher's exact tests were used for association, and Kappa statistics was used for interobserver agreement. Diagnostic performance markers included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy.

Results: The most common conditions included appendicitis (27.5%), bowel perforation (21.7%), and ectopic pregnancy (12.5%). Ultrasonography had an overall sensitivity of 80.8%, specificity of 99.1%, PPV of 89.0%, NPV of 98.3%, and diagnostic accuracy of 97.6%. Sensitivities of 69.7%, 88.5%, 100.0%, and specificities of 98.9%, 96.8%, 100.0% were seen for acute appendicitis, bowel perforation, and ectopic pregnancy, respectively. There was a significant relationship between ultrasound and surgical diagnosis of most of the acute abdominal conditions ( P < 0.001) except for appendiceal abscess ( P = 0.05). Ultrasound and surgical diagnosis of all the acute abdominal conditions showed beyond chance kappa (κ) interobserver agreement (0.20< κ ≤1.00).

Conclusion: With skilled hands, there is high concordance between ultrasound and surgical diagnosis of acute abdomen. Ultrasonography should be part of the initial evaluation of patients with surgical acute abdomen in a setting where emergency abdominal computed tomography is not readily available, accessible, and affordable.

Abstract: The coronavirus disease 2019 (COVID-19) pandemic has led to a global health crisis, with mass vaccination being a pivotal strategy in mitigating its impact. However, adverse events following immunization/vaccination have raised concerns, although most are mild. This case report details a 33-year-old male who developed fatal acute respiratory distress syndrome, congestive cardiac failure, and multi-organ failure after receiving the second dose of the COVID-19 vaccine. Autopsy revealed underlying mitral stenosis complicated by infective endocarditis, which likely contributed to the patient's death. Cytological, biochemical, and microbiological examinations of pleural, pericardial, and peritoneal fluids were inconclusive in identifying a specific cause. The temporal association between vaccination and death warrants further investigation, although definitive evidence linking the vaccine to the adverse event remains unclear. The findings emphasize the importance of continuous monitoring and further research into vaccine safety, whereas reinforcing the critical role of mass vaccination in controlling the pandemic.

Background: There are regional differences in rheumatoid arthritis (RA) disease-modifying antirheumatic drug (DMARD) use and availability. These stem from factors and peculiarities in population characteristics and socioeconomic indices. There is no published literature on the DMARD preferences or prescription patterns in Nigeria. The aim of this study was to document the prescription pattern of DMARD in Nigeria as well as factors affecting the choice of DMARD among Nigerian rheumatologists and establish a documentary evidence of what the real-life prescription pattern is in a low-middle income country for the treatment of RA.

Methods: Online survey using pretested structured questionnaire inputted on the SurveyMonkey App and its link sent to and answers received from practicing Nigeria consultant rheumatologists. Analysis of data was done using data exported to SPSS.

Results: A total of 26 (63.4%) responses from consultant rheumatologists in Nigeria were received. Most participants (84.62% [22]) had their place of practice at a teaching hospital. The initial choice of DMARD monotherapy was methotrexate (MTX) (88.5%), followed by sulphasalazine (11.5%). Cost of medications, need for rapid disease control, and presence of joint erosions were the most common reasons that influenced rheumatologists' choice of DMARDs. Prescription rate of biologic DMARDs (bDMARDs) was low.

Conclusion: MTX remains the DMARD of first choice for RA among Nigerian rheumatologists. Conventional synthetic DMARDs are the commonly available, widely used, and still effective armamentarium for RA in resource-poor settings like Nigeria. bDMARDs prescription rate for RA remains low in Nigeria.

Background: Acute coronary syndrome (ACS) in young adults presents unique clinical and diagnostic challenges, with limited data from the Indian subcontinent.

Aim: This study aims to assess the clinical profile, risk factors, and diagnostic findings of ACS in adults aged ≤40 years.

Materials and methods: This hospital-based, cross-sectional study included 60 patients aged 18-40 with confirmed ACS. Clinical symptoms, laboratory investigations, Electrocardiography (ECG), echocardiography, and coronary angiography were analyzed. Associations were tested using the Chi-square test, with P < 0.05 considered statistically significant.

Results: The median age was 35.5 years; 96.7% were males. Breathlessness and palpitations were reported in all cases, while chest pain was present in 81.7%. Hypertension (40%), diabetes (31.7%), smoking (28.3%), and drug use (55%) were common risk factors. Single-vessel disease was the predominant angiographic finding (61.7%). Smoking correlated significantly with ECG abnormalities ( P = 0.0382), and diabetes with severe coronary involvement ( P = 0.0429).

Conclusions: ACS in young adults is more prevalent in males and often presents with nonclassical symptoms. Diabetes and smoking are significantly associated with diagnostic severity. Early risk identification and preventive strategies are essential in this population.

Background: Hamelia patens Jacq., commonly referred to as firebush, is a tropical shrub belonging to the Rubiaceae family. It has been traditionally employed in various ethnomedical practices to address ailments such as dermatological infections, inflammatory conditions, and gastrointestinal disturbances. These therapeutic applications are attributed to its diverse array of bioactive phytoconstituents, including alkaloids, flavonoids, and phenolic compounds. Despite extensive studies on organic solvent extracts, there remains a paucity of data concerning the efficacy and phytochemical composition of traditional aqueous extracts.

Objective: This investigation aims to delineate the maceration-based extraction methodologies utilizing aqueous and ethanol solvents for H . patens leaves and to underscore the significance of each method in isolating pharmacologically active compounds.

Materials and methods: Freshly harvested H . patens leaves underwent thorough washing and were subsequently dried either by air in a shaded, well-ventilated environment or using an oven maintained at 40°C-50°C to preserve thermolabile constituents. The desiccated leaves were then pulverized into a coarse powder. For extraction, 5 g of the coarsely powdered material were subjected to maceration with 100 mL of distilled water and 50 mL of ethanol (70%-95%) for a duration of 24-72 h at ambient temperature, with intermittent agitation to facilitate solvent penetration. Postmaceration, the mixtures were filtered to obtain the respective aqueous and ethanol extracts. Comprehensive phytochemical screening was conducted to detect the presence of alkaloids, flavonoids, tannins, saponins, phenolics, glycosides, triterpenoids, phytosterols, and carbohydrates.

Results: Phytochemical analyses revealed that the aqueous extract evaluated positive for alkaloids, saponins, phytosterols, phenols, flavonoids, carbohydrates, glycosides, and triterpenoids, while tannins were absent. Conversely, the ethanol extract demonstrated the presence of phytosterols, phenols, flavonoids, carbohydrates, glycosides, and triterpenoids but evaluated negative for tannins, alkaloids, and saponins. These findings suggest that solvent polarity plays a pivotal role in the selective extraction of phytochemicals, with aqueous extraction favoring polar compounds and ethanol extraction being more efficacious for semi-polar constituents.

Conclusion: Maceration employing aqueous and ethanol solvents effectively isolates distinct profiles of bioactive compounds from H . patens leaves. The aqueous extract, enriched with polar phytochemicals, aligns with traditional medicinal preparations, whereas the ethanol extract, containing a broader spectrum of semi-polar compounds, holds considerable promise for pharmaceutical applications.

Background: Reconstruction of ligament injuries, particularly the anterior cruciate ligament, is a widely accepted approach for restoring knee function in anterior cruciate ligament (ACL) deficiency; however, postoperative infections remain a serious complication. Presoaking grafts in antibiotic solutions offers protective benefits against infection by providing local antibiotic prophylaxis without affecting graft integrity. No high-quality RCTs in India have evaluated this infection prevention method.

Methodology: In this prospective RCT at a tertiary center, 76 patients with complete ACL tears were allocated to presoaking of ACL grafts in either vancomycin solution (500 mg/100 mL saline for 10-15 min) in the experimental group or presoaking of ACL grafts in normal saline in the control group before implantation. A simple randomization technique using sealed opaque envelopes ensured unbiased allocation. The primary outcome was postoperative infection measured via C-reactive protein levels postoperatively to monitor the inflammatory response. Functional outcomes were assessed using the International Knee Documentation Committee (IKDC) and Lysholm Knee score at 6 months.

Results: This study aims to evaluate the effectiveness of vancomycin presoaking of ACL grafts in reducing postoperative infection rates in patients undergoing ACLR. The vancomycin presoaked ACL grafts group (n = 38) had 0% infection versus 5.26% in the saline presoaked ACL grafts group (n = 38) (P = 0.152). No graft failures occurred in both groups. Mean IKDC scores were 87.02 ± 6.75 in the vancomycin presoaked grafts group versus 87.19 ± 6.24 in the saline presoaked grafts group (P = 0.838), and mean Lysholm scores were 83.68 ± 7.66 in the vancomycin presoaked grafts group versus 86.47 ± 6.38 in the saline presoaked grafts group (P > 0.05), respectively.

Conclusions: Vancomycin presoaking of ACL grafts is safe and shows a trend towards lower infection risk without adverse effects on graft performance or recovery.