Annals of African Medicine最新文献

Context: Type 2 diabetes mellitus (T2DM) and hypertension are major chronic conditions affecting elderly populations globally, often combined with socioeconomic hardship and comorbidities, which can impair quality of life (QoL).

Aims: The aim of this study was to assess the health-related QoL among elderly persons with type 2 diabetes and hypertension living in urban slums of Bengaluru and to identify socio-demographic, clinical, lifestyle, and comorbidity factors associated with QoL.

Settings and design: A community-based cross-sectional study was conducted among 255 elderly persons (age ≥60 years) with T2DM and hypertension using probability proportional to size sampling from 12 slums in the field practice area of a tertiary care hospital in Bengaluru, India. Methods and Materials: Data were collected on sociodemographic profile, clinical status, disease duration, comorbidities, lifestyle behaviors, and health-related QoL using domain-specific assessments.

Statistical analysis used: Statistical analysis included descriptive statistics, ANOVA/Chi-square tests, and Pearson correlation.

Results: Of 255 participants, the mean age was 67.7 years. Almost half (47.1%) the participants reported poor QoL, predominantly in the social and psychological domains. The mean QoL score among the study subjects is 44.92 ± 7.6, which is below average. The highest score was 47.19 ± 14.6, seen in the physical domain, and the lowest mean scores were observed in social (42.96 ± 16.30) and psychological domains (43.92 ± 10.4).

Conclusions: The elderly with type 2 diabetes and hypertension in urban slums experience poor QOL influenced by sociodemographic, clinical, and lifestyle factors. Interventions emphasizing physical activity, diet adherence, comorbidity management, and social support are needed.

Abstract: Fibrocalculous pancreatic diabetes (FCPD) is an unique nonalcoholic form of chronic pancreatitis seen in tropical countries, characterized by pancreatic calcification in addition to pancreatic chronic inflammation and diabetes. In patients with FCPD, chronic and recurrent bouts of pancreatitis lead to calcifications followed by the development of diabetes. Pancreatic pseudocysts occur in 20%-40% of cases of chronic pancreatitis, and two-thirds of the pseudocysts occur in patients with alcohol related chronic pancreatitis. The association of FCPD with pancreatic pseudocysts is extremely rare. Till date only a single case of case of tropical chronic pancreatitis with giant pseudocyst and glucose intolerance was reported in a 16-year-old woman with cassava consumption. We report a novel case of multiple pseudocysts of the pancreas in a case of FCPD.

Background: In 2019, India shifted to competency-based medical education (CBME). This reform allows MBBS students to select electives in basic sciences, clinical programs, and research domains under the Graduate Medical Education Regulations 2019. Electives deepen learning through communicative and instrumental phases, contrasting with mandatory core courses.

Aim and objectives: To identify the perceptions of students and teachers regarding the newly introduced electives under the CBME curriculum.

Methodology: This cross-sectional study was conducted for a 2-month duration among MBBS medical students following the CBME curriculum, particularly the 2019-2020 batch and teachers assigned for different electives in JSS Medical College and Hospital, Mysuru. A total of 197 students underwent elective posting for 1 month. Data were collected using a structured digital self-administered questionnaire designed separately for the students and the coordinators.

Results: Out of 197 students and 36 teachers, 65.4% (129) in Block 1 and 57.3% (113) in Block 2 felt the duration of elective postings was sufficient. The majority of the students expressed that one more month should have been extended for elective postings. Among the teachers, 38.8% in Block 1 and 33.3% (12) in Block 2 felt the duration of elective postings was sufficient. Regarding the effectiveness of elective postings in evoking students' interest in the subject, the majority, i.e., 49.4% agreed, whereas 19.4% expressed neutral opinion.

Conclusions: In the present study, the majority of the students and faculty expressed positive responses about the selection process, implementation, utility, and effectiveness of the electives in the MBBS program.

Background: Estimating fluid status before surgery is not routine, but ultrasound can be used for this purpose. Previous studies have shown a correlation between collapsibility indices of the subclavian vein (SCV) and inferior vena cava (IVC). There is a limited data regarding the suitability of studying SVC for predicting hemodynamic events like hypotension during induction anesthesia. By studying SCV width variations prior to surgery, we hope to get an indirect estimate of the fluid status of the patient, which may predict the occurrence of postinduction hypotension during surgery.

Methodology: This was a prospective, observational, single-center study registered with the Clinical Trials Registry of India. Patients aged 18 years and above, with ASA physical status 1 or 2, undergoing elective surgery with general anesthesia (GA) and endotracheal intubation were enrolled as per inclusion criteria. There were two observers performing the procedure: observer 1 measuring the blood pressure every minute for 10 min and observer 2 doing the measurements of the SCV ultrasonographically. The measurements included SCVDmax, SCVDmin, and SCVCI, which indicate maximum and minimum diameters of the SCV and its collapsibility index. Measurements were taken both during spontaneous breathing, deep breathing, and after passive leg raising.

Results: In total, 80 patients were recruited for the study, and these data were analyzed. Patients were analyzed into two groups: a hypotension group (defined by absolute mean arterial pressure (MAP) <65 mmHg or a drop in MAP by more than 30% from baseline) and a no hypotension group. There were no significant differences between the two groups for baseline heart rate ( P = 0.0673), SCV diameters (maximum and minimum diameters measured in spontaneous, deep, and during PLR), and collapsibility indices (for spontaneous, deep, and during PLR).

Conclusion: Preoperative measurements of SCV diameter and its collapsibility index during spontaneous breathing, deep breathing, and passive leg raising are not reliable to predict the occurrence of hypotension after induction of GA.

Abstract: Acquired hemophilia A (AHA) is a rare autoimmune bleeding disorder caused by inhibitory autoantibodies against coagulation Factor VIII (FVIII), leading to spontaneous bleeding in individuals without a prior bleeding history. It is frequently associated with autoimmune conditions, malignancies, or idiopathic causes. Sjögren's syndrome is an uncommon trigger for AHA, and coexisting antiplatelet therapy can obscure the diagnosis. We report the case of a 67-year-old male with ischemic heart disease on dual antiplatelet therapy who presented with melena, hematuria, and ecchymoses for 15 days. Initial evaluation revealed severe anemia and isolated prolonged activated partial thromboplastin time (aPTT) with normal platelet count and prothrombin time. Imaging demonstrated a large bladder hematoma and right knee hemarthrosis. Autoimmune workup was positive for anti-nuclear antibody (speckled pattern) and anti-Ro52 antibodies, consistent with Sjögren's syndrome. Coagulation studies showed markedly reduced FVIII activity (2%) and high-titer inhibitors (256 Bethesda units), confirming AHA. High-dose corticosteroids were initiated; however, the patient developed worsening hematuria, acute kidney injury, and metabolic acidosis, ultimately succumbing to uncontrolled bleeding and multi-organ failure. This case highlights the diagnostic challenge of AHA in patients on antiplatelet therapy, where bleeding may be misattributed to medication effects. Persistent isolated aPTT prolongation should prompt evaluation for coagulation factor inhibitors, especially in the context of autoimmune features. Early recognition and initiation of hemostatic and immunosuppressive therapy are crucial to improve the survival.

Abstract: Palmyra palm sprout skin was extracted using ethanol to test its antibacterial activity against isolated urinary tract infection (UTI) pathogenic bacteria. The extract demonstrated excellent inhibitory activity at the concentration of 500 μl/well. It was observed that all the isolated UTI-causing bacteria were highly resistant to selected commercially available antibiotics. The ethanol extract of the palmyra palm sprout skin showed excellent antioxidant, anti-inflammatory, antidiabetic, and antiproliferative activities. Before boiling the Panam kilangu, the sprout skin is usually peeled from it and thrown away as it is considered of no use. However, our study demonstrates a waste-to-wealth based alternative use for the palmyra palm sprout skin. Based on studies, these by-products could be used as a source of valuable bioactive compounds. It showed excellent inhibitory activity at the concentration of 500 μg/well against UTI bacteria. It also showed to possess various secondary metabolites, such as flavonoids, saponins, etc. Gas chromatography-mass spectrometer analysis revealed the presence of various bioactive metabolites.

Background: Ulcers with skin loss causes lot of complications leading to delay in wound healing, prolonged hospital stay and complications like wound infections, need for prolong hospital stay, need for multiple surgery. Split skin grafting technique comprises of harvesting the skin graft from the healthy skin areas and is used to cover the exposed ulcers. With time newer techniques to treat ulcers were developed out of which one of the method is called as Dermatotraction. This technique utilizes the skin characteristics of stress relaxation (creep) and delayed primary closure is used. The procedure involves the approximation of the skin edges using the method of shoelace technique and a gradual skin traction is applied for a period, and when the two ends approximate secondary suturing is done.

Aims: To assess the outcomes of Dematotraction vs Split skin grafting in infected ulcers in a Tertiary Care Hospital in Mangalore.

Objectives: a) To Determine the clinical outcomes of the dermatotraction on complex wounds of varying size and shape, b) To analyze the outcomes of dermatotraction by comparing to Split Skin Grafting.

Material and methods: This study was done in Department of General Surgery. Prior to the study approval from the ethical committee was obtained and the study was done on the patients as per listed in the inclusion criteria. A total 52 cases were performed 26 cases in dematotraction group 26 cases in Split Skin Grafting group.

Results: The dermatotraction group was done in the 26 patients of which 18 patients was treated with the technique of primary closure and 6 patients had to undergo dermatotraction followed by secondary suturing, 2 patients had infection required further treatment. The split skin grafting 22 cases had uptake and 4 cases had graft rejection of which16 cases had complete uptake with 6 cases had partial uptake and 4 cases had complete rejection of the graft. Of the 26 cases in split skin grafting 4 patients also had donor site infection. Dermatotraction group had good cosmetic appearance with intact tactile sensations compared to the split skin grafting.

Conclusion: Split skin grafting has been a conventional method of treatment for peripheral limb ulcers. In this study we have found dermatotraction can be a cost effective, feasible procedure in selected patients with better outcomes and the quality of life. Further studies are warranted to establish dermatotraction to be considered as a standard of treatment for peripheral limb ulcers.

Context: Vipassana meditation (VM), a mindfulness-based practice, has been known to promote good health all the way. Global chronic diseases such as cardiovascular diseases, diabetes, and hypertension often bring physical and mental pain together. Through developing emotional regulation and helping to reduce stress, VM can be used as an alternative medicine in combination with the conventional therapies now used for treating this condition.

Objective: The aim of the study was to evaluate how VM alters key health measures, including body weight, blood pressure and sugar levels, pulse rate, body mass index (BMI), and emotional state. It also sought to identify changes in emotional spectrum of reactions, such as fear, expectations, and concern before/after the 10-day VM camp.

Materials and methods: A pre-experimental study was done at Khadavli Vipassana Center, from which time it admitted 156 first-time participants. After excluding four participants, the final sample size was 152. Health indices were assessed before and after the meditation using standard tools, while the emotional spectrum was ascertained with a unstructured questionnaire. Paired samples t-tests and analysis of the content of emotional responses were conducted on the data.

Results: There were significant improvements in physical health: the participants' mean weight decreased by 0.8 kg, BMI dropped 0.3 kg/m², and their systolic and diastolic readings were slightly reduced. This was accompanied with reduced random blood sugar (by 8.8 mg/dl). Oxygen saturation (SpO2) increased by 0.92%. Emotional responses demonstrated a marked reduction in fear and a corresponding increase in positive affect, including enhanced feelings of peace and well-being, observed upon completion of the 10-day intervention period. People said that they had found peace of mind and taken away stress.

Conclusion: VM has a significant impact on the physical health system and psychological health, which suggests that it may be not only useful in relieving chronic illness but also could become an adjunct to standard medical treatment. Randomized controlled trials are needed to confirm these findings.

Background: Dental caries is caused by plaque formation resulting from biofilm accumulation on tooth surfaces. The bacterium Streptococcus mutans plays a crucial role in biofilm formation. Allium sativum (garlic), known for its broad-spectrum antimicrobial properties, contains bioactive compounds such as allicin that may serve as effective antibacterial agents.

Objective: This study aimed to analyze the biomolecular interaction between allicin and a key virulence-associated protein of S. mutans.

Materials and methods: For computational analysis, molecular docking was performed using AutoDock software to evaluate the binding affinity of allicin with a virulence factor of S. mutans. Based on binding free energy (ΔG) values, screening results were analyzed using the PyMOL virtual screening tool.

Results: Molecular interaction analysis using LigPlot+ and PyMOL revealed that allicin exhibited an overall docking score of ΔG (-4.03 kcal/mol) and an inhibition constant (Ki) of 5.80 μM, indicating strong binding affinity for the target protein's active site (Glucan-bd_C/Surface_Ag-I/II_V). This compound formed two hydrogen bond interactions and engaged two catalytic residues of the enzyme, Asn814 and Lys811.

Conclusion: The in silico docking results support the therapeutic potential of allicin as a natural antimicrobial agent targeting bacterial virulence and highlight garlic as a candidate for developing novel strategies in managing oral infections.

Background: Diabetic retinopathy (DR) and diabetic peripheral neuropathy (DPN) are among the most prevalent complications of diabetes mellitus (DM), both of which stem from microvascular complications and are believed to have a shared underlying pathophysiology. A notable challenge is that patients may go unnoticed for either condition by their treating physician, given that these complications typically fall under different medical specialties. Consequently, this study aimed to investigate the clinical correlation between the severity of DR and DPN and explore their associations with glycemic variability and the levels of glycated hemoglobin (HbA1c).

Methodology: This is a hospital-based cross-sectional observational study involving 156 patients attending the ophthalmology outpatient department and the inpatient department at a tertiary care hospital in rural South India over a period of 2 years.

Results: There was an increase in the severity of DR with increasing duration of DM among patients (P < 0.001). The proportion of patients with DPN notably increased with increasing severity of DR among the patients (P < 0.001). Notably, the number of patients with DR and DPN changes increased with increasing glycemic values. These findings suggest a statistically significant association between DR and DPN and glycemic control.

Conclusion: This study revealed a positive correlation between the severity of DR and the presence of DPN, along with an association with HbA1c variability. This underscores the importance of interdisciplinary collaboration for comprehensive evaluation and management.