Annals of African Medicine最新文献

Background: Placental abnormalities are a significant determinant in fetal development and the main cause of maternal and perinatal death. However, regular postpartum placenta inspection is not widespread, and the placenta continues to be a poorly studied and comprehended human organ.

Objective: The present study aims toward the morphometric evaluation of the placental indices and its association with neonatal indices.

Materials and methods: A total of 83 study participants were selected from among the pregnant women. Placental indices, including placenta appearance, placenta shape, number of cotyledons, placenta thickness, placenta weight, and placenta volume, were analyzed. Neonatal indices, including birth weight, APGAR score, body length, head circumference, abdominal circumference, gender, and ponderal index, were analyzed. Association of placental indices with neonatal indices was carried out.

Results: Normal placenta, presence of a high number of cotyledons, higher placenta thickness, higher placenta weight, and higher placenta volume were significantly associated with APGAR score >7. There was no significant difference in the placenta shape in terms of APGAR score. Low birth weight was significantly associated with calcified placenta appearance and retroplacental clot, lower number of cotyledons, lower placental weight, and lower placenta volume. There was no significant difference in the placenta shape in terms of birth weight.

Conclusion: The present study provides important insights about the morphometric evaluation of the placental indices and its association with neonatal indices. A more comprehensive study on placental and umbilical cord parameters is necessary to expand the current knowledge.

Abstract: Traumatic dislocations of the proximal interphalangeal joint (PIPJ) of the lesser toes are rare injuries in the pediatric population, with limited literature available to guide management decisions. We report the case of a 5-year-old male who presented with irreducible dorsolateral dislocation of the right fifth toe PIPJ following trauma during play activities. Clinical examination revealed swelling, tenderness, and restricted movement of the affected digit. Plain radiographs confirmed the dislocation without associated fractures. Initial attempts at closed reduction under procedural sedation were unsuccessful, leading to the decision for surgical intervention. The patient underwent open reduction and internal fixation under general anesthesia. A dorsal longitudinal incision was made over the affected joint, revealing soft tissue interposition preventing reduction. The interposed tissue was carefully removed, anatomical reduction achieved, and joint stability maintained with Kirschner wire (K-wire) fixation. Postoperative management included appropriate analgesia, antibiotic prophylaxis, and immobilization. Regular follow-up demonstrated satisfactory healing without complications. This case demonstrates that irreducible pediatric toe PIPJ dislocations can be successfully managed with open reduction and K-wire fixation when closed reduction fails. Early recognition and appropriate surgical intervention are crucial for optimal outcomes. The rarity of these injuries necessitates high clinical suspicion and prompt specialist consultation to prevent potential complications and ensure proper treatment.

Abstract: Axenfeld-Rieger syndrome is a rare genetic disorder with an autosomal dominant inheritance pattern which encompasses a range of congenital malformations involving the anterior segment of the eye, along with systemic malformations such as craniofacial dysmorphism, dental abnormalities, umbilical abnormalities and congenital heart defects. Mutations in the transcription factor-encoding genes FOXC1 and PITX2 have been associated with the pathogenesis of acute radiation syndrome (ARS). This case report describes a case of a 26-year-old female with progressive loss of vision in both eyes for 3 years. On complete ophthalmic examination, both eyes exhibited characteristic posterior embryotoxon with iris hypoplasia and 360° peripheral anterior synechiae with raised intraocular pressures. The patient had dysmorphic craniofacial anomalies including a flat nasal bridge, maxillary hypoplasia, hypertelorism and the presence of characteristic redundant periumbilical skin. On the basis of distinctive ocular and systemic features, the patient was diagnosed with Axenfeld-Rieger Syndrome. The patient was managed medically with antiglaucoma drugs to maintain the intraocular pressure of the eye. Due to the rarity of ARS, this case focuses on the long-term management and follow-up of these patients and the need to address glaucoma which can potentially lead to blindness in the future.

Abstract: To report the nonresponse to intravitreal bevacizumab (IVB) and the progression from Leber's miliary aneurysm (LMA) to exudative Coats disease (CD) in a 14 year old Nigerian girl who received rescue treatment combining cryotherapy and intravitreal triamcinolone. Additionally, reporting LMA and CD in two other Nigerian females, detailing their treatment and outcomes. The first case involved a 14-year-old girl diagnosed with bilateral extrafoveal LMA, with best-corrected visual acuity (BCVA) of OD 6/9 and OS 6/6. She underwent a total of ten bilateral IVB treatments over 2 years due to the initial retinal laser photocoagulation's failure to control leakage. Despite IVB, her OD progressed to CD with severe intraretinal and subretinal exudation, exudative retinal detachment (RD), secondary cataracts, and a substantial reduction in vision. Her further management included lensectomy, subretinal fluid drainage, cryotherapy, and intravitreal triamcinolone. The RD resolved, and her vision stabilized at hand motion. The second case involved a 14-year-old girl diagnosed with unilateral CD, featuring widespread foveal involvement, retinal exudation, and inferior exudative RD in OD, with a BCVA of counting fingers. Treatment included subretinal fluid drainage, cryotherapy, and intravitreal triamcinolone. The RD resolved, and her vision improved to 6/60. The third case described a 32-year-old female with telangiectatic retinal vessels and foveal involvement due to intraretinal exudation, diagnosed with LMA in OS, which reduced her vision to 6/36. She defaulted on clinic appointments. The first case suggests that IVB alone may not be sufficient to control certain types of LMA and CD. Collectively, these three cases propose that in Nigerians and Africans, a female predisposition to LMA and CD may be more prevalent, contrasting with the male predisposition observed in other races.

Abstract: Ulnar hemimelia (UH), a rare congenital skeletal condition, is frequently linked to other upper limb abnormalities and is characterized by the partial or total absence of the ulna. We describe a rare instance of a 12-year-old patient with unilateral UH, humeroradial synostosis, and oligodactyly. The patient presented with obvious left upper limb shortening and functional limitations. The absence of the ulna, fusion of the humerus and radius, and the underdeveloped digits were all verified by radiographic examination. This case emphasizes the phenotypic variability linked to UH and contributes to the small body of literature on such complex presentations. In order to improve function and quality of life, management prioritized physiotherapy, supportive care, and regular follow-up for possible surgical procedures. For the best outcomes, early detection and a multidisciplinary approach are crucial.

Introduction: This research aimed to explore the link between diabetic nephropathy and diastolic dysfunction in individuals with type 2 diabetes mellitus (T2DM), as the precise impact of diabetes on left ventricle diastolic function in patients with chronic renal failure is limited.

Materials and methods: This cross-sectional study was conducted in the department of general medicine at tertiary care center, over 18 months. This study includes both men and women aged more than 35 years (>35-<70 years) with known or newly diagnosed diabetes mellitus. Involved participants with diabetes mellitus diagnosed using the American Diabetes Association criteria. Diabetic nephropathy was assessed using urine albumin and serum creatinine levels. Patients underwent a two-dimensional-directed M-mode transthoracic echocardiogram and mitral valve inflow assessment. Diastolic dysfunction was classified into three grades, and tissue Doppler imaging was used to measure the E/E' ratio. Data were collected using a predesigned pro forma and entered into an Excel spreadsheet. The study aimed to understand the relationship between diabetes and kidney function.

Results: The study involved 101 patients with T2DM, with a mean age of 53.46 ± 9.96 years. Diastolic dysfunction was observed in 57.4% of the population, with 34.7% having Grade I dysfunction, 18.8% having Grade II dysfunction, and 4.0% having Grade III dysfunction. The prevalence of diastolic dysfunction was higher among males (64.3%) compared to females (48.9%). Age-wise distribution showed 66.7% of patients with diastolic dysfunction, while no significant association was found between diabetes duration and diastolic dysfunction. Lipid profile analysis revealed significantly higher low-density lipoprotein levels in patients with diastolic dysfunction compared to those without. A direct relationship between worsening diabetic nephropathy and diastolic dysfunction was found. A significant correlation was found between declining estimated glomerular filtration rate and worsening diastolic dysfunction.

Conclusion: The study reveals a high prevalence of left ventricular diastolic dysfunction (LVDD) in type 2 diabetes, linked to age, diabetes duration, poor glycemic control, and diabetic nephropathy. The study suggests that glycemic control and diabetes duration may be more dominant determinants of LVDD. Early detection and aggressive management are crucial to mitigate the risk.

Background: Fragility fractures are commonly seen in the distal radius and hip in osteoporotic individuals. While hip fractures have high mortality rates, distal radius fractures are known to cause morbidity in the form of wrist stiffness. This study aims to compare the chronological age of patients who sustain distal radius and hip fractures following a trivial injury.

Methods: The study was done by reviewing available in-patient medical records between January 2019 and July 2024 of patients aged more than 50 years. The data was analysed on Jamovi software version 2.6.17 by using a Mann-Whitney U-test, the age difference of patients sustaining distal radius fractures with that of those sustaining hip fractures were analysed.

Results: This study included 362 patients, of which 112 had sustained distal radius fracture and 250 had sustained hip fractures. 61.2 years was the mean age for distal radius fractures, while that of hip fractures was 72.3 years. Age groups of these two fragility fractures showed a difference which was significant with a T statistic value of 5589 and P < 0.001.

Conclusion: Increased risk of sustaining fragility fracture in the hip as compared to distal radius with increasing age can be attributed to the delayed response to a fall, resulting in a direct impact on the hip on striking the floor. As the mortality associated with hip fractures is high, training to improve the reflexes, particularly those focused on developing the response of an outstretched hand during a fall should be incorporated in the elderly.

Objectives: To present a comprehensive overview of the clinical presentations, diagnostic approaches, treatment modalities, and outcomes in a series of cases of Ewing's sarcoma in the pediatric and adolescent age group.

Methodology: We identified all patients with primary Ewing's sarcoma who were treated at our teaching hospital from 2017 to 2024 with an average follow-up of 2 years. A structured data collection form was used to record available information on demographic variables, clinical presentation, investigations (X-ray, computed tomography scans, magnetic resonance imaging scans, and positron emission tomography scans), laboratory findings, histopathology, diagnosis, and any associated clinical findings. In addition, the outcome of various treatment modalities on Ewing's sarcoma evaluated by the response evaluation criteria in solid tumors (RECIST 1.1) was also recorded.

Results: The most common anatomical site was the ribs and intercostal space, followed by the left ethmoid sinus. The peak incidence was between 11 and 15 years of age, and the most common age of onset was <15 years of age. Immunohistochemical analysis was done in 66.7% of patients. All patients underwent chemotherapy, and 66.7% developed complications. The tumor increased in size by 20% in 41.7% of patients, and a reduction of 30% was also observed in 41.7% of patients. The outcome, as evaluated by RECIST, was not associated with any variable.

Conclusion: It can be concluded that Ewing's sarcoma is an aggressive tumor that needs to be diagnosed early and managed using a multidisciplinary approach. Given the rare nature of the disease, there are no agreed-upon guidelines for effective management. There is an urgent need to establish a new regimen that includes molecule-based pathological diagnosis and standardized treatment protocol.

Abstract: Ventriculoperitoneal shunt complications can occur in patients with hydrocephalus. Shunt complications such as shunt malformations, intracranial hypotension, non-compliant ventricles, and slit-like ventricles can be challenging to diagnose and manage. These patients with atypical symptoms on presentation who had a clinical radiological dissociation give us insight into the need to identify a diagnostic approach and management methods of various shunt complications using various investigations and meticulous clinical assessment.