Annals of African Medicine最新文献

Background: Globally, the leading causes of female morbidity and mortality include endometrial, ovarian, and cervical cancers. Even while posttreatment follow-up is crucial for managing problems and detecting recurrences early, adherence is still below ideal, especially in the low-resource countries. The aim of the study was to evaluate the impact of structured counseling and call-recall interventions on follow-up compliance in gynecological cancer survivors and identify barriers contributing to nonadherence.

Methodology: A prospective observational study was conducted over 18 months at Northern Indian tertiary care facility. A total of 187 women who had completed primary treatment for gynecological cancers that were histologically confirmed. Small-group counseling was provided through interactive sessions and printed materials, and after 3 and 6 months, follow-up reminders were sent out through a structured call-recall system.

Results: The most common cancers were ovarian (47.1%) and cervical (28.9%), 65.2% presented in early stages. Counseling was given to 64.2%, follow-up adherence was improved significantly (P = 0.002). Mean follow-up increased from 34.3% to 53.8% postintervention (P = 0.001). Following call recall, attendance increased by 57.5% and 62.4% at 3 and 6 months, respectively. Major barriers were reported, including limited awareness, lack of career assistance, and financial limitations. Younger age, greater socioeconomic status, literacy, and early-stage disease were all substantially correlated with better compliance (P < 0.05). After counseling, 68.3% of patients expressed high satisfaction, but there were mixed reviews of the call-recall system.

Conclusion: Among survivors of gynecological cancer, counseling and call-recall interventions significantly improved follow-up compliance. In order to maintain surveillance adherence, this approach addresses logistical, financial, and awareness-related barriers.

Abstract: Central diabetes insipidus (CDI) is a rare condition characterized by arginine vasopressin deficiency, leading to persistent polyuria and polydipsia. Although it can present at any age, idiopathic CDI in young adults is uncommon and diagnostically challenging. Inflammatory conditions such as infundibuloneurohypophysitis must be considered, particularly when magnetic resonance imaging (MRI) reveals a thickened pituitary stalk and absence of the posterior pituitary bright spot. Early recognition and differentiation from diabetes mellitus, nephrogenic diabetes insipidus, and primary polydipsia are crucial for effective management. We report the case of a 20-year-old male who presented with excessive urination and thirst for 6 weeks. Physical examination was unremarkable, and the patient had no history of trauma or systemic illness. Urine osmolality was markedly low, and MRI of the brain showed absence of the posterior pituitary bright spot and thickening of the infundibulum, suggestive of infundibuloneurohypophysitis. The patient responded well to desmopressin therapy with symptomatic improvement, thus supporting the diagnosis of CDI. This case highlights the importance of considering idiopathic CDI in young adults presenting with unexplained polyuria and polydipsia. Infundibuloneurohypophysitis should be suspected in patients with characteristic MRI findings even in the absence of overt systemic autoimmune disease. A methodical diagnostic approach, including hormone assays, imaging, and therapeutic trials, can enable early diagnosis and effective long-term management.

Abstract: Urethral stricture disease poses a significant reconstructive challenge, particularly in patients with long-segment strictures or those associated with lichen sclerosus. Staged urethroplasty remains a reliable and well-established approach in such complex cases. This case series evaluates the outcomes of Johanson's Stage II urethroplasty using inlay buccal mucosal grafts performed at a tertiary care centre. A retrospective review was conducted of patients who underwent Stage II urethroplasty following prior Stage I reconstruction. Preoperative assessment included uroflowmetry and retrograde urethrography, and an inlay buccal mucosal graft was used in selected cases requiring urethral augmentation. Patients were followed to assess functional outcomes and postoperative complications. Successful voiding was achieved in 90% of patients, with postoperative maximum urinary flow rates exceeding 15 mL/s. Two patients developed minor postoperative complications, which were managed conservatively. Cosmetic outcomes and sexual function were satisfactory in the majority of patients. Staged urethroplasty with buccal mucosal graft augmentation remains a gold-standard technique for the management of complex urethral strictures, offering excellent functional outcomes and durable results.

Abstract: Stress is ubiquitous in health and plays a vital role in the pathogenesis of many underlying diseases. Stress and health - this review highlights the interplay between stress and health, focusing on stress in noncommunicable diseases (NCDs) and communicable diseases. While acute stress can aid survival, chronic stress disrupts balance, creating "allostatic load" leading to prolonged activation of the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system causing elevated cortisol, inflammation, and immune suppression. With global morbidity and mortality being largely from NCDs, chronic stress is emerging as a common factor. Stress-induced inflammation exacerbates cardiovascular diseases, alters the gut-brain axis, dysregulates reproductive health, and increases risk for prematurity and low birth weight. Large as its impact is, stress is poorly understood and seldom treated appropriately in clinical settings that attend to physical disease. Stress assessments are infrequently carried out, and management guidance is seldom offered. This highlights the importance of standardized tools and interventions to assess and address stress in healthcare settings. Lifestyle factors such as diet and physical activity are often the focus while overlooking stress. The World Health Organization's Mental Health Action Plan lays the groundwork by calling for improved governance, access to services, and preventive approaches aimed at stress. However, its impact is limited by gaps in execution and resource allocation. Teaching students about how to combat stress can be incorporated into medical training, so providers can treat stress appropriately. Psychosocial support, lifestyle optimization, and resilience training should be integral components in high-quality care paradigms.

Background: Alzheimer's disease (AD) is the primary cause of dementia globally. Digestion and absorption of the nutrient decreases in old age and leads to nutritional deficiency. Modifiable risk factors, particularly dietary habits, are increasingly being explored as potential strategies for preventing the initial onset and progression of the disease.

Objective: The study evaluates the effect of small sized frequent meal on cognitive performance in subjects with Alzheimer's disease.

Material and methods: Total 80 subjects were enrolled based on Mini Mental State Examination (MMSE) score < 24, and then divided Group A and Group B, each group having 40 subjects. Assessment of calorie intake was done by food frequency questionnaire; nutritional assessment was done by serum biochemical parameters. We had done following intervention in meal schedule of group A: subject's total daily amount of food was divided into four small sized meal at definite time interval individually without any additional supplementation. Assessment of cognitive performance was done by MMSE score.

Result: Comparing the mean levels of serum albumin, t test revealed statistically significantly difference. Difference in mean level of Total Protein, Serum Globulin and Albumin/Globulin ratio was not statistically significant between two groups. After intervention, mean MMSE score increase significantly in Group A as compared to Group B.

Conclusions: Dietary pattern in older people who are on medical therapy for Alzheimer's disease should be changed to small sized frequent meal. It will help them for proper digestion and absorption of the nutrient, so that their cognitive performance can be improved by improving quality of.

Background: Innovative methods for oral health education (OHE) are needed to engage children in preventive dental behavior. Social media influencers have emerged as powerful tools in shaping children's attitudes.

Aim: This study aims to evaluate the effectiveness of OHE delivered through social media influencers in improving oral hygiene knowledge and practices among children aged 8-12 years.

Materials and methods: A parallel-group experimental study was conducted among 100 children (50 in control group and 50 in intervention group) in urban Bhubaneswar schools. The intervention group viewed a series of oral health videos delivered by a child-friendly social media influencer across 4 weeks, whereas the control group received standard education. Pre- and postintervention oral health knowledge was assessed through questionnaire. Clinical oral hygiene status was recorded using the Simplified Oral Hygiene Index-Score (OHI-S).

Results: The intervention group showed a statistically significant improvement in knowledge scores (pre: 5.1 ± 1.8, post: 8.4 ± 1.2, P < 0.001) and better oral hygiene outcomes (OHI-S reduced from 2.4 to 1.2). The control group showed minimal change.

Conclusion: Social media influencer-led OHE was effective in improving both knowledge and hygiene among children. Such digital strategies can enhance conventional health education methods in pediatric settings.

Abstract: Jejunojejunal intussusception is an exceptionally rare but potentially serious complication following Roux-en-Y gastrectomy, with an estimated incidence of 0.4%-0.64%. It most often occurs at the jejunojejunal anastomosis, typically in a retrograde fashion, due to postoperative motility disturbances. Although most cases occur within 2 years postoperatively, delayed presentations several years after surgery can pose diagnostic challenges. We report the case of an 81-year-old male who presented 6 years after D2 subtotal gastrectomy with Roux-en-Y reconstruction for gastric adenocarcinoma and high-grade neuroendocrine tumor. The patient developed acute-onset, severe colicky abdominal pain with vomiting and distension. Contrast-enhanced computed tomography revealed a "bowel-within-bowel" configuration at the jejunojejunal anastomosis, consistent with intussusception and distal ischemia. Diagnostic laparoscopy confirmed the diagnosis, and due to gangrenous changes in the distal afferent jejunal loop, an open resection with reconstruction of the jejunojejunal anastomosis and gastrojejunostomy was performed. The patient's postoperative recovery was uneventful. This case underscores the importance of maintaining clinical suspicion for intussusception in postgastrectomy patients presenting with acute abdomen, even years after surgery. Early imaging, timely diagnosis, and individualized surgical intervention are essential to prevent morbidity and ensure favorable outcomes.

Abstract: Laparoscopic donor nephrectomy (LDN) is increasingly performed worldwide; however, long-term data on renal outcomes in living kidney donors remain limited. This case series evaluates renal function trends following LDN at a tertiary care center. A retrospective analysis was conducted on 38 living kidney donors who underwent LDN. Renal function was assessed using serum creatinine, creatinine clearance (CCR) calculated by the Cockcroft-Gault formula, and DTPA renogram findings measured preoperatively, on postoperative day 2 (POD-2), and at the final follow-up. Statistical comparisons were performed using paired t-tests. The mean donor age was 45.2 ± 12.3 years, with 22 male and 16 female donors. Mean serum creatinine increased from 0.89 ± 0.10 mg/dL preoperatively to 1.24 ± 0.21 mg/dL on POD-2 and stabilized at 1.18 ± 0.18 mg/dL at long-term follow-up. Mean CCR declined from 104.6 ± 21.5 mL/min preoperatively to 74.6 ± 14.5 mL/min on POD-2, with partial recovery to 82.0 ± 16.0 mL/min at follow-up. Renal function was preserved in 88.2% of donors on POD-2 and in 90.2% at the final follow-up. These findings indicate that most donors maintain stable renal function following LDN. Creatinine clearance serves as a cost-free and effective parameter for donor evaluation and for tailoring postoperative monitoring and long-term follow-up. Overall, LDN appears to be a safe procedure when appropriate donor selection and structured follow-up are employed.

Abstract: Tuberculosis (TB) is a communicable disease with high morbidity, significantly affecting quality of life. It has high prevalence in developing countries and is broadly categorized into pulmonary and extrapulmonary TB. The axillary lymph nodes are affected in around 3% of tuberculous lymphadenitis. However, isolated axillary TB lymphadenitis (without TB at other sites) is even rarer. It sometimes creates diagnostic difficulty, particularly in female patients, as even though the possibility of breast cancer presenting with only enlarged axillary lymph nodes (Occult Breast Cancer) is extremely rare (0.3%-0.8%), the possibility of other pathologies such as lymphoma, fungal infections, and sarcoidosis need to be ruled out. It is more common in females compared to males, and it commonly involves the left side. Chest X-ray and ultrasound, followed by computer tomography of the Chest and Axilla are useful primary investigations for the diagnosis. Excision Biopsy and Histopathological examination of the lymph node are the confirmatory tests. We hereby report a case of isolated axillary tuberculous lymphadenitis in a 66-year-old immunocompetent female.

Background: The obturator foramen, an ovoid opening in the hip bone formed by the ischium and pubis, allows passage of the obturator artery, vein, and nerve through the obturator canal. Mostly covered by the obturator membrane, its congenital agenesis or partial underdevelopment is extremely rare and scarcely documented, yet it carries significant implications for pelvic surgery, orthopedic, vascular procedures, and radiological interpretation.

Objective: This study aimed to determine the prevalence, morphological characteristics, and clinical relevance of congenital agenesis of the obturator foramen in an Asian population.

Materials and methods: The study was conducted between 2019 and 2025 in the department of Anatomy on 228 dried human hip bones belonging to 114 pelvises, irrespective of age and sex. All hip bones were examined macroscopically for evidence of congenital agenesis complete or incomplete of the obturator foramen. Thickness measurements of the abnormal bony plate replacing the foramen were recorded using digital callipers. High-resolution photographs were taken for documentation.

Results: Overall, congenital agenesis complete, incomplete, or mixed was observed in 15 of 114 pelvises (13.2%). Unilateral complete agenesis of the obturator foramen and canal was identified in 3 right-sided (2.6%) and 4 left-sided (3.5%) hip bones, with an average bony plate thickness of 2.1 mm. Unilateral complete agenesis of the obturator foramen with a narrowed bony obturator canal occurred in 3 right-sided (2.6%) and 3 left-sided (2.6%) hip bones, demonstrating an average thickness of 2.2 mm. One pelvis (0.9%) exhibited mixed agenesis complete on the right and incomplete on the left, with an average thickness of 2.0 mm. In addition, one hip bones (0.9%) demonstrated bilateral complete agenesis of the obturator foramen and canal, showing a markedly increased average thickness of 1.9 mm. The thinnest bony plate recorded in the present study measured 0.5 mm.

Conclusion: Congenital agenesis of the obturator foramen is an exceptionally rare anatomical variant in the studied Asian population. Awareness of this anomaly is clinically important, as it can alter pelvic biomechanics, obscure radiological interpretation, and affect the surgical approach to the obturator region. Detailed anatomical knowledge may help prevent intraoperative complications and improve diagnostic accuracy.