Annals of African Medicine最新文献

Background: Serum resistin has been implicated in atherosclerosis and vascular smooth muscle dysfunction through inflammatory pathways, making it a potential biomarker for cardiovascular risk. Comparative data in diabetic patients with acute vascular events are limited. This study evaluates serum resistin and high-sensitivity C-reactive protein (hs-CRP) levels in type 2 diabetes mellitus (T2DM) with acute myocardial infarction (AMI) or acute ischemic stroke (AIS) to explore their association with vascular complications.

Materials and methods: A cross-sectional, hospital-based study was conducted among T2DM patients presenting with AMI or AIS. Serum resistin, hs-CRP, glycated hemoglobin (HbA1c), lipid profile, and body mass index (BMI) were evaluated, and their associations with vascular events were statistically analyzed, considering P < 0.05 as statistically significant.

Results: The mean serum resistin was significantly higher in the diabetes mellitus (DM) with AMI group (23.21 ± 5.65 ng/ml; P < 0.001) compared to controls (13.30 ± 2.94 ng/ml) but not in the DM with AIS group (19.90 ± 5.46 ng/ml; P = 0.215). hs-CRP was significantly elevated in both DM with AMI and AIS groups (3.43 ± 0.70 mg/l and 3.43 ± 1.01 mg/l, respectively) compared to controls (2.43 ± 0.62 mg/l; both P < 0.001). Positive correlations were observed between these biomarkers and conventional risk factors, including HbA1c, BMI, and low-density lipoprotein cholesterol.

Conclusion: Elevated serum resistin (notably in AMI) and hs-CRP (in both AMI and AIS) in T2DM patients highlight a strong association between inflammation and acute vascular events. These biomarkers may serve as accessible tools for early risk stratification and targeted preventive strategies in high-risk diabetic populations.

Background: Hyperbaric ropivacaine has been recently introduced commercially in India. Hyperbaric bupivacaine is the most commonly used local anesthetic drug in subarachnoid blocks. We conducted this meta-analysis to compare the onset and duration of sensory and motor blockade and complications of the two drugs.

Methodology: We searched Cochrane, PubMed, and Google Scholar databases till February 9, 2022, for randomized control trials comparing hyperbaric ropivacaine and hyperbaric bupivacaine in subarachnoid blocks without adjuvant. Studies comparing bupivacaine and ropivacaine with any other local anesthetic were not included. Study selection was done, and data were extracted. Individual study quality was assessed using the Cochrane risk of bias assessment tool. Methodological quality was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) guidelines. Trial sequential analysis was done to check if the sample size is adequate and if the conclusions are reliable or not. The primary outcome analyzed was duration of motor blockade, and secondary outcomes were duration of sensory blockade, onset of sensory and motor blockade, and complications such as hypotension, bradycardia, nausea, and shivering.

Results: After doing an extensive search, we found 18 studies as per our inclusion criteria. The duration of motor blockade (37.09, 26.93-47.24, P < 0.00001) and sensory (38.83, 24.97-52.69, P < 0.00001) was found to be significantly short in the ropivacaine group. Hypotension (P = 0.0004) and bradycardia (P = 0.02) were also found to be less in the ropivacaine group.

Conclusion: Hyperbaric ropivacaine has shorter duration of sensory and motor block and therefore a faster recovery as compared to hyperbaric bupivacaine.

Background: Laparoscopic cholecystectomy (LC) is the gold standard for symptomatic gallstone disease. About 5-10% require conversion to open surgery due to complex anatomy or intraoperative complications. Accurate preoperative prediction of difficult LC can improve surgical planning and patient counseling.

Aim: To evaluate a preoperative scoring system's ability to predict difficult LC and guide surgical preparedness.

Materials and methods: Prospective observational study of 150 patients (21-80 years) undergoing elective LC. Preoperative clinical, biochemical, and ultrasound factors were scored (total 15 points) and patients stratified into risk categories. Analysis used chi-square/Fisher's exact tests and ROC curves.

Results: Difficult LC occurred in 22% (very difficult 2%). Significant predictors (P < 0.05) included: age >60, male sex, history of cholecystitis, BMI >25, supra-umbilical scar, elevated ALP, GB wall >4 mm, impacted stone, contracted GB, and CBD >7 mm. The model's AUC was 0.927; score >6 predicted difficulty with 75.76% sensitivity and 98.29% specificity (LR+ 44.3).

Conclusion: The preoperative scoring system reliably predicts difficult LC. High-score patients (>6) may be triaged to experienced surgeons or considered for early open conversion to reduce complications.

Background: Steviol glycosides (SGs) from Stevia rebaudiana are known for their natural sweetness and potential health benefits. However, extraction efficiency and biological activity vary across genotypes and depend on the extraction conditions.

Aims and objectives: This study aimed to evaluate the effect of an optimized extraction method on yield, total polyphenol content, and the in vitro antioxidant and anti-inflammatory activities of steviol glycosides obtained from six S. rebaudiana genotypes.

Materials and methods: Steviol glycosides were extracted using an optimized protocol. Extraction yield was quantified, and total polyphenol content was determined by the Folin-Ciocalteu method. Antioxidant activity was evaluated by the 2,2 diphenyl 1 picrylhydrazyl (DPPH) radical scavenging and reducing power assays, while anti-inflammatory potential was assessed by the protein denaturation inhibition method. Gallic acid, ascorbic acid and diclofenac sodium served as reference compounds.

Results: The optimized method significantly enhanced extraction efficiency, reaching 149.00 ± 1.76 mg/g and 142.20 ± 1.62 mg/g for genotypes P7 and V9 7/7, respectively. Genotypes P7, V9, and P7 7/7 exhibited the highest total polyphenol content (0.1 mg/mL). The most potent antioxidant activity was recorded for P7 7/7 and Q1 (DPPH IC50 = 0.11 mg/mL), comparable to ascorbic acid (0.10 mg/mL). These genotypes also demonstrated the strongest anti-inflammatory activity (IC50 = 53.77 and 66.06 µg/mL), close to diclofenac sodium (66.02 µg/mL).

Conclusion: The optimized extraction process substantially improves the yield and bioactivity of Stevia-derived compounds. Genotype P7 is notable for its high yield and polyphenol content, while P7 7/7 and Q1 show superior antioxidant and anti-inflammatory potential.

Background: Frailty increases vulnerability to functional decline, hospitalization, and poor quality of life in older adults. Digital health interventions (DHIs), like mobile applications, wearable devices, and telehealth, show promise in promoting physical activity, self-management, and healthy aging. Thus, the purpose of this study is to thoroughly examine how well digital health treatments can stop or slow the evolution of frailty in older adults who live in the community.

Methodology: This research was carried out in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The eligible studies published between January 2015 and July 2025 were included in the study. Participants were community-dwelling older adults (≥60 years) with frailty or at risk of frailty. DHIs (telehealth, mobile health [mHealth], wearable devices, remote monitoring, and online platforms) were compared with usual care or nondigital approaches. Since interventions and outcome measures varied, data were extracted using a standardized form, their quality was evaluated using the proper risk of bias techniques, and then narratively synthesized.

Results: In this review, seven studies with a total of 1167 participants were included, comprising one observational descriptive study and two cross-sectional studies. DHIs, including wearable sensors, accelerometers, and mHealth programs, proved feasible and effective for frailty assessment and management, showing high adherence, accurate frailty detection, and improvements in mobility and physical activity. Overall, digital tools hold strong potential for objective frailty monitoring and healthy aging promotion.

Conclusion: DHIs such as wearable sensors and mobile applications are feasible and effective for monitoring, detecting, and managing frailty in older adults. They offer objective, noninvasive tools to support early detection, promote physical activity, and enhance geriatric care.

Abstract: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally developed for type 2 diabetes mellitus (T2DM) and obesity, show promising potential as a novel treatment for depression, particularly in patients with comorbid metabolic disorders. This narrative review examines the bidirectional relationship between obesity and depression, driven by shared mechanisms such as chronic low-grade inflammation, hypothalamic-pituitary-adrenal axis dysregulation, and impaired neuroplasticity. GLP-1 RAs, including liraglutide and exenatide, demonstrate neuroprotective effects by enhancing brain-derived neurotrophic factor expression and synaptic plasticity, alongside anti-inflammatory properties that reduce proinflammatory cytokines (e.g., tumor necrosis factor-alpha and interleukin-6). They also modulate serotonin turnover in mood-regulating brain regions, mirroring selective serotonin reuptake inhibitors. Preclinical studies in animal models reveal improved behavioral outcomes, while human observational studies and limited clinical trials, such as the LEAD-3 trial, report enhanced mood and quality of life in T2DM and obesity patients. However, challenges, including high treatment costs ($800-$1000/month), injectable administration, and needle-related anxiety, limit patient adherence, and clinical adoption. The lack of large-scale randomized controlled trials targeting depression as a primary outcome further hinders definitive conclusions. This review highlights GLP-1 RAs' potential to address both metabolic and depressive symptoms, offering a holistic approach to managing these interconnected conditions. Future research should focus on long-term efficacy, optimal dosing, and overcoming adherence barriers to establish GLP-1 RAs as a viable psychiatric treatment.

Background: Functional dyspepsia (FD) is a prevalent gastrointestinal (GI) disorder characterized by persistent upper abdominal discomfort without identifiable structural abnormalities. Its pathophysiology remains poorly understood, and conventional diagnostic tools often fail to detect underlying motility disorders.

Objective: The objective of this study was to evaluate the role of high-resolution esophageal manometry (HRM) in diagnosing esophageal motility abnormalities in patients with FD and normal upper GI endoscopy findings.

Materials and methods: This prospective observational study was conducted at Dr. D. Y. Patil Medical College, Pune, from January 2023 to March 2025. Thirty adult patients aged 18-60 years with persistent dyspeptic symptoms unresponsive to standard medical therapy and normal upper GI endoscopy were included. After Helicobacter pylori eradication therapy and proton pump inhibitor treatment, patients underwent HRM to assess esophageal motility. HRM findings were correlated with clinical symptoms to guide management decisions.

Results: The study cohort had a mean age of 32.03 ± 8.8 years, with a female predominance (60%). Common symptoms included epigastric pain (80%), anorexia (60%), nausea/vomiting (53.3%), and regurgitation (50%). HRM revealed abnormal findings in 50% of patients, with the most frequent abnormalities being hypertensive upper esophageal sphincter (10%) and low amplitude contractions (10%). Based on HRM findings, 60% of patients underwent surgical interventions, whereas 40% received conservative management.

Conclusion: HRM identified clinically significant esophageal motility abnormalities in a substantial subset of patients with FD and normal endoscopic findings. These findings suggest that esophageal dysmotility may underlie persistent symptoms in such patients and support the integration of HRM into the diagnostic workup of refractory FD.

Introduction: Acute encephalitis syndrome (AES) is a serious public health problem in India, especially in Uttar Pradesh, where children and adolescents are particularly affected. Although viral diseases such as Japanese encephalitis (JE) are the main cause, many cases remain unexplained. AES could be caused by a zoonotic leptospirosis, but its role is uncertain.

Aim: The aim is to assess the prevalence and clinical features of leptospirosis in children with AES in a tertiary care hospital and compare the etiology with other causes.

Materials and methods: Children aged 1-14 years with AES or AFI were included. Comprehensive clinical assessments, laboratory investigations and etiologic testing for leptospirosis (immunoglobulin M enzyme-linked immunosorbent assay, polymerase chain reaction and microscopic agglutination test) and other diseases (JE, scrub typhus, dengue, chikungunya) were performed. Comparative and descriptive statistics were used.

Results: 62% of the 100 AES patients were male, with a mean age of 75.4 ± 35.7 months. They mostly lived in rural areas (59%) and were poor (85%). Hepatosplenomegaly (53%, 23%), seizures (91%), and mental retardation (90%) were prevalent. Laboratory results showed anemia, leukocytosis, thrombocytopenia, and elevated aspartate transaminase/alanine transaminase. High protein and cell counts were found in the cerebrospinal fluid. The mortality rate was 14%. JE (20%) was the most common, followed by scrub typhus (16%) and dengue (14%), while 44% were undiagnosed.

Conclusion: JE, scrub typhus, and dengue encephalopathy cause most AES in Uttar Pradesh. Leptospirosis, a rare disease, should be investigated in the differential diagnosis, especially with multisystem involvement and environmental risk factors. Early leptospirosis diagnosis and treatment improve outcomes.

Abstract: Visceral artery pseudoaneurysms (PA) are a rare but potentially fatal complication associated with pancreatitis. Among these, PA of the left gastric artery (LGA) are extremely rare. We describe a case of a 43-year-old male who presented with severe epigastric pain, hematemesis, and hypovolemic shock. He was a chronic alcoholic and a known case of recurrent pancreatitis. Resuscitation was initiated, and laboratory findings revealed severe anemia and elevated pancreatic enzymes. An urgent contrast-enhanced computed tomography scan identified acute-on-chronic pancreatitis with pseudocysts and a bleeding PA originating from the gastroduodenal arcade. Emergency celiac angiography confirmed a LGA PA with active extravasation. Successful super-selective glue embolization was performed, resulting in immediate cessation of bleeding. The patient stabilized hemodynamically had an uneventful recovery. This case highlights the life-threatening nature of visceral artery PAs as a complication of pancreatitis and emphasizes the critical role of timely imaging and endovascular intervention in achieving a successful outcome.

Abstract: Central retinal vein occlusion (CRVO) is a vascular disorder of the retina that occurs with equal frequency in both men and women, most commonly affecting individuals older than 65 years. When CRVO appears in younger patients, it is often associated with an underlying inflammatory cause. We report a case of young pregnant female with CRVO, who had no underlying risk factors like systemic diseases and had normal laboratory tests. Virchow's triad associated with pregnancy could be the possible cause of CRVO.