Annals of African Medicine最新文献

Background: In chronic kidney disease (CKD) patients, the long-term effects of probiotic use are unknown.

Aim: This study aimed to evaluate the effectiveness of long-term probiotics supplementation on kidney function, inflammatory markers, and metabolic parameters in CKD patients with or without hemodialysis (HD).

Methods: This retrospective study included two groups: 70 CKD patients on HD and 124 stage IIIb-V CKD patients not on HD, with half of these patients in both the groups receiving probiotics, in addition to standard of care (SOC, n = 35 and n = 62, respectively), whereas another half received only SOC (n = 35 and n = 62, respectively). Kidney function (serum creatinine, blood urea nitrogen, and serum uric acid), systemic inflammation (high-sensitivity C-reactive protein [hs-CRP]), metabolic parameters (serum calcium, serum phosphate, and intact parathyroid hormone), and nutritional state (total iron binding capacity and serum albumin) were evaluated at 3-, 6-, and 12-months of treatment.

Results: At 12 months, the non-HD group that received SOC + probiotics had a significant improvement in all the parameters evaluated (all P < 0.0001), whereas those that received only SOC had a significant reduction in serum phosphate, serum uric acid, and hs-CRP (all P < 0.05). In the HD group, over 12 months, there was a significant reduction in only hs-CRP (P = 0.034) in the SOC + Probiotics subgroup. The non-HD group had a significantly greater change in all the parameters assessed relative to HD group (all P < 0.05), except serum calcium (P = 0.408).

Conclusions: Long-term probiotic use leads to significant improvement among non-HD CKD patients relative to CKD patients on HD.

Introduction: During the pandemic, masks were one of the main protective ways to prevent the spread of infection. Everyone was required to wear masks in academic institutions, however the types of masks used varied based on the setting. This has a lot of impact on learners during the pandemic, and this study aimed to find the problems faced by students.

Materials and methods: The study was a longitudinal observational study using a predesigned, prevalidated questionnaire. A total of 140 students responded to the questionnaire.

Results: The majority used disposable masks, followed by other types or combinations. We found that more than 54% wore masks for a period of 1-6 h in a day. In terms of problems, about 16.8%, 15%, and 14.5% experienced breathlessness, mask-induced acne, and fogging of glasses. Majority agreed that 70.7% had an opinion that wearing masks affects their performance in examinations due to various reasons. 53.3% agreed that mask wearing affects their listening in classes along with verbal and nonverbal communication with friends and teachers.

Conclusion: After the COVID-19 onset, face masks became mandatory across Asia, especially China. Surveyed individuals (98%) agreed that proper mask use is crucial for prevention. Mask wearing is now a societal norm. While masks reduce COVID-19 transmission risks, they also present drawbacks. Addressing these challenges, particularly in educational settings, is essential for comprehensive public health education and adaptation to new health practices.

Background: Traumatic injuries involving the dorsolumbar junction are prevalent in patients experiencing high-velocity impacts, especially road traffic accidents or falls from height, as well as in elderly patients with osteoporosis who sustain fractures even with minor trauma. The thoracolumbar junction represents a biomechanical transition zone susceptible to injury, and timely stabilization is critical to prevent or limit neurological impairment.

Objective: This study aimed to evaluate the clinical, radiological, and functional outcomes of patients with dorsolumbar spine fractures treated with posterior pedicle screw and rod fixation.

Materials and methods: A prospective observational study was conducted on 50 adult patients with dorsolumbar fractures (D10-L2) due to trauma. Clinical (the American Spinal Injury Association score, Visual Analog Scale [VAS]), radiological (Beck's index, regional kyphotic angle), and functional outcomes (Denis scales) were recorded preoperatively, postoperatively, and follow-up period at 3 and 6 months.

Results: The most common mechanism was fall from height (58.7%). Neurological improvement occurred in 30 out of 38 patients with incomplete deficits. There was a significant improvement in Beck's index (0.646 ± 0.08-0.776 ± 0.03) and regional kyphotic angle (15.67° ±5.87°-10.28° ±3.09°) over 6 months. VAS scores decreased from 6.6 ± 1.6 to 1.7 ± 1.1. At 6 months, 86.9% of patients had minimal-to-moderate pain (Denis P1/P2), whereas 69.5% returned to full-time work.

Conclusion: Posterior pedicle screw fixation provides effective radiological correction, pain relief, and neurological recovery in dorsolumbar fractures. It enables early mobilization and functional recovery with minimal complications.

Introduction: Metabolic syndrome (MetS), defined by central obesity, dyslipidemia, hyperglycemia, and hypertension, is a major risk factor for type 2 diabetes and cardiovascular disease. Despite its clinical importance, the underlying pathophysiology of MetS remains incompletely understood. Serum ferritin, a marker of iron storage, oxidative stress, and metabolic dysfunction, has been associated with insulin resistance and lipid abnormalities. This study aimed to investigate the relationship between serum ferritin levels and MetS, along with its individual components.

Materials and methods: This cross-sectional study included 230 participants, with cases diagnosed with MetS based on International Diabetes Federation criteria and age-matched controls. Clinical, anthropometric, and biochemical parameters, including serum ferritin levels, were assessed. Data analysis was performed using Stata MP-17, with statistical significance set at P ≤ 0.05.

Results: Individuals with MetS exhibited significantly higher waist and hip circumferences, blood pressure (BP), triglycerides, serum ferritin levels, and poorer glycemic control compared to controls (P < 0.001). Serum ferritin showed a positive correlation with body mass index (BMI), fasting glucose, triglycerides, BP, total leukocyte count, and neutrophils, and a negative correlation with lymphocyte count, indicating a strong association between elevated ferritin levels, metabolic dysregulation, and systemic inflammation.

Conclusion: Elevated serum ferritin is significantly associated with increased BMI, central obesity, dyslipidemia, and impaired glucose regulation in individuals with MetS. Its correlations with lipid and inflammatory markers suggest ferritin may serve as a surrogate biomarker for metabolic and cardiovascular risk.

Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Timely placental separation and effective uterotonic therapy are critical components in the prevention and management of PPH. Oxytocin has been the gold standard for uterotonic use; however, newer agents such as carbetocin offer longer duration of action and may improve maternal outcomes. Comparative evaluation of these agents in both vaginal and cesarean deliveries is essential for optimizing clinical protocols.

Aim: The aim of this study was to compare the efficacy of carbetocin and oxytocin in promoting placental separation and controlling PPH following normal vaginal delivery (NVD) and lower segment cesarean section (LSCS).

Methodology: This prospective, comparative observational study was conducted at the Department of Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College, Pune, over a period of 2 years from November 2022 to October 2024. A total of 200 women were enrolled and divided equally into two groups: Group A received 100 μg of intravenous carbetocin, and Group B received 10 IU of intravenous oxytocin. Each group included an equal number of women undergoing NVD and LSCS. Outcomes assessed included time for placental separation, duration of the third stage of labor, estimated blood loss, requirement for additional uterotonics, and incidence of PPH.

Results: The mean time to placental separation and third-stage duration were significantly shorter in the carbetocin group compared to the oxytocin group. Carbetocin was also associated with reduced intraoperative and postpartum blood loss and a lower need for additional uterotonic agents. The incidence of atonic PPH was notably lower in the carbetocin group, both in vaginal and cesarean deliveries.

Conclusion: Carbetocin is more effective than oxytocin in achieving faster placental separation, reducing third-stage labor duration, minimizing blood loss, and lowering the risk of atonic PPH in both normal and operative deliveries. Its longer duration of action and reduced need for repeat dosing make it a superior uterotonic agent for PPH prophylaxis.

Abstract: Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus fumigatus usually seen in asthmatic individuals, with pleural involvement being exceedingly uncommon. We describe a 23-year-old female with poorly controlled asthma who presented with progressive dyspnoea, chest pain, and left pyo-pneumothorax. Imaging demonstrated complete obstruction of the left main bronchus by a mucus plug with evidence of contralateral bronchiectasis. Laboratory evaluation revealed markedly elevated total IgE levels (6351.8 IU/mL) and raised specific IgE and IgG antibodies to A. fumigatus , fulfilling the modified ISHAM diagnostic criteria for ABPA. The patient was managed with systemic corticosteroids and itraconazole, leading to significant symptomatic and radiological improvement, with resolution of the air leak although minimal pleural thickening persisted as sequela. Pleural disease in ABPA is rarely reported, with published cases including effusion, hydropneumothorax, empyema, and pyo-pneumothorax, attributed to immune-mediated pleural inflammation, secondary infections related to therapy, or advanced fibrotic disease. Misdiagnosis as tuberculosis is frequent in endemic regions due to overlapping radiological features, often delaying appropriate therapy. Our case adds to the limited literature by highlighting pyo-pneumothorax as a potential presentation of ABPA, expanding its clinical spectrum beyond the conventional manifestations. The favorable outcome following combined corticosteroid-antifungal therapy reinforces the importance of early recognition and multidisciplinary management to prevent morbidity associated with such complications. Clinicians should remain vigilant when evaluating pleural involvement in asthmatics with elevated IgE and bronchiectasis, as timely diagnosis and targeted treatment can significantly improve outcomes.

Abstract: Odontogenic keratocyst (OKC) is an aggressive, benign, cystic lesion arising from the mandible. A 65-year-old male presented with increasing left jaw swelling for 20 years was diagnosed as OKC with the help of the radiological and pathological correlation. A computed tomography scan revealed the well-defined expansile solid-cystic lesion involving the left mandible with multiple foci of calcification and cortical breach. The patient was managed surgically with segmental mandibulectomy and mandibular reconstruction. Histopathology revealed the fibrous cyst wall lined by keratinized stratified squamous epithelium with a prominent basal cell layer. Due to the aggressive nature and high recurrence rate of the OKC, early diagnosis and precise surgical resection with clear margins are required. Radiological and histopathological correlation is needed for the accurate diagnosis, surgical planning and to prevent complications for the management of OKC.

Abstract: A 34-year-old lactating woman presented with erythematous indurated plaques around the perioral region, extending to the nose and forehead, mimicking granulomatous dermatoses. Dermoscopy showed follicular plugging and dermal inflammation. Histopathology revealed epithelioid cell granulomas with giant cells and nerve infiltration, confirming borderline tuberculoid leprosy. The patient was treated with multidrug therapy and closely monitored for reactions. This case underscores the diagnostic challenge of Hansen's disease with atypical centrofacial presentation and emphasizes the importance of histopathological confirmation for timely treatment, particularly in vulnerable groups such as lactating mothers.

Background: Isotonic fluids like 0.9% normal saline (NS) are recommended for maintenance intravenous fluid (mIVF) therapy in children. However, concerns exist regarding hyperchloremia and its associated complications, particularly in younger children.

Objective: The objective of the study was to evaluate the clinical and metabolic effects of 0.9% NS as mIVF in noncritically ill pediatric patients.

Materials and methods: This longitudinal study included 80 children aged 1 month to 13 years admitted to a tertiary care center, who received 0.9% NS as mIVF for at least 50% of a 24-h period. Baseline and 48-h clinical and biochemical parameters were recorded and compared.

Results: After 48 h, there was a significant decrease in heart rate, respiratory rate, blood urea, and serum creatinine, and a significant increase in blood pressure, serum sodium, potassium, and chloride (P < 0.05). Hyperchloremia was observed in 7.5% of children, all aged <5 years.

Conclusion: 0.9% NS may lead to significant clinical and metabolic changes, particularly hyperchloremia in younger children.

Background and aims: Optimal glottic visualization is fundamental for safe intubation in patients with difficult airways. We aimed to compare the effectiveness of left head rotation (LeHeR) versus the direct epiglottis lifting technique using the C-MAC D-blade videolaryngoscope in improving glottic view during intubation in adult patients with difficult airways.

Methods: In this prospective, randomized, double-blinded trial, 60 adult patients were allocated equally to receive LeHeR (Group L) or direct epiglottis lifting (Group E) technique for intubation. After standardized induction, videolaryngoscopy with C-MAC D blade was done, and the best glottic view was captured. The second glottic image was taken following LeHeR in Group L and direct epiglottis lifting in Group E. Percentage of glottic opening (POGO) in both images was compared later by an anonymized anesthesiologist. Change in POGO, ease and time to intubation, hemodynamic responses, and desaturation < 95% were compared in both groups.

Results: Demographics and baseline airway variables were comparable. Both maneuvers significantly improved intragroup POGO scores (P ≤ 0.001). The median second POGO was higher with epiglottis lifting than LeHeR technique (100 [interquartile range 75-100] vs. 75 [75-100], P = 0.03). Improvement in glottic view occurred in 96.7% of patients in Group E versus 63.3% in Group L (P = 0.002). Time to intubation (33 ± 12 vs. 31 ± 10 s), ease of intubation, hemodynamics, and incidence of desaturation were comparable.

Conclusion: Direct epiglottis lifting with C-MAC videolaryngoscope D blade provided significantly improved glottic visualization compared to LeHeR with comparable intubation time in patients with difficult airway.