Annals of African Medicine最新文献

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.

Abstract: Local anesthetics (LAs) are integral to surgical and diagnostic procedures, with allergic reactions being rare yet potentially life-threatening. We report a case of a 69-year-old male with chronic obstructive pulmonary disease and suspected lignocaine allergy, posted for transurethral resection of the prostate. Intradermal testing revealed a positive reaction to lignocaine but a negative response to preservative-free bupivacaine heavy. Based on this, spinal anesthesia was planned with bupivacaine heavy and fentanyl, along with prophylactic corticosteroids and antihistamines. The surgery proceeded uneventfully. This case highlights the critical role of intradermal sensitivity testing with the intended local anesthetic drug in preventing allergic reactions and guiding safe anesthetic management. Individualized assessment, careful interpretation of test results, and preparedness are key to ensuring patient safety in cases of suspected LA hypersensitivity.

Background: Airway fires during laser surgery in Indian operation theaters are rare yet catastrophic, and most hospitals usually do not include laser airway fire prevention and management in their routine healthcare training programs.

Objective: To develop, implement, and assess the efficacy of an Interprofessional Simulation module for operating room (OR) personnel to prevent and manage airway fires in the OR.

Methods: A mixed-method study was conducted among an interprofessional OR team comprising anaesthesiology and ENT residents, nurses, and allied health practitioners. Thirty-one participants were immersed in both didactic lectures and in situ simulation scenarios. Validated pre- and posttest 1 questionnaires were given after didactic lectures, and a repeat posttest 2 questionnaire was given after the simulation. Team performance and communication skills were assessed using a validated observer checklist before and after the scenarios. The debriefing session postsimulation was audio-recorded and transcribed for thematic analysis. Attitude toward the IPSE module was assessed using the Retro-Pre validated questionnaire.

Results: Quantitative data analysis revealed significant improvement in all three domains of knowledge (P = 0.001), attitude (P = 0.001), and performance towards the IPSE module (P = 0.012). Participants retained the knowledge, simulation scores on prevention and management, and significant improvement in team performance (P = 0.041) even after 6 months. Common themes such as defined roles, critical decision-making, collective troubleshooting, shared leadership, enhanced communication, realism, confidence gains, and learning from mistakes toward interprofessional simulation training were highlighted in the qualitative analysis done.

Conclusion: Implementing an IPSE module has shown promising results for enhancing knowledge and team performance in the prevention and management of laser airway fires.

Introduction: Sepsis is a life-threatening condition, characterized by a dysregulated response to infection; however, the understanding in the general population is low or lacking, especially in regions such as Saudi Arabia where such situations are sparse. The present study strives to assess the general awareness and knowledge of sepsis among the adult Saudi population and aims to identify the potential determinants of such awareness.

Materials and methods: It is a cross-sectional research study. The present study was able to solicit the data with a time frame from July to November 2024 through an online and self-administered survey instrument that can be circulated over social media sites. Sample criteria included participants that were over 18 years of age and resided in Saudi Arabia. The data were analyzed with reference to sociodemographic, level of prevalence, and knowledge about sepsis using e-SPSS.

Results: Out of 544 respondents, only 32% reported prior awareness of sepsis, with 19.8% indicating good knowledge. The most well-known symptoms were fever (58.6%) and pain (44.3%), but little was known about other symptoms and their causes. Age, educational attainment, and work in healthcare were among the demographic variables that were substantially linked to increased awareness.

Conclusion: The research provides evidence that a substantial number of the adult population in Saudi Arabia are not aware and do not have sufficient knowledge of sepsis. The data points to the fact that people in Saudi Arabia are in dire need of education on sepsis to improve recognition of this diagnosis and understanding of its significance, aiming at bettering the outcomes and emergence.

Abstract: Kartagener's syndrome is a rare autosomal recessive genetic disorder, a subset of primary ciliary dyskinesia. It comprises the triad of situs inversus totalis, bronchiectasis, and chronic paranasal sinusitis. The incidence is 1:30,000 live births, while the male: female ratio is 1:1. Most patients of Kartagener's syndrome present in early childhood with common symptoms of frequent colds, chronic cough with excessive production of purulent sputum, and recurrent lower respiratory tract infections affecting respiratory functions. Kartagener's syndrome commonly presents as infertility in males and subfertility in females. We present the clinical and radiological findings in a patient of Kartagener's syndrome referred to us with recurrent lower respiratory tract infections.

Background: Chronic kidney disease (CKD) is a global health challenge, with diabetic kidney disease being a major cause in India. Mitochondrial dysfunction is central to kidney injury, and mitochondrial DNA copy number (mtDNA-CN) reflects mitochondrial health. This study compared mtDNA-CN in urine cell pellets from diabetic CKD (DCKD), non-DCKD (NDCKD), and healthy controls (HC) in a South Indian cohort.

Materials and methods: This prospective, cross-sectional study included 75 participants (25 DCKD, 25 NDCKD, 25 HC). Urine cell pellet mtDNA-CN was measured by qPCR. Statistical analysis used ANOVA/Kruskal-Wallis tests (P < 0.05 significant).

Results: Participants averaged 55.08 ± 13.24 years old. DM patients showed significantly higher mtDNA-CN than non-DM patients (93.96 ± 14.01 vs. 49.04 ± 22.28; P = 0.0001). While no difference existed between CKD Stage III and IV, overall mtDNA-CN varied significantly across No CKD, Stage III, and Stage IV groups (P = 0.0001). A progressive increase in mtDNA-CN was observed from HC (31.84 ± 13.41) to NDCKD (66.24 ± 14.74) and then to DCKD (93.96 ± 14.01), with highly significant differences among these groups (P = 0.0001).

Conclusion: Our findings indicate a progressive increase in urine cell pellet mtDNA-CN across healthy individuals, NDCKD, and DCKD. This pattern, particularly in DCKD, may reflect a compensatory mitochondrial response to metabolic stress, suggesting mtDNA-CN as a promising noninvasive biomarker for disease monitoring.

Background: Platelets play a pivotal role in the pathogenesis of thrombotic vascular events such as acute ischemic stroke (AIS). Mean platelet volume (MPV) and immature platelet fraction (IPF) are emerging biomarkers of platelet activity and turnover. This study aimed to investigate the diagnostic significance of MPV and IPF in AIS and to explore their relationship with comorbidities such as diabetes mellitus (DM) and hypertension (HTN).

Materials and methods: In a cross-sectional design, 175 patients with first-ever AIS and 175 age- and sex-matched controls were evaluated. MPV and IPF values were obtained from automated hematology analyzers. Statistical analyses were performed using SPSS version 26, employing independent t-tests, Chi-square tests, and receiver operating characteristic (ROC) curve analyses.

Results: AIS patients exhibited significantly elevated MPV (9.60 ± 1.03 fL vs. 5.37 ± 1.09 fL, P < 0.001) and IPF (4.96% ± 2.44% vs. 2.95% ± 1.40%, P < 0.001) compared to controls. ROC analysis revealed MPV had an area under the curve (AUC) of 0.821, and IPF had an AUC of 0.747. Subgroup analysis showed that elevated MPV and IPF were more pronounced in AIS patients with coexisting DM and HTN. MPV showed significant elevation in AIS vs. controls in the DM + HTN subgroup (10.99 ± 1.73 vs. 9.52 ± 0.88 fL, P = 0.050), suggesting synergistic platelet activation in the presence of metabolic comorbidities.

Conclusion: Elevated MPV and IPF are significantly associated with AIS and may serve as accessible, cost-effective diagnostic markers. MPV in particular shows promise as a risk stratifier, especially in patients with DM and HTN. Future longitudinal studies are warranted to evaluate their prognostic potential.