Annals of African Medicine最新文献

Addison's disease is known to cause hyperkalemia. However, heart block as a result of such hyperkalemia is very rare. We report one such case where Addison's disease presented with hyperkalemia and resultant heart block and Stokes-Adam's syndrome along with other features of hypoadrenalism.

Background: In this observational study, clinical characteristics, etiologies, and outcomes of patients admitted to the hospital with community-acquired acute kidney injury (CAAKI) have been compared in contrast to those who hospital-acquired Acute Kidney Injury (HAAKI).

Methods: This was a prospective study of adults aged 18 years or above diagnosed with acute kidney injury (AKI) over a period of 17 months at a tertiary care hospital.

Results: 230 patients had AKI with the mean age of the study population being 45.33 ± 12.68 years. 178 (77.4%) patients were enrolled from medical unit, 25 (10.7%) from surgical unit, and 27 (11.7%) from obstetrical unit. The observed incidence of AKI was 15/1000 admissions. About 58.2% had CAAKI and 96 (43.7%) had HAAKI. Out of 230 patients, 170 (73.9%) patients were male and 60 (26.1%) were female. Sepsis was the most common (52.1%) etiology of AKI among the medical cases. Urosepsis, scrub typhus, and pneumonia were the most common causes of AKI. Sixty percent of AKI was Kidney Disease Improving Global Outcomes Stage 1 or 2 and 40% was in Stage 3. Oliguria was seen in 56.5%, hyperkalemia in 34.7%, fluid overload in 6.1%, and metabolic acidosis in 22.6%. The majority of patients had multiple organ involvement (52.1%) at the time of enrollment. About 116 (50.4%) had lung injury requiring mechanical ventilation and 95 (41.3%) were on inotropes. Mortality occurred in 19.5%. Anemia, the use of vasopressor drugs, and the need for intensive care support were independent predictive factors for mortality.

Conclusion: AKI was common in hospitalized patients and leads to significant inhospital mortality. AKI is largely a CAAKI, and the lesser extent is due to HAAKI. Many causes are potentially preventable. Early fluid resuscitation, effective antibiotics, appropriate antidotes, and timely referral of established AKI patients to centers with dialysis facilities can improve AKI outcomes.

The etiology of cerebral venous sinus thrombosis (CVST) is multifactorial. Although many acquired and genetic factors have been recognized as risk factors, hyperhomocysteinemia (hHcy) is independently associated with CVST. We describe three cases of CVST in this case series. All of them presented with headache. Two patients had papilledema and visual disturbances. On evaluation, there was CVST, and prothrombotic workup showed hHcy. In addition, two of them reported very low Vitamin B12 levels. All of them were treated with low-molecular-weight heparin followed by oral anticoagulation and Vitamin B6, B9, and B12 supplements. All of them responded to treatment, and follow-up imaging studies in two of them showed resolution of thrombosis. hHcy should be considered in the evaluation of CVST, especially in the setting of a pure vegetarian diet. Fortification of the diet with Vitamin B12 may be considered the majority of Indians consume predominantly vegetarian food.

Background: The present study aimed to explore medical students' expectations from their teachers in Moroccan medical schools, regarding their primary educational roles.

Methods: An online questionnaire was distributed to medical students from the five main public medical schools in Morocco using a snowball sampling strategy.

Results: Two thousand four hundred and eighteen complete answers were collected and analyzed. The respondents gave the highest scores to "information provider" and the lowest scores to "Planner." When asked about their most preferred role they would want to see in their teachers, 40.6% of the respondents chose "Facilitator."

Conclusion: These results highlight that Moroccan medical schools should become more invested in training their faculty members to meet the rapidly changing demands and requirements of modern medical education.

Background: Diabetes mellitus (DM) has affected over 387 million patients globally, expected to reach 592 million by the end of 2035. It is a metabolic disorder characterized by chronic hyperglycemia caused by either insulin deficiency, insulin resistance, or both.

Materials and methods: The present study was designed to estimate the levels of different bone markers; serum Vitamin D, alkaline phosphatase, phosphorus, and calcium in patients with type 2 DM (T2DM). The study was conducted on patients aged 20-50 years diagnosed with T2DM, who were attending the outpatient/inpatient department of internal medicine.

Results: The levels of calcium were decreased in the patients with diabetes and also the study proved a negative correlation between calcium and random plasma glucose (RPG). There was a significant negative correlation between RPG and serum 25(OH)D3.

Conclusion: We conclude that Vitamin D insufficiency is frequent in Moradabad, Uttar Pradesh. Sunshine exposure daily for 15 min on the face and hands is necessary to elevate the sunlight Vitamin D levels.

The antitubercular drugs are associated with different cutaneous adverse drug reactions. Toxic epidermal necrolysis (TEN) is a severe form of cutaneous reaction. Although it is rare, it carries a high mortality rate. We report a case of a 75-year-old man with abdominal tuberculosis, who developed pyrazinamide-induced TEN.

Introduction: Our purpose was to study the body composition in a healthy female Moroccan adult group, and to help physicians to evaluate nutritional status.

Materials and methods: Five hundred and nineteen healthy women aged from 20 to 80 years were included in the study. Bone mineral density at the hip and lumbar spine and the body composition parameters were measured by dual-energy X-ray absorptiometry: fat mass (FM), fat-free mass (FFM), and percentage (%) of body fat. The FFM index (FFMI) and the FM index (FMI) were calculated. We analyzed the population by age and body mass index (BMI) defined groups.

Results: The mean age of the population was 53.14 ± 13.69 years with an average BMI of 29.30 ± 5.04 kg/m2. Means of FM and FFM were 33.93 ± 9.18 kg and 36.91 ± 5 kg, respectively, with FM and FFMI of 13.65 ± 3.66 kg/m2 and 14.85 ± 1.91 kg/m2, respectively. The % FM, FFM, and their corresponding indices increased with age; a statistically significant difference was observed between the 20 and 39 age categories and the two other categories. The BMI category analysis showed that FFMI and FMI increased in obese women with a statistically significant difference between the four groups. Age and BMI were correlated significantly with the different parameters.

Conclusion: This is the first Moroccan study to present body composition indexes in healthy Moroccan female adults. These reference values may be useful for the clinical evaluation of body composition and nutritional status.

Introduction: It is estimated that nearly 5%-10% of Indian schoolchildren have hidden problems, with about 80%-85% of them having dyslexia. Failing to diagnose and address learning disabilities on time can lead to adverse outcomes, such as school dropouts and mental health issues. In this context, the study was designed to assess educators' knowledge regarding LD, its detection, and provisions for its management.

Methods: A cross-sectional study was conducted in 10 randomly selected English, Hindi, Marathi, and Urdu medium schools under Brihanmumbai Municipal Corporation from June 2018 to December 2019. The study participants were primary, upper primary, and high schoolteachers whose knowledge and practices regarding LD were assessed using a validated questionnaire.

Results: From the ten selected schools, 150 teachers were interviewed. The knowledge regarding LD was poor, with only 26.67% of the teachers expressing the inability of the child to learn in only one particular tenet of their studies as a learning disability, which was incorrect. Nearly 24.67% of the teachers expressed the correct opinion that children who had problems with two or more learning domains were found to have LD. Most of them were unaware of the provisions for children with LD. The most common factors influencing learning disability among children were the environment at home (approximately 40%), followed by health and frequent illness of a child (28.67%).

Conclusion: LD criteria, screening, provision, and referral should have been better understood by schoolteachers. Most of their expertise came from teacher training programs. Teachers closely study their pupils and can spot even modest changes in academic performance or behavior, making them the first screening medium for learning disabilities. Therefore, teachers must be trained to recognize LD and informed about available services such as urban rehabilitation centers for children with LD.

Introduction: Anatomy teaching has traditionally been based on dissection. However, reduced hours in total and laboratory hours in gross anatomy along with a dearth of cadavers have ensued the search for a less time-consuming tool.

Materials and methods: The study was conducted in the Department of Anatomy in Sheikh Bhikhari Medical College, Hazaribag. A total of 282 medical students were taught gross anatomy, using three different learning modalities: dissection (n = 95), plastic models (n = 94), and three-dimensional (3D) anatomy software (n = 93). The knowledge of the students was examined by 100 multiple-choice question (MCQ) and tag questions followed by an evaluation questionnaire.

Results: When performance is considered, the dissection and 3D group performed better than the plastic models group in total, MCQs, and tag questions. In the evaluation questionnaire, dissection performed better than the other two modalities. Moreover, dissection and 3D software emerged as superior to the plastic models group.

Statistical analysis: All data were analyzed using the one-way ANOVA and t-test. Group-based analysis by ANOVA and gender-based analysis were done by Student's t-test. A comparison of students' perceptions was done by Kruskal-Wallis H-test.

Conclusion: Dissection remains a favorite with students and accomplishes a significantly higher attainment of knowledge. Plastic models are less effective but are a valuable tool in preparation for cadaveric laboratories.