Annals of African Medicine最新文献

Introduction: Worldwide, diabetic nephropathy (DN) is a major contributor to end-stage renal disease. Early detection remains challenging, necessitating the identification of novel biomarkers. Platelet activation and size, as indicated by Mean Platelet Volume (MPV), have emerged as a potential marker for diabetic microvascular complications. To evaluate the association between MPV and DN in type 2 diabetes mellitus (T2DM) patients and assess its utility as an early diagnostic marker.

Materials and methods: One hundred and twenty-five T2DM patients aged >40 years were included in a cross-sectional study at a tertiary care center. Participants were categorized into nephropathy (n = 73) and non-nephropathy (n = 52) groups based on estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR). MPV was measured using automated hematology analyzers. Statistical analyses included correlation studies, receiver operating characteristic (ROC) curve analysis, and logistic regression.

Results: The nephropathy group demonstrated significantly elevated MPV levels compared to the nonnephropathy group (12.30 ± 1.55 vs. 9.61 ± 1.2 fl, P < 0.001). MPV showed strong correlations with diabetes duration (rs = 0.543, P < 0.001), eGFR (rs = -0.581, P < 0.001), and UACR (rs = 0.585, P < 0.001). ROC analysis revealed an optimal MPV cutoff of 11.04 fL for predicting nephropathy with 85.6% accuracy, 89.0% sensitivity, and 80.8% specificity. Each unit increase in MPV was associated with a 3.65-fold increased risk of nephropathy (odds ratio: 3.650, 95% confidence interval: 2.320-5.750, P < 0.001).

Conclusions: MPV represents a simple, cost-effective biomarker for early detection of DN in T2DM patients. Its incorporation into routine clinical assessment could facilitate timely intervention and improve patient outcomes.

Background: The disease cerebral palsy (CP) primarily impacts muscle control and movement, potentially resulting in numerous associated disorders in early childhood. One notable complication that may arise in individuals with CP is hearing loss, which can develop due to various underlying factors related to the condition.

Objectives: To assess hearing impairment in CP children by using brainstem evoked response audiometry (BERA).

Materials and methods: There were 110 confirmed cases of CP between the ages of 6 months and 10 years. Audiologic Assessment: BERA was used to evaluate the hearing of the children. Demographic, otologic, and audiologic information were collected systematically, accompanied by records detailing other otologic and medical conditions.

Results: The prevalence of hearing loss in children aged ≤4 years (CP). In addition, males were more commonly affected in CP. Prematurity was significantly higher (62%) in the group with hearing loss. The number of maternal infections was also significantly higher in the group with hearing loss (58.33%). Malnutrition, mode of delivery, maternal tobacco use, and maternal alcohol use were not significantly associated with hearing loss. The frequency of low birth weight patients (<2500 g) was higher in hearing loss (79.17%). Neonatal seizure was also significantly associated with hearing loss (54.17%) than in patients without hearing loss (24.42%). Meconium aspiration, delayed crying, neonatal jaundice, neonatal sepsis, exclusive breastfeeding, and immunizations were not significantly associated with hearing loss.

Conclusion: Preterm birth and maternal infections were significantly more common in the group with hearing loss. Low birth weight (<2500 g) and neonatal seizures were also significantly associated with hearing loss.

Background: Individuals with the breast cancer 1 gene (BRCA1) and breast cancer 2 gene (BRCA2) associated hereditary breast and ovarian cancer (HBOC) have an elevated risk of developing breast cancer in both men and women. The aim of the study was to assess the risk of HBOC using clinical history in patients diagnosed with breast or ovarian cancer (OC) receiving treatment.

Materials and methods: A cross-sectional study was conducted among 180 patients diagnosed with breast or OC, selected using a nonprobability convenience sampling technique. Data was collected using a self-structured tool for the sociodemographic and clinical variables, and the CanRisk tool was used to assess the estimated risk percentage value of BRCA1 or BRCA2 pathogenic or likely pathogenic variants based on the clinical variables. Data was analyzed using IBM SPSS version 20, Mann-Whitney U-test, and Kruskal-Wallis test, with P < 0.05 as the significance level.

Results: The results indicate an increased hereditary risk associated with early breast or OC diagnosis, married, late menarche, early menopause, young maternal age at first childbirth, and family history in patients diagnosed with breast or OC. A statistically significant association (P < 0.05) was found between estimated risk percentages for pathogenic or likely pathogenic variants BRCA1 or BRCA2 (including BRCA1, BRCA2, PALB2, CHEK2, ATM, BARD1, RAD51D, RAD51C, or BRIP) with the selected sociodemographic and clinical variables.

Conclusion: Genetic counseling and testing for patients diagnosed with breast or OC can identify HBOC risk, reducing complications and mitigating lifetime cancer risk through timely assessment and awareness.

Background: Anesthetic management in neurosurgical procedures requires rapid recovery and stable hemodynamics to enable early neurological evaluation. Sevoflurane and desflurane, with low blood-gas solubility, are commonly used inhalational agents. Dexmedetomidine, an α2-adrenergic agonist, provides sedation and hemodynamic stability. Limited studies have compared sevoflurane and desflurane in combination with dexmedetomidine for neurosurgical recovery.

Aims and objectives: To compare the recovery profile, cognitive function, and intraoperative brain relaxation in patients undergoing supratentorial tumor surgery under sevoflurane-dexmedetomidine versus desflurane-dexmedetomidine anesthesia.

Materials and methods: This prospective observational study was conducted at Kasturba Medical College, Mangalore, between March 2023 and August 2024. Ninety-six patients aged 40-65 years undergoing elective supratentorial craniotomy were enrolled and divided into two groups: Group A (sevoflurane with dexmedetomidine) and Group B (desflurane with dexmedetomidine). Recovery times (emergence, extubation, orientation), cognitive function (Short Orientation Memory Concentration Test, SOMCT), brain relaxation score, hemodynamics, and adverse events were assessed. Data were analyzed using independent t-tests and Chi-square tests, with P < 0.05 considered significant.

Results: Desflurane group showed significantly shorter emergence (8.1 ± 1.4 vs. 12.9 ± 1.2 min), extubation (13.9 ± 2.8 vs. 18.8 ± 1.3 min), and orientation times (36.2 ± 4.8 vs. 41.6 ± 4.3 min) compared to sevoflurane (P < 0.001). Cognitive recovery was faster with desflurane (SOMCT 7.8 ± 1.6 vs. 13.2 ± 3.0; P < 0.001). Brain relaxation was superior in the desflurane group (P < 0.001). Adverse events were fewer with desflurane (4.2% vs. 20.8%; P = 0.01). Hemodynamics remained stable in both groups.

Conclusion: Desflurane with dexmedetomidine provides faster emergence, better cognitive recovery, superior brain relaxation, and fewer adverse events compared to sevoflurane in supratentorial neurosurgery. It may be preferred when rapid postoperative neurological assessment is required.

Abstract: Segmental fractures of the proximal humeral shaft are rare and challenging to manage, particularly in elderly osteoporotic patients with multiple co-morbidities. Traditional open fixation methods carry risks of soft tissue complications, neurovascular injury, and delayed recovery. Minimally invasive techniques such as Closed Reduction and Internal Fixation (CRIF) with Titanium Elastic Nailing System (TENS) offer an alternative, though their use in segmental proximal humeral fractures remains underreported. We report the case of a 72-year-old female with diabetes mellitus, hypertension, and coronary artery disease, who presented with a segmental, comminuted fracture of the left proximal humeral shaft following trauma. Considering her co-morbidities, deranged blood parameters, and skin abrasions, CRIF with TENS under regional block anesthesia was performed. Two pre-bent elastic nails were inserted via medial and lateral entry points under C-arm guidance, achieving stable fixation with minimal blood loss and soft tissue disruption. The postoperative period was uneventful, with early initiation of physiotherapy and functional recovery. At follow-up, the patient demonstrated progressive callus formation, satisfactory cosmetic results, and functional range of motion without major complications. CRIF with TENS can serve as a safe and effective minimally invasive option for managing complex proximal humeral shaft segmental fractures in elderly patients with multiple comorbidities, offering advantages of reduced surgical morbidity, early rehabilitation, and improved cosmetic outcomes. Further studies are needed to establish its role in adult fracture management.

Background: Medical education is evolving toward interactive teaching methods, and small group teaching (SGT) is increasingly being adopted. While lecture-based teaching using PowerPoint (LBTP) remains common, its effectiveness in fostering student engagement, retention, and critical thinking is being questioned.

Objective: To compare students' perceptions of SGT versus LBTP among Indian medical undergraduates.

Methods: A cross-sectional, within-subject, comparative pilot study was conducted among 100 undergraduate medical students at Sheikh Bhikhari Medical College, Hazaribagh, India. The same topic was taught using two approaches: SGT (15-17 students per group, divided into six groups) and LBTP (a whole-class PowerPoint lecture). Feedback was collected via a semistructured questionnaire using Google Forms. Responses were analyzed using descriptive statistics and Chi-square tests (P < 0.05 was considered statistically significant).

Results: Of the 100 students, 98 completed the questionnaire. Most students (85%) rated SGT as more effective, particularly for understanding and engagement. Knowledge retention was higher with SGT (62.2%) compared to LBTP (11.2%). Strengths of SGT included better interaction, clarity, peer learning, and personalized feedback.

Conclusion: SGT was perceived as more effective than LBTP. These findings support the integration of interactive, learner-centered methods in resource-limited medical education contexts, such as those found in many parts of Sub-Saharan Africa and South Asia.

Introduction: Oral lichen planus (OLP) is a relatively common chronic inflammatory condition of unknown origin and is classified among oral potentially malignant disorders (OPMDs). Emerging evidence suggests that oxidative stress (OS) and compromised antioxidant defense may play a role in its pathogenesis. OPMDs represent morphologically altered tissues with a risk of progression to oral cancer. Therefore, identifying high-risk lesions with a greater likelihood of malignant transformation is crucial. This study aimed to evaluate and compare OS levels by assessing the immunohistochemical (IHC) expression of 4-hydroxynonenal (4-HNE), a marker of lipid peroxidation (LPO), in OLP tissues versus normal oral mucosa.

Materials and methods: The study included 30 formalin-fixed, paraffin-embedded tissue samples from histopathologically confirmed cases of OLP and 10 normal oral mucosa samples serving as the control group. All tissue sections were subjected to immunohistochemical staining using the 4-HNE antibody and examined under a light microscope. Statistical analysis was performed using Fisher's exact test.

Results: A significantly elevated cytoplasmic expression of 4-HNE protein was observed in the epithelial cells of lichen planus (LP) tissues compared to normal oral mucosa (P < 0.001). Approximately 90% of the normal tissue samples showed no detectable 4-HNE immunoreactivity.

Conclusion: These oxidative modifications suggest underlying pathophysiological changes primarily localized to the basal cell layer and the epithelial-connective tissue interface in LP tissues. Further research is needed to explore the role of OS across different clinical and histopathological variants of LP, to enhance early prediction of malignant transformation.

Background: Pregnancy-induced hypertension (PIH) is a significant cause of maternal and perinatal morbidity and mortality worldwide. Early prediction of PIH could facilitate timely intervention and improved outcomes. Among biochemical markers, maternal serum beta-human chorionic gonadotropin (β-hCG) has been suggested as a potential predictor, especially when measured during the second trimester. Identifying its predictive accuracy in clinical settings could enhance antenatal risk stratification protocols.

Aim: The aim of this study was to evaluate the efficacy of second-trimester maternal serum β-hCG levels in predicting the subsequent development of PIH.

Methodology: This was a cross-sectional analytical study conducted at the Department of Obstetrics and Gynaecology, Dr. D. Y. Patil Medical College, Pune, over a 3-year period from October/November 2022 to September/October 2025. A total of 200 antenatal women between 13 and 24 weeks of gestation were recruited. Serum β-hCG levels were measured and expressed in multiples of the median (MoM). Patients were followed up until delivery, and the occurrence of PIH was recorded. Subjects were categorized into two groups: those who developed PIH and those who remained normotensive. Data were analyzed to assess the relationship between β-hCG levels and risk of developing PIH.

Results: Among 200 participants, 34 (17%) developed PIH, while 166 (83%) remained normotensive. The mean β-hCG MoM was significantly higher in the PIH group compared to the normotensive group. A serum β-hCG cutoff value of >2.5 MoM demonstrated moderate sensitivity and high specificity in predicting PIH. The incidence of PIH was substantially higher in women with elevated β-hCG levels in the second trimester.

Conclusion: Elevated maternal serum β-hCG levels during the second trimester are significantly associated with the development of PIH. β-hCG may serve as a useful biochemical marker for early prediction of PIH, aiding in closer monitoring and timely management of high-risk pregnancies.

Background: Pancreatico-pleural fistula (PPF) is a rare complication of pancreatitis, with bilateral presentation being exceptionally uncommon. This case report describes the successful management of a bilateral PPF in a patient with alcohol-induced pancreatitis.

Case presentation: A 40-year-old male presented with epigastric pain and progressive breathlessness. Imaging revealed bilateral pleural effusions with pancreatic duct dilation and fistulous communication. Pleural fluid analysis showed markedly elevated amylase (6533 U/L) and lipase (31,319 U/L) levels. Management included bilateral chest tube drainage and endoscopic intervention with pancreatic duct stenting.

Results: The patient showed significant improvement following the combination therapy of conservative management and endoscopic intervention. After 32 days of hospitalization, the patient was discharged with a pancreatic duct stent in situ and planned follow-up for repeat endoscopic retrograde cholangiopancreatography.

Conclusion: This case highlights the importance of considering PPF in patients with unexplained pleural effusions and demonstrates the effectiveness of a multi-modal approach in managing bilateral pancreaticopleural fistulas.