Annals of African Medicine
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   Table of Contents - Current issue
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July-September 2022
Volume 21 | Issue 3
Page Nos. 173-304

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ORIGINAL ARTICLES  

The role of 12-lead electrocardiogram in the risk stratification of non-ST elevation acute coronary syndrome and the correlation with coronary angiography - The CINCHONa study - A prospective cohort study in Northern India Highly accessed article p. 173
Barun Kumar, Ashwin Kodliwadmath, Amar Nath Upadhyay, Ranjit Kumar Nath, Neeraj Pandit, Harsh Wardhan, Anupam Singh
DOI:10.4103/aam.aam_85_20  
Background: Clinical guidelines recommend risk stratification of non-ST elevation acute coronary syndrome (NST-ACS) using the GRACE risk score. However, the GRACE risk score is not followed widely in clinical practice due to various reasons. Our primary objectives of this study were to correlate the presenting electrocardiogram (ECG) of NST-ACS with coronary angiography (CAG) findings and to identify specific ECG changes that are suggestive of severe coronary artery disease (CAD) thus helping to triage all patients with NST-ACS. Materials and Methods: This prospective observational study was undertaken on patients diagnosed with NST-ACS in a medical college hospital, in Northern India over one and a ½ years. The admission ECG of the patients was compared with CAG findings to find out the correlation between the two with respect to severity of CAD. Categorical and quantitative variables were compared using the Chi-square test and independent t-test, respectively. Odds ratio (OR) were calculated using the univariate logistic regression analysis. Results: On comparing the two groups with normal and abnormal ECG, we found that smokers had significantly higher odds of having an abnormal ECG (OR 3.31; 95% confidence interval [CI] [1.29–8.50]). Patients with an abnormal ECG had significantly lower left ventricular ejection fraction compared to those with normal ECG (52.01 ± 10.56 vs. 55.96 ± 6.13%, P = 0.045). The patients with severe CAD on CAG had significantly higher odds of abnormal ECG (OR 3.68, 95% CI [1.2311.04]). Of the specific ECG abnormalities, ST depression and T-wave inversion in same or different leads were significantly associated with severity of CAD (OR 0.13, 95% CI [0.04–0.43], P = 0.001 and OR 0.13, 95% CI [0.03–0.46], P = 0.002, respectively). Conclusion: The identification of ECG changes suggestive of high-risk CAD can dictate to transfer such patients without delay to a percutaneous coronary intervention capable hospital for urgent CAG with intent to revascularization, thus helping in risk stratification of NST-ACS at the community level.
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Symptomatic survey of COVID-19 in the rural health and demographic surveillance site of Maharashtra, India Highly accessed article p. 180
Jayashree Sachin Gothankar, Arvinder Pal Singh Narula, Karamchand Patil, Rupeshkumar Deshmukh, Jayesh Patil, Prakash Doke, Ajit Karanjkar
DOI:10.4103/aam.aam_98_20  
Introduction: The COVID-19 epidemic is fast-evolving and restrictions to contain it changes quickly. The secondary attack rate (SAR) indicates the infectiousness at the household level, and it provides a clue of load of infections in the community. Rapid implementation of a large scale, but brief survey provides a nationally representative view of the pandemic's progression and impact as well as the effect of the measures taken to control the spread. Materials and Methods: This cross-sectional study was done for a period of 2 months July–August 2020, in one of the rural health and demographic surveillance system (HDSS) site in India among 11,507 households having 46,571 individuals with the objective to determine the prevalence of the COVID-19 infection and to estimate the family SAR. The data were collected using the mobile phone by calling the head of the households registered under the HDSS. The research tool was created using questions based on the guidelines provided by the Ministry of Health and Family Welfare, India. The interviewers were first trained in data collection. Results: The households of 33,780 individuals were contacted and 33 patients were diagnosed as COVID positive, prevalence rate of 0.1% was thus documented through telephonic survey. The mean age of COVID patients was found to be 37 ± 16 years, and 63% of the diagnosed patients were males, majority of them belonged to above poverty line households. During the survey, 46 individuals reported to have the symptoms suggestive of COVID, fever and cough were the most commonly reported symptoms. The family SAR of 17.2% was documented. Conclusion: Thus to conclude a low COVID-19 prevalence rate of 0.1%, a higher family SAR of 17.2% was reported in the current study. Timely diagnosis and quarantine of close contacts should be continued to be implemented rigorously to prevent the spread of the COVID-19 virus. These efforts will be useful to contain the epidemic before it reaches an alarming level in the rural areas.
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Role of dietary habits and personal hygiene on nutritional status of school-going adolescents: A cross-sectional study in selected schools located in slum areas of Nagpur City, Maharashtra p. 185
Mubashshera Firdous Khan, Sitikantha Banerjee, Kajari Bandyopadhyay, S Kalaiselvi, Sujiv Akkilgunata, Jaya Tripathy, Ranjan Solanki, Arvind Singh Kushwaha, Pradeep Deshmukh
DOI:10.4103/aam.aam_109_20  
Purpose: Adolescence is a nutritionally vulnerable time when rapid physical growth increases nutrient demand. Addressing the nutrition needs of adolescents could be an important step toward breaking the vicious cycle of intergenerational malnutrition. Under the healthy school initiative, a baseline assessment was carried out to assess the nutritional status, dietary habits, and personal hygiene of school-going adolescents to plan the future interventions at school level. Materials and Methods: A cross-sectional study was conducted in two government-aided schools for 6 months among 814 students of Class VI–IX to assess their dietary habits and personal hygiene by using the GSHS( Global School based student Health Survey) -2007(Indian version) tool. Anthropometric measurement was taken by standard technique. Results: The study found the proportion of thinness, stunting, and overweight/obesity as 40%, 20%, and 4.2%, respectively. Male students were found more thin (61.1% vs. 38.8%) and stunted (55.6% vs. 44.4%) as compared to female students. Less than one-fourth (13.7%) of the students reported <5 servings of fruits and vegetables. In multivariable analysis, male students, children of homemaker mother, skipping breakfast on all days of week, consumption of fast food ≥3 times/week, consumption of high sugary ready to use food, and infrequent handwashing after toilet were found to be predictors of thinness. Conclusion: Dietary habits and personnel hygiene were found to be important factors of undernutrition; promoting health behavior through school health policy with involvement of teachers, students, and parents is highly recommended to reduce the problem of undernutrition among adolescents.
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Enterococcal infections in a tertiary care hospital, North India p. 193
Rajesh Kumar Yadav, Loveleena Agarwal
DOI:10.4103/aam.aam_110_20  
Background: The emergence of Enterococcus as an important nosocomial pathogen is mainly attributed to its inherent resistance to commonly used antibiotics and now in recent times, it has acquired resistance to other available therapeutic options as well. Materials and Methods: Enterococcus isolates from clinical samples received in the department of microbiology over a period of 1 year were included in the study. Isolates were identified and species determined by standard methods. Antibiotic susceptibility test was done by Kirby Bauer disc diffusion test. Epsilometer test was done to determine the minimum inhibitory concentration for vancomycin. Results: A total of 145 Enterococcus isolates were obtained; 73 (50.3%) isolates were identified as Enterococcus faecalis, 69 (47.5%) Enterococcus faecium, 2 (1.3%) Enterococcus durans and 1 (0.68%) as Enterococcus gallinarum. Most of the isolates were from urine samples (125, 86.2%); followed by pus (16, 11.03%). Vancomycin resistance was seen in 14 (9.6%) isolates while linezolid resistance was seen in 8 (5.5%) isolates. Conclusion: E. faecalis is the most common clinical species isolated from clinical samples and the emergence of linezolid-resistant enterococci from the hospital is a matter of concern as till now it is considered to be the last resort for treatment in patients infected with vancomycin-resistant enterococci.
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Comparative evaluation of mineral trioxide aggregate and biodentine apical plug thickness on fracture resistance of immature teeth: An In vitro study p. 198
Pramod Mohite, Ankita Dadarao Ramteke, Ruchika Gupta, Suvarna Patil, Divya Gupta
DOI:10.4103/aam.aam_97_20  
Aim: This study aims to compare the fracture resistance of simulated immature teeth after using different thicknesses of Mineral Trioxide Aggregate (MTA) and Biodentine apical plug. Materials and Methods: Forty human maxillary anterior teeth were selected. Teeth were randomly divided into eight groups of five teeth in each group. Positive control group = 5 teeth; prepared without access cavity preparation. Access cavities of the remaining 35 teeth were prepared, and instrumented with Peeso reamers. Negative control = 5 teeth; filled with calcium hydroxide. Thirty teeth divided into Groups 1 and 2 of MTA (MTA-Angelus, Londrina, Brazil) and Biodentine (Septodant, Saint Maur des Fosses, France) and each group divided into three subgroups: subgroup A - 3 mm apical plug; subgroup B - 6 mm apical plug; and subgroup C: full canal length. The rest of the canals in subgroups A and B were filled with gutta-percha and AH Plus sealer. After the required storage period, all the samples were subjected to fracture testing under universal testing machine and fracture strength was recorded. Data were analyzed using 1-way analysis of variance with the Tukey post hoc test for multiple comparisons. Results: The negative control group showed the lowest fracture resistance compared with the other groups (P < 0.0001). The 6-mm apical plug subgroup of biodentine showed the highest fracture resistance. Conclusion: Within the limitations of this study, MTA and Biodentine can be used as an apical plug instead of root canal filling material to increase the fracture resistance of immature teeth.
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Clinical profile of ankylosing spondylitis at a teaching hospital p. 204
Yogesh Karoli, Sachin Avasthi, Swagat Mahapatra, Ritu Karoli
DOI:10.4103/aam.aam_103_20  
Introduction/Background: Ankylosing spondylitis (AS), a type of spondyloarthropathy, is an autoimmune disease that mainly involves spine joints, sacroiliac joints and their adjacent soft tissues, such as tendons and ligaments. Progression of disease can lead to fibrosis and calcification, resulting in the loss of flexibility and mobility of the spine. The common clinical presentation is inflammatory back pain which is often neglected. The aim of our study was to assess the demographic and clinical proflie of patients of ankylosing spondylitis diagnosed on the basis of radiographic sacroillitis. Methods: In a cross sectional hospital based study, the patients visiting to outpatient departments with inflammatory back pain were evaluated and 200 patients who had sacroiliitis according to modified New york criteria were diagnosed to have ankylosing spondylitis.The demographic and clinical profile was studied. Disease activity was assessed by using the ASDAS and BASDAI and function by BASFI and BASMI.Results: Amongst the study participants, 72 % were males and 28 % were females. The mean age of participants was 46± 12years. The mean duration of symptoms was10± 3 years. Out of all, 92% patients were HLA B27 positive. High BASDAI score (>4) was positively correlated with elevated CRP, ESR ,neutrophil lymphocyte ratio and had negative correlation with serum vitamin D levels. Conclusion: Most of the patients in our study had advanced disease might be due to delay in the diagnosis. They had high BASDAI with elevated inflammatory markers. Awareness for early and definite diagnosis of ankylosing spondylitis is needed to prevent irreversible structural damage, and worsening of quality of life.
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Harmful traditional practices among market women in ojuwoye market mushin, South West, Nigeria p. 208
Nkechi Chukwudi Ikeaba, Mobolanle Rasheedat Balogun, Tope Olubodun, Ifeoma Okafor
DOI:10.4103/aam.aam_112_20  
Traditions are the long-established patterns of actions or behaviors, often handed down within a community over many generations. Harmful traditional practices (HTPs) are customs that are known to have deleterious effects on people's health and obstruct the goals of equality, political, and social rights. They include female genital mutilation, intimate partner violence, male preference, child marriage, and food taboos. This study was carried out to assess the knowledge, attitude, and practice of HTPs among market women in Mushin Local Government Area (LGA) of Lagos, Nigeria. This cross-sectional, descriptive study was carried out among 235 market women in Ojuwoye market, Mushin LGA, Lagos. Respondents were selected using the systematic sampling method, and the data were collected using pretested interviewer-administered questionnaires. Data were analyzed using Epi info version 7. Proportions, mean, and standard deviation were generated and Chi-square test was used to explore the associations. Binary logistic regression was used to determine the predictors of HTP. Majority (66.8%) of the respondents had fair knowledge of HTPs. Overall attitude was generally good as 86% had an opposing attitude toward HTPs. About one-third of respondents (35.3%) practiced at least one form of HTP. Supportive attitude toward HTP was a predictor of HTP. Respondents with supportive attitude toward HTPs were 15.5 times more likely to practice HTPs than respondents with opposing attitude (adjusted odds ratio 15.51 confidence interval 4.22–57.07). Behavioral change programs should be geared toward improving the attitude of women against HTP and reducing the practice of HTP.
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An In vitro evaluation of effect of implant abutment on human gingival epithelial keratinocytes p. 217
Paulami Bagchi, Ahmed Ali Alfawzan, Swaroopkumar M Magar, Ritu Priya, Anuraj Singh Kochhar, Sneh Agrawal, Faris Jaser AlMutairi
DOI:10.4103/aam.aam_116_20  
Background: Abutment surfaces are being designed to promote gingival soft tissue attachment and integration. This confirms implant survival for long term by forming a seal around the prosthetics. Objectives: This study was done to compare the biocompatibility of three implant abutments: titanium uncoated, Ti-nitride coated, and modified polyetheretherketone (PEEK) with human gingival keratinocytes. Materials and Methods: The titanium-uncoated, titanium-nitride-coated, and modified PEEK discs (13 mm × 3 mm) were fabricated and compared with uncoated polyester cell culture discs, which were used as controls. These three implant abutments were evaluated for biocompatibility with respect to human gingival keratinocytes for viability, morphology, proliferation, and migration by scanning electron microscopy imaging and scratch wound healing assays. Measurements of roughness show changes between the investigated surfaces. Results: Keratinocytes cultured on all examined surfaces indicated adhesion and attachment. An assay of cell viability showed no substantial variances among the groups. The modified PEEK surface showed greater cell proliferation and migration among the three abutment materials. Conclusion: All three abutment material surface types showed similar epithelial biological responses. However, modified PEEK material showed the highest biocompatibility.
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Promoting the use of evidence in health policy-making in the economic commission of the West African States Region: Exploring the perception of policy-makers on the necessity of an evidence-based policy-making guidance p. 223
Chigozie Jesse Uneke, Issiaka Sombie, Ermel Johnson, Bilikis Iyabo Uneke, Stanley Okolo
DOI:10.4103/aam.aam_90_20  
Background: The West African Health Organization (WAHO) is promoting the use of evidence in policy-making within West Africa. The need for increased understanding of the complexities of the evidence-to-policy process among policy-makers in West Africa necessitates the development of evidence-based policy-making (EBPM) guidance. The purpose of this study was to interact with policy-makers from West African countries to identify the necessity of EBPM guidance for the subregion. Methods: A cross-sectional qualitative study design was used to elicit the views/opinions of senior health policy-makers from across the 15 West African countries on why an EBPM Guidance is necessary for the subregion. The policy-makers were engaged during WAHO-organized regional evidence-to-policy meetings on the improvement of maternal and child health outcomes held in Senegal in 2019. Face-to-face, one-on-one interactions, interviews, and deliberations during the meeting plenary sessions were held with the policy-makers, who participated in the regional meeting. Results: Up to 23 policy-makers representing 15 West African countries participated in the study. Policy-makers who took part in the study supported the development of an EBPM Guidance to facilitate evidence-to-policy process. Among the identified reasons why an EBPM Guidance for West Africa is a necessity were to understand: (i) how to deal with barriers and facilitators that influence evidence to policy process; (ii) how to acquire, access, adapt, and apply available research evidence in policy-making; (iii) how to deal with contextual issues and broad range of evidence; and (iv) how to engage parliamentarians and policy legislators to promote policy development. Conclusion: An EBPM is a valuable tool that can provide health sector policy-makers the needed guide on the evidence-to-policy process. Studies that will evaluate the impact of EBPM guidance on the policy-making process in low- and middle-income countries are advocated.
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Haptoglobin genotypes and malaria comorbidity in breast cancer and healthy Nigerian women p. 231
Titilope M Dokunmu, Patience O Obi, Omolara A Fatiregun, Oluwakemi A Rotimi, Sulaiman O Agodirin, Solomon O Rotimi
DOI:10.4103/1596-3519.356811  
Background: Breast cancer is the leading cause of mortality among women, with over a million cases recorded globally. Haptoglobin (Hp) protein and genotypes play important roles in cancer predisposition and progression, but studies have reported varying outcomes in populations. Aim: The association of Hp genotypes in breast cancer patients with malaria has not been investigated in Nigerians, which is the aim of our study. In healthy women (control; n = 279) and clinically diagnosed breast cancer patients (breast cancer; n = 70). Methods: Haptoglobin genotypes and Plasmodium falciparum cyclooxygenase III genes were detected by polymerase chain reaction (PCR). Proportions were compared, and the test of association was carried out with a significance level set at P < 0.05. Results: Overall, 311 of 349 (89%) individuals had malaria infection with similar proportions in breast cancer (63 of 70) and healthy control group (248 of 279); malaria incidence was, however, lower in Hp 2-2 breast cancer patients (P = 0.04). The prevalence of Hp genotypes was Hp 1-1 (78.2%), Hp 2-1 (7.2%), and 2-2 (14.6%). In breast cancer groups, Hp 2-2 genotype was significantly lower with 3 (4.2%) of 70 vs. 48 (17.2%) of 279 in control group (P = 0.006). Conclusions: The results of the study show low Hp 2-2 genotype relative to other genotypes in breast cancer patients; we conclude that low Hp 2-2 genotype is associated with lower malaria risk in breast cancer Nigerian women. It is important to further understand the roles malaria, Hp, and other genotypes play in the pathogenesis of aggressive breast cancer commonly seen in Nigerian women.
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Incidental blast injuries to the hands of hunters in suburban Africa p. 237
Olakunle Fatai Babalola, Adedayo Idris Salawu, Adeniyi Steven Hassan, Abiodun Idowu Okunlola, Omotola Oluseyi Banjo, Richard Oluyemi Fadairo
DOI:10.4103/aam.aam_113_20  
Background: Civilian blast injuries are common during celebrations and festivities. In the intervening times, civilian nonterrorist blast events are rare. The aim of this report is to highlight the increasing occurrence of blast injuries to the dominant right hand of hunters and the ensuing crippling consequences. Methodology: A review of incidental blast injuries to the hand among hunters was conducted. The case files, clinical photographs, and radiographs of consecutive cases of blast injuries presenting to our unit over 3½ years were studied. Result: Six patients had incidental blast injuries to the hand within the period. All the patients were males and hunters by profession. The age range was 30–49 years. The dominant right hand was involved in all the six cases with high-energy soft tissue and bony injuries. Five patients had staged soft tissue coverage while the sixth patient, after initial resuscitation, discharged against medical advice due to economic constraints. Multiple joint stiffness and significant disability occurred in all the affected hands. None of the patients represented for secondary procedures. Conclusion: Incidental blast injuries to the hands of local hunters are lifestyle threatening. The dominant right hand is invariably involved with attendant crippling socioeconomic consequences. Meticulous clinical care and methodical operative intervention are primal to hand salvage.
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An in vitro comparative assessment of manual hand file, rotary protaper ni-ti, erbium:yttrium–aluminum–garnet laser, canal brush, and ultrasound methods for smear layer removal p. 244
Prabu Mahin Syed Ismail, Abdul Majeed AlMogbel, Ritu Priya, Nandita Bansal, Sudha Mattigatti, Asha Nara, Faris Jaser AlMutairi
DOI:10.4103/aam.aam_115_20  
Background: Selection of instruments is important to prevent any complications such as ledge formation and instrument breakage. The main drawback linked with instrumentation is smear layer formation. Objectives: This study was done for comparison of manual hand file, rotary ProTaper Ni-Ti, erbium:yttrium–aluminum–garnet (Er:YAG) laser, ultrasound, and CanalBrush (CB) methods for smear layer removal. Methodology: Sixty freshly extracted single-rooted mandibular first premolars extracted for orthodontic treatment purpose were selected and classified into six groups. Group I was negative control in which no final agitation of irrigant was performed. In Group II, solution activation was performed with ProTaper Universal System, in Group III, solution activation was done with canal brush, in Group IV, ultrasound activation was done, in Group V, solution agitation was performed with Er:YAG laser agitation, and in Group VI, canal preparation with hand files was performed. Smear layer score was evaluated after canal preparation with each method. Results: Score 1 was seen in 3 (30%) in Group IV and 6 (60%) in Group V, score 2 was seen in 3 (30%) in Group I, 8 (80%) in Group II, 7 (70%) in Group III, 5 (50%) in Group IV, 3 (30%) in Group V, and 4 (40%) in Group VI. Score 3 was observed in 7 (70%) in Group I, 2 (20%) in Group II, 3 (70%) in Group III, 2 (20%) in Group IV, 1 (10%) in Group V, and 6 (60%) in Group VI. A statistically significant difference was found in smear layer removal score in all groups (P < 0.05) except between Group I versus VI (P > 0.05). Conclusion: Complete removal of the smear layer was not observed in any of the methods used in the study; however, Er: YAG laser was found to be better as compared to other methods.
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Health-related quality of life of persons with diabetic foot ulcers in a cosmopolitan city in northwestern Nigeria p. 250
Raliya Aliyu Habibu, Andrew Enemako Uloko, Ibrahim Danjummai Gezawa, Mansur Aliyu Ramalan, Fakhraddeen Yahaya Muhammad, Usman Ibrahim Abubakar, Abdullahi Muhammad
DOI:10.4103/aam.aam_2_21  
Background: Diabetic foot ulcer is one of the most serious and disabling complications of diabetes mellitus (DM). It is a major source of morbidity, mortality, and a leading cause of hospitalization. It constitutes a major burden to the patient, family, and health-care system as well as impairs quality of life (QoL). The aim of this study was to determine the QoL of persons with diabetic foot ulcers attending two major hospitals in a cosmopolitan city in northwestern Nigeria. Materials and Methods: We conducted a descriptive cross-sectional study at the diabetes outpatient clinics and wards of two major hospitals in Kano, Northwestern Nigeria. Sociodemographic characteristics, type of DM, duration of DM, and the presence of risk factors for foot ulcers were assessed. The QoL of patients with and without foot ulcer was determined a well-validated questionnaire for chronic diseases, short form 36 (SF 36) health-related QoL questionnaire. Results: We recruited 394 patients with DM (163 males and 231 females) with mean age and duration of DM of 50.8 ± 12.5 years and 7.72 ± 6.65 years, respectively. Ninety-five percent of the study participants had type 2 DM. Foot ulcers were present in 57 (14.5%) study participants. The QoL was generally poor (P < 0.001) in patients with DFU, compared with those without DFU in all domains of the SF 36, that indicated poor QoL in the physical, mental, and emotional well-being of the patients. Conclusion: Diabetic foot ulcers are quite common and impart significantly on the QoL of persons with DM affecting their physical, mental, and emotional well-being. Early detection and management of foot ulcers will reduce the burden of the disease and improve the QoL of affected individuals.
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The ambulatory blood pressure monitoring among obese and nonobese diabetes mellitus patients p. 255
Hella Fiona Mathews, Sunil Kumar, B Madhu, Oliver Joel Gona, KM Srinath
DOI:10.4103/aam.aam_65_21  
Background: Obesity and diabetes mellitus are two major factors related with the risk of metabolic syndrome and cardiovascular diseases. Co-existing hypertension with diabetes mellitus and obesity has poor prognosis for cardiovascular diseases. Ambulatory blood pressure monitoring (ABPM) correlates more closely to target organ damage than clinic blood pressure. Objectives: The objective of the study is to assess and compare ABPM pattern among obese and nonobese diabetes mellitus patients. Materials and Methods: A cross-sectional study was conducted among fifty obese and fifty nonobese diabetic patients who were classified based on their body mass index as per the WHO criterion. The clinical blood pressure measurements were measured on each subject using a digital sphygmomanometer, and 24 h ABPM was done and ABPM parameters such as dipping pattern, 24 h systolic blood pressure (SBP), diastolic blood pressure (DBP), Mean SBP, mean DBP, diurnal variability of SBP, DBP, Mean arterial pressure, pulse pressure, SD systole (Standard Deviation systole), SD diastole, white coat hypertension was derived and compared between the two groups. Results: Around 37 (74%) obese and 18 (36%) nonobese showed non dipping pattern in SBP and 28 (66.7%) of obese and 14 (33.3%) of nonobese showed a nondipping pattern in DBP and was found to be statistically significant (P < 0.001). On comparison between normotensive obese and normotensive nonobese, it was found that SBP non dipping pattern18 (67%) versus 9 (29%) and DBP nondipping pattern 12 (45%) versus 5 (16%) was statistically significant with P = 0.004, 0.016, respectively. Conclusion: Obese diabetes mellitus subjects had altered ABPM parameters and increased prevalence of nondipping status. In addition, obese diabetic patients who did not give prior history of hypertension were also found to have higher nondipping SBP and DBP patterns.
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Endoscopy for upper gastrointestinal bleeding in a tertiary hospital in Kaduna, North-West Nigeria: Experience and findings p. 262
Husain Yahya, Halima Umar, Bulus Timothy Shekari, Kalli Sani
DOI:10.4103/aam.aam_64_21  
Background: Upper gastrointestinal bleeding (UGIB) is a common medical emergency and upper gastrointestinal endoscopy (UGIE) makes diagnosis and treatment possible; performing this procedure within 24 h of bleeding is considered the standard of care for managing this condition. Access to upper endoscopy improves the prognosis of the disease. Methods: We present our experience and findings of performing UGIE in patients referred for UGIB to a new endoscopy unit in a tertiary center in North-West Nigeria. The age, gender, reasons for referral, interval between endoscopy, and last known episode of bleeding and endoscopic findings were obtained from endoscopy records. Results: We performed UGIE in 204 patients for UGIB over a 7-year period: Mean age 45.5 years (range 10–88 years), 61.8% male, 54.8% <50 years. Most patients (81.3%) had endoscopy seven or more days after the last known episode of bleeding and none had endoscopy within 24 h. Esophageal and gastric varices were found in almost 30% of patients while peptic ulcer disease was found in 23%. Portal hypertensive gastropathy was found in 12.7% of patients all of whom also had esophageal or gastric varices. Gastric mucosal erosions (7.4%) and gastric malignancy (6.4%) were other notable findings. No significant abnormalities were detected in 11.8% of patients. Conclusion: Bleeding from esophageal/gastric varices and peptic ulcer disease were the most common finding in our patients. There was delay in performing endoscopy and improving access and training for endoscopy will go a long way in addressing some of the challenges we identified.
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Misconception on oxygen administration among patients and their caregivers in Ado Ekiti, Nigeria p. 269
Adekunle Olatayo Adeoti, Olufemi Olumuyiwa Desalu, Tobiloba Elebiyo, Olusegun Ayanwale Aremu
DOI:10.4103/aam.aam_63_21  
Introduction: Appropriate oxygen administration is a life-saving therapy; however, patients and their caregivers could decline such therapy for several reasons. Poor perceptions may delay consent to oxygen therapy. There is a lack of data on the perception of oxygen use among patients and caregivers in our setting. Hence, this study was aimed at evaluating the perception of patients and their caregivers toward emergency oxygen use in a tertiary hospital in Nigeria. Materials and Methods: This survey was a descriptive cross-sectional study conducted between December 2017 and May 2018 at a tertiary hospital in southwestern Nigeria. We administered a structured questionnaire to 334 eligible patients and their 539 caregivers while on admission. Results: A significant proportion of the patients compared to their caregivers have had oxygen therapy in the past 40.6% versus. 6.9% P < 0.0001. The majority of the participants (patients vs. caregivers 84.7% vs. 81.1% P = 0.511) believed oxygen therapy to be beneficial and safe for use (patients vs. caregivers 79.4% vs. 78.6%; P = 0.8949). However, 21.1% of patients and 19.5% of caregivers believed it is solely for terminally ill patients. More than 50% of patients and caregivers thought oxygen can cause adverse effects and fire outbreaks. Most of the respondents considered oxygen therapy as expensive (patients vs. caregivers; 78.2% vs. 87.2%; P = 0.0176) which was regarded as a possible barrier to treatment (patients vs. caregivers 81.9% vs. 85.0% P = 0.3893). <1% of both patients and their caregivers have had any form of training in basic life support. Conclusion: The misconceptions about oxygen use require urgent attention by raising community awareness and knowledge toward improving the acceptability of this life-saving intervention.
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Impacted dentures in the pharynx and esophagus Implication for advocacy p. 274
Kenneth Baidoo, Paa-Kwesi Blankson, Sally Kwakye, Estella Bilson Amoah, Kafui Searyoh, Grace E Parkins, Amazing Grace Edem, Evelyn Nyamekye, Waltraud N O. D. Quartey, Christiana Boateng, Sandra Hewlett
DOI:10.4103/aam.aam_54_21  
Background: Impaction of dentures has potentially significant morbidity and management challenges. This study sought to leverage on the occurrence of swallowed dentures to advance discussions on its management and prevention. Methods: A 5-year retrospective review of patients seen on account of impacted dentures at the Ear, Nose, and Throat Department of the Korle-Bu Teaching Hospital was done. Variables obtained included age, sex, location of impacted denture, treatment done, denture type, number of teeth, and complications. Variables were analyzed, and descriptive summaries were reported. Results: There was a record of 898 cases of impacted foreign bodies which presented to the department. Fifty-five (6.1%) records were on account of impacted dentures. These consisted of 25 (45%) males and 30 (55%) females. Ranging from 23 to 98 years, the mean and median ages were 55.7 (±18.1) years and 56.5 years respectively. There were no complications, and no identifiable predisposing patient conditions. All prostheses were removable acrylic dentures, and some observations included worn-out and loose dentures, while several had their prostheses dislodging in the process of swallowing tablet medications with water. Conclusion: Swallowed dentures are not rare occurrences in Ghana. Denture wearers should, therefore, be encouraged to get professional reviews, especially when prostheses get unretentive, while dental professionals are urged to incorporate measures in their fabrication to reduce the occurrence of swallowed dentures.
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A study to evaluate the role of eosinophil count as a prognostic marker for assessing the outcome in patients with COVID-19 infection p. 278
Vishwanath Krishnamurthy, KJ Sujatha, T Anil Kumar, Priyanka Phaniraj, Tharanath Shankar, Madhu P Raj
DOI:10.4103/aam.aam_41_21  
Background and Objectives: The triaging of COVID-19 patients is of paramount importance to plan further management. There are several clinical and laboratory parameters that help in categorizing the disease severity, triaging, and prognostication. Little is known about the prognostic significance of eosinopenia in predicting the severity of COVID-19 from large hospital data, especially from low- and middle-income countries. The objective of this study is to evaluate the level of eosinopenia as an early prognostic marker for assessing the outcomes in COVID-19 patients and to assess the superiority of eosinopenia as a prognostic marker for assessing the outcomes in COVID-19 patients compared to lymphopenia and neutrophil-to-lymphocyte ratio (NLR). Methods: The study was carried out in a tertiary care hospital. A retrospective longitudinal approach was adopted wherein the hospital records of COVID-19 patients were analyzed. In our study, two separate groups of patients were included for analysis to describe the association between initial eosinophil counts of the patients and the clinical outcomes. In the first group, the disease severity in terms of clinical and radiological parameters was compared in patients of COVID-19 presenting with and without the presence of initial eosinopenia. Commonly used markers for triage, namely lymphopenia and NLR, were compared with the presence of initial eosinopenia among the patients who progressed to moderate and severe disease. In the second group, an analysis of eosinopenia was made among the patients who succumbed to the illness. Results: It was seen that 29.6% of patients with eosinopenia had moderate and severe disease compared to those without eosinopenia where only 10.8% had moderate disease, none had severe disease. It was seen that 19.7% of patients with eosinopenia but no lymphopenia had more severe disease compared to patients with lymphopenia but no eosinopenia where 10.8% of the patients had moderate disease, none had severe disease. In patients younger than 60 years who died of COVID-19, it was found that initial eosinopenia was found in 86%, whereas a high NLR >17 was seen in only 25.6% of patients who died, thus implying that is eosinopenia is an important marker of disease severity in COVID-19. Conclusions: Eosinopenia is an important parameter in the evaluation of COVID-19 and the presence of it should alert the clinicians regarding the further progression of the disease. It is not only an important marker but also an early marker for severe disease.
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Prevalence and characteristics of rotavirus acute gastroenteritis among under-five children in ahmadu bello university teaching hospital, Zaria, Nigeria p. 283
Sani Malam Mado, Fatima Jummai Giwa, Sakinatu Mahadi Abdullahi, Abdullahi Mohammed Alfa, Yahaya Yaqub, Yahaya Usman, Robinson Daniel Wammanda, Jason Mathiu Mwenda, Ayodeji Hassan Isiaka, Kabir Yusuf, Namadi Lawali
DOI:10.4103/aam.aam_31_21  
Background: Rotavirus infection is a significant cause of gastroenteritis in developing countries and, in severe cases even leads to death. The impact of rotavirus vaccine introduction in reducing the rotavirus disease burden in children was well known. The study was aimed to determine the prevalence and clinical characteristics of rotavirus gastroenteritis before the introduction of rotavirus vaccine into Nigeria's routine immunization program. Materials and Methods: We conducted a cross-sectional hospital-based study involving 735 children aged 0–59 months with acute gastroenteritis hospitalized at the Ahmadu Bello University Teaching Hospital Zaria from September 2017 to August 2020. Relevant sociodemographic and clinical data were obtained and entered into the World Health Organization standardized case investigation forms. Stool specimens were tested for rotavirus Group A antigen using the ProSpecT Rotavirus Microplate Assay by Thermoscientific Oxoid Microbiology UK. Results: One hundred and fifty-three stool samples tested positive for rotavirus giving a prevalence of 20.8%. One hundred and two (66.7%) children with rotavirus gastroenteritis were infants. There were 87 males and 66 females with M: F ratio of 1.3:1. Only 30 (19.6%) children with rotavirus-associated diarrhea presented with severe dehydration. The presence of vomiting was significantly associated with rotavirus diarrhea (P = 0.001). More cases of rotavirus diarrhea occurred in September through February. None of the studied children were vaccinated against rotavirus. Conclusion: The prevalence of rotavirus diarrhea remains high in this study. Infants were recognized as a high-risk group, and none of them were vaccinated against rotavirus and this underscores the urgent need for implementing the rotavirus vaccine in the national vaccination program to reduce the disease burden in the country. Résumé Contexte: L'infection à rotavirus est une cause importante de gastro-entérite dans les pays en développement et, dans les cas graves, entraîne même la mort. L'impact de l'introduction du vaccin antirotavirus pour réduire le fardeau de la maladie à rotavirus chez les enfants était bien connue. L'étude visait à déterminer la prévalence et les caractéristiques cliniques de la gastro-entérite à rotavirus avant l'introduction du vaccin antirotavirus dans le programme de vaccination systématique du Nigéria. Matériels et méthodes: Nous avons mené une étude hospitalière transversale portant sur 735 enfants âgés de 0 à 59 mois atteints de gastro-entérite aiguë. hospitalisé à l'hôpital universitaire Ahmadu Bello Zaria de septembre 2017 à août 2020. Données sociodémographiques et cliniques pertinentes les données ont été obtenues et saisies dans les formulaires normalisés d'investigation de cas de l'Organisation mondiale de la santé. Des échantillons de selles ont été testés pour le rotavirus Antigène du groupe A utilisant le test sur microplaque ProSpecT™ Rotavirus par Thermoscientific Oxoid Microbiology UK. Résultats: cent cinquante trois les échantillons de selles ont été testés positifs pour le rotavirus donnant une prévalence de 20,8 %. Cent deux (66,7 %) enfants atteints de gastro-entérite à rotavirus ont été nourrissons. Il y avait 87 hommes et 66 femmes avec un rapport M:F de 1,3:1. Seuls 30 (19,6 %) enfants atteints de diarrhée à rotavirus ont présenté déshydratation sévère. La présence de vomissements était significativement associée à la diarrhée à rotavirus (P = 0,001). Plus de cas de diarrhée à rotavirus se sont produits de septembre à février. Aucun des enfants étudiés n'a été vacciné contre le rotavirus. Conclusion: La prévalence de la diarrhée à rotavirus reste élevé dans cette étude. Les nourrissons ont été reconnus comme un groupe à haut risque et aucun d'entre eux n'a été vacciné contre le rotavirus, ce qui souligne la nécessité urgente de mettre en œuvre le vaccin antirotavirus dans le programme national de vaccination afin de réduire la charge de morbidité dans le pays. Mots-clés: Gastro-entérite aiguë, diarrhée à rotavirus, vaccin à rotavirus, Zaria
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CASE REPORTS Top

Recurrent inguinal hernia containing the urinary bladder: A rare occurrence p. 288
Friday Emeakpor Ogbetere, Udoka Imoisili
DOI:10.4103/aam.aam_100_20  
Inguinal bladder hernia (IBH) is an extremely rare occurrence and remains a challenge to the surgeon in the preoperative, intraoperative, and in the postoperative period. Its diagnosis requires a high index of suspicion, especially in the high-risk patients: elderly overweight/obese males with a recurrent hernia and lower urinary tract symptoms. Here, we report the case of a 78-year-old overweight male who presented with a bilateral direct inguinal hernia with the right being recurrent and irreducible. The diagnosis of IBH was made incidentally during the hernia repair. The patient was managed successfully by the replacement of the bladder in the pelvic position and inguinal herniorrhaphy done using the modified Bassini technique. The left groin hernia was also repaired using the modified Bassini technique. Our goal here is to reawaken the consciousness of the surgeons involved in inguinal hernia repair about IBH, particularly in high-risk patients.
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Dual arterial thrombosis: A diagnostic enigma p. 291
Shasthara Paneyala, SC Nemichandra, Harsha Sundaramurthy, K Vimala Christina Colaco
DOI:10.4103/aam.aam_96_20  
Cold agglutinin disease is a rare cause of arterial thrombosis leading to stroke, commonly encountered against a background of mycoplasma pneumonia infections. A 22-year-old patient presented with acute-onset left hemiplegia preceded by a short history of fever and cough. Magnetic resonance imaging (MRI) showed a right middle cerebral artery infarct. Serially repeated hemoglobin levels showed a progressive drop and peripheral smear showed evidence of hemolysis. Blood drawn for investigations would rapidly clot, suggesting a possibility of cold agglutinin-induced hemolysis. The patient was then worked up for all the possible causes of hemolytic anemia including secondary causes which were all negative except for significant immunoglobulin M mycoplasma levels with elevated cold antibody titers. The patient was then initiated on pulse steroids with azithromycin and doxycycline and hemoglobin levels stabilized. The patient also developed pulmonary thromboembolism which was managed with anticoagulation. The patient made a steady improvement, was discharged, and is on follow-up. Here, we present a unique case of mycoplasma associated cold agglutinin disease causing arterial thrombosis.
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Novel transthyretin gene mutation in familial amyloid neuropathy in India: Case p. 296
Shalesh Rohatgi, Satish Nirhale, Poonkodi Manohar, Prajwal Rao, Pravin Naphade, Furqan Mohd Akram Khan, Dhaval Dave, VV Sravya Kotaru, Sahil Gupta, Advait Gitay, Prashant Dubey
DOI:10.4103/aam.aam_260_21  
Familial amyloid polyneuropathy (PN), also known as amyloid transthyretin (TTR)-PN is an autosomal dominant adult-onset fatal disease, if not treated. It occurs due to mutations in (TTR) gene which leads to a faulty TTR protein which folds up to form amyloid and gets deposited mainly on nerves and causes length-dependent PN and autonomic dysfunction. We report a case of a 45-year-old female who presented with symptoms of painful peripheral neuropathy for 5 months, a history of deafness for 5 years, and cardiac pacemaker implantation 2 years ago for complete heart block. She denied any symptoms of autonomic dysfunction. Her brother with similar symptoms died of cardiac arrest at the age of 50 years. Clinical examination was suggestive of symmetrical sensorimotor PN. The nerve conduction study was suggestive of axonal sensorimotor PN. Abdominal fat biopsy was negative for amyloid. Sural nerve biopsy was suggestive of amyloid neuropathy. Genetic analysis showed c. 165G > T mutation encoding amino acid p. Lys55Asn on exon-4 of TTR gene. This mutation has not been reported from India.
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Steroid and sphingomonas p. 299
Pankaj Kumar Kannauje, Vinay R Pandit, Preetam Narayan Wasnik, Nanditha Venkat
DOI:10.4103/aam.aam_120_21  
Sphingomonas paucimobilis is a Gram-negative bacteria identified as a rare infectious agent, more commonly seen among immune-compromised hosts. Infections include bacteremia, septicemia leading to septic shock, bone and soft-tissue infections such as septic arthritis, osteomyelitis, infection of shunts, and implantable devices. Although the organism has been reported to have low pathogenicity, infections in the immune compromised can be devastating leading to even death.
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Retinal Toxicity from Chronic Hydroxychloroquine use in Kenya Highly accessed article p. 301
Oscar M Onyango, Sarah M Sitati
DOI:10.4103/aam.aam_118_21  
Irreversible visual loss due to retinal toxicity is one of the side effects of hydroxychloroquine (HCQ) therapy. The recent outbreak of the novel coronavirus-19 (COVID 19) has seen HCQ proposed as a possible treatment and prophylactic drug, leading to its increased use. Many are unaware of its ocular side effects. We describe a case of HCQ-induced retinopathy in a 46-year-old female who was referred by a rheumatologist for routine eye review.
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