Annals of African Medicine
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   2022| April-June  | Volume 21 | Issue 2  
    Online since July 6, 2022

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Effect of vitamin supplementation in patients of congestive heart failure deficient in vitamin D: A study at a tertiary care center of North India
Vivek Mohanty, Monika Pathania, Ankith Bhasi
April-June 2022, 21(2):107-112
DOI:10.4103/aam.aam_70_20  PMID:35848640
Introduction: Heart Failure is a leading cause of mortality worldwide including India. Most cross sectional studies have demonstrated heart failure is associated with deficiency of essential micronutrients including Vitamin D which may play a important role in pathogenesis of ventricular remodelling in heart failure. Aim: Our study performed aimed to determine the effect of supplementation in patients of Heart Failure presenting with Vitamin D deficiency to our institute on severity of Heart Failure. Design and Method: 97 patients of Heart failure coming to our institute were given conventional therapies for Heart Failure along with Vitamin supplementation based on serum Vitamin D levels and followed up for 3 months. Results: Patient of Heart failure having Vitamin D deficiency had significant reduction in cardiac biomarkers (NT-pro BNP levels), improvement in Left ventricular ejection fraction (LVEF) and more favourable reverse remodelling determined by Left ventricular end diastolic and systolic diameter (LVEDD & LVESD) though quality of life determined by WHODAS 2.0 score did not changed following 12 weeks supplementation of High Dose Vitamin D. Conclusion: Recognising and treatment of Vitamin D deficiency may determine long term prognosis in patients of Heart Failure.
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Clinical profile, etiology, and outcome of acute pancreatitis: Experience at a tertiary care center
ML Patel, Radhey Shyam, Virendra Atam, Harish Bharti, Rekha Sachan, Anit Parihar
April-June 2022, 21(2):118-123
DOI:10.4103/aam.aam_83_20  PMID:35848642
Background: Acute pancreatitis (AP) is an inflammatory process of the pancreas with varying degree of involvement of regional tissues. This was a population-based study on the incidence of AP. We aimed to determine the incidence, etiology, and outcome of AP. Materials and Methodology: This prospective study was conducted in the Department of Medicine, King George's Medical University, Lucknow, India, on 120 patients of AP. Clinical history, examination, and laboratory investigations were done. Severity of AP was assessed using the modified Atlanta classification. Results: A total of 120 patients comprising of 88 men (73.33%) and 32 women (26.66%) were recruited. The mean age of study participant was 36.96 ± 13.44 years. The most common presentation was abdominal pain followed by vomiting. The leading etiological factors were alcohol in 85 patients (70.8%) and gallstones in 25 (20.8%). It was idiopathic 5 patients (4.1%). Mortality was seen in three (2.5%) patients, all of which had severe pancreatitis. Patients with body mass index (BMI) ≥25 kg/m2, Hematocrit (HCT) ≥44% and C-reactive protein (CRP) ≥150 mg/l had an increased risk of developing a severe AP. Conclusions: Alcohol and gallstones were the most common etiological factors of AP, whereas HCT, CRP, and BMI were the useful predictors of severe pancreatitis.
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Prophylactic use of hydroxychloroquine (HCQS) in COVID-19: A questionnaire-based study in health care professionals
Gaurav Manikrao Rangari, Sushil Sharma, Roza Gorakhnath Bhaisare, C Madhavrao, Arup Kumar Misra
April-June 2022, 21(2):113-117
DOI:10.4103/aam.aam_82_20  PMID:35848641
Background: Coronavirus disease-2019 (COVID-19) pandemic has engulfed the whole world with millions getting infected and losing their lives. Health care professionals (HCPs) who are in the front line of fighting with COVID-19 are particularly vulnerable and it is crucial to protect them from COVID-19. In this regard, the Indian Council of Medical Research (ICMR) has recommended hydroxychloroquine (HCQS) chemoprophylaxis in HCPs. However, considering the lack of sufficient evidence the HCP are in a dilemma about this aspect. Moreover, there is a paucity of data on use of HCQS as a chemoprophylaxis among Indian HCP. Hence, this study was carried out to study the extent of use and also the perception of Indian HCP toward use of HCQS as a chemoprophylaxis for COVID-19. Materials and Methods: This was a cross-sectional study done on 205 HCPs working across India. The responses were collected electronically using a prevalidated semi-structured questionnaire. Results: 62.9% (129/205) respondents reported having taken HCQS chemo-prophylaxis for COVID-19 while 34.7% (76/205) did not take it. Among HCP, who did not take the prophylaxis, the main reasons cited were concern about adverse effects (61.5%) and lack of robust evidence (24%). Only 14% of respondents felt that there was sufficient evidence to justify use of HCQS for prophylaxis while an overwhelming majority (86%) felt otherwise or were uncertain. Conclusion: The majority of participants felt that despite a lack of proven efficacy, ICMR guidelines on HCQS prophylaxis in COVID-19 are justified considering the pandemic situation. Our study also found that HCQS is well tolerated by participants and there was no reported serious adverse effect and cardiac-related side effects among them.
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Chemotherapy-Associated nausea and vomiting: A cross-sectional survey of occurrence and management patterns at jos university teaching hospital, Nigeria
Kelvin Mogesa Manyega, Benjamin Nasara Joseph, Okunlola Charity Rotkangmwa, Maxwell P Dapar
April-June 2022, 21(2):124-131
DOI:10.4103/aam.aam_87_20  PMID:35848643
Background: The management patterns for chemotherapy-associated nausea and vomiting (CANV) in Sub-Saharan African settings have not been previously reported. The objectives of this study were to describe the prescribing pattern of antiemetics for CANV, to assess their adherence to guidelines, and to determine the occurrence of CANV. Subjects and Methods: This was a cross-sectional study, with data extracted from the records of adult patients who received chemotherapy from 2015 to 2018 at Jos University Teaching Hospital, Nigeria. The National Comprehensive Cancer Network Harmonized Guidelines™ for Sub-Saharan Africa for Antiemesis Version 3.2018 was used to determine the extent of guideline adherence. Results: Records of 165 patients were analyzed. Majority of the patients (76.4%, n = 126) received moderate-to-high emetic risk intravenous (IV) chemotherapy. Out of 129 antiemetic prescriptions for acute-phase prophylaxis, ondansetron (75.2%), corticosteroids (61.2%), and promethazine (24.8%) were the most prescribed agents. In the delayed phase, 50 patients received prophylactic antiemetics in the order of corticosteroids, ondansetron, and promethazine at 74%, 34%, and 26%, respectively. Guideline adherence was low for the acute-phase (23.6%), delayed-phase (20.6%), and overall period (17.6%). Among inpatients (n = 85), occurrences of nausea were negligible, whereas acute vomiting (9%) and delayed vomiting (15%) levels were considerable. Not receiving highly emetogenic IV chemotherapy was associated with significantly lower odds for nausea or vomiting occurrence, odds ratio 0.228 (95% confidence interval 0.054–0.967). Conclusions: Antiemetic guideline adherence was low due to antiemetic under-prescribing. A few nausea and vomiting events were recorded predominantly among patients who received highly emetogenic IV chemotherapy.
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Does serum kidney injury molecule-1 predict early diabetic nephropathy: A comparative study with microalbuminuria
Divya Balu, Vasanthan Krishnan, Vengadakrishnan Krishnamoorthy, R B Sudagar Singh, Senthil Narayanasamy, Gnanasambandan Ramanathan
April-June 2022, 21(2):136-139
DOI:10.4103/aam.aam_92_20  PMID:35848645
Introduction: Diabetic nephropathy (DN) is a multifactorial disease, one of the most common complications of diabetes and a major cause of chronic kidney disease. Kidney injury molecule-1 (KIM-1) is a sensitive and specific marker of kidney injury as well as a predictor of prognosis. Objective: The present study aimed to investigate the usefulness of serum KIM-1 as an early marker of DN. Patients and Methods: The present study included total 75 participants, among whom 25 nondiabetic participants were chosen as controls. The 50 diabetic participants were divided into two groups according to urine protein/creatinine ratio (UPCR) as participants with normoalbuminuria (T2DM patients without nephropathy) and microalbuminuria (T2DM patients with nephropathy). The complete blood count, blood glucose, HbA1c, serum electrolytes, and creatinine levels were measured using standard laboratory techniques, and serum KIM-1 levels were measured by sandwich enzyme-linked immunosorbent assay. Results: There was a significant difference in the mean serum KIM-1 between the control and diabetics without microalbuminuria (P = 0.0001). Patients with longer duration of diabetes had a higher serum KIM-1 values (P = 0.05 in DM without microalbuminuria; P = 0.007 for DM with microalbuminuria). Serum KIM-1 did not correlate with UPCR in controls (P = ‒0.167), in diabetics with microalbuminuria (P = 0.487). However, there was a significant correlation observed between UPCR and serum KIM-1 in diabetics without microalbuminuria (P = 0.04). Conclusion: The present study observed significantly increased levels of serum KIM-1 in both the diabetic groups compared to controls. Moreover, serum KIM-1 positively correlated with the duration of diabetes. Therefore, serum KIM-1 may be used as an early diagnostic marker to predict nephropathy among diabetes in our population.
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Ovarian cell tumor in a child with neurofibromatosis type 1
Lujain Majdi Qutub, Abdulmoein Eid Al-Agha
April-June 2022, 21(2):165-167
DOI:10.4103/aam.aam_93_20  PMID:35848651
Juvenile granulosa cell ovarian tumor is a rare cause ofpseudo-precociouspuberty. We report a case of a 6-year-old female with neurofibromatosis type 1 (NF1), associated with pseudo-precocious puberty (PPP). A thorough workup revealed a large multi-cystic right ovarian mass, which turned out to be a juvenile granulosa cell tumor (JGCT). This report documented a rare case of PPP caused by JGCT in a child with NF1. Verbal consent was taken from the family.
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Quality of life post total knee arthroplasty: Saudi Arabian experience
Abdallah S Alomran
April-June 2022, 21(2):158-160
DOI:10.4103/aam.aam_106_20  PMID:35848649
Background and Objective: Osteoarthritis of knee is quite common in Saudi Arabian population. Total knee arthroplasty (TKA) was reluctantly accepted in Saudi Arabia about 2 decades ago but there are few small number reports on quality of life (QOL) postsurgery. The objective of this study was to investigate the QOL and overall satisfaction postTKA. Methods: We retrospectively studied 200 patients' consecutive patients who underwent primary TKA at King Fahd Hospital of the University, AlKhobar, Saudi Arabia. Patient's age, sex, weight, height, body mass index, and range of movements at the time of surgery were extracted from the QuadraMED patients Database. The minimum follow-up was 24 months. At the last visit of 24 months, patients were evaluated using modified Western Ontario and McMaster Universities Osteoarthritis Index (MWOMAC), QOL using Short Form-36 Health Survey (SF-36), and patient satisfaction was assessed. Results: Among the 212 TKAs performed, 52 were male and 148 were female. One hundred and twenty two were right side and 90 were left side and 22 were bilateral. The mean age was 62.7 ± 5.1 years. There were no intraoperative complications. Nearly 95% resulted in patient satisfaction. SF-36 and all the parameters assessed significantly improved (P < 0.001). MWOMAC scores of the patients, which show all functions, had statistically significantly improved to (P < 0.001) except prayers before and after surgery did not change which was expected. The overall level of satisfaction was observed 95% of patients. Conclusions: Our study shows that TKA has a positive effect on pain, mobility, QOL, and ultimate satisfaction.
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The biphasic phenomenon of cytokine storm in COVID pneumonia
Nehal M Shah, Janakkumar R Khambholja, Nilay N Suthar, Hemang M Purohit
April-June 2022, 21(2):168-172
DOI:10.4103/aam.aam_94_20  PMID:35848652
COVID-19 is a viral disease that commonly presents with mild symptoms with predominant respiratory system involvement. However, it can cause serious complications such as acute respiratory disease, multi-organ dysfunction, especially in patients with comorbidities. As it is a new disease, the full picture of the disease and its complications are not yet fully understood. Moreover, the patients at risk of complications are not well identified, and the data about the biphasic pattern of cytokine storm syndrome are limited. Here, we report the case of a 64-year-old male having diabetes mellitus, hypertension, ischemic heart disease with triple-vessel coronary artery disease tested positive for severe acute respiratory syndrome coronavirus 2, then complicated with acute respiratory distress syndrome and two waves of cytokine storm in 28 days.
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Anesthesia for inguinal hernia repair: Experience with a tertiary hospital-based surgical outreach in a developing world
Ugochukwu Uzodimma Nnadozie, Nneka Alice Sunday-Nweke, Charles Chidiebele Maduba, Chinedu Ignatius Madu, Michael Ikechukwu Nnamonu, Mishack Ikechukwu Akunekwe, Arinze Aetelbert Igboanugo, Valentine Uche Okeke
April-June 2022, 21(2):140-145
DOI:10.4103/aam.aam_95_20  PMID:35848646
Background: The dearth of adequate facilities and anesthetists limits the number and extent of surgical cases that can be attended to in surgical outreach programs. Inguinal hernia remains a common health burden in the developing world. Tertiary hospitals provide good anesthetic complements to safe surgeries and will be a veritable tool in surgical outreaches. Objectives: The objective of the study is to assess the types/techniques of anesthesia used in uncomplicated open inguinal hernia repair in a tertiary hospital-based surgical outreach program. Materials and Methods: This study was a prospective analysis of anesthetic techniques used in all uncomplicated inguinal hernia repairs performed in outreach program over 1 week in May 2018. Data were collected with a pro forma, analyzed with SPSS, and presented in tables and figures. Results: One hundred and ninety-five patients with uncomplicated inguinal hernias were recruited for the study. The patients' age ranged from 0 to 89 years, with a mean age of 33.62 ± 22.75 years. Most cases occurred in children. The male-to-female ratio was 7:1, and the majority were primary hernia repairs. Eighty-seven (44.6%) patients had local anesthesia (LA), 65 (33.3%) had general anesthesia (GA), while 43 (22.1%) had spinal anesthesia (SA). One hundred and sixty-two (83.1%) patients needed intraoperative analgesic augmentation. One hundred and sixty-nine (86.7%) patients were operated as day-case surgeries, while 26 (13.3%) patients were discharged the day after surgery. The failure rate of LA and SA put together was 74.6%, but there was no conversion to GA. Anesthetic complication was observed in 3.4% of cases. Conclusion: Organizing inguinal hernia repair outreach in a tertiary hospital offers the benefit of a full complement of anesthesia, which ensures safe and smooth surgery with low anesthetic complications. Most cases were done as daycare surgeries despite the high failure rate of LA and SA. Résumé Contexte: Le manque d'installations adéquates et d'anesthésistes limite le nombre et l'étendue des cas chirurgicaux qui peuvent être traités dans les programmes de proximité chirurgicale. La hernie inguinale reste un fardeau de santé courant dans les pays en développement. Les hôpitaux tertiaires fournissent de bons compléments anesthésiques aux chirurgies sûres et seront un véritable outil dans les interventions chirurgicales. Objectifs: Évaluer les types / techniques d'anesthésie utilisés dans la réparation de hernie inguinale ouverte non compliquée dans un programme de proximité chirurgicale en milieu hospitalier tertiaire. Méthode: Une analyse prospective des techniques d'anesthésie utilisées dans toutes les réparations de hernie inguinale non compliquées effectuées dans le cadre d'un programme de sensibilisation sur une semaine en mai 2018. Les données ont été recueillies à l'aide d'un formulaire, analysées avec SPSS et présentées sous forme de tableaux et de figures. Résultats: Cent quatre-vingt-quinze patients atteints de hernies inguinales non compliquées ont été recrutés pour l'étude. L'âge des patients variait de 0 à 89 ans avec un âge moyen de 33,62 + 22,75 ans. La plupart des cas sont survenus chez des enfants. Le ratio homme / femme était de 7: 1 et la majorité était des réparations primaires de hernie. Quatre-vingt-sept (44,6%) des patients ont eu une anesthésie locale (LA), 65 (33,3%) une anesthésie générale (AG), tandis que 43 (22,1%) une anesthésie rachidienne (SA). Cent soixante-deux (83,1%) patients ont eu besoin d'une augmentation analgésique peropératoire. Cent soixante-neuf (86,7%) patients ont été opérés en garderie tandis que 26 (13,3%) patients ont obtenu leur congé le lendemain de la chirurgie. Le taux d'échec de LA et SA réunis était de 74,6%, mais il n'y a pas eu de conversion en GA. Une complication anesthésique a été observée dans 3,4% des cas. Conclusion: l'organisation de soins de proximité pour la réparation de la hernie inguinale dans un hôpital tertiaire offre l'avantage d'un complément complet d'anesthésie qui garantit une chirurgie sûre et en douceur avec de faibles complications anesthésiques. La plupart des cas ont été pratiqués en garderie malgré le taux d'échec élevé de l'anesthésie locale et rachidienne. Mots-clés: Réparation de hernie inguinale, chirurgie de jour, anesthésie générale, anesthésie locale, anesthésie rachidienne
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Prostate cancer characteristics: A descriptive analysis of clinical features at presentation in the last decade in a black African community
Fredrick O Ugwumba, Ikenna I Nnabugwu
April-June 2022, 21(2):153-157
DOI:10.4103/aam.aam_101_20  PMID:35848648
Background: Prostate cancer, previously reported as relatively rare in Nigeria, is currently the leading cancer and leading cause of cancer-related death in men. Late presentation appears to persist despite higher incidence rates and instituted awareness programs. This study assesses current prostate cancer indices at presentation to a 3rd tier referral hospital in South-east Nigeria and compares these indices with reported indices from previous decades. Materials and Methods: Retrospectively, the medical records of men presenting with histologically confirmed prostate cancer from January 2009 to April 2018 were reviewed. Age, spectrum and duration of clinical features, serum total prostate-specific antigen (tPSA), and prostate biopsy specimen Gleason Score (GS) at presentation were retrieved for the analysis using the SPSS software version 21. Obtained mean values and proportions were compared to reports from previous decades for observable shifts. Results: The medical records of 331 men 51–90 years of age (mean: 69.8 ± 8.0 years) were retrieved. Six (1.8%) men (median tPSA = 28.0 ng/ml; range 10.0–121.4 ng/ml) had screening-detected prostate cancer. About 72.0%, 52.0%, and 30.3% of men present with symptoms after 3 months, 6 months, and 12 months, respectively, and about 55.1% had other clinical features of disease progression beyond lower urinary tract symptoms. Symptom duration, serum tPSA (median 31.4 ng/ml; range 4.0–710.0 ng/ml), and % fPSA (median 20.6%; range 57.1%–8.6%) at presentation, as well as prevalent poorly-differentiated tumor (GS ≥7 [4 + 3] 62.2%) are yet to shift from reports from previous decades. Conclusions: Prostate cancer indices at presentation in South-eastern Nigeria, a resource-poor community in sub-Saharan Africa are yet to positively shift despite efforts at prostate cancer awareness.
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WhatsApp-Based virtual consultation in clinical practice during COVID times: A prospective institutional study
Ramakanth Bhargav Panchangam, Pradeep Puthenveetil, Sunil Kumar Kota, Sabaretnam Mayilvaganan
April-June 2022, 21(2):132-135
DOI:10.4103/aam.aam_88_20  PMID:35848644
Background: As the novel coronavirus disease 2019 (COVID-19) continues its pandemic surge globally, the attention toward the treatment of non-COVID diseases has become difficult. Software-based systems and social media platforms could provide alternatives for ensuring regular health-care non-COVID diseases. In this context, we evaluated our own experience with virtual consultation (VC) for the management of endocrine surgical patients during the current COVID pandemic. Materials and Methods: This prospective study was conducted in the endocrine surgery department spanning 4 months from April to July 2020. We employed WhatsApp-based group video conferencing for VC with both new and follow-up outpatients. We evaluated the satisfaction quotient of patients, regarding the three types of consultations (no consultation, VC, and direct consultation) on an ordinal scale of three modes of consultation. Results: Virtual consultation was performed with 102 new and 285 follow-up patients. Goiters, clinical findings, and wounds/scars (in post-operative cases) were evaluated virtually. Dosage of thyroxine replacement, calcium supplementation, and other medications was prescribed based on findings and history. Patients who needed surgery (25/102 cases) were given appropriate appointment. More than 82% of the patients in both groups preferred VC during this COVID pandemic. Conclusions: More than 82% of both new and follow-up patients preferred VC over direct or no consultation during this COVID pandemic. Our findings suggest that VC through social media platforms is capable of ensuring appropriate treatment and follow-up for endocrine diseases.
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Comparative Assessment of the Implementation of Integrated Disease Surveillance and Response in Public and Private Health Facilities in Jos North Local Government Area of Plateau State, Nigeria
Yetunde Olubusayo Tagurum, M Joy Dogo, GA Adah, IC Maimagani, OO Sodipo, T Adeniji, JC Daboer, ME Banwat, LA Lar, TJ Akosu, MP Chingle
April-June 2022, 21(2):146-152
DOI:10.4103/1596-3519.349974  PMID:35848647
Background: Due to the continuous increase in the spread of epidemic-prone diseases and the associated morbidity and mortality, integrated disease surveillance and response (IDSR) was introduced as the main strategy in resource-poor settings for the detection and notification of these diseases. Integrated disease surveillance is a combination of active and passive systems using a single infrastructure that gathers information about multiple diseases or behaviors of interest. Methods: A comparative cross-sectional study was conducted between March and July 2018 among selected public and private health facilities in Jos North Local Government Area (LGA), Plateau State. Quantitative data were collected with the aid of a semi-structured interviewer-administered questionnaire and facility-based checklist. Data were analyzed using SPSS version 23. Statistical significance level was set at P ≤ 0.05 at a 95% confidence level. Results: A total of 126 health workers were studied. IDSR-trained health personnel was found in 52.7% of the public health facilities compared with only 16.7% of the private health facilities studied (P < 0.001). Awareness of IDSR was higher in the public health facilities than in the private ones (P < 0.001). IDSR implementation was poorer in the private health facilities 40.7% compared with 76.4% in public health facilities (P < 0.001). Evidence of previous disease notification and reporting was seen only in 33.3% and 16.7% of public and private health facilities, respectively (P < 0.001). Conclusion: This study revealed that awareness and attitude of health workers in public health facilities in Jos North were higher than that of those in private health facilities and there is the sub-optimal implementation of IDSR among the health workers in Jos North LGA, especially among the private health facilities.
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Primary hyperparathyroidism: Correlation between cervical ultrasound and MIBI scan
Houda Salhi, Toumader Bouziane, Mustapha Maaroufi, Nadia Ismaili Alaoui, Hanan El Ouahabi
April-June 2022, 21(2):161-164
DOI:10.4103/aam.aam_73_20  PMID:35848650
Introduction: The standard gold treatment of primary hyperparathyroidism (PHP) is parathyroidectomy. Imaging in particular, cervical ultrasound (US) and technetium-99 m- méthoxyisobutylisonitrileparathyroid scintigraphy using the single-photon emission computed tomography (TC-99 m-MIBI-SPECT) are always indicated prior to parathyroid surgery, allowing the location of parathyroid adenomas. The objective of our study is to evaluate the contribution of TC-99 m-MIBI-SPECT and US in the preoperative topographic diagnosis of PHP. Materials and Methods: this is a descriptive and analytical retrospective study, conducted in our department of Endocrinology, Diabetology and Metabolic Diseases in Hassan II University Hospital of Fez between 2009 and 2018. All patients who received a para-thyroidectomy for PHP were recruited. All patients had received a cervical US and a TC-99 m-MIBI-SPECT. We compared imaging data before surgery with data from intraoperative exploration and anatomopathological findings of surgical samples. Results: Forty-eight patients were collected. US correctly identified parathyroid adenoma in 85.40% of patients with PHP versus 89.50% in TC-99 m-MIBI-SPECT. US correctly predicted surgical outecomes in 97.60% of patients and TC-99 m-MIBI-SPECT in 97.72% of cases. Their combination had better results in sensitivity and positive predictive value. Conclusion: TC-99 m-MIBI-parathyroid scintigraphy SPECT had a higher probability for solitary parathyroid adenoma compared to cervical US. Its use coupled with the TC-99 m-MIBI-parathyroid scintigraphy SPECT allows reliable preoperative tracking.
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