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   2022| October-December  | Volume 21 | Issue 4  
    Online since November 16, 2022

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Effect of scalp infiltration with bupivacaine on analgesic requirement following elective craniotomy
Abdulkareem A Abdullahi, Abdulrahman Aliyu
October-December 2022, 21(4):309-315
Background: Postcraniotomy pain and perioperative assessment of patients' neurological function are some of the issues associated with craniotomy surgeries. Cost-effective pain control will result in good clinical outcome, decrease the length of hospital stay, and reduce total cost. Infiltration anesthesia is a recognized modality of cost-effective pain control. Objective: The study determined the effect of scalp infiltration with 0.25% plain bupivacaine on pain control following craniotomy. Methods: A prospective randomized study recruited 50 consenting patients scheduled for craniotomy under general anesthesia into two study groups. All patients received routine general anesthesia as per local protocol and received scalp infiltration after skin closure. Group A received 20 ml of 0.25% plain bupivacaine, while Group B received 20 ml normal saline. Pain scores were assessed using the Visual Analog Scale (VAS) on admission into the intensive care unit (ICU) then at 4, 8, 12, 16, 20, 24, and 48 h after surgery. The interval between the end of surgery and the first request for analgesia, 4 hourly intervals pentazocine and the cumulative doses of pentazocine given for postoperative pain relief. Results: The presenting VAS at the ICU and total postoperative analgesic consumption at 48 h were significantly lower in the bupivacaine group compared to the saline group. In addition, the increase in time to the first analgesic request was statistically significant between the two. There was a trend toward the reduced incidence of sedation and postoperative nausea and vomiting in the bupivacaine group compared to the saline group. Conclusions: Postoperative scalp infiltration with plain 0.25% bupivacaine reduced pain intensity and opioid analgesic consumption among the studied patients. Resultantly, it can be regarded as an effective technique of pain management after an elective craniotomy.
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The evaluation of serum lipid profile in chronic Hepatitis B patients at a Tertiary Care Centre in Western India: A cross-sectional study
Durga Shankar Meena, Deepak Kumar, Mahendra Kumar Garg, Mahadev Meena, Bharat Seju, Gopal Krishana Bohra, Naresh Kumar Midha, Mithu Banerjee
October-December 2022, 21(4):316-321
Introduction: Hepatitis B virus (HBV) is known as a metabolovirus due to its impact on lipid and glucose metabolism in the liver. Previous literature showed a trend of hypolipidemia and reduced risk of metabolic syndrome in hepatitis B surface antigen-positive patients. However, data from the Indian population are lacking. We evaluate the relation of lipid profile with HBV infection and severity of liver disease. Materials and Methods: This was an observational cross-sectional study in which 50 patients with chronic hepatitis B and 43 anthropometrically matched seronegative controls were enrolled. Demographical, clinical, and laboratory data including lipid profile (high-density lipoprotein [HDL], low-density lipoprotein [LDL], triglycerides, and total cholesterol [TC]) were collected. Seropositive patients were categorized based on prognostic models (model for end-stage liver disease [MELD] and Child-Pugh score) for further analysis. Results: Our study revealed significant low levels of serum TC, HDL, and LDL cholesterol in hepatitis B patients compared to seronegative controls (133.06 vs. 162.39, 35.56 vs. 43.65, and 76.62 vs. 99.95 mg/dl respectively, P < 0.05). The patients with high MELD and Child-Pugh score were associated with hypolipidemia. Significant low levels of LDL and TC were observed in Child-Pugh class C in comparison to class A (94.8 vs. 149.2 and 50.6 vs. 87.9 mg/dl respectively, P < 0.05). Conclusions: A significant reduction in various lipid parameters was seen with chronic hepatitis B. Furthermore, prognostic score (high MELD and Child-Pugh score) were associated with hypolipidemia.
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Chylous ascites in a case of henoch-schonlein purpura - A case report and literature review
Pushkar Galam, Joseph Kurian Mundakal
October-December 2022, 21(4):305-308
Chylous ascites is a rare form of ascites characterized by the accumulation of lymph fluid in the peritoneal cavity. Henoch-Schonlein purpura (HSP) is a form of vasculitis usually seen in children affecting small vessels. Gastrointestinal (GI) manifestations of HSP are coming to the forefront as a presenting symptom. The presence of a rash usually succeeds the GI manifestations, making diagnosis difficult and leading to unnecessary surgical interventions. Our case shows a 38-year-old female who presented with an acute abdomen followed by an erythematous rash noticed later on, with radiological investigations suggestive of acute appendicitis. Chylous ascites was found as an incidental finding on diagnostic laparoscopy with a healthy appendix.
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Prevalence of hypertension and determinants of poor blood pressure control in patients with Type 2 diabetes mellitus attending a Tertiary Clinic in Lagos, Nigeria
Oluseyi Adegoke, Babawale Taslim Bello, Gbenga Olorunfemi, Ifedayo A Odeniyi
October-December 2022, 21(4):348-354
Objective: The objective is to determine the prevalence of comorbid hypertension and blood pressure (BP) control among patients with Type-2-diabetes-mellitus attending a tertiary-hospital in Lagos, and identify the determinants of poor BP control. Materials and Methods: A cross-sectional study of 238 consecutive patients with Type-2-diabetes Mellitus (DM) at the adult diabetes-clinic of a tertiary health-facility in Lagos, Nigeria over a 5-month period. Data were retrieved with the aid of structured-investigator-administered-questionnaire, physical examination, and review of hospital record. Hypertension was defined as BP ≥140/90 mmHg and target BP control was defined as <130/80 mmHg. Logistic regression analysis was used to identify the independent determinants of poor BP control. Results: Comorbid hypertension was present in 187 (78.6%) of study participants with males (68/87 [78.8%]) and females (119/151 [78.2%]) similarly affected, P = 0.907. Older age (62.9 ± 10.1 vs. 54.9 ± 9.6 years) and obesity (35.3% vs. 17.6%) were associated with comorbid hypertension, P < 0.05. Awareness, treatment, and medication adherence rates were 96.3%, 100%, and 46%, respectively. Only 17.1% (n = 32/187) had BP controlled to target. Waist circumference (WC) (adjusted odd ratio: 1.04, 95% confidence interval [CI]: 1.01–1.06) and poor glycemic control (adjusted odd ratio: 5.39, 95% CI: 2.07–13.99) were the predictors of poor BP control. Conclusion: The prevalence of co-morbid hypertension in Type 2 DM patients in our setting is high and the BP control rate is low. Increasing WC and poor glycemic control are the independent determinants of poor BP control. Individualized weight reduction and glycemic control strategies may help achieve target BP control.
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Obstructive sleep apnea in hypothyroidism
Chitranshu Pancholi, Shyam Chand Chaudhary, Kamlesh Kumar Gupta, Kamal Kumar Sawlani, Sudhir Kumar Verma, Abhishek Singh, Ajay Kumar Verma, Kauser Usman, Virendra Atam
October-December 2022, 21(4):403-409
Introduction: Obstructive sleep apnea (OSA) and hypothyroidism are closely linked as hypothyroidism has been shown to lead to the development of OSA through multiple mechanisms. With the changing lifestyle patterns worldwide and increased prevalence of obesity, the burden of OSA has substantially increased. The association of OSA with hypothyroidism is essential to establish. If identified early, treatment of OSA and associated hypothyroidism can be done timely to minimize the potential harmful complications of OSA on all aspects of the patient's health. Aims: This study was done to find out the prevalence of OSA in hypothyroidism patients. Setting and Designs: It was a cross-sectional study, done over a period of 1 year in a tertiary care hospital. Materials and Methods: A total of 100 hypothyroidism patients were enrolled after taking written consent. All patients were subjected to STOP-Bang questionnaire and patient falling in intermediate-high risk (score3-8), were taken for overnight polysomnography to confirm the diagnosis of OSA (AHI ≥5). Statistical Analysis Used: The Statistical Package for the Social Sciences version 21.0 statistical analysis software. Results: Out of 100 patients, who underwent polysomnography, 74 (74%) cases had OSA (AHI ≥5). Out of total 74 OSA cases, 29 (39.2%) cases had mild OSA (AHI 5–14), 15 (20.3%) cases had moderate OSA (AHI 15–30), and 30 (40.5%) cases had severe OSA. The age of the study population ranged between 24 and 78 years and the mean age was 58.28 ± 11.22 years. The mean age of the patients in the OSA group (59.27 ± 11.17 years) was higher than the non-OSA group (55.46 ± 11.09 years). Majority (64%) of our cases were male, and the proportion of males was found to be higher than females in both the groups (OSA/non-OSA). The body mass index (BMI) of the OSA group was found to be statistically higher as compared to that of the non-OSA group (P = 0.040). The BMI was found to be higher in severe OSA, but it was not statistically significant (P = 0.128). The mean value of FT4 was lower and thyroid-stimulating hormone (TSH) was higher in the OSA group as compared with the non-OSA group. However, no significant association was found between FT4 and TSH values in both the groups. Out of 100 cases, 41 patients were treatment naïve with mean TSH value of 13.1 ± 7 and 59 were on treatment with mean TSH of 8.3 ± 4. Treatment-naïve patients had a statistically higher number (85.3%) of OSA cases in comparison to patients on treatment (66.1) (P = 0.030). Conclusions: Prevalence of OSA is quite high in hypothyroidism. Patients with hypothyroidism should be screened for OSA for early diagnosis, especially in individuals with higher BMI. Treatment of hypothyroidism reduces the prevalence of OSA.
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Investigation and comparison of the effects of two probiotic bacteria, and in reducing mutans streptococci levels in the saliva of children
Vijaya Lakshmi Bolla, Munnangi S Reddy, Namineni Srinivas, Ch Sampath Reddy, Pradeep Koppolu
October-December 2022, 21(4):395-402
Background: Probiotic organisms Lactobacillus reuteri UBLRU-87 and Bifidobacterium bifidum UBBB-55 were proven to be acting against the caries causing organisms. Aims: This study aims to evaluate the influence of Lactobacillusreuteri, Bifidobacterium bifidum and their blend on Mutans streptococci count in the saliva of children, and also to appraise the sustainability of their action. Materials and Methods: A randomized, double-blind and placebo-controlled study with 60 subjects (15 in each group) in 6–14 years of age group. The children consumed curd containing Bifidobacterium bifidum (UBBB 55, MTCC 5398) and Lactobacillus reuteri (UBLRu 87, MTCC 5403), and their blend once daily for 14 days. The control group received curd with no Probiotic in it. The saliva samples were collected just before the curd (T0) administration to establish baseline levels of mutans streptococci and after a day of the final consumption of the curd (T14). The follow-up samples at 21 days (T21) and 28 days (T28) after the baseline were also collected to know the sustainability of action probiotics on mutans streptococci if any. Results: Statistically significant reduction of mutans streptococci is observed in the group administered with Lactobacillus reuteri and the effect lasted up to a minimum of 21 days. Mixed cultures are seemed to be not effective against the oral microorganisms. Conclusions: The probiotic organism Lactobacillus reuteri in Indian curd is effective on salivary mutans streptococci, and the effect was sustained for some period after the administration.
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Knowledge, awareness, and attitude among dental students regarding oral cancer in Saudi Arabia
Bassel Tarakji
October-December 2022, 21(4):444-450
Background: Oral cancer awareness among junior and seniors' dental undergraduate students may have an impact on the early detection and prevention of oral cancer. Aims and Objectives: To assess oral cancer awareness, knowledge and attitude among undergraduate dental students in government and private colleges in Saudi Arabia. Material and Methods: A cross-sectional survey was undertaken to assess oral cancer knowledge, awareness and attitude among undergraduate dental students in government and private colleges in Saudi Arabia. All junior and senior students enrolled during the 2020– 2021 academic year, were eligible to participate (n=189). Results: The study shows that dental Students at private and government colleges in Saudi Arabia are generally knowledgeable regarding Knowledge, awareness, attitude and management of oral cancer. There was no significant difference between knowledge, awareness, attitude, and management of oral cancer between students in either private and government colleges. Results shows that 99 (88.9%) of dental students in government colleges considered human papilloma virus as a risk factor, higher than dental students in private colleges 48 (73.3%). My results indicated that dental students considered (87%) tobacco, and alcohol (83.6%) as main risk to oral cancer, whereas, 100 (53%) identified limited consumption of fruit and vegetables and 124 (65.6%) considered old age as risk factor for oral cancer. Conclusion: The variation in correct answers indicate to need to reinforce the undergraduate dental curriculum with regards to oral cancer education; particularly in its prevention and early detection. Revision of knowledge senior students in oral cancer is highly recommended.
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The role of micronucleus scoring in cervical papanicolaou smears: A 1-year study
Kanwardeep Kaur Tiwana, Mohanvir Kaur, Shaina Goyal, Lachhima Bhandhari
October-December 2022, 21(4):355-360
Aims and Objectives: To compare the micronucleus (MN) score in all the major diagnostic categories as per “The Bethesda System for Reporting Cervical Cytology” 2014 including negative for intraepithelial lesions and malignancy (NILM), inflammatory, abnormal squamous cells of undetermined significance (ASC-US), abnormal squamous cells cannot exclude high-grade squamous intraepithelial lesion (HSIL) (ASC-H), low-grade squamous intraepithelial lesion (LSIL), HSIL, and invasive carcinoma (IC) and to assess the role of MN scoring as a biomarker for predicting risk of carcinoma. Materials and Methods: A total of 1000 conventional cervical smears stained with Papanicolaou (Pap) stain, comprising unsatisfactory for evaluation (86), NILM (140), inflammatory (696), ASC-US (23), ASC-H (16), LSIL (18), HSIL (15), and IC (6) were studied independently by two pathologists, and the number of MN cells per 1000 epithelial cells in high-power (×400) and oil immersion (×1000) was counted and expressed as MN score per 1000 cells. Results: The mean MN score ± standard deviation was found to be 0.99 ± 0.744 in NILM cases, 0.67 ± 0.782 in inflammatory cases, 1.57 ± 0.507 in ASC-US cases, 1.63 ± 0.50 in ASC-H cases, 1.56 ± 0.511 in LSIL cases, 2.47 ± 0.516 in HSIL cases, and 3.0 ± 0.00 in IC cases. A step-wise increase was observed in MN score from inflammatory to IC categories. Conclusions: MN score is a reliable and easy test that can be used in conjunction with routine cervical PAP to assess the risk of malignant transformation in the uterine cervix as a biomarker for predicting the risk of carcinoma.
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The efficacy of new neuronal growth factor in the healing of the sciatic nerves in rabbits
Mir Sadat-Ali, Dakheel Abdullah Aldakheel, Majed N Alabdali, Dana T Aljaafari, Abdulla A Alsulaiman, Abdallah S Alomran, Ayesha Ahmed, Fahd A Alkhamis
October-December 2022, 21(4):361-365
Background and Objective: Regeneration of nervous tissue is unpredictable and an ideal growth factor to influence the healing of the injured nerves is not available. A recent study in rats had shown that a new neuronal growth factor (NNGF) was effective in the early healing of the sciatic nerves. The aim of this experimental study is to test the efficacy of NNGF in the healing of iatrogenic division of the sciatic nerves in a larger animal (rabbits). Methods: White New Zealand 20 male rabbits of 6 months of age were divided into two groups. Intramuscular ketamine and xylazine were used to anesthetize the animals. The sciatic nerves were divided using scalpel blade 15 and 10/0 Vicryl was used to repair the divided neural tissue. In the study group, 10 mg/kg body weight of NNGF was instilled on the top of the divided nerves and the wound was closed. At 4 weeks, the operated limbs were observed for any trophic skin changes. Nerve conduction studies were carried out using train-of-four-Watch SX, Organon (Ireland) Ltd., and Ireland. The rabbits were put to death humanely and the sciatic nerves were removed and delivered to the pathologist in 2% formalin. The pathologists were blinded about the two groups. Results: Electromyographic study done at 4 weeks showed in the untreated group; the mean twitches 1-T4 was 0.45 ± 0.31% and in the treated group, the average was 77.912 ± 5% (P > 0.001). Microscopic anatomy in the treated group revealed prominent healing by regeneration was evidenced by showing growth of its proximal segments into an empty endoneurial tube which was not seen in the control group. In the control group, the nerves showed no histological element of healing by regeneration. Conclusions: NNGF proves that in a larger animal at 4 weeks profoundly influenced early regeneration of experimentally created divisions of myelinated nerve tissue.
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Comparative efficacy of coronally advanced flap with and without guided tissue regeneration in the management of gingival recession defects: A split-mouth trial
Santhi Priya Potharaju, Santha Kumari Prathypaty, Ravi Kanth Chintala, D Sunil Kumar, Y Durga Bai, Vijaya Lakshmi Bolla, Pradeep Koppolu, Ali Barakat, Amara Swapna Lingam
October-December 2022, 21(4):415-420
Background: The gingival recession causes tooth sensitivity, poor esthetics, and tooth mobility in severe cases. Scientific documentation revealed effective root coverage (RC) and increased keratinized tissue heights acquired with the coronally advanced flap (CAF) for multiple recession defects. Objectives: This research evaluates and compares the efficacy of CAF procedures with and without Type I collagen bio-absorbable membrane in guided tissue regeneration (GTR) in the treatment of Miller's Class I and II gingival recession. Materials and Methods: A total of 30 sites from 15 patients were selected for the study after fulfilling the presurgical phase of treatment. The chosen sites were randomly allocated into Group A CAF and Group B (CAF + Resorbable GTR membrane). The clinical variables such as plaque index, gingival index, recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), clinical attachment level (CAL), and surface area of the defect were recorded at the baseline and 6 months postoperatively. Results: Both therapies resulted in a notable gain in RC with a mean of 73.13% and 71.60%, respectively, but it was not statistically significant when compared between the groups. Both the RD and RW were significantly reduced from baseline to 6 months postoperatively. Although there was a gain in WKG and CAL in both experimental sites, no significant difference was observed between both the groups. Conclusion: Although there are several RC procedures, CAF furnishes a foreseeable, straightforward, and appropriate perspective for treating Miller's Class I and II recessions. Integrating this approach with placing a bio-absorbable membrane does not seem to improve the results following surgical treatment of such defects. However, both groups showed the potential advantage of achieving RC.
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Diabetes mellitus foot ulcer and associated factors among Type 2 diabetes patients in a Tertiary Institution in Southwest Nigeria
Adedayo Idris Salawu, Gbadebo Oladimeji Ajani, Michael Osisiogu Soje, Owolabi Dele Ojo, Eunice Oluremi Olabinri, Omotola Olawale Obajolowo, Olakunle Fatai Babalola, Tope Michael Ipinnimo, Hameed Banjo Oguntade, Olufemi Olusola Adediran
October-December 2022, 21(4):339-347
Aim: This study aims to assess the proportion of diabetic foot ulcer (DMFU) and associated factors among patients with type 2 diabetes in a tertiary hospital in Southwest Nigeria. Methods: A pretested semi-structured interviewer-administered questionnaire adapted from the STEPwise Approach to Surveillance of Noncommunicable Disease Risk Factors of WHO.14 was used for data collection from a sample of 181 patients with type 2 diabetes mellitus. Sociodemographic, behavioral, clinical, and laboratory variables were collated from the participants. Chi-square test and logistic regression were used to identify the predictors of DMFU. Results: A total of 166 patients had their questionnaires completed. The mean age (standard deviation) of the respondents was 62.6 (14.3) years. The proportion of DMFU was 18.7%. More than two-third (71.1%) of our respondents had clinical symptoms suggestive of peripheral neuropathy while 34.3% of the patients seen in the study had evidence of peripheral vascular disease on duplex Doppler ultrasound. Male patients were about five times more likely to have DMFU than female patients (adjusted odds ratio [AOR] =5.27; 95% confidence interval [CI] = 1.001–27.841). Those with duration of diabetes ≥10 years were more likely to have DMFU than those with disease duration <10 years (AOR = 15.47; 95% CI = 1.201–199.314). Patients with fasting blood glucose (FBG) of ≥ 7.2 mmol/L were about four times more likely to have DMFU than those with FBG of <7.2 mmol/L (AOR = 4.19; 95% CI = 1.618–18.463). Conclusions: The proportion of DMFU was 18.7%, and the predictors identified included sex, duration of disease, and FBG level.
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A study of rhino-orbito-cerebral mucormycosis with COVID-19: A new challenge in North West of Rajasthan
Surendra Kumar, Harish Kumar, Manoj Mali, Babu Lal Meena
October-December 2022, 21(4):383-389
Background: Mucormycosis is a life-threatening fungal disease in immunocompromised patients. There has been increase in the number of mucormycosis associated with COVID-19 patients in second wave. Now country battle with both COVID-19 and mucormycosis. An invasive mucormycosis infection has been a significant burden in India after COVID-19. It has been recently emerged a notifiable disease by the Rajasthan government. Our aim is to develop awareness regarding the importance of early detection and treatment of mucormycosis with COVID-19 and reduce the morbidity and mortality. Materials and Methods: This is a Prospective longitudinal study including 34 patients diagnosed with acute invasive fungal infection by contrast enhancement magnetic resonance imaging studies of paranasal, orbit and brain or nasal biopsy for KOH/culture. Diagnosis is made through routine blood tests, biopsy, and radiological imaging. The patients taken for the study were COVID-19 reverse transcription-polymerase chain reaction positive or recent post COVID-19 (within 15 days) or symptoms of COVID-19 with bilateral pneumonitis. The study was conducted with 34 patients admitted to the department of medicine with mucormycosis within a month may 2021. Results: A total of 34 patients with a mean age of 50.92 years old and male female ratio 24/10 (70.5/29.41) were included in this study. The most common comorbidity was diabetes mellitus (23 patients 67.64%). Nine patients were newly diagnosed or recent onset of diabetes with or after COVID-19 infection. Twenty-four (70.58%) patients were COVID-19 positive or recent (within 15 days) history of COVID-19 positive. Seven (20.58) patients had the history of steroid as a treatment during COVID-19 and 5 (14.70) patients was on oxygen inhalation. One (2.94%) patient was fully vaccinated, and 5 (14.70) patients had the history of steam inhalation. The most common involvement was naso-orbital mucormycosis found in 28 patients (82.35%) followed by nasal-and orbital 26 (76.47) and 18 (52.94), respectively. Naso-Orbito-Cerebral was seen in 16 (47.05) patients. The more common reported symptoms and signs were headache (76.47), facial numbness (64.70), Nasal discharge (52.94), and ophthalmoplegia (52.94). Cranial nerve involvement was seen in 10 patients (facial palsy in 8 patients and bulbar palsy in 2 patients). Total mortality was 7 (7/34 20.58%). Conclusion: COVID-19 infection associated with the wide range of invasive mucormycosis. Early diagnosis and Clinical suspicion of acute invasive fungal sinusitis among COVID-19 patients is essential for better outcomes and higher survival.
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Risk factors and occurrence of chronic kidney disease following acute kidney injury in Children
Muzafar Jan, Mohd Ashraf, Ruhail Ahmad Baba, Sayar Ahmad Bhat
October-December 2022, 21(4):366-370
Background: Chronic kidney disease (CKD) is an irreversible progressive condition with diverse etiologies among which acute kidney injury (AKI) is increasingly being recognized as an important one. Methods: This was a prospective observational study of pediatric intensive care unit (PICU) patients admitted with different etiologies, at a tertiary care hospital for children in Kashmir India, between October 2018 and September 2020. AKI was defined as an increase in absolute serum creatinine (SCr) ≥0.3 mg/dL or by a percentage increase in SCr 50% and/or by a decrease in urine output to <0.5 mL/kg/h for >6 hours (h). Besides analysis of AKI and associated PICU mortality, post-AKI patients after discharge were kept on follow-up for complete 1 year. Results: From 119 enrolled patients with AKI with no preexisting risk factors, 5.6% (n = 8/119) developed CKD. The AKI-associated mortality rate after 48 h of PICU stay was 13.4% (n = 16/119). At time of discharge from hospital, elevated blood pressure (BP) (n = 5/8) and subnephrotic proteinuria (n = 3/8) were the statistically significant sequels of AKI (P value <0.001) for progression to CKD. After 3 months of follow–up, elevated BP (n = 7/8) and subnephrotic proteinuria (n = 3/8) were significantly associated with progression to CKD at 1 year (P < 0.005). Conclusions: Occurrence of CKD after an attack of AKI was not uncommon and the risk of long-term consequences in the form of hypertension, proteinuria, and CKD is significant, which may be much higher than observed. It is prudent that all post-AKI PICU discharged patients must be monitored for the long-term consequences of AKI.
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Exposure to patients' sample and prevalence of Hepatitis B and C virus infection among health-care workers in a Nigerian Tertiary Hospital
Oluwafemi Johnson Adegbamigbe, Musah Yusuf, Kabir Adekunle Durowade, Oluwatosin Oluwagbenga Oguntoye, Yemisi Ogundare
October-December 2022, 21(4):322-326
Background: Hepatitis B and C lead to chronic disease in hundreds of millions of people and together constitute the most common cause of liver cirrhosis and cancer with attendant mortality. Objective: The objective of this study was to estimate the prevalence of hepatitis B and C virus infection among different categories of health-care workers, looking at the exposure to patients' samples and the prevalence rate among these categories of health workers. This will help to ascertain the risk and the need to pay more attention to preventive measures. Materials and Methods: This was a cross-sectional study conducted over a 2-year period among 217 health-care workers at the department of Haematology of the Federal Teaching Hospital, Ido-Ekiti, Nigeria. Respondents were randomly selected, and blood samples were taken for the hepatitis B and C screening. Data were analyzed using SPSS 20; bivariate analyses were done, and the level of statistical significance was set at P < 0.05. Results: A total of 13 (6.0%) tested positive for HBsAg. Analysis of the marital status of those that tested positive to Hepatitis B, revealed that the highest number (77%) was found among the married, while the singles and the divorced constitute 15.3% and 7.7% respectively. The nurses and nonhealth professionals (admin staff) constitute the highest positive yield of hepatitis B virus (HBV), followed by medical doctors and laboratory staff. The age of the respondent was found to have a statistically significant association with HBV serology (P < 0.05). Conclusion: There is a comparatively lower prevalence of HBsAg among the health-care workers who are directly exposed to patients' samples. The age of the respondent has a significant association with hepatitis B infection.
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Clinicopathological features, risk profile assessment, and the surgical outcome of gastrointestinal stromal tumors in Lagos, Nigeria
Olanrewaju Samuel Balogun, Adedapo Olumide Osinowo, Fatimah Biade Abdulkareem, Olugbenga O Ajayi, Oluwole Ayoola Atoyebi, John Taiwo Da Rocha-Afodu
October-December 2022, 21(4):432-438
Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. GISTs originate from the interstitial cells of Cajal and are most commonly found in the stomach. Most available reports on GISTs in the Sub-Sahara Africa were in case reports and case series. Aim: To report our local experience and challenges in the management of GISTs in 33 patients in Lagos, Nigeria. Methodology: This is a descriptive study of adult patients of 16 years and above managed for GISTs at the Lagos University Teaching Hospital and some Lagos private hospital facilities between January 2015 and March 2021. Information on the patients' demographic characteristics, clinicopathological features, surgery performed, and postoperative complications were retrieved from the hospital's medical records for analysis. Data analysis was carried out using IBM SPSS Statistics for Windows, Version 23.0., Armonk, NY, USA: IBM Corp. Results: Thirty-three patients comprising 19 males and 14 females with a male: female ratio of 1.4:1 were included in the study. The mean age at presentation was 52.5 years. Abdominal pain (69.7%) and anemic symptoms (45.4%) were the principal modes of presentation. Abdominal computed tomography (CT) scan revealed stomach as the primary source of GISTs in 75.8% of patients. Forty-five percent of the patients had CT features of local organ invasion and 27.2% had features of metastasis. Surgical resection was feasible in 28 (84.8%) patients. Postoperative mortality was recorded in two patients with recurrent GISTs. Histological cell types were spindle cell (57.6%), mixed spindle and epithelioid (24.2%), and epithelioid (18.2%). Joensuu high-risk tumors (64. 3%) were the most prevalent in our series. Conclusion: Advanced-stage disease and features of anemia were hallmarks of GISTs among patients in this series. Surgical resection of GIST may be possible in some cases of advanced disease. Spindle cell types and high-risk GISTs were the most common pathological varieties in our patients.
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Splenic injuries in native Africans: Presentation, limitations of management, and treatment outcomes in a civilian trauma service in Southeast Nigeria
Aloysius Ugwu-Olisa Ogbuanya, Uzoamaka Esther Ajuluchuku, Ugochukwu Uzodimma Nnadozie, Onyeyirichi Otuu, Daniel Akuma Umezurike, Nwanneka Kwento
October-December 2022, 21(4):327-338
Background: Splenic trauma has emerged as a major global health burden, especially in developing nations with limited diagnostic and therapeutic facilities. The current trend toward nonoperative management (NOM) and adoption of splenic salvage whenever feasible calls for local evaluation of our current practice. The aim of this study was to document the epidemiology and outcomes of management of splenic injuries in our setting. Patients and Methods: This was a multicenter, prospective study of epidemiology and outcomes of patients with splenic injuries recruited over 10 years in southeast Nigeria. Results: Approximately 66% of all patients with abdominal injuries sustained splenic trauma. A total of 313 patients with splenic trauma were recruited; 226 (72.2%) were managed operatively (OM) and 87 (27.8%) conservatively (NOM). Majority (75.7%) had blunt abdominal trauma (BAT), while 24.3% sustained penetrating injuries. Sonographic grading showed that 46 (14.7%), 58 (18.5%), 79 (25.2%), 106 (33.9%), and 24 (7.7%) patients had grades I, II, III, IV, and V injuries, respectively. Isolated splenic injuries occurred in 172 (55%) patients, and the rest (141, 45%) had associated intra-abdominal injuries. Two-thirds (67.1%) were aged 16–45 years. In the OM group, 178 (78.7%) had total splenectomy, while 48 (21.3%) had splenic salvage. There was a statistically significant difference (P = 0.022) in the rate of postoperative complications between the splenectomy and splenorrhaphy groups. The overall mortality rate was 4.5%. Major predictors of morbidity and mortality were high-grade splenic injuries, total splenectomy, multiple injuries, advanced age, and comorbidities. Conclusion: Splenic injuries complicate approximately two-thirds of all abdominal injuries in our environment and majority of these injuries were due to BAT. In this study, majority had OM and splenic salvage rate was relatively low.
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Study of early warning efficiency of different laboratory markers in predicting progression of disease in COVID-19
Vishwanath Krishnamurthy, K Mohammed Suhail, S Shaikh Mohammed Aslam, Madhu P Raj, Prashanth Patil, Priyanka Phaniraj
October-December 2022, 21(4):371-376
Introduction: COVID 19 pandemic has given rise to several challenges to clinicians and one of the keys in this is to predict the set of patients who progress from mild disease to moderate and severe. Apart from the symptomatology and signs, there are several lab parameters varying from biochemical, hematological to radiological parameters which help us in stratifying the stage of disease and also in deciding on which set of patients need close and vigilant monitoring. This would help us in better stratification of disease and utilize the available infrastructure and resources in an optimum way for better management of the disease. Aim: To analyze the early warning efficiency of laboratory parameters individually or in combination in predicting the progress of disease in patients from mild to moderate/severe disease. Materials and Methods: This was taken up as a retrospective study with 100 cases and 100 controls. The demographic details, inflammatory markers, biochemical markers and hematological markers were analyzed. Test of significance was employed to compare categorical variables while student t-test was employed to test the difference in the mean value such as age between case and control (Mann–Whitney U-test in parameters not having normal distribution). Receiver operating characteristic (ROC) curve was constructed for these parameters using cases and controls and area under the curve (AUC) were estimated which was used as an indicator of sensitivity and specificity of the parameter in their early warning efficiency. The critical values for each of the parameters either individually or in combination was estimated as well. Results: Among the parameters C reactive protein (CRP), d-dimers and eosinopenia have the best early warning efficiency. The area under the ROCs curve for neutrophil lymphocyte ratio (NLR), CRP. Ferritin, lactate dehydrogenase, Eosinopenia was 0.609, 0.947, 0.614, 0.554, 0.617 respectively at triage. However, a combination of eosinopenia with CRP (AUC-0.732) or NLR with CRP (AUC-0.728) have a good sensitivity and specificity in predicting the outcome regarding the progression of the disease. Conclusions: Among the parameters, CRP, d-dimers, Eosinopenia and NLR have the best early warning efficiency. However, a combination of Eosinopenia and CRP at triage should also serve as a red flag sign in patients apart from the well-known NLR and IL6 values.
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Perception and assumptions of young waterpipe smokers in Mumbai, India
Vijayalaxmi Nimma, Amara Swapna Lingam, Aibani Saddik Gaffar, Sonali Kadam, Easwaran Ramaswami, Amit Ramchandani
October-December 2022, 21(4):410-414
Background: Hookah smoking has been on raise all over the world, including India, especially among youngsters. There is growing evidence suggesting the high school children experimenting this form of tobacco. Objective: The objective of this study was to investigate the characteristics, behavior, and perceptions related to hookah smoking among the hookah smokers in Mumbai. Materials and Methods: A cross-sectional survey was conducted among 200 randomly selected young adults between the age group of 15–35 years in Mumbai who visited different dental clinics. The questionnaire was distributed as Google Forms online in the month of November and December 2019 and those who submitted completed responses were included in the study. Results: Only 114 participants returned with the completed forms in the time period of 2 months. The results showed that the majority of participants were between 20 and 24 age, comprising 58% who were having the habit of hookah smoking. Among which 24% females, 76% males had history of hookah habit. Eight percent of males started smoking hookah from very young age. Males (29.89%) shared one hookah pot with four members. Forty percent of the participants stated that they are interested to smoke again because of hookah flavor. Conclusion: Easy availability of newer forms of smoking at online markets could play a role in promoting the use of hookah among youngsters. Most products are being sold without any warnings, and there is no means to control the selling of the products to minors. Educational intervention is urgently needed to create awareness among youth about the harmful effects of hookah smoking.
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Perception of interns regarding influence of dressing on professional performance at workplace in dentistry
Anjali Giridhar Bhoyar, Seema Kambala, Sharayu Vinod Nimonkar, Mithilesh Murlidhar Dhamande
October-December 2022, 21(4):451-455
Background: In a health-care setup, interpersonal communication plays a pivotal role in the attainment of professional outcomes. Dressing is an indirect mode of communication. Since ancient times, it is assumed that doctor's clothing have a positive effect on the minds of patients. This survey evaluates the perception of interns from dental sciences regarding the impact of dressing on professional performance at workplace. Materials and Methods: A self-designed questionnaire was distributed among a batch of interns who were willing to participate in the survey. Seventy-six interns returned the responses which were complete without any duplication. All the survey forms were scrutinized and the data were collated. Qualitative analysis of the assembled data was performed to evaluate intern's perception about the association between dressing and professional performance at workplace. Results: Results of the survey demonstrated that 81.6% of the participants dress up to work as per their temperament. About 65.8% of the participants believed that dental professionals should choose formal wear for workplace settings. Majority of the participants, i.e., 67.1%, believed that dressing affects perception on personality traits such as dignity and character of a professional. A wide number of interns perceived that dressing alters the behavior of self, patients, and colleagues (55.3%, 71.1%, and 68.4%, respectively). The result of this survey also showed a positive correlation between dressing and professional traits such as confidence, responsibility, and efficiency (75.0%, 63.2%, and 63.2%, respectively). Notably, 55.3% opined against enforcing a dress code for dental institutions/dental offices. Conclusion: The result of the study represents the positive influence of dressing on professional performance at workplace in dentistry as perceived by interns from the faculty of dental sciences.
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Pattern of eye diseases in adults at the general outpatient clinic of a Tertiary Hospital in Nigeria
Adaora Amaoge Onyiaorah, Nkiru N Kizor-Akaraiwe, Sebastian N N. Nwosu
October-December 2022, 21(4):421-425
Objective: To determine the pattern of eye diseases at the general outpatient department (GOPD) of a Nigerian tertiary hospital. Materials and Methods: Patients selected by systematic random sampling at the GOPD of a Nigerian tertiary hospital were studied. Information on sociodemographics and ocular complaints were obtained using interviewer-administered questionnaire. Ocular examination included visual acuity measurement and anterior and posterior segments examinations. Data analysis was with Statistical Package for the Social Sciences. Results: Three hundred and eighty-two patients, comprising 124 (32.5%) males and 258 (67.5%) females, aged between 18 and 86 years, mean 44.8 ± 15.4 years, were studied; 112 (29.3%) had eye diseases but only 88 (78.6%) patients complained of ocular disorder(s). Common complaints were poor vision 53 (60.4%), red eye and grittiness 15 (17.0%) each. Common eye diseases were lens 52 (13.6%) and conjunctiva 46 (12.0%) disorders. Attaining higher education was protective against eye diseases (P < 0.05). Conclusion: Nearly a third of patients at the GOPD have eye diseases. Therefore, primary eye care should be integrated into the GOPD service with provision of relevant manpower and facilities for care of the ophthalmic patients.
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American college of radiology thyroid imaging reporting and data system score has high diagnostic value in the diagnosis of malignant thyroid nodules: A prospective single-center cross-sectional study
Souvik Biswas, Binit Sureka, Darwin Kaushal, Poonam Elhence, Amit Goyal, Taruna Yadav, Akhil Goel, Pushpinder Singh Khera
October-December 2022, 21(4):377-382
Introduction: A palpable thyroid swelling is a very common finding and is seen in almost 12% of Asian Indian population. Thyroid imaging reporting and data system (TI-RADS) can be used as a risk stratification system to determine malignant or benign thyroid nodules and necessity of further intervention. Objective: The objective of this study was to determine the positive predictive value (PPV) of TI-RADS category/ultrasound using TI-RADS categories in the diagnosis of malignancy in clinically suspected thyroid nodule and necessity for further intervention in the case of malignant thyroid nodules. Materials and Methods: We conducted a prospective study evaluating 110 patients (140 thyroid nodules) from March 2018 to April 2020 including patients with thyroid swelling. Ultrasound was performed by a radiologist on the patients, and targeted fine-needle aspiration cytology from thyroid nodules was interpreted by an experienced pathologist. Ultrasound features and TI-RADS category were compared with cytology and surgical histopathology. Sensitivity, specificity, PPV, and positive likelihood ratio in different categories of TI-RADS nodules were calculated. Results: A total of 113 thyroid nodules were assessed. Out of 113 nodules (right lobe – 64, isthmus – 6, and left lobe – 43), 84 nodules were benign and 29 nodules were malignant. Eleven (10%) patients were found to have metastatic cervical lymphadenopathy. There was no significant difference in the occurrence of malignant nodules according to gender, location of the nodule, or size of the nodule. The mean anteroposterior and transverse diameter of benign nodule was 14.1 ± 6.9 mm and 20.9 ± 9.9 mm, respectively, whereas in the case of malignant nodules, it was 15.6 ± 7.1 mm and 19.5 ± 9.0 mm, respectively. A TI-RADS score of ≥4 had 84% PPV for malignancy. The PPV for malignancy was 32.2%, 49.1%, and 100% for TI-RADS 2, 3, and 5 categories. Conclusion: TI-RADS is a simple, practical, and cost-effective tool for assessing the malignancy rates of thyroid nodules. TI-RADS categories 4 and 5 have high PPV for malignancy in thyroid nodules.
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Spectrum of magnetic resonance abnormalities in leigh syndrome with emphasis on correlation of diffusion-weighted imaging findings with clinical presentation
Chandan Kakkar, Seema Gupta, Shruti Kakkar, Kamini Gupta, Kavita Saggar
October-December 2022, 21(4):426-431
Background: Leigh syndrome (LS) is a progressive neurodegenerative disorder of infancy/early childhood secondary to mitochondrial dysfunction. Imaging plays a pivotal role in the diagnosis of LS with certain typical magnetic resonance imaging (MRI) findings considered as a part of diagnostic criteria. We appraised various MRI findings on conventional MRI sequences and also assessed potential correlation between diffusion abnormalities and patient's clinical presentation. Aims: Our aim was to describe various patterns of central nervous system involvement in LS and to assess the correlation of diffusion-weighted imaging abnormalities with clinical presentation. Settings and Design: The design of the study was retrospective comprising 8 children with LS who had MRI between years 2014 and 2019. Subjects and Methods: Eight children between the age group of 4 months 8 years with LS based on clinical presentation, elevated lactate levels in CSF/Blood, and typical MRI findings were included in the study. Results and Conclusions: Brainstem was involved all (100%) patients while basal ganglia was affected in 5 (62.5%) children. Cerebral white matter involvement was present in 3 (37.5%) children, cerebellar in 2 (25%) children while spinal, corpus callosum, and thalamic involvement were observed in one (12.5%) patient each. Diffusion restriction was observed in 6 children, all of them presented with altered sensorium. Conventional MRI serves as an excellent tool for the diagnosis of LS in children with clinical suspicion. Acute encephalopathy frequently presents with diffusion restriction corresponding to active lesions. Hence, diffusion restriction on MRI predicts the activity of lesions in patients with LS.
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Low dose and the conventional dose of 0.5% hyperbaric bupivacaine produce comparable outcomes in the lower segment caesarean section. An observational study
Sudhir Kumar, Neeta Santha
October-December 2022, 21(4):390-394
Background: Spinal anesthesia with 0.5% hyperbaric bupivacaine is an approved technique for lower segment cesarean sections. This study compared two different hyperbaric bupivacaine doses for spinal anesthesia in the lower segment cesarean section. We hypothesized that low-dose spinal anesthesia had similar outcomes as conventional doses of bupivacaine. Methods: This was a comparative observational study involving seventy healthy parturients who were posted for elective cesarean section. Patients were supposed to receive 0.5% hyperbaric bupivacaine and were divided into groups, low dose (LB-1.8 ml) and conventional-dose (HB-2.2 ml) group. The extent of motor blockade, sensory blockade, hemodynamic effects, visual analog scale for pain, and patient satisfaction were measured. The data were analyzed using the median and interquartile range for all parameters. A statistical package SSPS version 25.0 was used to do the analysis. Results: Hemodynamic stability was well maintained in both groups. Almost 100% of the patients in both groups achieved a grade 3 motor blockade in 8 min. T6 level of sensory blockade was achieved in 6 min by 100% of the patients. The low-dose group made a faster recovery compared with the high-dose group. Conclusion: Low-dose spinal anesthesia can cause similar hemodynamic and analgesic effects as the conventional-dose group. The only benefit of low dose spinal as compared with conventional-dose group was faster recovery from the anesthetic effects.
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Eosinophilic gastroenteritis: A case series of a rare disease from an apex Tertiary Care Center in South India
Sandheep Janardhanan, Allwin James, Alagammai Palaniappan, Jibin Lukose, Mohan Narasimhan, Ramesh Ardhanari
October-December 2022, 21(4):461-465
Eosinophilic gastroenteritis (EGE) is a rare disease with a myriad of presentations. In this case series of four patients from South India, we describe three classical manifestations of the disease (mucosal, muscular, and serosal). Two of them had obstructive jaundice as a presenting complaint due to duodenal obstruction, whereas one had massive upper gastrointestinal bleed. There are very few case series regarding this disease from India. Its presentation as hemetemesis and obstructive jaundice is also very rare,with only few such case reports reported till now.
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Marriage to first pregnancy interval and related factors among women in North Central Nigeria
Nkeiruka Ameh, Adegboyega Moses Oyefabi, Madugu Nana Hawwa
October-December 2022, 21(4):456-460
Background: The age at which a woman gets married may affect the timing and occurrence of her first pregnancy as well as the total number of children she will have in her lifetime. Factors which affect the marriage to first pregnancy interval include the age at marriage of the woman, her educational level, and cultural and religious beliefs among others. This study seeks to find out the marriage to first pregnancy interval and factors that affect this interval as well as the average number of children of women in North Central Nigeria. Materials and Methods: This was a cross-sectional community survey utilizing structured questionnaires. Information on marriage to first pregnancy interval as well as related factors was obtained from 300 currently or ever-married women in Abuja, North Central Nigeria. Results: The women were aged 13–72 years (mean: 28.67 years); the mean age at first marriage was 21.57 years, and the mean age at first pregnancy was 22.48 years. Marriage to first pregnancy interval was <3 months in 68 (22.6%), 1 year in 86 (28.6%), and ≥2 years in 154 (51.3%). The mean number of children for 45 years and above was 4.5. Overall, women who are artisans were found to be more likely to have a pregnancy soon after marriage. Husband's place of residence, educational qualification of the woman, age at marriage, tribe, and religion did not significantly affect first marriage to first pregnancy interval. Conclusion: Women in this part of Nigeria marry in early adulthood and are likely to want to have their first pregnancy soon after marriage. This has social implications for population dynamics and planning.
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Analysis of the distance between lingual frenal attachment and mandibular incisal edge position in establishing occlusal plane in three different races
Jafar Abdulla Mohamed Usman, Arista Kesumo, Nor Shazana Shahirah Binti Mohd Shahari
October-December 2022, 21(4):439-443
Introduction: The orientation of the occlusal plane forms the basis for the arrangement of teeth conducive to satisfactory esthetics and function, making it one of the most important clinical procedures in prosthodontic rehabilitation. This study aimed to analyze and compare the vertical distance between the anterior attachment of lingual frenum (AALF) and the incisal edge of mandibular central incisors among three races in Malaysia. Materials and Methods: The sample consisted of 63 dentate subjects (21 Malays, 21 Chinese, and 21 Indians) who were chosen based on the inclusion criteria. Two models were made using irreversible hydrocolloid impressions, and an average of the value was obtained. Lingual frenum was recorded in function. Casts were fabricated with dental stone. AALF was marked and the vertical distance was measured using a caliper. Results: In Malays, the mean and standard deviation of the vertical distance were 14.2 ± 0.9 mm, with a range of 12.3–16.0 mm; in Chinese were 14.4 ± 0.9 mm, with a range of 12.0–16.9 mm; and in Indians were 15.1 ± 1.0 mm, with a range of 13.0–17.2 mm. The difference among the three races regarding the distance between AALF and the incisal edge of mandibular central incisors was statistically significant (P < 0.05). Among the three races, Malays and Indians have the greatest mean difference. Conclusion: According to the results of the current study, the distance between AALF and the incisal edge of mandibular central incisors might be a proper criterion for the initial adjustment of occlusal rims. The values obtained from three different races were significantly different from one another, hence a different range of values was used to establish occlusal height for different races.
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