Annals of African Medicine最新文献

{"title":"Intentional Ingestion and Multidisciplinary Management in a Fatal Polypharmacy Overdose.","authors":"Swapnil Patil, Shivraj Prashant Patil","doi":"10.4103/aam.aam_208_25","DOIUrl":"https://doi.org/10.4103/aam.aam_208_25","url":null,"abstract":"<p><strong>Abstract: </strong>This case report aims to disclose intentional overdosing of drugs that impact the cardiovascular and central nervous systems which have very serious and life-threatening effects on the body. In the present case study, a 22-year-old male medical student with a known history of depression and recurrent episodes of suicide who was on regular psychiatric medications purposefully consumed an unknown quantity of clonazepam, prazosin, ivabradine, and propranolol in an attempt of suicide in a powdered form. He was brought to the emergency department by his parents with signs of severe bradycardia, hypotension, and respiratory failure; his heart rate remained low despite prompt intervention by medications to maintain heart rate, and temporary installation of a pacemaker was done to maintain heart rate. Lipid emulsion therapy, also known as intralipid, was started to maintain blood pressure despite using medications. The patient was also put on vasopressin assistance to prevent further damage to vital organs and death. This case report highlights the importance of early detection, vigorous cardiovascular stabilization, prompt intervention, and comprehensive psychological management in preventing recurrence in such cases of fatal polypharmacy cases.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relugolix for Metastatic Hormone-sensitive Prostate Cancer with Impending Paraplegia.","authors":"Prem Kumar, Pragya Prem, Raajul Jain, Ziaur Rahman","doi":"10.4103/aam.aam_192_25","DOIUrl":"https://doi.org/10.4103/aam.aam_192_25","url":null,"abstract":"<p><strong>Abstract: </strong>Luteinizing hormone-releasing hormone agonists, used in advanced prostate cancer, can cause an initial testosterone surge and may inadequately suppress follicle-stimulating hormone, potentially promoting tumor growth. Injectable gonadotropin-releasing hormone (GnRH) antagonists avoid this surge but have drawbacks like injection-site reactions and monthly dosing. Relugolix, an oral GnRH antagonist, offers rapid testosterone suppression without flare and reduced cardiovascular risks. We report a 72-year-old man with suspected metastatic prostate cancer, presenting with severe neuritic pain and lower limb weakness. Relugolix, started before biopsy along with zoledronic acid and steroids, led to symptom relief within 24 h. This case supports Relugolix's utility in urgent hormone-sensitive metastatic prostate cancer care.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Solitary Rectal Ulcer Syndrome with Fibrotic Rectal Stricture: A Diagnostic Dilemma.","authors":"Ajay Pranami, Anushka Verma, Amol Dahale, Prashant Gopal","doi":"10.4103/aam.aam_322_25","DOIUrl":"https://doi.org/10.4103/aam.aam_322_25","url":null,"abstract":"<p><strong>Abstract: </strong>Solitary rectal ulcer syndrome (SRUS) is an uncommon, benign condition that presents with a wide range of symptoms mimicking other pathological conditions, often leading to misdiagnosis and delays in treatment. A 60-year-old male patient was diagnosed with SRUS with rectal stricture with the help of colonoscopy, anorectal manometry, magnetic resonance defecography, and histopathological examination. He was managed with high-fiber diet, laxatives, biofeedback therapy, argon plasma coagulation, and stricture dilatation, which effectively alleviated the patient's condition. SRUS is a rare benign condition typically associated with mucosal trauma from chronic straining, self-induced rectal manipulation, or rectal prolapse. The pathogenesis behind SRUS includes rectal wall compression, ischemia due to poor blood supply, chronic inflammation, and mechanical trauma due to repeated digital evacuation, leading to mucosal ulceration and, in some cases, fibrosis and stricture formation. Stricture in SRUS is rare and may mimic malignancy, leading to delays in appropriate diagnosis. The differential diagnosis includes inflammatory bowel disease and neoplasms. Hence, histological confirmation is critical. SRUS with rectal stricture is an unusual presentation that requires a high index of suspicion. Histopathological confirmation remains the gold standard for diagnosis. Early diagnosis is, therefore, essential for effective management of SRUS.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Evaluation of the Accuracy of Invasive Point-of-care Hemoglobin Devices.","authors":"Anushil Anand, Shashi Bhushan Singh, Ashish Kumar Singh, Chetan Singh, Pradip Kumar Bhattacharya, Vidya Sagar, Nisha Kumari, Jyoti Thakur, Dewesh Kumar","doi":"10.4103/aam.aam_236_25","DOIUrl":"https://doi.org/10.4103/aam.aam_236_25","url":null,"abstract":"<p><strong>Aims: </strong>The aim of the study was to evaluate the accuracy of two devices that measure hemoglobin (Hb) from blood samples taken from small capillary tubes (HemoCue® Hb 301 System) and another from whole blood taken from veins or arteries (Horiba H550) with a laboratory reference analyzer (Beckman Coulter DxH 520).</p><p><strong>Subjects and methods: </strong>A cross-sectional study was conducted, in which capillary and venous blood samples were taken from 529 individuals across outpatient and inpatient wards of both genders, with an age range from 7 to 83 years. The accuracy and agreement were statistically evaluated using Lin's concordance correlation coefficient.</p><p><strong>Results: </strong>We observed a higher diagnostic accuracy in the venous blood-based point-of-care device than in the capillary blood-based device in classifying the anemia.</p><p><strong>Conclusions: </strong>The Horiba H550 shows remarkable accuracy in classifying the anemia closer to the laboratory reference. Further, this study underlines the significance of blood samples collected from venous in measuring Hb levels.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Dexmedetomidine on Delirium in Elderly Patients Postoperatively: A Randomized Controlled Trial.","authors":"Gayatri Kisku, Nitu Nitu, Tushar Kumar, Saurabh Suman, Shio Priye, Dipali Singh, Ladhu Lakra","doi":"10.4103/aam.aam_166_25","DOIUrl":"https://doi.org/10.4103/aam.aam_166_25","url":null,"abstract":"<p><strong>Introduction: </strong>Delirium, a common acute brain dysfunction in older adults, features rapid changes in attention, awareness, and thinking that fluctuate. It presents diversely with altered activity levels and sleep. Postoperative delirium (POD), often seen in the postanesthesia care unit, is a temporary mental status change, with hypoactivity being common. Low arousal is not the same as altered brain function.</p><p><strong>Methods: </strong>It is a double-blind randomized controlled trial enrolling 130 patients. The primary objective was to determine whether intraoperative dexmedetomidine administration reduced the incidence of POD in elderly patients. Group A received dexmedetomidine infusion at 0.5 μg/kg/h without a loading dose after induction, and Group B received the same volume of normal saline after induction. Patients were assessed for delirium twice a day until the 5th postoperative day.</p><p><strong>Results: </strong>Delirium was present in 14 participants (10.8%) in Group A and 25 participants (19.2%) in Group B, totaling 39 participants (30%) across both the groups. The majority of participants (71.8%) experienced delirium resolution within 24 h, with a higher proportion in Group B compared to Group A.</p><p><strong>Conclusion: </strong>Dexmedetomidine demonstrated a beneficial role in reducing the incidence and duration of delirium, stabilizing hemodynamic parameters, and shortening hospital stay compared to normal saline. Incorporating dexmedetomidine into standard sedation protocols, alongside nonpharmacological strategies, may improve patient outcomes and enhance recovery.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ovarian Cyst Torsion and Vanishing Twin Syndrome in an Ovulation-induced First-trimester Pregnancy: A Rare Case Report.","authors":"Komal Singh, Aloke Prasad, Abhijit Mandal","doi":"10.4103/aam.aam_301_25","DOIUrl":"https://doi.org/10.4103/aam.aam_301_25","url":null,"abstract":"<p><strong>Abstract: </strong>A case of 25-year-old primigravida with 8 weeks of pregnancy presented to gynaecology outpatient department with severe abdominal pain. The patient has been receiving treatment outside and conceived after ovulation induction and timed intercourse. She was diagnosed with twisted ovarian cyst, twin pregnancy, and sepsis. Laparotomy was performed and a right sided salpingo-oophorectomy was carried out immediately. Histopathological examination revealed a haemorrhagic cyst. Throughout the antenatal period she was monitored closely. Initially she had a twin pregnancy at the time of laparotomy and also at 12th week scan. However, by the 5th month congenital anomaly scan only a singleton pregnancy was detected. Ultimately, she delivered at term via caesarean section for pregnancy induced hypertension and polyhydramnios. The baby is doing well. Patient who conceived after ovulation induction can present with twisted ovarian cyst due to enlarge ovary caused by the effects of the treatment. It is essential to consider twisted ovarian cyst as a differential diagnosis in pregnant patients presenting with acute abdominal pain during first trimester.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Endotracheal Tube Size Estimated by Ultrasonography and Age-based Formula for Choosing Appropriate Size in Pediatric Patients.","authors":"Anjana Kashyap, Madhava Pai Kanhangad","doi":"10.4103/aam.aam_246_25","DOIUrl":"https://doi.org/10.4103/aam.aam_246_25","url":null,"abstract":"<p><strong>Introduction: </strong>Pediatric endotracheal intubation is challenging due to airway anatomical differences. Accurate endotracheal tube (ETT) sizing is crucial for effective ventilation and preventing complications. Traditional age, weight, or height-based methods are often unreliable, leading to multiple attempts. Ultrasonography (USG), by measuring cricoid diameter, offers a more precise alternative. This study compares USG with age-based formulae in selecting the appropriate ETT size.</p><p><strong>Materials and methods: </strong>This prospective study involved 96 pediatric patients (2-12 years) undergoing elective surgery. Group A used the Penlington formula, whereas Group B used USG-guided ETT selection. The subglottic diameter was measured using USG, and the closest matching ETT was chosen. An independent anesthesiologist performed an air leak test to assess ETT suitability.</p><p><strong>Results: </strong>USG-based selection (Group B) resulted in fewer ETT exchanges and higher rates of correctly sized tubes compared to the Penlington formula (P = 0.003). Group A significantly underestimated ETT size (P = 0.001), whereas Group B showed a minor overestimation (P = 0.04).</p><p><strong>Discussion: </strong>USG provided a more precise method for ETT selection, reducing repeated intubations and associated risks.</p><p><strong>Conclusion: </strong>USG-based cricoid diameter estimation is a more reliable method for determining ETT size than traditional formulas, reducing tube exchanges and enhancing patient safety.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of Thyroid Function Tests and Inflammatory Markers (White Blood Cell Count and High-sensitivity C-reactive Protein) in Prediabetic Patients at Tertiary Care Center.","authors":"Madhulika L Mahashabde, P Jugal Sriram, Sai Krishna Reddy Paidi, Rishikesh Sunilsingh Chauhan","doi":"10.4103/aam.aam_120_25","DOIUrl":"https://doi.org/10.4103/aam.aam_120_25","url":null,"abstract":"<p><strong>Background: </strong>Prediabetes represents a transitional state in glucose metabolism with an increasing global and national prevalence, particularly in India. Recent evidence suggests that both thyroid dysfunction and chronic low-grade inflammation may play pivotal roles in the progression of prediabetes to overt Type 2 diabetes mellitus (T2DM). Thyroid hormones regulate glucose metabolism, while inflammatory markers such as white blood cell (WBC) count and high-sensitivity C-reactive protein (hs-CRP) are indicators of systemic inflammation often elevated in metabolic disorders.</p><p><strong>Objectives: </strong>This study aimed to evaluate thyroid function and inflammatory markers in prediabetic individuals, assess the prevalence of thyroid dysfunction, and analyze the correlation between thyroid parameters and inflammatory markers.</p><p><strong>Materials and methods: </strong>A case-control study was conducted at a tertiary care center in Western Maharashtra, enrolling 200 participants (130 prediabetics and 70 age- and sex-matched controls). Thyroid function tests (thyroid-stimulating hormone [TSH], Total T3 and T4), thyroid antibodies, WBC count, and hs-CRP levels were analyzed and compared between groups. Statistical analyses were conducted to evaluate correlations and significance.</p><p><strong>Results: </strong>Thyroid dysfunction, particularly elevated TSH levels, was more prevalent in prediabetic individuals compared to controls. A significant proportion of prediabetic patients exhibited elevated hs-CRP and WBC counts, indicating underlying low-grade inflammation. A positive correlation was observed between TSH levels and inflammatory markers, suggesting a possible link between early thyroid dysfunction and systemic inflammation in prediabetic states.</p><p><strong>Conclusion: </strong>Prediabetes is associated with both subclinical thyroid abnormalities and elevated inflammatory markers, highlighting the need for comprehensive metabolic screening in this population. Early identification and management of thyroid and inflammatory dysfunction may offer an opportunity to delay or prevent the onset of T2DM and its complications.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Study of Gastrointestinal Symptoms in Patients with Diabetes Mellitus.","authors":"Sreevidya Yekkaluru, Manasi Harale, Sandesh Raut, Tushar Pancholi","doi":"10.4103/aam.aam_123_25","DOIUrl":"https://doi.org/10.4103/aam.aam_123_25","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes mellitus (DM) is a chronic metabolic disorder associated with numerous complications affecting multiple organ systems. Among these, gastrointestinal (GI) symptoms are commonly observed but often underdiagnosed and undertreated. Understanding the prevalence and patterns of these symptoms in diabetic individuals is crucial for optimizing clinical management.</p><p><strong>Aim: </strong>In this study, the frequency of GI symptoms in individuals with DM was assessed, and their relationship to antidiabetic drugs, the length of diabetes, and glycemia control was investigated.</p><p><strong>Materials and methods: </strong>A cross-sectional, observational study was conducted on 200 diabetic patients at a tertiary care hospital. Detailed medical histories were recorded, and participants underwent laboratory investigations, including HbA1c levels. Statistical analyses were performed to determine associations between GI symptoms and various clinical parameters.</p><p><strong>Results: </strong>Among the 200 participants, 67.5% reported at least one GI symptom. The most common symptoms were fecal incontinence (37%), nausea and vomiting (34.5%), abdominal bloating (33.5%), and constipation (32.5%). Poor glycemic control (HbA1c ≥9.0%) was significantly associated with increased prevalence of GI symptoms (P < 0.01). Biguanides (metformin) were the most frequently prescribed antidiabetic drug (93%), but no significant association was found between specific oral hypoglycemia agents and GI symptoms.</p><p><strong>Conclusion: </strong>GI symptoms are highly prevalent in diabetic patients, with poor glycemic control playing a major role in their occurrence. Routine screening for GI symptoms should be incorporated into diabetes management to improve quality of life and treatment adherence.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optical Coherence Tomography Analysis of Macular Edema Across Disease Spectra.","authors":"Renu Magdum, Priyanka Sangram Aher, Tushar Pancholi, Surbhi Chodvadiya, Gufran Ali Kamdar, Arpit Gupta, Ahan Gupta, Prashansa Gupta","doi":"10.4103/aam.aam_263_25","DOIUrl":"10.4103/aam.aam_263_25","url":null,"abstract":"<p><strong>Introduction: </strong>Macular edema (ME) is a leading cause of visual impairment associated with various retinal pathologies. Spectral-domain optical coherence tomography (SD-OCT) provides high-resolution imaging, allowing detailed assessment of ME patterns and structural changes.</p><p><strong>Aim: </strong>The aim of this study was to evaluate the distribution and characteristics of ME across different etiologies using SD-OCT.</p><p><strong>Materials and methods: </strong>This cross-sectional observational study included patients with ME from diverse etiologies. SD-OCT was used to assess central macular thickness, retinal volume, cystoid spaces (CS), epiretinal membrane (ERM), hyperreflective foci, and disorganization of retinal inner layers (DRIL).</p><p><strong>Results: </strong>A total of 54% of the study participants were female, with a mean age of 57 years. Diabetes mellitus (50.4%) was the most common etiology, followed by retinal vein occlusions, age-related macular degeneration, ERM, and inflammatory causes. CS were observed in 49.6% of cases, and DRIL in 48%. Severe visual impairment was more frequent in diabetic and vaso-occlusive cases.</p><p><strong>Conclusion: </strong>SD-OCT effectively identifies structural patterns in ME across etiologies, assisting in diagnosis and management planning.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}