Annals of African Medicine最新文献

{"title":"Excipient Lung Disease and Fatal Outcome Among Young Adults: A Case Series on the Hidden Dangers of Intravenous Drug Abuse in India.","authors":"Dhivya Prakash, R Vijay Balaji, R Raguram, S Narayanan, Venkatesh Janarthanan, Senthil Kumaran","doi":"10.4103/aam.aam_210_24","DOIUrl":"https://doi.org/10.4103/aam.aam_210_24","url":null,"abstract":"<p><strong>Background: </strong>Excipient lung disease (ELD) arises from the intravenous (IV) injection of crushed oral tablets, leading to acute or chronic pulmonary complications. Despite its significance, ELD is under-recognized, particularly in countries like India, where over-the-counter availability of pharmaceutical drugs contributes to rising abuse rates. This study investigates sudden deaths among young adults due to ELD, emphasizing the need for increased awareness and preventive measures.</p><p><strong>Materials and methods: </strong>This case series examined 10 cases of sudden death in individuals aged 18-25 with a history of IV drug abuse. Data were collected from postmortem examinations, death scene investigations, and toxicological and histopathological analyses. The aim was to confirm ELD as the cause of death and understand its presentation.</p><p><strong>Results: </strong>Deaths in these cases were strongly associated with drug overdoses. Death scene investigations revealed signs of IV drug use, such as track marks and drug paraphernalia. External and internal examinations showed consistent pathological findings, including edematous lungs with frothy secretions, granulomatous reactions in the pulmonary vasculature, and right ventricular hypertrophy. Toxicological analyses detected substances such as tapentadol and tetrahydrocannabinol, with excipients linked to ELD found in histopathological examinations.</p><p><strong>Conclusion: </strong>When injected, excipients such as talc and microcrystalline cellulose lead to granulomatous reactions and pulmonary complications. The study highlights the prevalence of ELD among young adults in India and the challenges in diagnosing this condition due to its nonspecific presentation and lack of disclosure of drug abuse history. Effective public health measures and stricter regulation of prescription drugs are crucial in preventing ELD-related deaths. This study underscores the severe health risks associated with IV drug abuse of oral tablets, leading to ELD. The findings emphasize the need for enhanced awareness, accurate documentation, and preventive strategies to address the rising substance abuse among youth in India.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647194","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":"Sarcoidosis Presenting as Space Occupying Lesions in Liver.","authors":"Devansh Bajaj, Deepak Suvarna, H V Aradya, H P Nandeesh, Abhishek Kabra","doi":"10.4103/aam.aam_246_24","DOIUrl":"https://doi.org/10.4103/aam.aam_246_24","url":null,"abstract":"<p><strong>Abstract: </strong>This case report illustrates a typical presentation of hepatic sarcoidosis, a granulomatous liver disease that often manifests as an extrapulmonary feature of systemic sarcoidosis. The patient, a 60-year-old female, exhibited dyspeptic symptoms and anorexia. An abdominal ultrasound revealed space-occupying lesions in the liver, and elevated levels of alkaline phosphatase and gamma-glutamyl transferase were noted. Liver biopsy findings showed Grade 2 macrovesicular steatosis and noncaseating granulomatous inflammation. In addition, significantly elevated angiotensin-converting enzyme levels were observed, further supporting the diagnosis. This case underscores the importance of recognizing hepatic granulomatous foci, which can be crucial in determining the etiology and facilitating the diagnosis of sarcoidosis. The combination of clinical, biochemical, and histological findings played a pivotal role in diagnosing systemic sarcoidosis with hepatic involvement.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633392","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 Case of Acute Massive Pulmonary Embolism with Multiple Cardiac Arrests and Successful Systemic Thrombolysis.","authors":"S Mohammed Mahaboob Pasha, Bony Baiju, Boban Varghese, Ajin A Sunny","doi":"10.4103/aam.aam_273_24","DOIUrl":"https://doi.org/10.4103/aam.aam_273_24","url":null,"abstract":"<p><strong>Abstract: </strong>Massive pulmonary embolism (PE) is a potential noncardiac cause of cardiac arrest with unfavorable prognosis. Maintaining a high degree of clinical suspicion, use of bedside focused cardiac ultrasound and computed tomography pulmonary angiography (CTPA) aid in rapid management. Thrombolytic therapy with anticoagulation is indicated in treatment of massive PE provided that there are no contraindications and there is low risk of bleeding. We present a case of massive PE with multiple cardiac arrests who successfully responded to systemic thrombolysis along with anticoagulation, barring a moderate bleeding complication.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633388","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":"Exploring the Intersections between Triglyceride-rich Lipoproteins and Acute Coronary Syndrome: A Cross-sectional Study.","authors":"Priya Baluni, Sandesh Sadanand Raut, Prasad Chandrakant Bagare, Saurabh Ashok Sujanyal, Sachin Shivnitwar","doi":"10.4103/aam.aam_256_24","DOIUrl":"https://doi.org/10.4103/aam.aam_256_24","url":null,"abstract":"<p><strong>Background: </strong>Within 20 years, cardiovascular disease (CVD), which is currently the main cause of death in the Indian subcontinent, is expected to overtake all other causes of death in South Asia. Acute coronary syndrome (ACS), a critical form of CVD, is associated with multiple risk factors including hyperlipidemia. While triglyceride-rich lipoproteins (TRLs) and their remnants are well-studied traditional markers such as low-density lipoprotein (LDL-C) and high-density lipoprotein-cholesterol (HDL-C), new research indicates that they may possibly be important in ACS risk. Delayed removal of CM and very LDL remnants has been linked to increased cardiovascular risk. This study aims to explore the association between TRL-C, a surrogate marker for these atherogenic lipoproteins, and ACS.</p><p><strong>Materials and methods: </strong>Between November 2018 and March 2020, a cross-sectional study was carried out in hospitals at Smt. Sucheta Kriplani Hospital and Lady Hardinge Medical College in New Delhi. The study included 200 patients aged 18 or older, diagnosed with ACS. Data were collected on lipid profiles and cardiac biomarkers from venous blood samples. TRL-C was computed by subtracting LDL-C and HDL-C from total cholesterol. Patients were divided into three groups according to the type of ACS they had ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina (UA). Statistical analyses, including ANOVA and Kruskal-Wallis tests, were used to examine associations between TRL-C levels and ACS types.</p><p><strong>Results: </strong>The average TRL-C was significantly higher in STEMI patients (43.68 mg/dL) compared to NSTEMI (31.27 mg/dL) and UA (25.31 mg/dL) (P < 0.0001). The study found no significant associations between TRL-C levels and the use of statins or between previous ACS events and the spectrum of current ACS.</p><p><strong>Conclusion: </strong>TRL-C is significantly associated with the severity of ACS, with higher levels correlating with more severe forms of the condition. Despite the use of statins, TRL-C levels remained a significant predictor of ACS severity, suggesting that TRL-C could be a valuable marker for assessing cardiovascular risk beyond traditional lipid profiles. Further research is needed to explore the role of TRL-C in recurrent ACS and its potential utility in refining treatment strategies.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603471","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":"Maternal Serum Neuropilin a Prognostic Marker in Fetal Growth Restriction: A Tertiary Center Experience.","authors":"Rekha Sachan, Pushpalata Sachan, Shalini Yadav, Munna Lal Patel, Wahid Ali","doi":"10.4103/aam.aam_289_24","DOIUrl":"https://doi.org/10.4103/aam.aam_289_24","url":null,"abstract":"<p><strong>Introduction: </strong>Fetal growth restriction (FGR) is defined as a pathological decrease in the rate of fetal growth. Neuropilin-1 (NRP1) is a transmembrane glycoprotein, involved in the regulation of angiogenesis, and has emerged as a potential biomarker for various pregnancy-related complications. A recent study showed that NRP1 is downregulated in the placenta of FGR pregnancies. This study aimed to evaluate the role of NRP1 as a prognostic marker in FGR.</p><p><strong>Methods: </strong>This was a case-control study, carried out in the department of obstetrics and gynecology in collaboration with pathology over a period of 1 year. After informed consent and ethical clearance, a total of 200 pregnant women were enrolled. FGR was defined as per Delphi criteria 2016. 100 women who had FGR, were classified into two groups, 37 had severe FGR, 63 had mild FGR, and 100 women who had appropriate for gestational age fetuses were considered controls. 2 ml venous blood sample was withdrawn and maternal serum NRP1 (sNRP1) level was measured by ELISA technique using (Elabscience) ELISA kit as per producer protocol.</p><p><strong>Results: </strong>Severe FGR was found in 18.5% and mild FGR in 31%. On umbilical artery Doppler, mean pulsatility index (PI) and resistive index (RI) were increased in severe FGR fetuses as compared to mild FGR (PI 2.170 vs. 1.462 and RI 0.723 vs. 0.725). Mean sNRP1 level was high in severe FGR as compared to mild FGR, (1970.84 pg/ml vs. 1708.31 pg/ml) while a significant low level of sNRP1 (1080.75 pg/ml) was found in fetuses of appropriate for gestation age (P ≤ 0.001). At the cutoff value of sNRP1 >1493 had a sensitivity of 100% and specificity of 96% for prediction of FGR (P < 0.001).</p><p><strong>Conclusions: </strong>Maternal serum sNRP1 has good diagnostic and prognostic value in FGR.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603548","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":"Transformative Results in Giant Pyoderma Gangrenosum with Dexamethasone-cyclophosphamide Pulse.","authors":"Avinash Jadhav, Jahanvi Goyal, Amit Girme, Kirti Shrikant Deo","doi":"10.4103/aam.aam_223_24","DOIUrl":"https://doi.org/10.4103/aam.aam_223_24","url":null,"abstract":"<p><strong>Abstract: </strong>Pyoderma gangrenosum (PG) is a cutaneous ulcerative condition that can present in various forms, including ulcerative, bullous, pustular, vegetative, and peristomal. It often occurs and recurs in areas subjected to trauma due to the pathergy phenomenon, where irritation or injury triggers flare-ups. The condition typically begins as a painful erythematous lesion that rapidly progresses to a necrotic or blistering ulcer. PG is commonly associated with systemic conditions such as rheumatologic diseases, paraproteinemia, inflammatory bowel disease, and hematologic cancers. Active or poorly controlled PG can result in significant morbidity, including severe pain, loss of mobility, and anemia of chronic disease. Diagnosis is primarily clinical, and treatment is generally focused on systemic corticosteroids. Complete healing may take months, with ongoing maintenance therapy. However, long-term immunosuppression can lead to various adverse effects. Despite recent therapeutic advances, the prognosis of pyoderma gangrenosum remains unpredictable.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603568","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":"The Role of Oxytocin versus Carbetocin in Prevention of Postpartum Hemorrhage in Cesarean Section: A Randomized Control Trial.","authors":"Kiran Trivedi, Tulika Sinha, Payal Boipai, Pooja Kumari, Apoorwa Sharma, Achala Singh, Shiwani Kumari","doi":"10.4103/aam.aam_218_24","DOIUrl":"https://doi.org/10.4103/aam.aam_218_24","url":null,"abstract":"<p><strong>Background: </strong>Preventing postpartum haemorrhage (PPH) is a significant concern because of its effect on maternal morbidity and mortality. PPH is leading cause of maternal death in developing countries and also globally.</p><p><strong>Aim: </strong>Evaluation of safety and efficacy of carbetocin versus oxytocin for PPH prevention in caesarean deliveries.</p><p><strong>Methods: </strong>Double blind randomised controlled trial carried for one year. 42 pregnant patients included in study, who underwent caesarean section and fulfilled inclusion criteria. Patients divided into two groups A and B with 21 in each group, with the help of computer generated random number, group A recieved 100 microgram of carbetocin through intravenous route and 1 ml of normal saline given intramuscularly as placebo, group B received 10 IU oxytocin through intramuscular route and 1 ml of normal saline is given intravascular.</p><p><strong>Result: </strong>Mean age was 25.19 years±3.86 years and 24.76 years±3.93 in group A and group B respectively. Mean blood loss significantly reduced in carbetocin compared to oxytocin with significant p value 0.006, haemoglobin deficit was less in group A as we compare with group B having p value 0.052 whereas incidence of PPH in group A was 4.76 % and group B was 19.05% and had p value of 0.343, not significant. Effect of both medication on blood loss varies significantly across different BMI categories.</p><p><strong>Conclusion: </strong>Observation shows equal efficacy and safety of both carbetocin and oxytocin in prevention of postpartum haemorrhage in caesarean section but carbetocin is considered as uterotonics of crucial importance due to heat stability in poor resource settings, therefore use of carbetocin could be better in comparison to oxytocin in PPH prevention.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603552","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":"To Compare the Effect of Reduction in Pain on Propofol Injection after Administration of 6% Hydroxyethyl Starch versus 2% Lidocaine.","authors":"Merlyn Varghese, Y V Suresh, Ashna Shetty, B Prathvi","doi":"10.4103/aam.aam_178_24","DOIUrl":"https://doi.org/10.4103/aam.aam_178_24","url":null,"abstract":"<p><strong>Background: </strong>Propofol injections can cause discomfort for various reasons, and the onset of this discomfort can be either sudden or delayed. Several interventions are being explored to reduce the pain associated with propofol administration. Against this backdrop, we compared the severity of pain during propofol injection in patients preadministered with either 6% hydroxyethyl starch (HES) 130/0.4 or 2% lidocaine during the induction of anesthesia.</p><p><strong>Materials and methods: </strong>A comparative and observational study was conducted among 70 patients (35 in each group) undergoing elective surgery under general anesthesia. Adult patients classified as American Society of Anesthesiologists 1 and 2, aged 18-55 years, of either gender, were included. A comprehensive preanesthetic assessment was carried out. Hemodynamic variables, incidence and severity of pain, and side effects were assessed. Data analysis was performed using the SPSS version 17.</p><p><strong>Results: </strong>At 10-s postoperative period, 14.3% of participants in the HES group experienced pain, while only 2.9% of participants in the lidocaine group reported pain. At 20 s, 14.3% of participants in the HES group experienced pain, compared to 2.9% in the lidocaine group. In the HES group, 91.4% experienced no pain before losing verbal contact, whereas 97.1% in the lidocaine group reported no pain. The incidence of pain was higher in females than males at all time points (P < 0.05).</p><p><strong>Conclusion: </strong>In our observational study, both HES and lidocaine demonstrated hemodynamic stability, supporting their safe use as premedication agents. However, the differences in pain incidence suggest that lidocaine may offer advantages in certain scenarios.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603555","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":"Lichen Planus Pemphigoides: From Lichenoid to Bullous Disease.","authors":"Avinash Jadhav, Kirti Deo, Anuja Masare, Shambhavi Singh","doi":"10.4103/aam.aam_252_24","DOIUrl":"https://doi.org/10.4103/aam.aam_252_24","url":null,"abstract":"","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603545","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":"Susac Syndrome with Classical Triad: A Case Report and Literature Review.","authors":"Bashair Alshehri, Amaar Amir, Razan Alshehri, Hissah Alturki, Talal Aljudi, Asma Alzuabi","doi":"10.4103/aam.aam_234_24","DOIUrl":"https://doi.org/10.4103/aam.aam_234_24","url":null,"abstract":"<p><strong>Abstract: </strong>Susac syndrome is a rare microangiopathy affecting the brain, retina, and cochlea. Individuals affected typically present with a classical clinical triad of branch retinal artery occlusion (BRAO), encephalopathy or white matter lesions, and sensorineural hearing loss. Herein, we report an exceedingly rare case of a middle-aged female patient with multiple presentations related to her visual field complaints. The presence of multiple bilateral BRAOs, in addition to sensorineural hearing impairment and white matter lesions on the brain magnetic resonance imaging, led to the diagnosis of Susac syndrome. Cases of Susac syndrome are few and far between and have seldom been reported in detail. Awareness of this rare presentation by clinicians and radiologists is of utmost importance to aid in correctly diagnosing and treating such patients.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603550","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}