Annals of African Medicine最新文献

{"title":"Association between Serum Uric Acid Levels and Islet Beta-cell Function in Type 2 Diabetes Mellitus.","authors":"Nitesh Shukla, Ashok Kumar, Lalit Kumar Tyagi, K P Sindhura","doi":"10.4103/aam.aam_190_24","DOIUrl":"https://doi.org/10.4103/aam.aam_190_24","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes mellitus (T2DM) is a disease characterized by insulin resistance (IR) and insufficiency. Serum uric acid (SUA) is a biomarker of diabetes risk, with Indian populations having varying levels due to diet, lifestyle, and genetic susceptibility. However, the relationship between UA and T2DM is contentious due to its association with obesity. The study explores the relationship between serum uric acid levels and islet beta-cell function in type 2 diabetes patients, estimating the correlation, examining factors such as age, gender, or body mass index (BMI), and estimating the correlation between uric acid levels and IR.</p><p><strong>Methods: </strong>A study at Santosh Medical College in Ghaziabad involved 167 patients over 18 years old with type 2 diabetes, diagnosed based on fasting plasma glucose levels, and glycated hemoglobin (HbA1c). The patients underwent detailed history and physical examination, including fasting blood glucose, lipid profile, serum urea, creatinine, uric acid, HbA1c, insulin sensitivity index, and islet beta-cell function indices.</p><p><strong>Results: </strong>The study involved 170 patients, with 84 (49.41%) being male and 86 (50.59%) being female. The mean lipid profile was similar across genders, with no significant differences in HbA1c, random blood sugar (RBS), total cholesterol (TC), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-c), and homeostatic model assessment of IR (HOMA-IR). Smoking and alcohol consumption were significantly higher in males, while family history of T2DM was comparable between both genders. The relationship between SUA quartiles and other parameters and HOMA-IR in males was not significantly different, while in females, the mean age, BMI, waist circumference, waist-hip ratio, HbA1c, RBS, TC, TG, HDL-c, low-density lipoprotein-cholesterol, HOMA-IR, and creatinine were not significantly different. The correlation of HOMA-IR and uric acid was positive but not significantly associated.</p><p><strong>Conclusion: </strong>The study found a significant positive correlation between serum uric acid levels and IR in males and females and a positive but nonsignificant correlation with BMI, suggesting that SUA could predict islet β-cell activity.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584386","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":"Conundrum of Acute Liver Failure.","authors":"Battu Sai Vishnu, B Sai Surya Teja, I Lavanya Sri, Eswar Ganti","doi":"10.4103/aam.aam_9_25","DOIUrl":"https://doi.org/10.4103/aam.aam_9_25","url":null,"abstract":"<p><strong>Abstract: </strong>A 20-year-old male with fever, myalgia, and jaundice developed severe liver dysfunction, progressing to acute liver failure (ALF). Initial treatment for malaria and supportive care did not resolve symptoms, with persistent jaundice and elevated liver enzymes. Laboratory tests confirmed Plasmodium falciparum/Plasmodium vivax infection. Further evaluation revealed drug-induced liver injury (DILI) from prescribed medications and possible hepatotoxic effects of herbal supplements. Hepatitis A, exacerbated by malaria, DILI, and herbal toxicity, contributed to compounded hepatic dysfunction. Management included intravenous fluids, hepatoprotective agents, and antipyretics. This case underscores the importance of considering multiple etiologies, including infections, drug toxicity, and environmental factors, in ALF.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596067","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":"Assessing Autonomic Dysfunction in Diabetes: A Hospital-based Study in a Developing Country.","authors":"Khalid A Dafalla, Azza O Alawad, Tarig Hakim Merghani, Fathelrahman M Ahmed, Ahmed Alsiddig Ebraheem","doi":"10.4103/aam.aam_202_24","DOIUrl":"https://doi.org/10.4103/aam.aam_202_24","url":null,"abstract":"<p><strong>Background: </strong>Autonomic nervous system (ANS) dysfunction is a common complication in patients with diabetes mellitus, potentially affecting the various organ systems leading to significant morbidity. This study aimed to evaluate ANS dysfunction in diabetic patients attending Wad Madani Teaching Hospital, Sudan.</p><p><strong>Materials and methods: </strong>A cross-sectional and hospital-based study was conducted on a sample of 100 patients in Wad Madani Teaching Hospital in Sudan. For each participant, a data collection form was utilized to record the sociodemographic details, previous medical history, and patient assessment results including heart rate (HR), blood pressure (BP), weight, and height. Patients were assessed for the signs of autonomic dysfunction using the clinical examinations and standardized autonomic function tests. HR variability (HRV), BP response to standing, and deep breathing tests were the primary methods used to assess ANS function. The results were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 26. 0.</p><p><strong>Results: </strong>The mean age of the participants was 63.4 ± 9.9 years, with males comprising 75% of the sample. Of the participants, 48% were overweight and 22% were obese, with 77% demonstrating poor glycemic control (hemoglobin A1c ≥ 7.0%). Only 11% of participants had normal HRV during deep breathing, while 56% showed abnormal values. For the HR response to standing, 27% of participants had abnormal results. Regarding BP response to standing, 19% had abnormal readings. Autonomic dysfunction was prevalent, with 89% of participants exhibiting some degree of dysfunction, including early parasympathetic (16%) and combined parasympathetic and sympathetic dysfunction (19%).</p><p><strong>Conclusion: </strong>Autonomic dysfunction is highly prevalent among diabetic patients in Wad Madani, with most exhibiting parasympathetic and sympathetic dysfunctions. This underscores the need for the early diagnosis and management of autonomic complications in diabetic patients to improve the outcomes and quality of life.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575613","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":"Echocardiographic Assessment of Structure and Function of Left Ventricle in Chronic Kidney Disease Along with its Determinants in a Tertiary Healthcare Center in Tribal Region of Jharkhand.","authors":"Anchal Kujur, Siddharth Kapoor, Usha Saroj, Abhay Kumar, Stuti Srishti, Sujeet Anand, Gregory Minj, Ajit Dungdung, Shishir Kumar Mahato","doi":"10.4103/aam.aam_191_24","DOIUrl":"https://doi.org/10.4103/aam.aam_191_24","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Chronic kidney disease (CKD) is a complex pathophysiologic process that leads to irreversible changes in kidney structure and function. The left ventricle (LV) remodeling, which is evident as LV hypertrophy (LVH) is highly prevalent in patients with CKD even in the early stages and has a strong association with cardiovascular mortality, multiple studies have suggested that there is a strong association between high albuminuria and LVH, which was found to be independent of low GFR, hypertension, and diabetes. The most commonly used noninvasive method for estimating cardiac function and size is 2D echocardiography. It has the benefit of being portable, available, and providing images of the heart in real time. In CKD patients, echo is the most important noninvasive method for predicting cardiovascular risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This was a cross-sectional observational study approved by the institutional ethics committee through memo no. 210/IEC, Rajendra Institute of Medical Sciences (RIMS) dated October 3rd, 2023. The study was conducted on patients with CKD admitted to the Department of Internal Medicine at RIMS, Ranchi, Jharkhand between November 2023 and July 2024. Taking the prevalence of 6.3%, the sample size comes out to be 95, and we have taken 114 patients for our study. Data were collected using Google Forms, and a template was generated in an Microsoft Excel sheet. SPSS software version 22.0 and JAMOVI software version 2.3 were used for data analysis. A Chi-square test with Fisher's exact test for cells &lt;5 was applied for the test of significance between variables. A multivariate analysis was performed for associations between variables. P ≤0.05 was considered statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study was conducted on 114 patients, of whom 69% were males and 31% were females. Among comorbidities, hypertension, diabetes, smoking, dyslipidemia and alcohol were studied. The majority of cases (63%) belonged to CKD Stage 5 compared to other stages of CKD. Most of the cases (33%) had a moderate reduction in the LV ejection fraction (LVEF), and 52% of the cases had concentric hypertrophy. Grade 1 LV diastolic dysfunction was the most common (76%). In Stage 5 CKD, 43% of the patients had a moderate decrease in the LVEF. Using the Chi-square test, a significant association was found between CKD stages and LVEF (P ≤ 0.023). The relationship between different variables and LVEF in the participants was evaluated, and the Chi-square test was used to determine the P value. P ≤0.05 was considered statistically significant. Alcohol, albuminuria, and dyslipidemia were found to be significant determinants of LVEF. Multinominal logistic regression analysis was applied to the above variables, and all three variables, including alcohol, albuminuria, and dyslipidemia, came out to be significant determinants of LVEF in patients with CKD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Car","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575617","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":"Percutaneous Nephrolithotomy in the Management of Renal Stone: An Audit of Outcomes and Complications.","authors":"Idorenyin Cletus Akpayak, Chukwudum Dennis Ikeh","doi":"10.4103/aam.aam_5_25","DOIUrl":"https://doi.org/10.4103/aam.aam_5_25","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous nephrolithotomy (PCNL) is considered one of the most significant advances in minimally invasive urologic surgery. It offers a better stone-free rate compared to other available treatment modalities of renal stones at a lower complication rate compared to open surgery. Despite the availability of extracorporeal shock wave lithotripsy and flexible ureteroscopy, PCNL remains the gold standard modality for large and complex renal stones. Here, we review our initial experience with standard PCNL in the prone position for renal stones >1.5 cm with respect to stone clearance rate and complications as seen in our patients.</p><p><strong>Patients and methods: </strong>Records of 24 patients who had standard PCNL and pneumatic lithotripsy between September 2020 and September 2023 were reviewed retrospectively. All the patients who had the standard PCNL for renal stones >1.5 cm were the subjects of this study. Data on patients' demographics, indication for the surgery, location of stone, size of stone, postoperative nephrostomy placement, nephrostomy tract size, complications, duration of surgery, duration of hospital stay, and status of stone clearance were obtained, and the data were subjected to statistical analysis.</p><p><strong>Results: </strong>A total of 24 patients underwent the standard PCNL. The mean age of the patients was 47.0 ± 10.28 years (16 males and 8 females; range: 17-68 years). Flank pain was the main indication for the surgery. The mean stone size was 2.5 cm (range: 1.6-3.3 cm). The mean Hounsfield unit was 1248.2 HU (range: 927-1502HU). At a single session, we achieved 100% stone clearance in 20 (83.3%) patients. Two (8.3%) of our patients required a second session of PCNL due to intraoperative bleeding and perforation of the pelvicalyceal system necessitating termination of the procedure and insertion of nephrostomy tube. In another 2 (8.3%) patients, the stones migrated and became inaccessible. One (4.2%) patient stayed for 10 days due to persistent urine leak, which eventually stopped after the insertion of a double-J stent and administration of antibiotics. The Clavien-Dindo grading system was used to classify postoperative complications. A total of 14 (58.3%) patients had Grade I complications, while 3 (12.5%) patients had Grade II and 1 (4.2%) had Grade IIIa complications.</p><p><strong>Conclusion: </strong>PCNL is an effective minimally invasive technique for the treatment of large renal stones. Our initial experience suggests that the complication rate in PCNL is well within the acceptable limit.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575678","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 Cortical Venous Thombosis Secondary to Tuberculous Meningitis.","authors":"K M Srinath, Tanmay Kulkarni, K Nandini, M Basava Chethan","doi":"10.4103/aam.aam_242_24","DOIUrl":"https://doi.org/10.4103/aam.aam_242_24","url":null,"abstract":"<p><strong>Abstract: </strong>A male patient in his 20s presented with new-onset seizures. Computed tomography head plain was normal. However, in view of persistent occipital headache, magnetic resonance imaging brain with magnetic resonance venogram scan was done which showed left lateral sinus thrombosis. The patient developed fever spikes after admission. Hence, cerebrospinal fluid analysis was sent which was suggestive of a tuberculous etiology. The patient was started on intravenous steroids and antitubercular treatment along with low-molecular-weight heparin. The patient's general condition improved significantly following which the patient was discharged with antitubercular medications, newer oral anticoagulants, and a tapering dose of steroids. To the best of our knowledge, only few case reports have been documented in relation to tuberculous meningitis presenting as cortical venous thrombosis.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575594","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":"Interstitial Capillary Congestion and Diffuse Alveolar Damage: Incidental or Factual Findings in the Lungs of Autopsy Cases Positive for Coronavirus Disease-19.","authors":"Preeti Agarwal, Shiuli Rathore, Anurag Singh, Poorvi Mathur, Anuragani Verma, Ravindra Kumar Garg, Anoop Kumar Verma, Amita Jain","doi":"10.4103/aam.aam_263_24","DOIUrl":"https://doi.org/10.4103/aam.aam_263_24","url":null,"abstract":"<p><strong>Background: </strong>Interstitial capillary congestion and diffuse alveolar damage (DAD) were frequently observed in patients who died from Coronavirus disease-19 (COVID-19). The research question pertains to observing these findings in COVID-19-positive patients lacking pulmonary symptoms. The histological examination of lung samples from COVID-19-positive patients who do not succumb to COVID-19-related pulmonary complications can provide an answer. This study analyzed postmortem lung autopsy samples from individuals who did not succumb to COVID-19-related pulmonary complications. The research article aimed to examine the morphological variations in postmortem lung samples of COVID-19 patients who did not succumb to the disease, and to compare these changes with those observed in cases of COVID-19-related deaths, utilizing existing English literature.</p><p><strong>Methodology: </strong>This prospective study included subjects who died without complications from COVID-19-related injuries, had positive real-time polymerase chain reaction throat swabs, and exhibited no pulmonary manifestation of COVID-19 disease. A comprehensive histomorphological analysis of the lung samples was conducted.</p><p><strong>Results: </strong>A total of 20 subjects were enrolled in this study. Capillary congestion was the most prevalent histomorphological change observed in lung autopsies, seen in 90% (18/20) of cases, followed by emphysema in 75% (15/20) and the acute phase of DAD in 25% (5/20) of cases. Acute bronchopneumonia and fibrotic nodules were identified in 20% (4/20) and 10% (2/20) of the study population, respectively.</p><p><strong>Conclusion: </strong>In postmortem lung autopsy of COVID-19-positive patients lacking symptomatic pulmonary issues, capillary congestion, diffuse alveolar destruction, and emphysema were prevalent. The findings indicate that COVID-19 exhibits varied responses to damage and inflammation that do not correlate with mortality. This study enhances the understanding of pathophysiological lung tissue variations in COVID-19 patients who have non-COVID-19-related deaths, potentially educating forensic pathologists and supporting future research endeavors.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575677","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":"Significance of Intracranial Pressure Monitoring Postearly Decompressive Craniectomy in Traumatic Brain Injury Patients: An Institutional Study.","authors":"Anand Prakash, Saurav Kumar Besra, Md Habibullah Ansari","doi":"10.4103/aam.aam_237_24","DOIUrl":"https://doi.org/10.4103/aam.aam_237_24","url":null,"abstract":"<p><strong>Background: </strong>Intracranial pressure (ICP) monitoring after early decompression in postoperative period serves as a valuable tool in diagnosing postoperative intracranial hypertension/raised ICP which guides for more appropriate medical treatment to reduce ICP or even subsequent surgery which ultimately decides the outcome of the patients.</p><p><strong>Materials and methods: </strong>It is a prospective study from March 2023 to August 2023 in the Department of Neurosurgery, Rajendra Institute of Medical Sciences, Ranchi. This study includes 16 patients with severe traumatic brain injury with a Glasgow Coma Scale (GCS) score of <8 who underwent early decompressive craniectomy. Finally, 16 patients were included in this study and were divided into two groups. The following parameters were analyzed age, sex, initial GCS, pupillary response, blood pressure, pulse rate, and respiratory rate 2-week mortality. Two-week time frame was selected because in our institute, 85% of deaths occur in the 1st week after injury.</p><p><strong>Results: </strong>The statistical analysis was performed by SPSS 22.0 and differences were observed between the two groups.</p><p><strong>Conclusion: </strong>The present study suggests that ICP monitoring, in conjunction with postoperative treatment after early decompressive craniectomy, is associated with a significantly reduced risk of death.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575680","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":"Insight into \"Problem-based Learning\" in Medical Education - Students' Perceptions about its Facilitators and Barriers: A Cross-sectional Study.","authors":"Samir Dwidmuthe, Siddarth Dubhashi, Vinod Pusdekar, Vivek Tiwari, Samrat Sahoo","doi":"10.4103/aam.aam_140_24","DOIUrl":"https://doi.org/10.4103/aam.aam_140_24","url":null,"abstract":"<p><strong>Introduction: </strong>Problem-based learning (PBL), a method of small-group learning was introduced in 1969 at McMaster University and has been extensively used in various disciplines. PBL transforms the traditional teacher-centered approach to student-centered approach, thereby emphasizing on the necessity for student's participation in the discussion. The aim of the study was to assess the perception of students on PBL techniques, preparedness, and resource utilization for conducting PBL sessions.</p><p><strong>Methodology: </strong>This cross-sectional study was conducted at a medical college, wherein all the students who had attended a PBL session in any subject were included in the study. Questionnaires were used to record students' responses. Student's responses were assessed using a prevalidated questionnaire on, the perceived benefits of PBL sessions, the process of conduction of PBL and learning resources used for self-directed learning. Student feedback was recorded using a Google Forms. Each response was recorded using a three-point Likert scale (Agree/neutral/disagree). Data were compiled in a Microsoft Excel worksheet.</p><p><strong>Statistical analysis: </strong>Qualitative data were collected and were analyzed using appropriate statistical tests. The feedback data were obtained to analyze the effectiveness of programs and plan appropriate changes in the conduction of PBL sessions.</p><p><strong>Results: </strong>Students mentioned that PBL was useful in better understanding of the basic sciences. PBL enhanced collaborative learning and helped them recognize their strengths and weaknesses. Participating in the PBL sessions improved their communication, leadership skills and decision-making ability.</p><p><strong>Conclusion: </strong>PBL session was an effective teaching-learning method in MBBS curriculum and it encourages self-directed learning in students and also ensures better integration of the basic and clinical sciences particularly problem-solving skills. Preparedness of tutors and resources available for conducting PBL are important to ensure satisfactory outcomes of PBL sessions.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575620","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":"Safety of Rapid Intermittent Bolus versus Slow Continuous Infusion of Hypertonic Saline for Managing Symptomatic Severe Hyponatremia: A Systematic Review and Meta-analysis.","authors":"Deep Dutta, Manoj Kumar, Ameya Joshi, Meha Sharma","doi":"10.4103/aam.aam_249_24","DOIUrl":"https://doi.org/10.4103/aam.aam_249_24","url":null,"abstract":"<p><strong>Aims: </strong>Three percent hypertonic saline (3NS) is an established treatment for severe hyponatremia. The optimal regimen for administering 3NS for severe hyponatremia, with the aim to minimize side effects is not known. This systematic review and meta-analysis aimed to evaluate the safety profile of rapid intermittent bolus (RIB) versus slow continuous infusion (SCI) of 3NS for managing symptomatic severe hyponatremia.</p><p><strong>Methods: </strong>Databases were searched for studies evaluating the use of RIB versus SCI/conventional therapy of 3NS for managing symptomatic severe hyponatremia. The primary outcome was to evaluate the occurrence of overcorrection of hyponatremia. Secondary outcomes were to evaluate the need for relowering therapy, duration of hospital stay, changes in sodium levels, osmotic demyelination syndrome (ODS), and mortality.</p><p><strong>Results: </strong>Data from three studies (290 patients) with severe hyponatremia was analyzed. Patients receiving RIB had a similar occurrence of overcorrection (relative risk [RR]: 1.59 [0.40, 6.35]; I2 = 61%; P = 0.51), need for relowering treatment to bring down serum sodium back to the normal range (RR: 2.53 [0.32, 20.20]; I2 = 81%; P = 0.38), ODS (RR: 2.24 [0.09, 57.18]; P = 0.63) and mortality (RR: 0.51 [0.08, 3.30]; I2 = 31%; P = 0.48), as compared to those receiving SCI. Patients receiving RIB had a marginally higher duration of hospital stay, which approached statistical significance (mean difference: 3.71 days [-0.18, 7.59]; I2 = 0%; P = 0.06).</p><p><strong>Conclusion: </strong>Both RIB and SCI of hypertonic saline were safe and effective for managing severe symptomatic hyponatremia. The reduced duration of hospital stay with SCI of hypertonic saline may suggest this may be the optimal way of administering hypertonic saline.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575679","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}