Annals of African Medicine最新文献

{"title":"Anesthetic Management of a Patient Undergoing Lymphangiography and Thoracic Duct Embolization for Chylothorax Following Coronary Artery Bypass Grafting.","authors":"Sunil Vasudev Rao, Keerthi Raj, Prajwal Siddappa, Ashna Shetty","doi":"10.4103/aam.aam_244_24","DOIUrl":"10.4103/aam.aam_244_24","url":null,"abstract":"<p><strong>Abstract: </strong>The thoracic duct is susceptible to damage from a variety of surgical operations, including esophagectomy, lung resection, and mediastinal or aortic surgery, because of its anatomical placement. Lymphatic leaks are known as chylothorax, which is a common complication of coronary artery bypass grafting. However, In congenital cardiac surgeries, the incidence of chylothorax ranges from 2.5% to 4.7%, while in esophageal procedures, it is 0.4%-4%. There have been a few reports of a chylous lymphatic leak following coronary bypass surgery. In this case report, we would like to present the anesthetic management of a chyle leak that developed a couple of days following triple coronary arterial bypass surgery, which was successfully managed with suprainguinal fascia iliaca compartment block for the embolization of the lymphatic duct.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"933-936"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526173","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 Prospective Comparative Study of Clinical Outcomes of Hook Plate and Endobutton Fixation Techniques for Acromioclavicular Joint Dislocation in Jharkhand, Eastern India.","authors":"Govind Kumar Gupta, Yaswant Kumar, Abhishek Kumar, Aditi Kashyap, Ashok Kumar Sharma","doi":"10.4103/aam.aam_179_24","DOIUrl":"10.4103/aam.aam_179_24","url":null,"abstract":"<p><strong>Background: </strong>Acromioclavicular joint dislocations (ACJDs) are prevalent shoulder injuries that often lead to significant disability, necessitating surgical repair to regain joint stability and function. The evolution of surgical techniques and the development of various implants have introduced multiple treatment modalities, among which the hook plate (HP) and the endobutton (EB) have gained prominence. The HP and EB are prominent implants used for this purpose, each offering distinct advantages and potential complications.</p><p><strong>Aim and objective: </strong>This study aimed to evaluate the clinical outcomes of acromioclavicular (AC) joint fixation with HP and EB fixation techniques in treating acute AC joint dislocations.</p><p><strong>Materials and methods: </strong>The present study was an observational prospective study conducted at Rajendra Institute of Medical Sciences, Ranchi, involving 34 patients, divided into two groups: EB and HP groups receiving fixation of ACJD by EB and HP techniques, respectively. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, the University of California, Los Angeles (UCLA) score, and American Shoulder and Elbow Surgeons (ASES) score at 1 st , 3 rd , 6 th , and 12 th months postoperatively.</p><p><strong>Result: </strong>Results demonstrated significant improvements in both the EB and HP groups over time, indicating reduced pain and disability. Throughout the follow-up period, the EB group consistently showed lower DASH scores and higher UCLA scores than the HP group. At 12 months, the EB group also exhibited a slightly higher ASES score, suggesting better functional outcomes and increased joint stability.</p><p><strong>Conclusion: </strong>The EB fixation technique may offer superior clinical outcomes in terms of functional improvement, joint stability, disability, and pain reduction compared to the HP technique for ACJD.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"735-740"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186300","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":"Clinico-epidemiological Patterns, Risk Factors, and Seroprevalence of Hepatitis C in Patients Attending a Tertiary Care Center in North India.","authors":"Sana Islahi, Sweta Singh, Shefali Gupta, Altaf Ahmad Mir, Arti Dwiwedi, Akhalesh Kumar Shakya, Priyanka Dwiwedi, Somdatt Sen","doi":"10.4103/aam.aam_216_24","DOIUrl":"10.4103/aam.aam_216_24","url":null,"abstract":"<p><strong>Introduction: </strong>The hepatitis C virus is an important cause of chronic hepatitis and primary hepatocellular carcinomas. Early treatment of HCV infection, especially in the acute phase, can facilitate elimination of the virus and prevent chronic infection. This will limit HCV-related liver damage and mortality. This study provides the current clinical-epidemiologic pattern, risk factors and seroprevalence of hepatitis C in clinical suspected cases attending different departments of a tertiary care centre.</p><p><strong>Methods: </strong>The study was conducted for a period of 1 year (March 2023 to March 2024) in the Department of Microbiology, AIIMS, Raebareli. After obtaining ethical clearance, serum samples were collected from all patients referred to the Department of Microbiology to determine antibodies against HCV. An ELISA was performed for anti-HCV antibodies and HBsAg. The results and relevant clinical information were noted and analysed.</p><p><strong>Results: </strong>Of the 16911 samples, 127 (0.75%) were positive for anti-HCV antibodies. Of the 127 anti-HCV positive samples, 88 (69.3%) samples had an S/Co ratio >5.0, while 39 (30.7%) samples had an S/Co ratio <5.0. Majority of the cases were in the age group 46-60 years (31%), followed by the age group 31-45 years (26.%) and 61-75 years (26.%). The number of male cases (55.91%) was slightly higher than female cases (44.09%). In our study, serum bilirubin was elevated in 29.8% (29/127) of anti-HCV seropositive patients, alanine transaminase (ALT) was elevated in 56.7% (72/127) of seropositive patients and 49.6% (63/127) of seropositive patients had elevated aspartate transaminase (AST). A history of surgery (30.9%) was the most important risk factor in the seropositive patients.</p><p><strong>Conclusion: </strong>The study shows the seroprevalence of hepatitis C virus in patients with clinical suspicion, with 0.75% of samples testing positive for anti-HCV antibodies. Most positive cases were observed in adults aged 46-60 years, with elevated ALT and AST levels found in several seropositive patients. Surgical history has emerged as a notable risk factor.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"791-795"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697363","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 STOP-BANG and Berlin Questionnaire in the Prediction of Overweight and Obese Patients Developing Desaturation during Induction of General Anesthesia: A Prospective Observational Study.","authors":"Srinivas Hebbal Thammaiah, Akshitha Jayakumar, Rashmi Hosahalli Sreenath, K N Archana, Vyshnavi Sriram","doi":"10.4103/aam.aam_240_24","DOIUrl":"10.4103/aam.aam_240_24","url":null,"abstract":"<p><strong>Introduction: </strong>Obstructive sleep apnea increases perioperative risk due to compromised airway patency. This study compared the predictive capabilities of the STOP-BANG and Berlin Questionnaires for intraoperative desaturation among overweight and obese patients undergoing general endotracheal anesthesia.</p><p><strong>Aims: </strong>The study primarily aimed to compare desaturation onset time and time to reach 93% oxygen saturation on room air during induction of general anesthesia. Secondary objectives included assessing associated airway complications.</p><p><strong>Settings and design: </strong>A prospective observational study was conducted at a tertiary hospital with overweight and obese patients undergoing elective surgeries under general endotracheal anesthesia.</p><p><strong>Subjects and methods: </strong>Hundred patients aged 18-60 years, body mass index ≥ 25 belonging to the American Society of Anesthesiologists Physical Status Class I-II, divided based on assessment by STOP-BANG (Group S) and Berlin (Group B) Questionnaire participated in the study. Standard anesthesia protocols were followed. SpO2, heart rate, and blood pressure were monitored. Desaturation onset, duration, and airway complications were recorded.</p><p><strong>Statistical analysis used: </strong>Comparisons were made using t -tests and Chi-square tests, with significance set at P < 0.05.</p><p><strong>Results: </strong>Group S had significantly lower SpO2 during induction ( P = 0.001) and intubation ( P = 0.007), shorter desaturation onset (1.12 vs. 1.55 min, P = 0.00089), and shorter desaturation duration (1.56 vs. 2.21 min, P = 0.013). More patients in Group S required advanced airway equipment (6 vs. 4), and 18% had postoperative desaturation versus none in Group B ( P = 0.002). Higher STOP-BANG scores showed stronger correlations with lower SpO2, earlier desaturation onset, longer desaturation periods, and increased airway complications.</p><p><strong>Conclusions: </strong>The STOP-BANG questionnaire is a superior tool for predicting desaturation among overweight and obese patients during induction of general endotracheal anesthesia.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"870-875"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964950","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":"Barriers to Effective Wound Healing in Surgical Site Infection Following Cesarean Section.","authors":"Devyani Misra, Vandana Gautam, Mariyam Faruqui, Manodeep Sen","doi":"10.4103/aam.aam_189_24","DOIUrl":"10.4103/aam.aam_189_24","url":null,"abstract":"<p><strong>Background: </strong>Cesarean section (CS) is the most common surgical procedure worldwide and although usually safe is sometimes associated with morbidity and mortality. Surgical site infection (SSI) post-CS is a frequently encountered cause of prolonged hospitalization and financial burden on the healthcare system. The reported incidence is 9%-17%. Risk factors are poor antenatal care, comorbidities, chorioamnionitis, prolonged labor, improper use of antibiotics, and emergency delivery. Although enormous data are available regarding the risk factors for SSI, not much information exists about factors affecting wound healing.</p><p><strong>Aim: </strong>The aim is to evaluate the barriers to effective wound healing and response after primary management in SSI among women undergoing CS.</p><p><strong>Methods: </strong>A prospective study was done enrolling 100 women with SSI post-CS. Swabs were taken from those with SSI and cultures were done. Wound characteristics and healing were followed. Data were collected and analyzed.</p><p><strong>Results: </strong>Most were primiparous (44%) and 66% of CS were emergency during labor. Factors which significantly affected healing were socio-economic status, emergency/elective delivery, surgery in labor or prelabor, personal hygiene, history of previous CS, anemia, Southampton wound grade, duration since membrane rupture >18 h, and day of primary wound repair since presentation ( P < 0.05). Longer mean duration of day since surgery and delayed primary repair also significantly affected wound healing.</p><p><strong>Conclusion: </strong>SSI may not always be avoidable. Predicting the risk with associated factors and judicious use of antibiotics may help reduce the incidence.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"741-749"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973255","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":"An Anesthetic Management of Takayasu Arteritis with Aortic Regurgitation in a Parturient Posted for Cesarean Section.","authors":"Ashna Shetty, D Akshatha, Shilpa A Naik, R K Ranjan, Freeda Praveena Cutinha, Prajwal Siddappa","doi":"10.4103/aam.aam_243_24","DOIUrl":"10.4103/aam.aam_243_24","url":null,"abstract":"<p><strong>Background: </strong>Takayasu arteritis is an idiopathic, chronic, and inflammatory condition that mostly affects the aorta and its branches. Nearly 80% of occurrences involve females who are in their reproductive years. Although there is no effect on the disease's progression during pregnancy, these patients should be monitored for blood pressure (BP) changes and restricted intrauterine growth because they can develop complications such as hypertension, multiple organ dysfunction, and stenosis that reduces regional blood flow. Anesthetic implications of Takayasu arteritis include uncontrolled hypertension, maintenance of mean arterial pressure which is adequate to maintain end organ function, difficulty in monitoring of arterial pressure and tight maintenance of fluid regime.</p><p><strong>Case presentation: </strong>A 31-year-old parturient, Gravida 3 Para 2 Living 0, hailing from north part of Karnataka, known hypertensive with previous lower segment cesarean section (LSCS) was a diagnosed case with Takayasu arteritis presented to us for elective LSCS. She had ahistory of two previous deaths of her neonate immediately following delivery. Moreover, on further evaluation was diagnosed with the above condition. Although a diagnosed case, she was never put on any treatment for the same. She was otherwise healthy carrying out her routine work without any discomfort. Her two-dimensional echo revealed severe aortic regurgitation. Rheumatology and CTVS opinion were taken. Cesarean section was planned under combined spinal epidural taking into account her clinical state and hemodynamics.</p><p><strong>Conclusion: </strong>Pregnant women with Takayasu arteritis may experience an array of complications. Careful patient evaluation, treatment of TA and its complications, formulating anesthetic plan are fundamental. The key issue for these individuals is maintaining perfusion. Regional anesthesia is a safe anesthetic treatment that offers thorough preanesthetic examination and close monitoring of neurological status and BP for cesarean sections in pregnant women with Takayasu arteritis. Avoiding hemodynamic alterations and maintaining organ perfusion during the perioperative period are the most crucial objectives. To avoid postoperative complications, the patient should be monitored in an intensive care unit.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"937-940"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952265","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":"Assessment of Interleukin-6 Levels in Patients with Liver Cirrhosis and its Correlation with Disease Severity and Mortality.","authors":"Chavi Sharma, Sumit Pal Singh Chawla, Ravinder Garg, Sarabjot Kaur, Rajat Bhatt, Shubham Aryan, Sagarneel Chaudhuri","doi":"10.4103/aam.aam_271_24","DOIUrl":"10.4103/aam.aam_271_24","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;Interleukin-6 (IL-6) is a pleiotropic cytokine that has an important function in the regulation of immunity, inflammation, hematopoiesis, and cancer biosynthesis. Liver cirrhosis is an advanced stage of liver fibrosis, and inflammatory cytokines play a key role in the activation of numerous cells involved in the pathogenesis of fibrosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;The aims of this study were to assess serum IL-6 levels in patients with liver cirrhosis, and to study the correlation of IL-6 levels with the disease severity and mortality at 1 month in these patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Settings and design: &lt;/strong&gt;This prospective observational study was conducted in the Medicine department of a tertiary care teaching hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Subjects and methods: &lt;/strong&gt;The study was conducted on 50 patients with liver cirrhosis aged 20-60 years. Serum IL-6 levels were measured by the chemiluminescence method in all the patients at the time of presentation. The relationships between IL-6 levels and the disease severity, in terms of Child-Turcotte-Pugh (CTP) score and class, and between IL-6 levels and mortality at 1 month, were analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Statistical analysis used: &lt;/strong&gt;The continuous variables were expressed as mean and standard deviation, whereas the categorical variables were summarized as frequencies and percentages (%). Non-normally distributed variables were expressed as the median and interquartile range (IQR). The Mann-Whitney U -test was employed for the comparison of two continuous variables and the Kruskal-Wallis test was employed for comparing 3 or more continuous variables. Spearman's correlation coefficient (ρ) was employed to check the correlation between two continuous variables. Logistic regression analysis was used to identify independent predictors of disease outcome. P &lt;0.05 was considered statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Most patients were males (82%), and the maximum number of patients were in the age groups of 35-44 (32%) and 45-54 years (34%). Most of them had decompensated cirrhosis (CTP class B: 42% and CTP class C: 40%). On follow-up, 84% of patients were alive at 1 month, whereas 16% expired. Mean IL-6 levels of the study population were 38.39 ± 39.36 pg/mL. IL-6 levels showed a positive correlation with grade of ascites ( P = 0.0001), grade of encephalopathy ( P = 0.0001), CTP class ( P = 0.0001), CTP score (ρ = 0.863), international normalized ratio (ρ = 0.356), serum bilirubin (ρ = 0.432), and a negative correlation with serum albumin (ρ = -0.344). IL-6 levels were significantly higher in patients who expired in comparison to those who were alive at 1 month (mean: 109.87 ± 45.57 pg/mL, median [IQR]: 120.13 [73.87-145.60] pg/mL vs. 24.77 ± 17.60 pg/mL, 22.55 [11.87-35.50] pg/mL, P = 0.0001). IL-6 was found to be a significant predictor of disease outcome (odds ratio = 1.084, 95% confidence interval = 0.99-1.19).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;I","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"876-883"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802325","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":"Attitudes, Behaviors, and Stigmatization toward Women with Breast Cancer among Saudi Arabian Men.","authors":"Israa Aqeel Alghafli, Ghadeer Aqeel Alghafli, Latifah Khalid Alnami, Zahra Ali Alhajji, Reem Ali AlQarni, Ghadah Abdullah Albejais, Jumanah Jamal Alabbad, Loai S Albinsaad, Mohammed Yousef Alessa, Ali Saleh Albinsaad","doi":"10.4103/aam.aam_247_24","DOIUrl":"10.4103/aam.aam_247_24","url":null,"abstract":"<p><strong>Introduction: </strong>Globally, breast cancer is the most frequent cancer to affect women. The death rate from breast cancer has dramatically dropped as a result of recent advancements in screening and therapy. The negative attitude that society has toward cancer patients, known as the stigma, keeps them from developing effective coping strategies. This study aimed to examine the attitudes of Saudi Arabian men, their behaviors, and their stigma toward females with breast cancer.</p><p><strong>Materials and methods: </strong>This descriptive cross-sectional study was conducted in the Eastern Province of Saudi Arabia between February 4 and March 31, 2024. Following a comprehensive pilot study involving 50 participants, the researchers developed and validated a pre-structured online questionnaire.</p><p><strong>Results: </strong>In total, 796 (68.2%) met the inclusion criteria and completed the study questionnaire. Participants' ages ranged between 18 and 60 years with a mean age of 31.6 ± 11.8 years old. Regarding educational level, 129 (23.8%) had a secondary level of education or below, and 403 (74.2%) were university students/graduates. Regarding males' attitudes toward females with breast cancer, the lowest score, indicating the most positive attitude, was reported for a section on cancer-related myths and preconceptions (1.4/5), followed by women's working ability (1.6/5), disease severity (1.8/5), and nervousness (2.1/5). Attitudes toward marriage and concealing showed the highest scores, indicating the lowest attitude and perception levels (2.3/5 for each). Men's score for attitude and stigma was 1.9 ± 0.6 of 5 (38%).</p><p><strong>Conclusion: </strong>This study showed that educated men with sufficient knowledge about breast cancer showed positive attitudes and low stigma towards females with the disease.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"827-834"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690900","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":"Atypical Kawasaki Disease in a 5-month-old Infant.","authors":"Hiba Habeebu Rahiman, Subhranshu Sekhar Kar, Mariam Mehwish Mohsin, Rajani Dube, Naheel Mohammed Jumaa Alboot","doi":"10.4103/aam.aam_27_25","DOIUrl":"10.4103/aam.aam_27_25","url":null,"abstract":"<p><strong>Abstract: </strong>Kawasaki disease (KD) is an acute febrile vasculitis primarily affecting medium-sized arteries in children under 5 years. Infants under 6 months represent a diagnostic challenge due to atypical or incomplete presentations, increasing the risk of coronary artery lesions and complications such as aneurysms. Early diagnosis and treatment with intravenous immunoglobulin (IVIG) and aspirin are crucial to prevent long-term cardiac sequelae. We report a rare case of KD in a 5-month-old Bangladeshi girl presenting with prolonged fever, rash, and sterile pyuria. Initial evaluations pointed to partially treated meningitis, delaying KD diagnosis. Subsequent symptoms included edema, osteoarthritis, and persistent inflammation, leading to an echocardiographic detection of a small coronary aneurysm. Treatment with IVIG, aspirin, and corticosteroids resulted in the resolution of symptoms and normalization of cardiac findings. Infants below 6 months often present with incomplete KD, complicating diagnosis and delaying treatment. This case underscores the importance of considering KD in febrile infants with persistent inflammation, even in the absence of classic symptoms. Echocardiography and laboratory markers remain essential for early detection and management. Increased awareness and timely intervention in atypical and incomplete KD presentations are critical for reducing complications, particularly in high-risk groups like infants under 6 months.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"944-948"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762845","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":"Diplopia Rhinoceros.","authors":"B Sai Surya Teja, Ajith Balineni, I Lavanya Sri, Krishna Sowmya Mulpuri, Eswar Ganti","doi":"10.4103/aam.aam_14_25","DOIUrl":"10.4103/aam.aam_14_25","url":null,"abstract":"<p><strong>Abstract: </strong>Bilateral cranial nerve VI palsy is a rare neuro-ophthalmological presentation often associated with systemic or intracranial pathologies. In diabetic patients, cranial neuropathies can occur due to immune suppression, ischemia, or infectious complications. This case highlights the interplay of poorly controlled type 2 diabetes mellitus (T2DM), sinusitis, and skull base inflammation leading to bilateral lateral rectus palsy. A 56-year-old postmenopausal woman presented with a 10-day history of headache, an 8-day history of right-sided facial pain, and progressive binocular diplopia over 5 days. Initial evaluation revealed poorly controlled T2DM (blood glucose: 256 mg/dL) and hypertension. Neurological examination identified bilateral esotropia, limited abduction, and confirmed bilateral cranial nerve VI palsy. Imaging revealed bilateral ethmoidal and sphenoidal sinusitis with skull base inflammation. The patient had a concurrent diagnosis of esophageal candidiasis. The findings suggested diabetic predisposition to infection leading to sinusitis-related skull base osteitis and cranial neuropathy. Cranial nerve VI is anatomically vulnerable to ischemic and compressive injury due to its long intracranial course and proximity to the clivus and sphenoid sinus. Chronic hyperglycemia exacerbates susceptibility to infections and ischemia by impairing immune responses and inducing microvascular damage. The patient was treated with glycemic optimization, antimicrobial therapy for sinusitis, and antifungal agents for candidiasis. Multidisciplinary care ensured systemic and local disease control, preventing further complications. This case underscores the importance of considering neuro-ophthalmological complications in diabetic patients presenting with cranial nerve involvement and systemic infection. It highlights the need for timely diagnosis and targeted management to prevent permanent neurological deficits. Further studies are warranted to explore the pathophysiology and optimal treatment approaches for such rare diabetic complications.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"949-953"},"PeriodicalIF":0.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762800","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}