Annals of African Medicine最新文献

{"title":"Nebulized Dexamethasone versus Intravenous Dexamethasone in Prevention of Postoperative Sore Throat: An Interventional Study.","authors":"Debahuti Chatterjee, Shweta Sinha, Laxmi Shenoy, Aparna Satish, Malavika Kulkarni, Sushma Thimmaih Kanakalakshmi","doi":"10.4103/aam.aam_150_25","DOIUrl":"10.4103/aam.aam_150_25","url":null,"abstract":"<p><strong>Context: </strong>This study investigated the effects of preoperative dexamethasone, administered intravenously or through nebulization, on postoperative sore throat (POST) and glucose regulation in patients undergoing general anesthesia (GA) with endotracheal intubation.</p><p><strong>Aims: </strong>This study aimed to asses the effectiveness of nebulised versus intravenous dexamethasone in prevention of postoperative sorethroat in patients undergoing GA with endotracheal intubation.</p><p><strong>Settings and design: </strong>This study was a prospective, single-blind, randomized controlled trial with a sample size of 138 participants.</p><p><strong>Subjects and methods: </strong>A total of 144 patients were randomized into three groups (48 each): Group A (control), Group B (nebulized dexamethasone), and Group C (intravenous dexamethasone). Baseline characteristics, including age, gender, and ASA classification, were similar across groups. POST was assessed at multiple time points postoperation, whereas modified Cormack-Lehane grading and intubation attempts were recorded intraoperatively. Blood glucose (general random blood sugar [GRBS]) levels were measured pre- and postoperatively to assess the effect of dexamethasone.</p><p><strong>Statistical analysis used: </strong>Statistical analysis was performed using SPSS (Statistical Package for the Social Sciences) version 21 (IBM SPSS Statistics, IBM Corporation, NY, USA).</p><p><strong>Results: </strong>The gender distribution differed significantly across groups ( P = 0.04), whereas other demographic factors were comparable. Group B reported the lowest incidence of POST across all time points, with significant reductions compared to Groups A and C ( P = 0.001). Cormack-Lehane Grade 1 laryngeal view rates were similar across groups ( P = 0.76), with no significant differences in intubation attempt numbers ( P = 0.76). Postoperative GRBS was significantly higher in Group C than in Group B ( P = 0.001), indicating increased glucose levels with intravenous dexamethasone.</p><p><strong>Conclusions: </strong>Preoperative nebulized dexamethasone effectively reduced POST incidence with minimal impact on postoperative glucose levels, whereas intravenous administration was associated with higher glucose levels. Nebulized dexamethasone may be a preferable option for sore throat prevention in patients undergoing GA with endotracheal intubation, balancing efficacy and metabolic impact. Further studies are recommended to confirm these findings.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"645-651"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881907","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":"Programmed Death Ligand-1 Expression and Its Determinants in Patients with Lung Cancer: A Tertiary Care Center Experience in India.","authors":"Mohammad Arif, Ved Prakash, Hemant Kumar, Saumya Shukla, Anurag Tripathi, Mrityunjaya Singh, Sachin Kumar, Ajay Kumar Verma","doi":"10.4103/aam.aam_147_25","DOIUrl":"10.4103/aam.aam_147_25","url":null,"abstract":"<p><strong>Background: </strong>Targeted therapy and immunotherapy have improved survival and quality of life in advanced lung cancer. In this study, we evaluated the frequency of programmed death ligand-1 (PDL-1) expression in lung cancer and its association with different clinical and histological subtypes.</p><p><strong>Materials and methods: </strong>It is a descriptive observational study, in which patients diagnosed with lung cancer were included. PDL-1 testing was done using the monoclonal antibody PDL-1 SP263 primary antibody. The association between the PLD-1 expression with the clinical parameters and histological grading of the disease was analyzed using the Chi-square test.</p><p><strong>Results: </strong>One hundred and fifty patients were included in our study. The majority of the patients had nonsmall cell lung cancer (90.7%). Among these, 78.7% had adenocarcinoma, 19.1% had squamous cell cancer, and only 2.2% had adeno-squamous cancer. Thirty percent were PDL-1 positive. In patients who were PDL-1 positive, high PDL-1 expression (tumor proportion score ≥50%) was seen in 40%. There was no significant difference seen in PDL-1 expression among different histological subtypes. A significant association of PDL-1 expression was seen with the young age group (34.8% below 60 years vs. 22% above 60 years), and history of tobacco chewing (42% vs. 27%). It was also seen more in men, nonsmokers, in those without history of biomass fuel exposure, less advanced stage, and with no history of pleural invasion. In patients with adenocarcinoma, significantly high PDL-1 expression was seen in those who were negative for EGFR mutation.</p><p><strong>Conclusion: </strong>Our study has found new and different associations between PDL-1 expression and patient outcomes.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"601-607"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881909","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":"Role of Thoracic Epidural Anesthesia in Providing Adequate Intraoperative and Postoperative Opioid-free Analgesia for Breast Cancer Surgeries.","authors":"Nitu Puthenveettil, Sunil Rajan, Jerry Paul","doi":"10.4103/aam.aam_130_25","DOIUrl":"10.4103/aam.aam_130_25","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer is the most common malignancy in women. Postoperative pain and opioid analgesics are suspected to influence cancer recurrence. In this study, we try to assess the feasibility of providing complete opioid-free surgical anesthesia and postoperative analgesia for breast cancer surgeries.</p><p><strong>Methodology: </strong>This prospective observational study was performed on 30 patients posted for breast cancer surgery under thoracic epidural anesthesia. The epidural catheter was placed in the upper thoracic space. A titrated bolus of 10-12 mL of 2% lignocaine with adrenaline followed by an infusion of 0.2% ropivacaine at 5-10 mL/hour was used. Time taken from epidural bolus to skin incision, the total dose of local anesthetic and propofol required, postoperative pain score, the patient and surgeon satisfaction score, and adverse events were noted.</p><p><strong>Results: </strong>Opioid-free epidural anesthesia was successful in all patients. The average time required to start the surgery after placement of the epidural catheter was 17.8 ± 2.5 min. The average total dose of local anesthetic and propofol supplemented was 6.9 ± 4.5 mL and 18.9 ± 11.8 mg, respectively. Postoperative pain scores were <4 at all time points. The average surgeon and patient satisfaction scores were 9.1 ± 0.2 and 9.1 ± 0.2, respectively. Thirteen percent of patients required treatment for hypotension. There were no episodes of bradycardia or airway compromise.</p><p><strong>Conclusions: </strong>Based on our data, it appears to be safe to perform opioid-free breast cancer surgeries under thoracic epidural anesthesia with complimentary sedation and local infiltration. Epidural infusion of local anesthetic provides excellent intra- and postoperative analgesia, which helps avoid the use of opioids.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"514-517"},"PeriodicalIF":0.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697439","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":"Diagnostic Surprises: Thoracic Malignancies with Atypical Features in Young Adults.","authors":"Hemant Kumar, Aneeket Rastogi, Sanjay Singhal, Sagar Jain","doi":"10.4103/aam.aam_755_25","DOIUrl":"https://doi.org/10.4103/aam.aam_755_25","url":null,"abstract":"<p><strong>Abstract: </strong>This case series highlights three young patients who presented with thoracic malignancies typically seen in older adults. The first case involved metastatic soft tissue sarcoma in a young male in his twenties, the second was a young female in her late thirties diagnosed with adenocarcinoma of the lung after prolonged fever, and the third was a young male in his early twenties with metastatic osteogenic sarcoma presenting as chest pain and respiratory distress. These cases emphasize the need for heightened clinical suspicion and early diagnostic evaluation of malignancies in young individuals, even in the absence of traditional risk factors, to enable timely and appropriate management.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759901","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":"Recurrent Hemolytic Anemia in an Infant with Hereditary Elliptocytosis at a Nigerian Hospital.","authors":"Efeturi Agelebe, Oshiname Frederick Pamehase, Temitope Eunice Agelebe, Oyetoke Christina Oderanti","doi":"10.4103/aam.aam_767_25","DOIUrl":"https://doi.org/10.4103/aam.aam_767_25","url":null,"abstract":"<p><strong>Abstract: </strong>Hereditary elliptocytosis (HE) is a genetic disorder of the red blood cell membrane leading to chronic hemolytic anemia. It is under-recognized as a cause of anemia in Nigerian infants. We report the case of a 6 month old male Nigerian infant presenting with recurrent pallor over 3 months, necessitating five prior blood transfusions at the Pediatric Emergency Unit of Efeturi's Lifeline Hospital, Osogbo, Nigeria. Physical examination revealed severe pallor and a tachycardia of 160 beats/min. Investigations conducted revealed a packed cell volume of 22% and a peripheral blood film showing numerous elliptocytes and poikilocytes. Anemia was managed with packed cell transfusion, and the patient was discharged and followed up monthly. This case underscores the role of peripheral blood morphology in diagnosing HE even in private practice in resource-limited settings. It illustrates the substantial burden of recurrent, transfusion-dependent anemia caused by HE in infancy and highlights the need for improved access to diagnostic and long-term care for chronic hematological disorders in this region.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760059","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":"Early Surgical Intervention in an Infant with Angiomyxoma: Ensuring Complete Excision and Prevention of Recurrence.","authors":"Jovitha Maria Jacob, Akarsh Reddy, Aishwarya Verma, Mayur Ingale, Vinod Shinde, Manu S Babu","doi":"10.4103/aam.aam_753_25","DOIUrl":"https://doi.org/10.4103/aam.aam_753_25","url":null,"abstract":"<p><strong>Abstract: </strong>Angiomyxoma is a rare, benign mesenchymal tumor rarely encountered in the infantile hard palate. This case report describes the presentation, diagnostic workup, and successful management of an angiomyxoma in an 11-month-old male infant. An 11-month-old male was presented to the ENT department with a slowly enlarging, asymptomatic palatal swelling first noticed at 9 months of age. Intraoral examination revealed a 2 cm × 2 cm, soft, nontender mass on the anterior hard palate. A contrast-enhanced computed tomography scan identified a well-defined, oval, heterogeneously enhancing cystic lesion (8 mm × 15 mm × 18 mm) with no bony erosion. The patient underwent complete surgical excision under general anesthesia. The lesion was excised in toto via an intraoral approach, revealing a well-encapsulated, gelatinous mass. Histopathological examination confirmed the diagnosis of angiomyxoma, showing spindle cells in a myxoid stroma with numerous thin-walled vessels. The postoperative course was uneventful, and the child resumed feeding normally. At the 6-month follow-up, there was no evidence of recurrence, and both functional and cosmetic outcomes were excellent. This case underscores that angiomyxoma, though rare, should be considered in the differential diagnosis of pediatric palatal masses. A combination of cross-sectional imaging and complete surgical excision is the cornerstone of management, leading to a favorable prognosis with low recurrence risk.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759887","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":"Comparative Study of the Prognostic Efficiency between Ranson's Criteria and Modified Computed Tomography Severity Index in Patients Diagnosed with Acute Pancreatitis.","authors":"A Naren Kumar, Chandan Sanga","doi":"10.4103/aam.aam_103_26","DOIUrl":"https://doi.org/10.4103/aam.aam_103_26","url":null,"abstract":"<p><strong>Background: </strong>Acute pancreatitis (AP) ranges from mild disease to severe forms associated with organ failure and significant mortality. Early assessment of disease severity is important for timely management and improved outcomes. Ranson's criteria is a traditional clinical scoring system, whereas the modified computed tomography severity index (MCTSI) is a radiological scoring system used to assess disease severity. This study compared the prognostic performance of these two scoring systems in patients with AP.</p><p><strong>Materials and methods: </strong>A hospital-based cross-sectional observational study was conducted from 2020 to 2021 at a tertiary care center in Chengalpattu, Tamil Nadu, India. A total of 122 adults aged 25-70 years with confirmed AP were included. Disease severity was assessed using Ranson's criteria at admission and 48 h and MCTSI based on contrast-enhanced computed tomography findings. Outcomes evaluated included organ failure, mortality, and length of hospital stay. Receiver operating characteristic curve analysis was performed.</p><p><strong>Results: </strong>The mean age was 41.8 ± 8.9 years, with male predominance (98.4%), and alcohol was the most common etiology (75.4%). According to the MCTSI classification, 26.2% had mild, 53.3% moderate, and 20.5% severe pancreatitis. Organ failure occurred in 29.5%, and mortality was 5.7%. Length of hospital stay increased significantly with disease severity (P < 0.001). MCTSI showed higher predictive accuracy with area under the curve = 0.93 compared with 0.81 for Ranson's criteria.</p><p><strong>Conclusion: </strong>MCTSI demonstrated superior prognostic performance compared with Ranson's criteria in predicting severity and clinical outcomes in AP and may be useful for early risk stratification.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759939","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 Cross-sectional Study of Skin Prick Test Sensitivity to Common Allergens in Patients of Nasobronchial Allergy.","authors":"Dinesh Arumugam, Jereen Varghese, Nithin Thomas","doi":"10.4103/aam.aam_784_25","DOIUrl":"https://doi.org/10.4103/aam.aam_784_25","url":null,"abstract":"<p><strong>Introduction: </strong>Nasobronchial allergy, which includes allergic rhinitis and asthma, is a common and debilitating condition. Identifying specific allergens responsible for symptoms is essential for effective management. Skin prick tests (SPTs) are a reliable diagnostic tool for detecting immunoglobulin E-mediated allergic reactions, especially to environmental and food allergens.</p><p><strong>Aim and objectives: </strong>This study aimed to assess skin prick sensitivity to common allergens in patients with nasobronchial allergy. The primary objective was to identify the most common allergens, and secondary objectives included assessing sensitivity patterns and their relationship with sociodemographic factors.</p><p><strong>Materials and methods: </strong>This hospital-based cross-sectional study was conducted in the Department of Pulmonary Medicine at a tertiary care hospital over 18 months. A total of n = 125 consecutive patients aged 18 years and above with uncontrolled nasobronchial allergy were recruited. SPTs were performed using 85 allergens. Sociodemographic data were collected, and the Sino-Nasal Outcome Test-20 (SNOT-20) was used. Data analysis was performed using SPSS version 29.</p><p><strong>Results: </strong>Among 125 participants, 49.6% had a positive SPT reaction. The most common allergens identified were House dust (78%), dust mites (Dermatophagoides arina) (76.8%), fungal spores (Aspergillus fumigatus, 64%), and plant allergens (Ischaemum indicum, 73.6%). Food allergens such as prawn (50.4%) and paneer (49.6%) were also prevalent. The mean SNOT-20 score was 42 ± 20.8, indicating moderate sinus and nasal symptoms. While most demographic factors showed no significant association with allergen sensitivity, housing type was significantly associated with food allergens, and rural participants had higher fungal allergen sensitivity (P = 0.040). These findings highlight the burden of allergen sensitivity and its impact on nasal and sinus symptoms in affected individuals.</p><p><strong>Conclusion: </strong>This study highlights that dust mites, food allergens, and fungal spores are among the most common sensitizing agents in patients with nasobronchial allergy. These findings can guide personalized allergy management and environmental interventions for affected individuals.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759797","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":"Case Report Bilateral Retinal Vasculitis: A Vision-threatening Flare of Systemic Lupus Erythematosus.","authors":"Lokisha Chandwani, Siddhartha Gollamudi, Renu Magdum, Himani Yadav","doi":"10.4103/aam.aam_216_26","DOIUrl":"https://doi.org/10.4103/aam.aam_216_26","url":null,"abstract":"<p><strong>Abstract: </strong>Retinal vasculitis is a rare but severe manifestation of systemic lupus erythematosus (SLE) that can lead to profound visual morbidity if not promptly recognized and aggressively managed. We report a case of a 21-year-old female with a history of SLE diagnosed in 2023 with mucocutaneous and hematological involvement, who presented with bilateral vision-threatening retinal vasculitis following a 2-year period of noncompliance with immunosuppressive therapy. The patient initially experienced low-grade fever for 5 months, followed by a generalized tonic-clonic seizure and progressive bilateral painless visual deterioration over 15 days, accompanied by dyspnea on exertion and oral ulcers. Ophthalmic examination revealed bilateral retinal vasculitis with macular edema, retinal hemorrhages, vascular sheathing, and extensive capillary nonperfusion on optical coherence tomography angiography. Visual acuity at presentation was 6/36 in the right eye and finger counting at close to face in the left eye. Systemic investigations confirmed active SLE with anemia, elevated inflammatory markers, and positive antinuclear antibodies. The patient was managed with high-dose intravenous methylprednisolone for 3 days followed by oral prednisolone, mycophenolate mofetil, and hydroxychloroquine, along with sectoral laser photocoagulation for ischemic areas. After treatment, significant improvement was observed with resolution of hemorrhages, decreased macular edema, improved visual acuity to 6/12 bilaterally, and reduction in capillary dropout areas. This case emphasizes the critical importance of multidisciplinary management and strict adherence to immunosuppressive therapy in SLE patients to prevent sight-threatening complications.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759855","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":"Air Pyelogram for Percutaneous Nephrolithotomy in Patients with Iodinated Contrast-induced Anaphylaxis.","authors":"Suraj Bhondave, Racheruvu Siddhartha","doi":"10.4103/aam.aam_826_25","DOIUrl":"https://doi.org/10.4103/aam.aam_826_25","url":null,"abstract":"<p><strong>Abstract: </strong>Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large renal calculi. Fluoroscopic access conventionally requires iodinated contrast, which may precipitate anaphylaxis in sensitized individuals. We report two cases of contrast-induced anaphylaxis, in which air pyelography was successfully used to delineate the pelvicalyceal system and obtain safe renal access during PCNL.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759896","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}