Epididymal tuberculosis: Case report

The increasing incidence of extrapulmonary tuberculosis (EPT) parallels the global increase in the prevalence of tuberculosis. Epididymal tuberculosis (TB), a rare form of EPT, may present both diagnostic and treatment challenges. A case of epididymal TB where the diagnosis was made after an orchidectomy for a suspected malignancy is discussed. The thrust of this presentation is to highlight the varied clinical manifestations of tuberculosis, the great masquerader, in our local setting. The case highlights the need to have a high level of diagnostic suspicion. This will limit unnecessary surgical procedures and prevent complications associated with delay in initiating treatment

Pituitary Apoplexy: Report Of Two Cases

Pituitary apoplexy is a common clinical syndrome characterised by acute headache, ophthalmoplegia, diminished visual acuity and altered mental status caused by the sudden haemorrhage or infarction of the pituitary gland. The two cases reported highlight the variability in presentation which underscores the need for a high index of suspicion and the need for MRI in patients presenting with a thunderclap headache and \'normal\' initial investigations. East African Medical Journal Vol. 85 (3) 2008: pp. 142-14

Antiretroviral therapy dose adjustments based on calculated creatinine clearance

Background: Whereas therapy for HIV is dependent on level of creatinine clearance, most laboratories locally only report an absolute creatinine value. There is likelihood that the patients already on antiretroviral therapy (ART) may have required dosage adjustment at the time of initiation of therapy or sometime during ongoing therapy. This paper explores a group of patients who are already on ART to determine their creatinine clearance and assess the need for ART dose adjustment. Objective: To determine the proportion of stable HIV outpatients who have a documented creatinine clearance (CrCI) and the proportion requiring antiretroviral drug dose adjustments depending on their creatinine clearance. Design: Retrospective observational study. Setting: One stop HIV medical clinic, Aga Khan University Hospital, Nairobi between January and February 2007. Subjects: Ninety three patients seen. Results: None of the study subjects had a calculated creatinine clearance in their medical records. Fifteen of the 93 patients (16.1%) had no serum creatinine performed in the twelve months preceding the last clinic visit. Nine of the remaining 78 patients (11.5%) had evidence of renal insufficiency (CrCI \u3c60mls/min) as estimated by the Cockroft Gault method, with six patients (7.7%) requiring dose adjustments to the one or more drugs in their antiretroviral therapy (ART) regime (CrCI \u3c50mls/min). Conclusion: It is imperative to have a CrCI prior to and during follow up of patients with HIV disease on ART to reduce potential drug toxicities and interactions, especially with the increased utilisation of newer and potentially more nephrotoxic antiretrovirals

Utility of liver biopsy in HIV-infected patients presenting with febrile illnesses and inconclusive evaluation

Objectives: To determine the utility of liver biopsy in providing a diagnosis in HIVinfected patients presenting with febrile illnesses and inconclusive initial investigative work up. Design: A retrospective descriptive study. Setting: The Aga Khan University Hospital, Nairobi. Subjects: Twelve in-patients with HIV disease who underwent liver biopsy following inconclusive initial investigative work up for febrile illnesses between January and December 2007. Results: Seven out of 12 patients had granulomatous hepatitis reported on histology with characteristic tuberculous epitheloid granulomas all having stainable acid-alcohol fast bacilli on Ziehl-Nielsen (ZN) stain. The mean alkaline phosphatase (ALP) and gamma glutamyl transpeptidase (GGT) levels in these seven patients were 260U/L and 304U/L respectively, while the mean aspartate aminotransferase (SGOT) and alanine aminotransferase (SGPT) were 106U/L and 72U/L respectively. Conclusion: Disseminated tuberculosis is still among the most common causes of unexplained pyrexia in our HIV- infected cohort and a liver biopsy, performed earlier in the investigative work up of unexplained fever in the HIV-infected patient, would be a useful adjunct in providing a diagnosis

The influence of antiretroviral therapy on the QTc interval in an African cohort

Cardiovascular disease in human immunodeficiency virus (HIV) infection encompasses a wide range of pathologic entities, including myocardial, pericardial, and endocardial disease, atherosclerosis, arrhythmias, and vasculitis. The most common manifestations of HIV-associated heart disease in sub- Saharan Africa are pericarditis, cardiomyopathy, and pulmonary hypertension [1]. Coronary artery disease, lipodystrophy, and metabolic syndrome, although common in developed countries, are traditionally thought to be less clinically significant problems in the African subcontinent [2]. It is well known that prolongation of the QTC interval can predispose patients to potentially fatal ventricular tachyarrhythmias, particularly torsades de pointes, and thus is an independent predictor of cardiovascular morbidity and mortality [3]

Pediatric blood transfusion practices at a regional referral hospital in Kenya

BACKGROUND Severe anemia in children is a major public health problem in sub-Saharan Africa. In this study we describe clinical and operational aspects of blood transfusion in children admitted to Coast Provincial General Hospital, Kenya. STUDY DESIGN AND METHODS This was an observational study where over a 2-year period, demographic and laboratory data were collected on all children for whom the hospital blood bank received a transfusion request. Clinical data were obtained by retrospective review of case notes over the first year. RESULTS There were 2789 requests for blood for children (median age, 1.8 years; interquartile range [IQR], 0.6-6.6 years); 70% (1950) of the samples were crossmatched with 85% (1663/1950) issued. Ninety percent (1505/1663) were presumed transfused. Median time from laboratory receipt of request to collection of blood was 3.6 hours (IQR, 1.4-12.8 hr). Case notes of 590 children were reviewed and median pretransfusion hemoglobin level was 6.0 g/dL (IQR, 4.2-9.1 g/dL). Ninety-four percent (186) were transfused “appropriately” while 52% (120) were transfused “inappropriately.” There was significant disagreement between the clinical and laboratory diagnosis of severe anemia (exact McNemar's test; p < 0.0001). Antimalarials were prescribed for 65% (259) of children who received blood transfusions but only 41% (106) of these had a positive blood film. CONCLUSION In this setting, clinicians often order blood based on the clinical impression of “severe anemia.” This has implications for laboratory workload and the blood supply itself. However, the majority of children with severe anemia were appropriately transfused. The use of antimalarials with blood transfusions irrespective of blood film results is common practice

Nivel de conocimientos de estudiantes de medicina sobre diagnóstico y manejo del infarto agudo del miocardio

Introduction: acute myocardial infarction is a disease with high morbidity and mortality.Objective: to determine the knowledge level of medical students about the diagnosis and management of acute myocardial infarction.Method: an observational, descriptive and cross-sectional study was carried out between January and February 2022 in medical students from the University of Medical Sciences of Pinar del Río who participated in the provincial update workshop on acute myocardial infarction. Through intentional sampling, a sample of 92 students was selected. To collect the information, a survey was used using Google Forms.Results: the female sex (65,21%), the age group from 21 to 22 years (65,21%) and the fourth-year students (50%) prevailed. Hypertension was the most identified risk factor (97,98%). 97,82% of the students identified precordial pain as the main clinical manifestation. 100% identified the presentation with complications, where sudden death was the most identified (81,52%). 100% point to the electrocardiogram as the main complementary, where ST alterations were the most identified (84,78%). 95,65% of the students indicated constant monitoring of vital parameters and cardiovascular function as the management measure.Conclusions: Medicine students belonging to the clinical area at the University of Medical Sciences of Pinar del Río have an adequate level of knowledge about the diagnosis and management of acute myocardial infarction.Introducción: el infarto agudo del miocardio constituye una enfermedad con elevada morbilidad y mortalidad.Objetivo: determinar el nivel de conocimientos de estudiantes de medicina sobre el diagnóstico y manejo del infarto agudo del miocardioMétodo: se realizó un estudio observacional, descriptivo y transversal entre enero y febrero de 2022 en estudiantes de Medicina de la Universidad de Ciencias Médicas de Pinar del Río del ciclo clínico que participaron en el Taller provincial de actualización sobre infarto agudo de miocardio. Mediante un muestreo intencional se seleccionó una muestra de 92 estudiantes. Para la recolección de la información se empleó una encuesta mediante Google Forms.Resultados: predominó el sexo femenino (65,21 %), el grupo etario de 21 a 22 años (65,21 %) y los estudiantes de cuarto año (50 %). La hipertensión fue el factor de riesgo más identificado (97,98 %). El 97,82 % de los estudiantes identificó el dolor precordial como principal manifestación clínica. El 100 % identificó la presentación con complicaciones, donde la muerte súbita fue la más identificada (81,52 %). El 100 % señala al electrocardiograma como principal complementario, donde las alteraciones del ST fueron las más identificada (84,78 %). El 95,65 % de los estudiantes indicaron la monitorización constante de los parámetros vitales y función cardiovascular como la medida de manejo.Conclusiones: los estudiantes de Medicina pertenecientes al área clínica en la Universidad de Ciencias Médicas de Pinar del Río poseen un adecuado nivel de conocimientos sobre el diagnóstico y manejo del infarto agudo del miocardio.  

HIV-ASSOCIATED PULMONARY HYPERTENSION: CASE REPORT

With the advent of highly active antiretroviral therapy, there has been a signifi cant change in the epidemiology of pulmonary disease in HIV/AIDS. The relative prevalence of non-infectious manifestations is likely to rise. HIV associated pulmonary hypertension (HIV-PH), albeit low prevalence, is associated with signifi cant morbidity and mortality. Presently, despite having scanty evidence on the management modalities of HIV-PH, evidence extrapolated from idiopathic pulmonary hypertension is being utilised to effectively manage some of these patients. Efforts should therefore be made to screen, diagnose and treat these patients. A case of a thirty year old female with HIV disease and severe pulmonary hypertension is presented

PITUITARY APOPLEXY: REPORT OF TWO CASES

Pituitary apoplexy is a common clinical syndrome characterised by acute headache, ophthalmoplegia, diminished visual acuity and altered mental status caused by the sudden haemorrhage or infarction of the pituitary gland. The two cases reported highlight the variability in presentation which underscores the need for a high index of suspicion and the need for MRI in patients presenting with a thunderclap headache and 'normal' initial  investigations