Nigerian Medical Journal : Journal of the Nigeria Medical Association最新文献

Background: It is established that there is a strong relationship between perception and outcome of learners' satisfaction, achievement, and success and that a positive learning environment well received by learners is necessary for positive learning outcomes. This study is a first step in providing an answer to the question "how do learners perceive preclinical medical education in Ife" with the aim of obtaining information which can serve as basis for the review of teaching methods and improvement of learning environment.

Methodology: A questionnaire adopted from two validated questionnaires (Dundee Ready Education Environment Measure questionnaire from Dundee and another from a study carried out in Bangladesh) was administered to 187 respondents comprising 106 final year students and 81 newly qualified doctors to obtain the information about their perception of teaching and learning of the three major preclinical participants. Items were rated using the 5-point Likert scale, and each item was scored 4-0. Data were analyzed using the descriptive and inferential statistics. Values were expressed as the mean of scores.

Results: The mean gross scores for the 19 items rated for anatomy, biochemistry, and physiology were 28.92, 35.76, and 45.06 (out of 76), respectively. Physiology had the highest score in all the subdomains examined, with 62% of the respondents rating their overall quality of learning experience in the subject "very good." Scores for perception of learning environment were generally low (7.54 ± 0.43, 10.44 ± 0.42, and 12.51 ± 0.47, out of a total of 28 for anatomy, biochemistry, and physiology, respectively).

Conclusion: The opinion of learners in this study emphasizes the need for the improvement of teaching methods and learning environment.

Background: Human immunodeficiency virus (HIV) infection poses a great health and economic burden, especially in developing nations where a high burden of disease has been described. A previous study in Uyo shows that some characteristics associated with a higher prevalence of HIV infection include female gender, exposure to tertiary level of education, and late disease presentation. This study aimed at determining the sociodemographic and the clinical characteristics of highly active antiretroviral treatment-naïve (HAART-naïve) HIV-seropositive patients at Uyo, Nigeria.

Materials and methods: This was a cross-sectional comparative study of 210 respondents, composed of 105 HAART-naïve HIV-seropositive patients (subjects) and an equal number of sex- and age-matched HIV-negative individuals (controls). Data were collected using pretested interviewer-administered questionnaires and hospital records. Anthropometry and blood pressure (BP) were measured for all the respondents, while clinical and immunologic staging were done for subjects. Data obtained were analyzed using SPSS v 20. P ≤ 0.05 was taken as statistically significant.

Results: The mean age of the respondents was 34.5 ± 9.2 years, and the male-to-female ratio was 1:2.3, with no difference between the subjects and controls (P = 0.880 for age and P = 0.943 for gender). Mean body mass index and mean diastolic BP were significantly lower in the subjects (P < 0.001 and 0.037, respectively). Female gender, secondary level of educational attainment, and unskilled employment were significantly associated with HIV infection. Majority of the respondents presented in clinical Stage 1 or 2 disease, with CD4 count >350 cells/ml.

Conclusion: The burden of HIV infection is higher in females and in those with sociodemographic characteristics suggestive of lower socioeconomic status, however, majority of these appeared to present in early disease.

Background: Hemodialysis is the most common renal replacement therapy (RRT) modality in Africa and few countries enjoy reimbursement from the government to fund it. Africa contributes <10% of the total RRT patients worldwide this is mainly due to high cost.

Aims and objectives: We aimed to review the clinical characteristics and outcomes of patients requiring hemodialysis in our center over a 7 years period, to highlight the enormous challenges encountered.

Materials and methods: This is a retrospective study of patients aged 15 years and above that was seen between April 2010 and March 2017 at the Hemodialysis unit of Abubakar Tafawa Balewa University Teaching Hospital. Information was extracted from the patient's case folders and dialysis charts.

Results: In total, 226 patients had hemodialysis over the period, 124 (54.9%) were male and 102 (49.1%) were female. Sixty-one (27%) patients had acute kidney injury (AKI), 143 (63.3%) had chronic kidney disease (CKD), whereas 22 (9.7%) had acute-on-CKD. A total of 2215 sessions of hemodialysis were done in the period, of which 782 (35.3%) were for AKI and 469 (21.2%) for acute on CKD. A total of 138 (60.6%) patients were discharged and 58 deaths were recorded.

Conclusion: Although there is rapid proliferation of hemodialysis facilities in the country, many patients could not afford adequate hemodialysis. Inadequate dialysis due to finances was the main cause of death in these category of patients.

Background: Fine-needle aspiration cytology (FNAC) is widely employed as an initial investigative tool in the diagnosis of various lesions in the body, however, it is limited in the provision of precise architectural detail of lesions. This is said to be responsible for the wide variation in the documented usefulness and accuracy relative to histopathology. This study aimed to correlate cytopathological and histopathological examination (HPE) of head and neck lesions, and assess the usefulness and accuracy of FNAC in our center.

Materials and methods: This was a retrospective study that utilized historical data obtained from case notes and histopathology records of 91 patients that had both FNAC and HPE done for head and neck lesions in our center during the study. The FNAC results were correlated with that of the histopathological diagnosis to obtain the accuracy of the FNAC diagnosis. Diagnostic validity of FNAC in terms of sensitivity, specificity, and predictive value were also evaluated.

Results: A total of 91 FNAC-HPE sample pairs were included. The Sensitivity and specificity for benign lesion was 95.4% and 42.3%, respectively, while for sensitivity and specificity for malignant lesion was 31.8% and 96.9%, respectively. The overall Sensitivity and specificity for cytology was 96.8% and 30.4%, respectively.

Conclusion: FNAC appears to be a useful tool in the initial assessment of head and neck lesions in our center, however, the high rate of missed diagnosis especially as concerned malignancies has dire negative treatment implications. There is need to develop capacity for improved skill in making cytopathologic diagnoses among anatomical pathologists involved in the use of FNAC as diagnostic and screening tool.

Background: Unprotected heterosexual sexual act has been correlated with unwanted pregnancy and sexually transmitted diseases (STDs) especially HIV/AIDS, which still has a high endemicity in Africa. This study aimed to determine the association between socio-demographic variables (SDVs), sexual experience, and the use of condom.

Setting and design: This was a cross-sectional study comprising 542 undergraduate students, randomly selected from three Nigerian universities.

Methodology: Well-structured open-ended questionnaires were administered to respondents. Bivariate analysis was used to determine the association between SDVs and attitude to condom use and between the SDVs, sexual experience and the use of condom. Data were analyzed using Epi6 6.04 and SPSS 10.0 software packages. Pearson's Chi-square (χ²) and Fisher's exact tests were used as applicable. The level of significance was set at P < 0.05.

Results: Approximately 46% of the respondents were sexually active (consisting of about 71% of those 25-29 years old and 58% of the males [P < 0.001]). About 50.4% had a single sexual partner and 86.7% had "ever used" condom. The most common reasons given for use of condom were prevention of pregnancy (91.7%) and STDs (89.1%). All the SDV except religion significantly (P < 0.05) accounted for the disparity in sexual attitudes of the students. Those aged 25 years and above, males and Tiv tribe were more likely to indulge in sexual activities (P < 0.001). More females (98%) compared to males (83%) had ever used condom in their sexual experience (P = 0.010), while there was no significant association between any of the SDVs and use of condom in the last sexual exposure (P > 0.05).

Conclusion: SDVs play a role in determining the attitude of students towards condom use and sexual experiences. Programs regarding sexual and reproductive health including safe sex education especially among young Nigerian students should be developed or strengthened.

Background: The purpose of this study is to estimate disease burden, clinical features, and outcome in the emergency surgical management of peptic perforation in a rural government tertiary care center where patients are socioeconomically very poor and also impacted by lack of good quality health-care facility.

Materials and methods: The study had retrospectively analyzed 121 patients with peptic perforation who had undergone emergency laparotomy at Midnapore medical college, West Bengal, India, from June 2018 to December 2019. All patients >12 years were included in this study. Exclusion criteria were other traumatic and nontraumatic gastrointestinal perforations.

Results: The study population had 112 males and 9 females with a mean age of 44.80 ± 15.29 years and maximum incidence in the 6^th decade (P = 0.001). Smoking and alcohol were associated with 54.5% and 49.6%, respectively. The symptoms were pain abdomen (100%) with vomiting (38.8%) and fever (33.9%). The signs of hypotension, peritonitis, distension, and pneumoperitoneum were observed in 34.7%, 64.5%, 39.7%, and 83.5%, respectively. Only 20.7% of patients were admitted within the first 24 h. The mean duration of symptoms was 2.3 days. Most perforations were located on the duodenum (74.4%) with duodenal to gastric perforation ratio 2.9:1. The mean size was 1.02 cm. Chest infection (19%) was the most common complication. The mortality rate was 9.1%. The mean length of hospital stay was 11.1 days.

Conclusion: Peptic perforation remains a major disease burden in our environment predominantly due to late presentation, leading to high morbidity and mortality.

Background: Conduct disorder is a mental disorder characterized by hostile and sometimes physically violent behavior. It is a source of concern not only to the parents but also to the children's teachers and the community. Its prevalence rate in our environment is unknown.

Aim: The aim of the study is to determine the prevalence rate of conduct disorder among primary school pupils in Ikot-Ekpene, Southern Nigeria.

Materials and methods: Vanderbilt attention-deficit hyperactivity disorder (ADHD) diagnostic teacher rating scale for oppositional defiant disorder/conduct disorder was administered on 1174 pupils aged 6-12 years drawn from 12 primary schools in Ikot-Ekpene, Akwa-Ibom State, Nigeria. Parents of the pupils with conduct disorder completed a pro forma on their sociodemographic characteristics.

Results: One hundred and fifteen of the studied 1174 pupils had conduct disorder with a prevalence rate of 9.8%. A greater number of males had conduct disorder with a male-to-female ratio of 4.75:1. Children from upper social class comprised the highest number with conduct disorder. Younger children (6-9 years) were more affected (76.5%) than the older ones. The predominant symptom exhibited by the children was difficult temperament. Comorbidities associated with conduct disorder were ADHD, anxiety disorder, and depression.

Conclusion: The prevalence rate of conduct disorder is within the global range in our environment and tends to affect the younger children. Policy should be put in place to screen these children at school entrance so as to render appropriate health intervention.

Introduction: Despite the importance of zinc in the human body, there is paucity of data on the zinc status of Nigerian children. The aim of this study was to determine the serum zinc levels of children attending the pediatric outpatient clinic of a tertiary hospital in South East Nigeria and to assess their need for routine zinc supplementation.

Materials and methods: One hundred children aged 5-60 months were recruited consecutively from the pediatric outpatient clinic. Their socioeconomic class (SEC) was assessed using the tool developed by Oyedeji. Physical examination was carried out to exclude malnutrition and/or liver disease. Samples were collected in the morning from nonfasting subjects and were analyzed using atomic absorption spectrophotometer. Serum zinc deficiency was defined as zinc level <80 μg/dl.

Results: The overall median (range) serum zinc level was 83.3ug/dl (60-105 μg/dl) while the median (mean rank) serum zinc levels among male and female subjects were 83.4 μg/dl and 84.2ug/dl, respectively (U = 1071.00; P = 0.228). A total of 26 (26%) apparently healthy children had low serum zinc levels. There was no association between gender and serum zinc levels (χ² = 2.163; P = 0.141). A significant positive but weak relationship was found between SEC and zinc levels (r = 0.208, P = 0.038) but not between serum zinc levels and age of the children (r = 0.185, P = 0.065).

Conclusion: A significant proportion of Under-5s could have low serum zinc levels. Routine zinc supplementation may be necessary among this age group in Nigeria.

Objectives: The objective of the study was to explore the usage of the Goldmann applanation tonometry and noncontact tonometry interchangeably in the measurement of intraocular pressure (IOP) in glaucoma patients.

Materials and methods: The study involved 441 clinically diagnosed glaucoma patients receiving care at a referral facility. IOP measurements were obtained using both the Noncontact tonometer and Goldmann applanation tonometer The repeatability of the measures was analyzed by comparing the repeated measures of the devices using paired t-test and calculating the correlation coefficient. A Bland-Altman analysis was used to determine the limits of agreement between the two procedures.

Results: There were 271 (61.5%) males and 170 (38.5%) females and their age ranged from 18 to 73 years (mean age = 49.37; standard deviation ± 14.81 years). The findings of the study showed significantly lower readings (P < 0.001) of the GAT (right eye = 17.40 ± 7.48 mmHg; left eye = 16.80 ± 7.49 mmHg) compared to the NCT (right eye = 20.15 ± 8.30 mmHg; left eye = 19.74 ± 8.31 mmHg). There was a strong positive correlation between the GAT and NCT findings in the right eye (r = 0.871, n = 441, P < 0.001) and in the left eye (r = 0.887, n = 441, P < 0.001). There was a wide limit of agreement between NCT and GAT measurements.

Conclusion: There was statistically significant higher measures obtained with NCT than the GAT but did not exceed the allowable inter-device difference. There was a strong positive correlation between GAT and NCT measurements. However, it is strongly recommended that these devices are not used interchangeably in the monitoring of IOP in glaucoma due to the wide range of limits of agreement.