Nigerian Journal of Clinical Practice最新文献

Background: Lumbar radiculopathy (LR) is frequently associated with proprioceptive deficits, altered load distribution, peri-knee muscle thinning, and early degenerative changes in femoral cartilage, potentially accelerating osteoarthritis development.

Aim: This study aimed to assess distal femoral cartilage thickness, rectus femoris muscle (RFM) thickness and cross-sectional area, and gastrocnemius medialis muscle (GMM) thickness using ultrasonography (USG) in patients with unilateral LR.

Methods: A prospective cross-sectional design was employed, including 50 patients with MRI-confirmed unilateral LR (L3-S1) of at least 3 months' duration. Clinical assessments included the LANNS, VAS, and ODI. Bilateral femoral cartilage thickness (medial, lateral, intercondylar), RFM thickness and cross-sectional area, and GMM thickness were measured by USG. Comparisons were made between radiculopathy and intact sides and according to symptom duration (3-12 vs. >12 months).

Results: The RFM cross-sectional area (4.12 ± 1.27 vs. 4.50 ± 1.18 cm², P = 0.001) and thickness (1.40 ± 0.28 vs. 1.51 ± 0.28 cm, P = 0.001) were significantly lower on the affected side. The intercondylar cartilage thickness was also reduced (0.23 ± 0.05 vs. 0.25 ± 0.05 cm, P = 0.014). Patients with symptom duration > 12 months exhibited thinner intercondylar cartilage than those with 3-12 months (0.22 ± 0.05 vs. 0.25 ± 0.05 cm, P = 0.014). Significant correlations were identified between intercondylar cartilage thickness and GMM thickness (r = 0.316, P = 0.026) and between medial condyle cartilage thickness and RFM cross-sectional area (r = 0.362, P = 0.010).

Conclusions: LR is associated with femoral cartilage thinning and peri-knee muscle atrophy on the affected side, underscoring the risk of early osteoarthritis. Early rehabilitation strategies focusing on periarticular muscle strengthening are warranted. USG represents a practical, dynamic, and noninvasive modality for monitoring these changes.

Background: Early serum beta-human chorionic gonadotropin (β-hCG) levels are commonly used to assess pregnancy viability following in vitro fertilization (IVF). However, their predictive value for live birth remains uncertain.

Aim: This study evaluates the predictive value of early β-hCG levels on post-transfer days 12 and 14 in determining live birth outcomes after IVF.

Methods: A retrospective chart review was conducted on 755 women who underwent IVF between 2017 and 2023. Demographic, clinical, and laboratory data were collected. Serum β-hCG levels were measured on post-transfer days 12 and 14. Receiver operating characteristic (ROC) curve analysis determined optimal β-hCG cutoff values for predicting live birth.

Results: Among participants, 414 (54.8%) achieved live birth. Mean β-hCG levels on day 12 were significantly higher in the live birth group (554.5 ± 378.4 mIU/mL) compared to the non-live birth group (208.0 ± 162.5 mIU/mL, P < 0.001). On day 14, levels remained elevated in live birth cases (1466.8 ± 890.3 mIU/mL vs. 570.0 ± 452.8 mIU/mL, P < 0.001). The rate of β-hCG increase was also greater in the live birth group (P < 0.001). ROC analysis identified cutoffs of 205.5 mIU/mL on day 12 (72.4% sensitivity, 72.3% specificity) and 535 mIU/mL on day 14 (71.4% sensitivity, 71.3% specificity).

Conclusion: Early β-hCG levels are strong predictors of live birth following IVF. Establishing clinical thresholds may enhance early pregnancy assessment and patient counseling.

Background: Mentorship is a key element of postgraduate medical training, offering academic, professional, and psychosocial support that positively influences trainee success and wellbeing. Understanding both mentor and mentee perspectives is crucial to enhancing mentorship programs.

Aim: To evaluate the mentorship experience of mentors and mentees in the Family Medicine Residency Program in Riyadh, Saudi Arabia, and identify strengths and areas for improvement.

Methods: A cross-sectional descriptive study was conducted from September to December 2023 across Family Medicine Training Centers in Riyadh. We used an online self-administered questionnaire to collect data on demographics, prior mentoring experience, perceived support, mentor qualities, and satisfaction. Data were analyzed using Statistical Package for the Social Sciences (SPSS) v21.0 with descriptive statistics and Chi-square tests to explore associations.

Results: Of 183 participants (84 mentees, 99 mentors), 70.2% of mentees and 65.7% of mentors reported satisfaction with their mentoring experience. Both groups identified clinical rotations, exam preparation, and problem solving as the higher areas of support. Mentees reported lower support in work-life balance (45.2%) and emotional/psychological wellbeing (41.7%). Good communication and trustworthiness were the most valued mentor qualities. Female mentees were significantly more comfortable discussing difficult issues (P = 0.045). While 73.3% of mentors believed their role positively impacted mentees' development, only 44.4% felt they had sufficient time for mentoring.

Conclusion: The program demonstrates strengths in overall satisfaction and academic support but shows gaps in emotional and holistic support. Recommendations include structured mentor training, protected time, gender-sensitive approaches, and regular feedback to enhance program effectiveness.

Background: With the rapid spread of technology, excessive and uncontrolled digital device use has become a growing concern, especially among university students. This behavioral pattern, referred to as digital addiction, may negatively affect musculoskeletal health, cognitive function, mental wellbeing, and overall quality of life.

Aim: This study aims to enhance understanding of digital addiction by exploring its prevalence among university students and identifying related factors.

Methods: A cross-sectional study was conducted among 203 university students to assess their digital addiction using the Digital Addiction Scale (DAS). Other factors were assessed through the Musculoskeletal Health Questionnaire (MSK-HQ), International Physical Activity Questionnaire Short Form, Pittsburgh Sleep Quality Index, Cognitive Failures Questionnaire (CFQ), Depression, Anxiety and Stress Scale-21 (DASS 21), Body Awareness Questionnaire, SF-12, and Jamar hand dynamometer. To identify DAS associated factors, multiple regression analysis was performed using DAS as the dependent variable.

Results: The participants' mean age was 21.11 ± 1.41 years, with a body mass index of 22.35 ± 3.54 kg/m². About 51.2% of the study participants had high digital addiction. While MSK-HQ (P = 0.001) and SF-12 (Mental Component Score) (P = 0.012) were significantly lower in the high digital addiction group, CFQ (P < 0.001) and DASS 21 (P = 0.037) were found to be higher. Multiple regression analysis showed that DAS was only associated with MSK-HQ (P = 0.013, B = -0.373, 95% CI: -0.66 to -0.08) and CFQ (P = 0.002, B = 0.260, 95% CI: 0.09 to 0.42).

Conclusion: The study highlights disparities in musculoskeletal health, cognitive levels, mental health, and quality of life among students based on levels of digital addiction, with higher addiction correlating to poorer musculoskeletal health and increased cognitive errors.

Purpose: To evaluate the effectiveness and safety of combining intravitreal dexamethasone implant (IVDI) and ranibizumab in patients with persistent diabetic macular edema (DME) who are unresponsive to multiple treatments.

Methods: This study included 36 eyes from 28 patients. Eligibility criteria were persistent DME with a central macular thickness (CMT) ≥300 µm despite ≥3 consecutive monthly intravitreal anti-VEGF injections and/or focal/grid laser photocoagulation at least 6 weeks before enrolment. Patients with <50% reduction in CMT or <2-line improvement in best-corrected visual acuity (BCVA) after prior treatments were enrolled. All eyes received a single IVDI and were followed monthly for 6 months. If BCVA decreased by ≥5 ETDRS letters or CMT increased by ≥100 µm, additional intravitreal ranibizumab (IVRB) was permitted. The primary outcomes were BCVA, intraocular pressure (IOP), and CMT.

Results: The baseline mean BCVA was 0.65 ± 0.30 logMAR, mean CMT 501.2 ± 145.9 µm, and mean IOP 16.2 ± 2.5 mmHg. BCVA improved significantly to 0.53 ± 0.27 logMAR at month 1 (P = 0.002), 0.46 ± 0.27 at month 2 (P < 0.001), and 0.54 ± 0.31 at month 3 (P = 0.014). Correspondingly, CMT decreased to 293.7 ± 77.6 µm, 273.3 ± 51.3 µm, and 351.0 ± 112.3 µm (all P < 0.001). DME recurred in 16-17 eyes between months 3 and 5, requiring additional IVRB. Following retreatment, BCVA remained stable (0.50-0.54 logMAR, P ≤ 0.029) and CMT persisted between 353 and 382 µm (P ≤ 0.001) through month 6. IOP increased significantly during the first 2 months but returned to baseline thereafter.

Conclusions: IVDI demonstrated substantial enhancement in patients with chronic persistent DME who were resistant to different treatments, with peak efficacy observed in the second month. Therefore, it may be considered an alternative therapeutic choice.

Objectives: Although implant therapy with sandblasted large grit acid-etched (SLA) titanium (Ti) and titanium-zirconium alloy (TiZr) has been a reliable option in edentulous cases, the conventional 3-month healing period remains relatively long, encouraging efforts to further shorten healing time and enhance early osseointegration. Significant progress in Ti and TiZr implant surface properties has been made to overcome the critical challenges of implant dentistry. Although both nonthermal atmospheric plasma (NTAP) treated and SLActive® implants can provide super-hydrophilic surfaces and increase osteoblast adhesion and differentiation on titanium implants, the comparison of NTAP-treated Ti and TiZr SLA® and Ti and TiZr SLActive® surfaces on osteogenic differentiation has not been fully studied yet. The study aims to compare osteogenic differentiation in vitro on NTAP-treated Ti and TiZr SLA® and Ti and TiZr SLActive®.

Material and methods: Ti and TiZr SLA® were treated with a plasma source to convert hydrophobic Ti and TiZr SLA® surfaces into hydrophilic state and compared the osteogenic differentiation in vitro with Ti and TiZr SLA and SLActive® surfaces. Contact angle measurements, scanning electron microscopy (SEM), and surface roughness were performed to physical characterization of implants. Then, osteogenic differentiation of hBMSCs on the implants was evaluated for 21 days by calcium assay, alkaline phosphatase assay, DNA content quantification kit, and mRNA expression with Quantitative real-time PCR analysis.

Results: NTAP treatment increased the wettability of all SLA implants. Ti and TiZr NTAP-treated implants had higher osteoblastic proliferation and differentiation compared with untreated ones. SLActive implants showed maximum osteogenic differentiation. In terms of material difference, TiZr SLActive discs had higher differentiation compared to SLActive discs.

Conclusions: NTAP treatment was found to be effective in increasing wettability. The accelerated osteoblastic difference was seen in NTAP-treated samples compared to SLA samples. Although nonthermal atmospheric plasma (NTAP) treatment effectively improved the hydrophilicity of SLA surfaces and accelerated osteogenic differentiation, the SLActive® surface-particularly TiZr SLActive®-demonstrated the most pronounced effect in promoting osteogenesis in this in vitro study.

Background: Cesarean delivery is rising globally, and Sub-Saharan Africa is no exception.

Aim: This study investigated the prevalence and factors associated with cesarean delivery in Kigali, Rwanda.

Methods: This hospital-based cross-sectional study was carried out in two hospitals in Kigali, Rwanda. A questionnaire was used to collect sociodemographic and obstetrical data, including mode of delivery. Weight, height, and hemoglobin level were measured using standard procedures. Multivariate binary analysis was performed.

Results: In this study, 445 pregnant women were included. The median (interquartile [IQR]) age and parity were 30.0 (26.0‒35.0) years and 1.0 (0.0‒3.0), respectively. One hundred and eleven (24.9%) women were delivered via cesarean, of whom 66 (59.5%) were delivered via emergency cesarean and the remaining 45 (40.5%) via elective cesarean. In multivariate logistic regression, maternal age (adjusted odds ratio [AOR] = 1.11, 95% confidence interval [CI] 1.05‒1.16), having a husband with educational attainment of secondary or less (AOR = 1.73, 95% 1.08‒2.80), and a history of miscarriage (AOR = 3.77, 95% CI 2.02‒7.03) were significantly associated with cesarean delivery. There was no significant association between cesarean delivery and parity, anemia, or low birth weight.

Conclusion: One out of four pregnant women in Kigali was delivered via cesarean regardless of their parity. Age and history of miscarriage can be used as a predictor for cesarean delivery in Rwanda. Additional socio-epidemiological research is recommended to explore the impact of increasing maternal age without an increase in parity and low educational levels among husbands on the mode of delivery in Rwanda.

Background: Ankylosing spondylitis is a chronic inflammatory disease that may involve the cardiovascular system, yet echocardiographic cardiac abnormalities remain underrecognized and incompletely characterized.

Aim: The purpose of this study is to assess echocardiographic abnormalities in ankylosing spondylitis (AS) patients and to compare the results with a control group of apparently healthy individuals who were matched for age and sex.

Methods: Fifty-five AS patients and 29 healthy controls participated in a case-control study. The two groups were evaluated using transthoracic echocardiography including two-dimensional and M mode echocardiography, along with pulse wave Doppler and tissue Doppler imaging. All the participants were assessed for their left ventricular (LV) function, pericardial effusion, pulmonary artery pressure, any valvular involvement, and aortic root diameter.

Results: Using conventional echocardiographic parameters, there were no appreciable changes between the patients and controls. When comparing AS patients to controls, some diastolic function parameters were significantly lower. In patients with AS, the E/A ratio and the E wave velocities were lower (P = 0.02 and 0.03, respectively). Patients with AS had considerably reduced lateral and septal a' and e' velocities. Furthermore, in comparison to controls, a greater proportion of AS patients had reduced septal e' velocity (P = 0.03) and lateral e' velocity (P ≤ 0.001). Nevertheless, just one AS patient had left ventricular diastolic dysfunction (LVDD).

Conclusion: This study showed that while conventional echocardiographic findings and LVDD frequency did not differ significantly between those with AS and the healthy participants, some diastolic function parameters were significantly impaired in AS patients, which might suggest the possibility of minor cardiac involvement in those with AS.

Background: The numerous toxic substances present in cigarettes have a suppressive effect on the immune system, lowering antibody levels and making smokers more susceptible to diseases.

Aim: To determine the effect of smoking on serum IgG, IgA, IgM, and IgE levels in those who smoke in Türkiye.

Methods: This cross-sectional study was conducted over a 3-month period in individuals who visited the Family Medicine Outpatient Clinic. Those who smoked cigarettes were included as the case group, and non-smokers as the control group. The nicotine dependence levels of the smokers were recorded using the Fagerström Nicotine Dependence Test (FNBT). IgG, IgA, IgM, and IgE levels were measured in both groups. Comparisons were made between the two groups, and a significant P value was taken as <0.05.

Results: The study was completed with a total of 300 participants, with an average age of 34.28 ± 11.10 years (range: 18-65), and 69.7% (n = 209) were male. Of the participants, 51.0% (n = 153) were smokers, with a higher frequency of smoking among males (P < 0.001). IgG levels were found to be higher in non-smokers (P = 0.002). No significant differences were found in IgM, IgA, and IgE levels between smokers and non-smokers (P = 0.080). There was no significant correlation between nicotine dependence levels and Ig levels.

Conclusion: While IgG levels were lower in smokers, IgA, IgM, and IgE levels were similar to those in non-smokers. This decrease in antibody levels may adversely affect the immune system, increasing susceptibility to diseases. The negative impact of smoking on the immune system should not be overlooked, especially in preventive medicine practices.