Nigerian Journal of Clinical Practice最新文献

Background: A consequence of improved survival of people living with human immunodeficiency virus (HIV) (PLHIV) is an aging population with an increased risk of developing atherosclerotic cardiovascular diseases (ASCVDs). International guidelines recommend primary preventive strategies which should be integrated into routine care of PLHIV.

Aims: This study audited the ASCVD preventive practices offered to PLHIV at the adult antiretroviral clinic in Ibadan.

Methods: This was a retrospective review of clinical records of all persons who were recruited into the antiretroviral therapy clinic between January 1 and December 31, 2018. Cardiovascular disease (CVD) preventive practices were audited against recommendations of the American Heart Association for PLHIV.

Results: The records of 568 persons with a mean (standard deviation) age of 39.95 (11.77) years were reviewed. There were 365 (64.26%) females and 203 (35.74%) males. Only 364 (64.08%) patients had the required parameters for the calculation of the low-density lipoprotein cholesterol (LDL-C) by the Friedewald formula. Ten-year ASCVD risk was not calculated for any of the patients during their clinic visits. Thirty-seven (6.51%) patients had either an LDL-C ≥4.91 mmol/L or an age between 40 and 75 years with diabetes mellitus or ASCVD risk score (when calculated) ≥ 7.5%. Only one of these persons was referred for specialist care of lifestyle modification. Fifty (8.80%) persons had an eGFR <60 mLs/min, but only 11 (1.94%) were referred for nephrology care.

Conclusion: The integration of primary preventive cardiovascular practices into routine care for PLHIV is suboptimal. A revision of the recommendations of the Nigerian National Guidelines for HIV may be a useful first step addressing this.

Background: Rapid Response Teams, strategically devised to mitigate mortality and morbidity stemming from unforeseen deteriorations and cardiac arrests within healthcare facilities, are ubiquitously implemented on a global scale.

Aim: The aim of the study is to compare emergency physicians (EPs) and non-EPs on management protocols of Hospital Medical Emergency Teams (HoMET).

Methods: This was a retrospective cross-sectional study. The hospital archive underwent a retrospective scanning process, and patient records were meticulously examined. The assessment encompassed various facets, including demographic characteristics, activation locations, and response and intervention times of HoMET teams, composed of both EPs and other healthcare professionals. Data analysis was conducted using SPSS software version 20.0.

Results: A total of 1056 calls were included, with 52% (n = 549) involving male patients. The average age was 67.15 ± 19.45 years. EPs served as the team leader in 53% of the calls. Cardiac arrest was considered in 93.6% of the cases. The EPs group exhibited a higher average patient age, longer intervention times, and shorter arrival times (P < 0.001, P = 0.027, P < 0.001, respectively). A significant difference was observed in the locations of the calls and the groups of calls considering cardiac arrest (P < 0.001, P < 0.001, respectively).

Conclusion: The optimization of intervention teams is imperative given the persistently high incidence and mortality rates associated with in-hospital cardiac arrests. Leveraging the expertise of EPs in the management of arrests and critical patients can potentially enhance the effectiveness of these teams. Nonetheless, further research is warranted to comprehensively explore and validate this aspect.

Background: Emotional availability and responsiveness in intrapartum care increase women's birth satisfaction, comfort, and quality of nursing/midwifery care. In Turkey, there is no instrument for measuring emotional availability and responsiveness in intrapartum care.

Aim: An established translation, reliability, and validation approach was used to obtain the Turkish form of the A-EAR-IC scale.

Methods: A descriptive cross-sectional study was used. This study was conducted in Istanbul, Turkey. The study sample consisted of 132 Turkish midwives working in the birth room. The construct validity of the scale was tested using confirmatory factor analysis, whereas the concurrent scale validity was tested using the Emotional Labor Behavior Scale. Internal consistency analysis was performed to test the reliability of the scale.

Results: The results of the EAR-IC measure showed that it fit the one-factor model. The goodness-of-fit indices of the one-factor model containing eight items were acceptable. The instrument showed satisfactory content validity (I-CVI =0.80-1.00, S-CVI =0.88). According to CFA, the structure with one factor showed acceptable model fit (χ2/df: 1.74, CFI: 0.96, IFI: 0.96, RMSEA: 0.07, and SRMR: 0.02). Concurrent validity of the instrument was assessed with the "in-depth behavior" subscale of the Emotional Labor Behavior Scale for Nursing. Spearman's correlations revealed that the EAR-IC was moderately positively correlated with the in-depth behavior concern subscale of the ELBS (rho =0.62, P < 0.001).

Conclusion: The Turkish version of the EAR-IC is a suitable, effective, and reliable instrument for measuring the emotional aspects of intrapartum caregiving midwives.

Background: While we attempt to restore occlusion in completely edentulous patients there is a consensus among clinicians to articulate the cast using average value and avoid performing facebow transfer. Various studies question the application of facebow transfer in the fabrication of removable complete denture fabrication.

Aim: This study was therefore aimed to study the effect on condylar guidance with casts mounted by the facebow method, Bonwill's method, and radiographic method.

Methods: A cross-sectional study was performed using casts of edentulous patients attending the Department of Prosthodontics. After establishing a tentative jaw relationship using wax occlusal rims in the edentulous participants, the casts were mounted by Bonwill's method and the facebow transfer method to a semi-adjustable articulator. Protrusive records of the subjects were used to program the articulator to obtain the condylar guidance values. Digital lateral cephalographs were made both in centric and protrusive jaw relationships. The mandibular condyles were then traced and overlapped to obtain radiographic values. The condylar guidance values obtained by Bonwill's method, facebow method and radiographic method were compared using Wilcoxon's signed rank test and Mann-Whitney U test. The SPSS Statistics for Windows (Version 21.0. Armonk, NY, USA:IBM Corp.), and, at a probability value of 0.05, the significance of every statistical test was predetermined.

Results: Ten edentulous 45-70 year olds participated in the study. The mean discrepancy between radiography and facebow methods was 12.8° for the right side and 12.7° for the left (P < 0.005). The difference between radiography and Bonwill's methods was significant (P < 0.005), with a mean difference of 34.3° for the right side and 34.7° for the left side. The difference between Bonwill's method and the facebow method was significant (P < 0.005), with a mean difference of 21.5° for the right side and 22° for the left side.

Conclusion: The condylar guidance values obtained by clinical methods (Bonwill's and Facebow) were significantly lesser (P < 0.005) compared to the values obtained by radiographic method.

Background: Skin tones may be predictive of anterior tooth shade. An analysis of the relationship of skin tone to anterior tooth shade within a population may facilitate the prescription of complete dentures with optimal esthetics and realism.

Aim: This study aimed to assess the relationship between skin tones and shades of upper anterior teeth among a diverse Nigerian adult population.

Methods: The study was conducted between February and December 2022 among consecutive healthy adults recruited from dental clinics of five teaching hospitals in four cities located across four geopolitical zones of Nigeria. Skin tones were recorded using the National Immigration Service (NIS) Skin Color scale. The Vitapan Classic® shade guide was used to record the tooth shade of the upper central incisors and canines. Bivariate and multivariate tests of associations were performed, and predictive probabilities were developed.

Results: A total of 1070 adults with a mean age of 30.8 ± 10 years participated in the study. NIS skin tones 6 (29.8%) and 5 (27.7%) were the most common, while hues A (48.7% in incisors and 48.4 % in canines) and B (41.1% in incisors and 40.1% in canines) were predominant. The values of the incisors and canines were positively related to skin tone (P = 0.001) and age (P = 0.001 for incisors and P = 0.003 for canines). Hue was also significantly associated with skin tone for canines (P = 0.01) and gender (P = 0.001). Regression models showed increasingly darker skin tones were positively related to duller values for incisor teeth (β = 0.173, OR =1.19, P < 0.001). The values for canines were more likely to be >2 (β = 0.118, OR =1.12, P = 0.01), but without significant positive relationship to increasingly darker skin tones (β = -0.99, OR =0.91, P = 0.22).

Conclusion: Skin tones were associated with upper anterior tooth shade. There was a positive relationship between skin tones and the shades of upper anterior teeth. Skin tones could guide the clinician in shade selection during complete denture prescriptions.

Background: Although Tideglusib cytotoxicity studies and its effects on human dental pulp-derived stem cells (DPSCs) have been examined in previous studies, there is no study investigating the expression of type 1 collagen and type 3 collagen by Tideglusib.

Aim: The purpose of this study is to examine the effect of Wnt signaling activation using Tideglusib execution on human DPSC to determine its potential efficacy in collagen expression.

Methods: Stem cell isolation was performed from five human third molar wisdom tooth pulps. DPSCs identified in only one sample were treated with 50 nM Tideglusib for 24 h and 1 week. Axin-2, type 1 and type 3 collagen expressions were evaluated by Western blot analysis. DPSCs without treatment served as a negative control. The Mann-Whitney U test was used for statistical analysis.

Results: The levels of type 1 collagen and Axin-2 in the test group were significantly higher than those in the control group at 24 h (P = 0.000, P = 0.001, respectively). Compared to the control group, a slight increase in type 3 collagen expression was observed in the test group at 24 h (P value = 0.063). Application of 50 nM Tideglusib for 1 week revealed marked decreases in type 1 and type 3 collagen expressions (P = 0.029, P = 0.038, respectively). In contrast, there was a significant increase in the level of Axin-2 (P = 0.000) compared to the control group.

Conclusion: The fact that Wnt signaling pathway activation obtained by Tideglusib application on DPSCs confirmed by the finding in the increase of Axin-2 at short and long-term evaluation periods which is resulted in the increase in the type 1 collagen expression at 24 h and decrease at 1 week together with the decrease in type 3 collagen expression at 1 week warrants further studies to evaluate the effect of Tideglusib on extracellular matrix expression.

Background: Ovarian cancer exhibits a significant prevalence and incidence on a global scale. Low-grade or high-grade epithelial-type ovarian cancer can be classified by using the dualistic model. Inflammation has been associated with AKNA protein by cancer researchers. The potential of AKNA as a cancer biomarker is supported by its significance and association with ovarian carcinoma. Uninvestigated is this enormous potential.

Aim: This study examines the correlation between AKNA expression in low-grade and high-grade ovarian tumors and its utility as a predictive biomarker for ovarian cancer.

Methods: This study examined a total of thirty-one samples, which were classified into three groups: cyst, low-grade, and high-grade ovarian carcinoma. The departmental archive was accessed for the following information: age, tumor size, nuclear grade, mitosis, ovary volume, implant tumor status, lymph vascular invasion status, lymph node metastasis, and tumor-infiltrating lymphocyte. The expression of AKNA was determined using IHC staining. The information was collected and analyzed via analysis of variance.

Results: The AKNA H-score shows the mean difference between all three groups (P < 0.001). Cysts had the highest AKNA expression, followed by low-grade and high-grade ovarian carcinoma.

Conclusion: Higher-grade ovarian cancer expressed less AKNA compared to cysts or low-grade forms of the disease. This considerable difference suggests that AKNA might predict ovarian cancer tumor grade.

Background: A chest radiograph is the most commonly requested and performed imaging for diagnosis and screening including medical examination.

Aim: The study aimed to determine the prevalence and pattern of incidentalomas in radiographs of cases presenting for pre-employment medical examination.

Methods: This was a retrospective review of chest radiographs conducted for patients presenting for pre-employment medical examination from January to December 2022. Relevant data including sociodemographic characteristics, clinical details and chest radiograph reports were retrieved using study proforma from all patients with complete medical data were analyzed using statistical package for social sciences (SPSS) version 23 with the level of statistical significance set as P <0.05 taken as statistically significant.

Results: Three hundred and eleven chest radiographs of subjects aged 20-49 years were evaluated, of which 22 (7.1%) incidentalomas were found. Most were females (55%). Of these incidentalomas, 12 (54.6%) were in the cardiovascular system, while the skeletal and pulmonary systems accounted for eight (36.4%) and two (9.1%), respectively. In all participants, clinically significant findings were eight (2, 6%), comprising of cardiomegaly five (1.6%), leash of vessels in the upper zone one (0.3%), blunt costophrenic angle one (0.3%), and right-sided aortic arch one (0.3%). Age and gender have no statistical significance in the incidental findings.

Conclusion: Although the incidence of clinically significant incidentalomas appears low in our environment where beliefs and lack of adequate healthcare financing prevent the majority from seeking timely medical attention, chest radiograph remains an invaluable tool for pre-employment medical examination. Some underlying medical conditions could be picked up, further investigation sought to save life, and it serves as a baseline with which future findings may be compared.

Background: Burnout in the health care industry is a potential hazard that has reached epidemic proportions mostly among doctors in practice and training. Burnout has enormous consequences on doctors, patients, and health care institutions.

Aim: This study aimed to determine the prevalence and predictors of burnout among resident doctors in Enugu State, Nigeria.

Methods: This was a mixed-method study of 420 resident doctors in tertiary hospitals in Enugu State, Nigeria. Data were collected using Oldenburg Burnout Inventory and in-depth interviews of chief resident doctors of selected departments. Data were analyzed using IBM statistical package 23.0 and Nvivo 11. Test of significance was set at 0.05.

Results: The mean age of participants was 34.11 ± 5.08 years. The prevalence of burnout groups among resident doctors was 84.3% in the burnout group, 4.8% in the disengagement group, 6.9% in the exhaustion group, and 4.0% in the non-burnout group. Gender (OR = 1.861, C.I = 1.079-3.212), duration of training (OR = 1.740, C.I = 1.008-3.005), and working hours (OR = 2.982, C.I = 1.621-5.487) were the predictors of burnout; only working hours (OR = 0.279, C.I = 0.091-0.0862) was the predictor of disengagement; and gender (OR = 0.248, C.I = 0.107-0.579) was the predictor of exhaustion. Heavy workloads, long working hours, migration, poor working environment, job insecurity, poor remuneration, and management style were identified factors of burnout.

Conclusion: There was high prevalence of burnout among resident doctors, predicted by gender, duration of training, and working hours. Interventions are needed to reduce burnout, prevent the "brain drain", and improve resident doctors' overall well-being.