Nigerian Journal of Clinical Practice最新文献

Background: The diagnosis of endometrial cancer is made by surgical staging. Lymph node dissection (LND) in early-stage endometrial cancer is a controversial issue. Detection of pelvic lymph node metastasis in surgical staging is clinically very important. Metastases are associated with a higher risk of recurrence and highlight the importance of postoperative adjuvant treatments.

Aim: We aimed to investigate the relationship between pelvic lymph node involvement and endometrial cancer prognostic factors and the predictive value of pelvic lymph node metastasis.

Methods: The relationship and predictive value of pelvic lymph node metastasis (PLNM) in 275 patients, who underwent hysterectomy, bilateral salpingo-oophorectomy and at least pelvic LND for endometrial cancer in our Gynaecological Oncology Clinic between 2008 and 2021 were investigated.

Results: PLNM was present in 31 (11.2%) patients. In univariate analyses, adnexal involvement, perineural involvement, perinodal involvement, cervical stromal involvement, peritoneal and omentum metastasis, cytology positivity, disease stage, Cerb, and CEA positivity were found to be significant with PLNM. PLNM was statistically found to affect 5-year survival (P < 0.01). PLNM was also interpreted as a predictive criterion for paraaortic lymph node metastasis (PALNM). The most significant predictors in multivariate analysis are LVSI, depth of myometrial invasion and PALNM (LVSI P < 0.01, depth of myometrial invasion P < 0.001, PALNM P < 0.001).

Conclusion: In this retrospective study, multivariate analyses showed that LVSI and depth of myometrial invasion were independent risk factors for pelvic lymph node involvement. Pelvic lymph node positivity was also a predictive factor for paraaortic lymph node involvement. There is no consensus on the surgical staging of endometrial cancer. Surgical staging therefore serves to identify patients for whom treatment for extrauterine disease is indicated and to avoid overtreatment of the majority of patients with localised disease. Routine paraaortic lymphadenectomy may not be necessary in patients without pelvic LN metastasis.

Background: Acute kidney injury (AKI) is a frequent complication of congenital heart surgery with cardiopulmonary bypass (CPB) in pediatric patients, contributing to significant morbidity and mortality.

Aim: To determine the prevalence and perioperative predictors of AKI after pediatric CPB.

Methods: In this single-center retrospective cohort study, medical records of 84 pediatric patients (<18 years) undergoing elective or urgent CPB-assisted congenital heart surgery (November 2018-December 2024) were reviewed. AKI was diagnosed using kidney disease: Improving Global Outcomes (KDIGO) criteria. Demographic, clinical, and laboratory variables were analyzed via univariate and multivariate logistic regression; predictive accuracy was assessed with receiver operating characteristic (ROC) analysis.

Results: AKI occurred in 32.1% of patients, predominantly KDIGO stage 1. Independent predictors included lower preoperative creatinine (OR = 0.019,P= 0.040), lower body weight (OR = 0.92, P= 0.024), and higher postoperative day 1 blood urea nitrogen (BUN) (OR = 1.05,P= 0.007). Preoperative creatinine (AUC = 0.82) and postoperative day 1 BUN (AUC = 0.73) had the highest discriminative ability. AKI was associated with prolonged intubation (P = 0.017), higher vasoactive-inotropic scores on postoperative days 1-3, and increased peritoneal dialysis rates (P = 0.032).

Conclusion: Lower baseline creatinine and body weight, along with elevated early postoperative BUN, independently predict AKI after pediatric CPB. Incorporating these parameters into perioperative risk models may facilitate early renal-protective strategies. Prospective studies with larger cohorts and biomarker integration are warranted.

A splenic artery pseudoaneurysm is an uncommon complication, but a potentially fatal condition of recurrent pancreatitis or necrotising pancreatitis and is often diagnosed incidentally on abdominal computed tomography. We report a case of a 45-year-old patient, who is a chronic alcoholic and previous history of recurrent pancreatitis, presenting with upper abdominal discomfort for the past 3 days. Investigation revealed raised serum amylase and lipase levels. On computed tomography, there was the presence of a well-defined intrasplenic lesion that was iso-attenuating on the plane scan and showed smooth-walled hypoattenuation on post-contrast images. On computed angiographic images, this lesion was seen adjacent to the intraparenchymal branch of the splenic artery, consistent with a splenic artery pseudoaneurysm and successfully managed by the interventional radiology team. Therefore, splenic artery pseudoaneurysm is an uncommon but serious complication of necrotising pancreatitis. Early diagnosis through imaging and timely interventional management are essential to prevent catastrophic outcomes.

Context: Cryptococcosis is an opportunistic fungal infection caused by Cryptococcus neoformans and gatti. The disease is associated with significant morbidity and mortality and commonly occur in people with human immunodeficiency virus infection or acquired immunodeficiency syndrome (HIV/AIDS). Cryptococcal meningitis is the dreaded infection caused by Cryptococcus neoformance with very poor management outcome.

Aims: In this study we determined the seroprevalence and risk factors of cryptococcosis among HIV/AIDS patients attending the antiretroviral clinic in University of Maiduguri Teaching Hospital (UMTH), Maiduguri, Borno state.

Settings and design: This was a hospital based cross sectional study that was carried out in UMTH from August 2020 to November 2021.

Methods and material: A total of 161 HIV positive patients participating, who were drawn using systematic sampling technique. A semi structured questionnaire was used to collect socio- demographic characteristics as well as risk factors variables. Blood samples were collected in an EDTA container and tested for CrAg and CD4 count using Mascia Brunelli s.p.a Milano, Italy, and Partec Cyflow fluorescent cell sorter, Germany respectively. Ethical approval was obtained from the ethical review committee of UMTH.

Statistical analysis used: Data was analyzed using Microsoft excel 2013 and Epi-info version 7.2.

Results: We found a cryptococcal antigenemia prevalence of 28.6%. The mean age was 42 years (SD 9.9) with a male: Female ratio of 1.1:1. Significant risk factors for Cryptococcal antigenemia were IV line use [OR: 2.55 (1.24-6.04)] using bivariate analysis while multivariate analysis showed poultry farming [AOR: 2.76 (2.89-13.93)], low CD4 T-cells count (<200,000 cells/µl of blood) [AOR: 3.48 (4.63-29.62)], and high HIV viral load (>10,000 viral copies/mL of blood) [AOR: 5.78 (3.72-9.54)] as significant risk factors for cryptococcosis.

Conclusions: This study found a high cryptococcal antigenemia among HIV infected patients with low CD4+ T-cell count, and high HIV viral load. Poultry farming is associated with cryptococcosis.

Background and aim: This study provides a comparative and comprehensive analysis of current developments and research gaps, offering insight into future directions in novel dentistry.

Materials and methods: The Web of Science search for the bibliometric analysis was conducted using Title, Abstract, and Keywords with the terms TS ("INJECTABLE COMPOSITE" OR "FLOWABLE COMPOSITE"). This indicates that the study focuses on documents containing "injectable composite" or "flowable composite" within the field of dentistry. This bibliometric analysis encompasses publications from 2004 to 2024, totaling 430 documents.

Results: The study presents the growth rate, research trends, and thematic development over the years. Additionally, the most cited articles from the past two decades were analyzed in detail. The annual growth rate of this field is 16.3%, reflecting a steady increase in research activity. Although publication numbers remained stable from 2004 to 2023, a significant rise was noted in 2024. "Operative Dentistry," "Dental Materials," and "Dental Materials Journal" were the leading sources with the highest number of related articles. Among the contributing countries, the United States leads with 84 publications, followed by Türkiye, which ranks second with 75 publications. In evaluating the most cited studies, the research by Julian Leprince et al. has the highest number of citations, with a total of 247.

Conclusion: This bibliometric analysis of flowable and injectable composites in dentistry provides critical insights into the evolving research landscape and scientific discussions in this field. It highlights emerging trends, research patterns, and advancements in the application of these composites in dental practice.

Background: Breast cancers most frequently present as mass lesions; however, they do not always manifest as a mass. With the advancement and widespread use of breast imaging techniques, the detection rates of non-mass lesions have increased.

Aim: In this study, we aimed to present the results of excision of suspicious calcification foci, often detected mammographically, and marked with a wire.

Methods: Data from patients with suspicious non-mass calcification foci in the breast, who were treated in the General Surgery Clinic and Service of the Training and Research Hospital of the University of Health Sciences between 2017 and 2023, were retrospectively collected and analyzed through the hospital automation system.

Results: The study included 44 patients aged between 39 and 69 years, with a mean age of 50.9 SD7.0 years. Twenty-five patients (56.8%) were postmenopausal. Breast Magnetic Resonance Imaging (MRI) was performed in seven patients (15.9%). All patients underwent stereotactic wire localization guided by mammography. All patients were operated on, with 41 (93.2%) undergoing microcalcification excision (MCE). Frozen section analysis was performed in all cases. Re-excision was required in seven patients (15.9%). The initial postoperative pathology results indicated malignancy in 10 patients (22.7%) and high-risk lesions in 14 patients (31.8%). Twenty-two patients (50.0%) received treatment from a medical oncology specialist. No recurrence or metastasis was observed in any patient.

Conclusion: Suspicious microcalcifications, often detected on screening or follow-up mammograms, may not form palpable masses, but can serve as an early indicator of breast cancer. Histopathological evaluation via wire-localized excision provides a reliable diagnostic and therapeutic approach, particularly in centers lacking access to stereotactic biopsy equipment.

Background: Contrast-induced nephropathy (CIN) is a common cause of acute renal failure. CIN is defined as an increase in serum creatinine (sCr) occurring after iodinated contrast agent (ICA) administration and is usually transient. When patients with mildly elevated baseline sCr levels are included, the risk of CIN in patients undergoing cardiac catheterization can be as high as 20%.

Aim: To determine the role of glucose-to-lymphocyte ratio (GLR) in predicting the risk of developing CIN after coronary angiography (CAG).

Methods: This is a retrospective study that included 929 patients who underwent CAG for non-ST elevation myocardial infarction (NSTEMI). The incidence of CIN was determined. GLR was calculated by dividing the blood glucose level by the lymphocyte count.

Results: CIN developed in 124 patients (13.3%) after the CAG procedure including percutaneous coronary intervention. CIN (+) patients were older than CIN (-) group (67.1 ± 10.8 vs. 62.4 ± 11.5, P = 0.046). The number of patients with diabetes mellitus was also higher in CIN (+) group (71 (57.3%) vs. 386 (48%), P < 0.001). Multivariate logistic regression analysis showed that GLR score (OR: 1.025, 95% confidence interval (CI): 1.0221-1.029, P < 0.001), serum glucose levels (OR: 1.011, 95% CI: 1.009-1.013, P < 0.001), white blood cell count (OR: 1.182, 95% CI: 1.101-1.268, P < 0.001), neutrophil-to-lymphocyte ratio score (OR: 1.12 95%CI: 1.077-1.167, P< 0.001) and platelet to lymphocyte ratio score (OR: 1.012, 95% CI: 1.009-1.015, P < 0.001) were independent predictors of the development of CIN. Receiver Operating Characteristic analysis, at a cut-off point of 104.39, GLR demonstrated 70% sensitivity and 82% specificity for detecting CIN.

Conclusions: GLR value at admission was associated with the development of CIN after CAG in patients with NSTEMI.

Background: N-terminal pro-brain natriuretic peptide (NT-proBNP) is associated with morbidity and mortality due to heart failure and cardiovascular disease.

Aim: We aimed to examine the association of NT-proBNP with incident chronic kidney disease (CKD) in patients with no history of heart failure and diabetes.

Methods: We prospectively enrolled patients with no history of diabetes who underwent an oral glucose tolerance test to screen for diabetes between 2011 and 2013. Patients with a diagnosis of heart failure, and those who had an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 were excluded. We measured their NT-proBNP levels, and followed their renal function and survival status until March 2023. Cox-proportional hazard models were conducted to examine the association of NT-proBNP (>125 vs. ≤125 pg/mL) with incident CKD (defined as an eGFR <60 mL/min/1.73 m2) and all-cause mortality.

Results: A total of 197 patients were analyzed. After a median follow-up period of 10.6 years, patients who had a higher NT-proBNP (>125 vs. ≤125 pg/mL) at baseline were associated with a higher risk of incident CKD and all-cause mortality (hazard ratio [HR] 2.54, 95% CI 1.34 to 4.82, P = 0.004). This risk remained significant after multivariate adjustment (adjusted HR 2.23, 95% CI 1.10 to 4.52, P = 0.026).

Conclusion: A higher NT-proBNP (>125 vs. ≤125 pg/mL) was independently associated with risk of incident CKD and all-cause mortality in patients with no history of heart failure and diabetes.

Background: Atypical urinary tract infections (aUTIs) are often associated with structural anomalies, antibiotic resistance, and an increased risk of complications in children.

Aim: This study aimed to evaluate the utility of high-sensitivity C-reactive protein (hs-CRP) and other inflammatory markers in distinguishing aUTIs from typical UTIs. Hs-CRP, CRP, procalcitonin, platelet count, neutrophil-to-lymphocyte ratio, immature granulocyte ratio, CRP-to-albumin ratio (CAR), and albumin were analyzed.

Methods: This cross-sectional study included a total of 123 pediatric patients diagnosed with UTI who presented to the Department of Pediatrics at a University Hospital from January 2024 to 2025. Statistical analyses were conducted using SPSS v27.0, with significance set at P ≤ 0.05. The independent samples t-test compared normally distributed continuous variables between groups, while the Mann-Whitney U-test compared non-normal data. The Chi-square test compared categorical variables. Spearman rank correlation coefficients analyzed continuous variable correlations. The discriminative ability of each inflammatory parameters in predicting aUTI was assessed using ROC curve analysis.

Results: Children with aUTI had significantly higher PLT, CRP, and hs-CRP levels, and lower albumin levels. While hs-CRP showed a sensitivity of 80% and a specificity of 50%, CRP showed a sensitivity of 71% and a specificity of 55% for the prediction of atypical infections. The cutoff values were identified as 80.9 for CRP and 60.5 for hs-CRP. CAR was found to have a sensitivity of 63% and a specificity of 60% for predicting atypical infections.

Conclusion: Hs-CRP, PLT, CRP, and CAR offer a useful combination for early identification of aUTIs in pediatric patients. These findings support the integration of hs-CRP into pediatric UTI diagnostic protocols to enhance early risk stratification and guide timely intervention.

Background: When blood pressure cannot be measured in the upper arm, the lower leg site is usually used.

Aim: To compare the agreement between noninvasive and invasive blood pressure values for each site (arm, thigh, and ankle) in intensive care patients.

Methods: This prospective observational study was conducted in a tertiary intensive care unit. The arm, thigh, and ankle were used for a noninvasive blood pressure measurement. All noninvasive measurements were performed in both sitting and semi-sitting positions. Blood pressure values at each site were compared with intra-arterial measurements. The agreement between the invasive and noninvasive measurements was evaluated by a Bland-Altman analysis.

Results: A total of 348 paired blood pressure values were collected from 58 patients (mean age 42.29 ± 13.90, 44.8% female). The agreement between invasive and noninvasive blood pressure measurements in the arm and thigh site was acceptable. The agreement between invasive and noninvasive readings of diastolic and mean blood pressure in the supine position (bias ± SD of 3.21 ± 8.48, and 2.34 ± 7.08 mmHg, respectively; P < 0.05) and systolic, diastolic, and mean blood pressure in the semi-sitting position (bias ± sd of 2.36 ± 8.74 vs 3.93 ± 8.57 and 3.41 ± 7.15 mmHg, respectively; P < 0.05) was not acceptable.

Conclusion: The agreement between invasive and noninvasive readings of systolic, diastolic, and mean blood pressure was worse at the ankle than that observed at the arm and the thigh.