Nigerian Journal of Clinical Practice最新文献

Autoimmune hemolytic anemia (AIHA) is an acquired hemolytic disorder caused by autoantibodies and/or complement-mediated destruction of red blood cells (RBCs), often driven by dysregulated B lymphocyte activity. A notable clinical association exists between AIHA and lymphoproliferative disorders (LPD), particularly chronic lymphocytic leukemia, and non-Hodgkin's lymphoma (NHL). To summarize the clinicopathological link, prevalence, pathogenesis, and management strategies of AIHA associated with NHL. This narrative review synthesizes evidence from 20 peer-reviewed studies published between 2011 and 2024, identified through PubMed, Google Scholar, and manual citation tracking. Eligible studies were restricted to English-language articles addressing the prevalence, pathogenesis, clinical features, diagnosis, or treatment of AIHA in NHL. Approximately 7%-10% of NHL patients develop coexisting AIHA, while up to 20% of AIHA patients are eventually diagnosed with lymphoma. The reported incidence of AIHA among NHL patients varies widely (0.23%-15.7%), reflecting methodological and population differences. Proposed mechanisms include chronic antigen stimulation and dysregulated antibody production. The coexistence of both conditions complicates management: Treatment generally prioritizes NHL-directed therapy, while glucocorticoids and rituximab are commonly used for AIHA control. AIHA and NHL share overlapping immunopathological pathways with important clinical implications. Early recognition of AIHA in NHL is essential to optimize patient outcomes. Future priorities include developing biomarkers to identify high-risk patients and conducting large-scale randomized trials to validate complement inhibitors for cold agglutinin disease (CAD).

Background: Cervical spondylosis of the vertebral artery type (CSA) affects vertebral artery blood flow and is associated with sympathetic dysfunction and apoptosis. While treatments like electroacupuncture have been explored, the impact of massage therapy on CSA remains unclear.

Aims: This study examines how massage therapy affects sympathetic neurotransmitters, vertebral artery blood flow, and apoptosis in cervical spondylosis of the vertebral artery type (CSA).

Materials and methods: Forty rabbits were divided into four groups: normal, model, electroacupuncture (EA), and massage. The CSA model was induced by neck injections of a sclerosing agent in all groups except the normal group. The EA group received electroacupuncture at "Fengchi" (GB 20) and "Jiaji" (C3-5), while the massage group underwent pushing manipulation at C3-5. Vertebral artery blood flow was measured using laser Doppler imaging, and serum levels of neuropeptide Y (NPY) and norepinephrine (NE) were assessed by ELISA. Histological changes were observed with H and E staining, apoptosis was evaluated by TUNEL assay, and protein expression of CHOP, Bcl-2, and Bax was analyzed by western blotting.

Results: Following model induction, vertebral artery blood flow significantly decreased in all rabbits. Massage improved blood flow, decreased serum NPY and NE levels, alleviated lumen narrowing and intimal thinning of the vertebral artery, and significantly reduced the apoptosis, as well as the expression of CHOP and Bax proteins, while increasing Bcl-2 expression. These effects surpassed those observed in the EA group.

Conclusion: Massage effectively reduces sympathetic neurotransmitter release, mitigates apoptosis, and improves vertebral artery blood flow, offering a viable treatment for CSA.

Background and aim: This study aimed to investigate the relationship between eating habits, assessed using the Three-Factor Eating Questionnaire Revised 18 (TFEQ-r18), degree of obesity, and impact of these factors on morbid obesity in individuals requiring bariatric surgery.

Methods: A total of 55 adult patients, who presented to our clinic between 2020 and 2024 dates and were scheduled for obesity surgery, were included in the study, and their demographic and physical data were recorded.

Results: They were administered the TFEQ-r18 questionnaire, which consists of 18 questions: six assessing Cognitive Restraint (CT), nine on Uncontrolled Eating (UE), and three on Emotional Eating (EE). The mean age was 34.0 ± 11.1 years; 11 (21.8%) were male. The mean weight was 113.9 ± 20.7 kg, and the body mass index (BMI) was 42.1 ± 6.9 kg/m². The mean score was 14.9 ± 3.4 (49.4%), the CR score was 21.1 ± 6.8 (44.8%), the UE score was 7.4 ± 3.0 (48.9%), and the EE score was 43.4 ± 8.8 (47.0%). Only the item "When I smell a delicious meal…" was associated with higher BMI (P = 0.046); other response groups showed similar BMI values (all P ≥ 0.050). Class III obesity rates did not differ across responses (p ≥ 0.050), and no significant differences were observed in total or subscale TFEQ-R18 scores across obesity classes (p ≥ 0.050). Likewise, no significant correlations were found between total/subscale or item scores and BMI (p ≥ 0.050).

Conclusion: In this pre-bariatric cohort, TFEQ-R18 subscales (cognitive restraint, uncontrolled eating, emotional eating) were not associated with BMI or obesity class, suggesting that trait-level eating scores alone may be insufficient for appraising obesity severity. Findings are limited by unadjusted analyses and the cross-sectional design; future covariate-adjusted and longitudinal studies are warranted.

Background: Clubfoot is a childhood disability occurring in 1 out of every 1000 live births. About 80% of these are found in low and middle income countries. Although this condition is treatable using serial manipulation and casting, problems of access and compliance to treatment may result in treatment default and drop-out.

Aim: This study serves as a pilot to evaluate the awareness of care givers about clubfoot, and identified the barriers they face during their ward's treatment. Methods: Caregivers of patients attending the clubfoot clinic of a tertiary centre, were consecutively recruited over a 3 month period. An interviewer administered semi-structured questionnaire was used to collect data on their demographics, prior knowledge about clubfoot, and barriers to effective compliance with treatment protocol. All data was analyzed using SPSS version 23. Chi-square test was used to determine the relationship between socio-demographic variables and prior knowledge about club foot. P-value was considered significant < 0.05 at 95% confidence interval.

Results: A total of 67 care givers participated in the study. There were 58 females (86.6%) with male to female ratio of 1:6.4. Thirty-two respondents (47.8%) had a prior knowledge of club foot deformity. Fourty six (69%) had their lives/work affected by frequent clinic visits, while 43 (64.2%) travelled beyond 10km to access care. Frequent change of cast was a concern to 54 (80.6%), while travel costs was a limitation for 43 (64.2%). There was no significant relationship between socio-demographic variables and Knowledge of club foot among the primary care givers.

Conclusion: The study identified at gap in awareness of club foot deformity among primary care givers of children with club foot. Distance travelled by care givers as well as cost of transport were important barriers to effective access to care for club foot deformity.

Background: Methanol poisoning is a severe medical emergency associated with high morbidity and mortality. Methanol poisoning leads to metabolic acidosis, visual disturbances, and central nervous system complications. Early diagnosis and timely treatment, including hemodialysis, are critical in improving outcomes.

Objectives: This study aimed to evaluate the clinical and laboratory predictors of mortality and the need for hemodialysis in methanol poisoning patients. It also sought to establish cutoff values for critical parameters that influence clinical decisions.

Methods: A single-center retrospective cross-sectional study was conducted on patients over 18 years of age with suspected methanol poisoning between 2010 and 2022. Demographic, clinical, and laboratory data were collected and analyzed. Predictive parameters for mortality and hemodialysis were identified using Receiver Operating Characteristic (ROC) analysis.

Results: Sixty-four patients were included, with a mean age of 47.7 years and 92.2% being male. Mortality occurred in 29.7% of patients. ROC analysis identified a serum pH cutoff of ≤7.08 for mortality prediction (AUC: 0.894, P<0.001) and ≤7.315 for predicting the need for hemodialysis (AUC: 0.891, P<0.001). Serum bicarbonate levels were significant predictors, with a cutoff of ≤8.45 for mortality (AUC: 0.820, P<0.001) and ≤15.55 for hemodialysis (AUC: 0.883, P<0.001). Elevated lactate levels (cutoff ≥3.67 mmol/L) and an anion gap ≥27.25 were also strong predictors of mortality.

Conclusion: Early recognition of critical parameters such as serum pH, sodium bicarbonate, lactate, and anion gap are essential in managing methanol poisoning.

Background: Syncope is one of the most common reasons for hospital admission. Several risk scores exist for the follow-up, discharge, and hospitalization of such patients.

Aim: To investigate the effect of the R+S value and other electrocardiography (ECG) findings on the 30-day prognosis of patients presenting to the emergency department with syncope of unknown cause.

Methods: This study examined 217 patients (116 males and 101 females) aged 18 years and older who presented to the emergency department with syncope. In the ECG, atrioventricular block, right or left bundle branch block, ventricular hypertrophy, QT interval prolongation, QRS duration prolongation, pathological Q wave, pathological ST-T changes, and arrhythmias were accepted as pathological. In addition, we collected the patients' chest ECG derivations in which the highest R wave was present, and the derivation in which the most profound S wave was present; these values were collected, and the maximum R+S values were recorded. The mortality status of the patients within 30 days was recorded. (The level of significance was set at P < 0.05).

Results: Patients with bundle branch block, arrhythmia, QRS prolongation, QT prolongation, and atrioventricular block in the ECG had a higher mortality rate (P < 0.05). We calculated the sum of the highest R+S values and found a significant relationship between the increase in this value and the increase in patient mortality (P = 0.002).

Conclusion: Higher mortality was observed in patients with syncope who showed elevated R+S values, bundle branch block, arrhythmia, QRS prolongation, QT prolongation, and AV block in ECG.

Background: Preeclampsia is a significant cause of maternal and perinatal mortality. Prediction and early diagnosis using a reliable biomarker will prevent its complications.

Aim: To compare the plasma fetal fibronectin levels among preeclamptic and normotensive pregnant women.

Methods: It was a prospective comparative observational study of 78 preeclamptic women and 78 normotensive controls. Following ethical approval, sociodemographic and medical information were obtained from the participants. Blood samples were also collected and analyzed for fetal fibronectin using the Assay Max kit. Data were analyzed using SPSS®. The Student's t-test was used to compare the mean fetal fibronectin levels in preeclamptic and control groups. A P value less < 0.05 was considered statistically significant.

Results: The mean ages of the preeclamptic and normotensive women were 29.4 and 28.2 years respectively (P = 0.192). The mean plasma fetal fibronectin level for the preeclamptics was 2562.8 µg/ml, while that for the controls was 2440.8 µg/ml (t = 0.278, P = 0.783). The majority (65%) of the participants from both study groups had elevated serum fetal fibronectin levels. There was no significant association between serum fetal fibronectin and having preeclampsia (P = 0.528). There was a significant negative correlation between the mean arterial blood pressure and serum fetal fibronectin levels of normotensive women (r = -0.272, P = 0.016). There was, however, no significant correlation between the mean arterial blood pressure and serum fetal fibronectin levels of the preeclamptics (r = 0.057, P = 0.618).

Conclusion: Maternal serum fetal fibronectin levels in preeclamptic are not significantly different from those in normotensive women.

Background: Shear wave elastography (SWE) can measure the stiffness of the thyroid gland in terms of velocity.

Aim: This prospective study aimed to quantify the velocity values in m/s via shear wave elastography in cases of Hashimoto thyroiditis (HT) and Graves' disease (GD) to provide additional diagnostic insights by comparing the velocity values of healthy subjects against those with HT and GD.

Material and methods: In this prospective study, we measured the velocity values of the thyroid gland using SWE among patients diagnosed with HT, GD, and the control group. We numerically assessed and compared the velocity differences between groups. The study comprised 52 patients with HT 44 patients with GD and 41 healthy control subjects.

Results: A statistically significant difference was noted in the thyroid gland velocities between HT and GD patients when compared to the control group. The mean velocities for HT patients (2.31 ± 0.4 m/s) and GD patients (2.20 ± 0.33 m/s) were significantly higher than that of the control group (1.87 ± 0.33 m/s). There was no significant difference in thyroid gland velocity values between HT and GD patients (P = 0.16). The optimal cutoff mean velocity value for the prediction of diffuse thyroid disease (HT and GD) was 2.19 m/s. For this cutoff value, the mean velocity had 62% sensitivity, 93% specificity, 71% diagnostic accuracy, 95% positive predictive value, and 51% negative predictive value for the presence of diffuse thyroid disease.

Conclusion: SWE, alongside ultrasound, could enhance the differentiation between HT, GD, and healthy thyroid glands.

Background: Volumetric analyses conducted using magnetic resonance imaging (MRI) indicate that structural changes in the cerebellum, thalamus, and basal ganglia reflect the neurodevelopmental impacts of bipolar disorder (BD).

Aim: This study aims to investigate neuroanatomical alterations in the volumes of the cerebellum, thalamus, and basal ganglia in children and adolescents with BD.

Methods: Twenty-three adolescents aged between 13 and 17 years who were diagnosed with BD Type I manic episode according to DSM-V criteria and presented to the Gaziantep University Department of Child and Adolescent Psychiatry between January 2020 and February 2025 were included. The control group consisted of adolescents who underwent brain MRI for complaints such as headache or dizziness, showed no pathological findings, and had no psychiatric diagnosis. All participants were evaluated with a semi-structured interview (K-SADS-PL), and brain MRIs were obtained using a 1.5 Tesla scanner (Gyroscan Intera, Philips Medical Systems Nederland). Volumetric measurements were performed by the same radiologist in both groups.

Results: The BD group showed a significantly larger thalamic volume compared with healthy controls (13.67 ± 1.93 vs. 11.49 ± 1.80; P = 0.0002). No significant differences were observed in cerebellar (139.99 ± 21.44 vs. 140.23 ± 11.13; P = 0.7765), caudate nucleus (9.65 ± 1.70 vs. 8.88 ± 1.40; P = 0.117), or lentiform nucleus (16.33 ± 2.43 vs. 15.50 ± 2.69; P = 0.2859) volumes between the groups.

Conclusion: The findings suggest that neuroanatomical traces of BD can be found at an early stage in children and adolescents. These results provide important insights into the pathophysiological mechanisms of the disorder and support the potential utility of neuroimaging methods in early diagnosis and intervention.

Background: Somatosensory amplification plays a role in the development of pain and psychological distress associated with chronic musculoskeletal conditions, such as knee osteoarthritis (OA).

Objective: The aim of the current research is to examine the relationship between the level of somatosensory amplification and psychological and functional status in patients diagnosed with knee OA.

Methods: The study included 88 patients with knee OA (mean age: 63.55 ± 10.06 years; 79.5% female). Patient evaluation was conducted using several standardized tools: the Somatosensory Amplification Scale (SSAS), Tampa Scale for Kinesiophobia (TAMPA), Visual Analog Scale (VAS), Beck Depression Inventory (BDI), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC).

Results: In individuals aged 75 and over, SSAS (P= 0.011) and BDI (P < 0.001) scores were statistically significantly higher than those of both 40-64 and 65-74 years age groups; TAMPA (P= 0.04) and WOMAC (P= 0.001) scores were statistically significantly higher than those of 40-64 years age group. TAMPA (P= 0.008), BDI (P= 0.019), and WOMAC (P= 0.005) scores were significantly higher in females than in males. The studied parameters did not change significantly according to the disease duration. When the relationship between somatosensory amplification and kinesiophobia, pain, depression level, and functional status was examined, positive correlation was revealed between the SSAS and TAMPA (r= 0.232, P= 0.029), BDI (r= 0.379, P= 0.000), and WOMAC (r= 0.299, P= 0.005) scores.

Conclusion: Patients with knee OA often experience increased depression, kinesiophobia, pain, and reduced functional status. They also tend to show heightened somatosensory amplification, linked to psychological distress and functional limitations. Addressing these cognitive patterns within individualized rehabilitation may improve treatment outcomes.