Nigerian Postgraduate Medical Journal最新文献

Background: Internet Addiction (IA) and Internet Gaming Disorder (IGD) may provide significant challenges for medical students as it is linked to sleep and mental health can obstruct academic pursuits, affect long-term professional aspirations and yield extensive adverse effects on society at large.

Objectives: To find the prevalence of IA, IGD, insomnia and depression amongst medical undergraduates and to examine their correlation.

Materials and methods: A mixed-methods study was conducted amongst 402 undergraduate medical students at a rural medical college. Data were gathered by a semi-structured, self-administered questionnaire encompassing socio-demographic information, the Young Internet Addiction Test, the short form of the Internet Gaming Disorder Scale (IGDS-SF), the Insomnia Severity Index (ISI) and the Patient Health Questionnaire. Focus group discussions were done with 56 students chosen for their high scores in IA and IGD. Thematic analysis was employed to discern patterns and themes within the qualitative data. Data triangulation was conducted to interpret and elucidate the quantitative results using qualitative observations.

Results: The mean age of the study participants was 20.39 ± 1.43 years. IA was present in 41.04%, gaming disorder in 20.89%, insomnia in 36.56% and depression in 14.42% participants. Year of study and hostel stay had a statistically significant association with all (P < 0.002). There was a strong and statistically significant association found between IA and IGD with depression and insomnia (P < 0.0001). Furthermore, a statistically significant correlation was found between scores and grades of IA and IGD; and insomnia and depression.

Conclusion: Internet usage amongst medical students was notably high (40%) and showed a significant association with insomnia and depression. Hence, early identification of students at risk for IA and IGD is crucial, as these addictions often overlap with other psychological issues.

Background: Portal hypertension (PH) is a significant effect of chronic liver disease (CLD), resulting in variceal haemorrhage, ascites and hypersplenism. Apparent diffusion coefficient (ADC) and diffusion-weighted imaging (DWI) values serve as potential non-invasive indicators for evaluating the PH and liver fibrosis.

Aims: This study evaluated the impact of portal hypertension on the ADC values of the liver and spleen and related PH severity with the Child-Pugh score.

Materials and methods: A cross-sectional study was performed with individuals exhibiting clinical and radiological indications of CLD and PH and also with healthy controls. Magnetic resonance imaging was employed to assess spleen and liver ADC values, which were linked with clinical severity of diseases.

Results: Liver ADC levels were substantially reduced among patients with cirrhosis when compared with controls, suggesting the existence of fibrosis. Conversely, spleen ADC values were elevated in affected patients, signifying splanchnic congestion. A particular spleen ADC level showed elevated sensitivity and specificity for detecting severe illness. Liver ADC reduced and spleen ADC enhanced with worsening Child-Pugh classification. An increased spleen ADC correlated with variceal hypersplenism and haemorrhage.

Conclusion: DWI-derived ADC values constitute a non-invasive, reliable method for assessing liver fibrosis and the severity of PH, hence validating their application in clinical evaluation and early management for patients with CLD.

Background: Brain death (BD) is the irreversible loss of brain function, assessed through consciousness, brainstem reflexes and apnoea testing. Previous research indicates that experienced physicians perform better in BD determination, underscoring the need for structured education.

Objective: This study evaluates the level of knowledge about BD amongst physicians in Saudi Arabia, comparing expertise across neurology, neurosurgery and intensive care and investigating knowledge gaps.

Subjects and methods: Amongst 162 physicians surveyed, the majority were aged 25-35 years (61.7%) and male (65.4%). Most were Saudi nationals (84.6%) and worked in governmental hospitals (92.0%). Intensivists comprised the largest speciality group (45.1%). Despite 95.1% having encountered BD patients, 41.4% felt that criteria were not well understood in their medical community. Confidence in diagnosis was 49.4%, while 51.9% had formal training. A cross-sectional study was conducted using an online questionnaire, targeting neurologists, neurosurgeons and intensivists through snowball sampling. Data were analysed using the SPSS 29.0.0.

Results: Significant associations were found between knowledge levels and factors such as age (P < 0.001), nationality (P = 0.009), experience (P < 0.001), and confidence in diagnosis (P = 0.025). Multivariate analysis identified years of experience (P = 0.011, Exp (B) = 2.338, 95% confidence interval: 1.211-4.514) as the strongest predictor of high knowledge..

Conclusion: The findings highlight the variability in physicians' understanding of BD, emphasising the need for enhanced training programmes and refresher courses to improve competency in diagnosis and criteria adherence.

Background: Community-acquired pneumonia (CAP) is one of the major causes of morbidity and mortality worldwide, and it often requires intensive care interventions with vasopressor support and mechanical ventilation. Accurate risk stratification is essential for optimising clinical decision-making. While both SMART-COP and CURB-65 scoring systems are used for CAP severity assessment, their predictive abilities for intensive care needs remain debated.

Aims: The aim of the study was to see if SMART-COP or CURB-65 more accurately predicts the need for vasopressors and ventilators in CAP patients.

Materials and methods: This prospective observational study observed patients over a 9-month period at SRM Medical College Hospital and Research Center, enrolling 98 adult CAP patients. Clinical and laboratory parameters were recorded at admission, and patients were stratified using SMART-COP and CURB-65 scores. Statistical analyses included sensitivity, specificity, Chi-square tests, logistic regression, and receiver operating characteristic (ROC) curve analysis.

Results: SMART-COP demonstrated superior sensitivity for predicting vasopressor support (85.7%) and mechanical ventilation (80.0%) compared to CURB-65 (42.9% and 36.0%, respectively). The area under the ROC curve for SMART-COP was higher (0.782 for vasopressor support, 0.745 for mechanical ventilation) than CURB-65 (0.612 and 0.595, respectively). Logistic regression confirmed SMART-COP as a stronger predictor of critical care interventions (P < 0.001).

Conclusion: SMART-COP more accurately predicts the need for vasopressors and ventilators in CAP patients than CURB-65. These findings support its integration into clinical protocols for better risk stratification and resource allocation. Further studies are required to validate these findings in larger cohorts.

Background: Acute pancreatitis (AP) is a pancreatic inflammatory condition characterised by a varied clinical course, ranging from mild self-limiting episodes to severe disorder associated with significant morbidity and mortality. Proper severity evaluation is crucial for prompt intervention and enhanced outcomes.

Aims: This study assesses the efficacy of the Modified Computed Tomography (CT) Severity Index (MCTSI) and Revised Atlanta Classification (RAC) in conjunction with the Bedside Index for Severity in AP (BISAP) for evaluating disease severity and forecasting clinical outcomes.

Methods: A cross-sectional observational study was performed at SRM Medical College Hospital involving 45 patients with AP. BISAP was carried out following 24 h of admission, whereas MCTSI was evaluated using contrast-enhanced CT. Severity was categorised utilising RAC, and clinical-radiological connections were examined.

Results: RAC indicated that 40%, 46.7% and 11.1% of patients encountered mild, moderately severe and severe AP, respectively. The mean BISAP and MCTSI scores were 1.8 ± 0.9 and 6.1 ± 2.3, respectively. Despite individual variations in raw scores, correlation analysis employing Spearman's rank test revealed a statistically significant moderate positive correlation between BISAP and MCTSI (rho = 0.563, P < 0.01). This suggests that as BISAP ratings escalated, MCTSI levels similarly increased, demonstrating a correlation between the two scoring systems in assessing illness severity.

Conclusion: BISAP and MCTSI provide combined advantages in predicting the severity of AP. The RAC continues to be a reliable classification system. The integration of clinical and imaging methods improves early risk assessment and leads to appropriate care.

Background: Pain from needle insertion during haemodialysis is a common challenge requiring effective pain management for patient comfort.

Aims: The aim of this study to compared rhythmic breathing combined with Hugo point acupressure versus vapocoolant spray on pain intensity during needle insertion in haemodialysis patients.

Subjects and methods: A randomised controlled trial was conducted in Iraq between 4 December 2024 and 16 January 2025, and involved 157 patients. Participants were assigned into five groups: control (n = 34), rhythmic breathing (n = 24), Hugo point acupressure (n = 35), combination rhythmic breathing with acupressure (n = 37) and vapocoolant spray (n = 27). Pain intensity was assessed using the Visual Analogue Scale immediately following needle insertion. Data analysis was performed using SPSS.

Results: The control group reported the highest mean pain score (64.79), followed by rhythmic breathing (37.79), Hugo point acupressure (33.14), the combination group (28.35) and vapocoolant spray (25.59). All interventions significantly reduced pain compared with the control group (P < 0.001). The combination group was superior to rhythmic breathing or acupressure alone (P < 0.001). Vapocoolant spray was also more effective than each single intervention (P < 0.01), yet the difference between vapocoolant spray and the combination group was not significant (P > 0.05).

Conclusions: The combination of rhythmic breathing and Hugo point acupressure reduced pain more effectively than either intervention alone. Although vapocoolant spray was highly effective, it did not significantly outperform the combination. Thus, the combined method provides a reliable alternative, especially for patients unable to use vapocoolant spray or in resource-limited settings.

Background: Traditional methods such as manual palpation and fine-needle aspiration cytology (FNAC) have limitations in differentiating benign and malignant thyroid nodules (TNs).

Aim: This study aimed to evaluate the accuracy of ultrasound elastography (USE) in differentiating benign and malignant TNs in a tertiary care hospital setting.

Materials and methods: A prospective study among patients with TNs who visited the hospital between July 2022 and November 2023. Patients with solitary TNs detected through ultrasonography (USG) were included. All patients underwent USG, USE and FNAC. Quantitative data were presented as mean, while qualitative data were expressed as frequencies and percentages. The diagnostic accuracy, sensitivity and specificity were calculated. A Chi-square test was used to assess the relationship between different methods used for diagnosis. P <0.05 was considered statistically significant.

Results: A total of 33 patients, 84.8% female, mean age of 49.4 ± 19.6 years, were included. Histological evaluation revealed 39.4% of the lesions were malignant with a predominance of papillary carcinoma (61.5%), while 60.6% were benign. Among the benign lesions, majority were identified as colloid nodules (70.0%). Diagnostic efficacy of thyroid imaging reporting and data system (TI-RADS) was 78% and there was a significant correlation between TI-RADS classification and cytological findings (P = 0.00025). USE showed a sensitivity, specificity, positive predictive value and negative predictive value of 80.0%, 92.3%, 94.1% and 75.0%, respectively. There was a significant correlation between the elastography findings and the cytological outcomes (P = 0.0001).

Conclusions: USE shows great potential as a novel method for differentiating solid TNs and indicating optimal sites for FNAC.

Background: Fumonisins are mycotoxins produced by Fusarium spp. They are classified as Group 2B carcinogens by the International Agency for Research on Cancer.

Aim: We aimed to investigated the association between gastric cancer (GC) and urinary fumonisins levels.

Methods: We conducted this age- and sex-matched case-control study in Lusaka, Zambia. Cases were patients with histologically confirmed GC while controls did not have cancer. We tested the urine samples for fumonisins using high-performance liquid chromatography, collected information on risk factors using interviewer-administered questionnaires and analysed the reults in Stata version 15.

Results: A total of 52 participants were included in the study, 26 GC cases and 26 controls. In each group, 15 (58%) were females. The median age was 54 years; interquartile range (IQR) 46-66. Fumonisins was detected in 10 (19%) of the samples. Quantitatively, levels of fumonisins were higher in cases (73 µg/ml; IQR 40-109) than in controls (21 µg/ml (IQR 5-47), but this difference was not statistically significant, P = 0.25. Qualitatively, there was no association between GC and presence of fumonisins in urine (odds ratio 1.0, 95% confidence interval [CI] 0.2-5.1, P = 1.00). Lack of formal education and low socio-economic status were associated with urinary fumonisins P = 0.04 and 0.02, respectively. However, on regression analysis, only low socio-economic status remained statistically significant with a regression coefficient of 50, (95% CI 29-70); P < 0.001.

Conclusions: This study has demonstrated that urinary fumonisins levels are associated with low socio-economic status but not to GC.

Background: The global incidence of acute pancreatitis (AP) is increasing, and it has an unpredictable course. As AP is associated with high mortality rates, it is important to effectively assess severity and manage the disease.

Aims: We assessed the use of PANC-3 scores for predicting the severity of AP and compared these scores with the Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores.

Materials and methods: A prospective study in patients with AP at a tertiary care hospital in Karad, India. Demographic characteristics, clinical presentation, laboratory findings and radiological data of the patients were recorded within 24 h of admission. The severity of AP was assessed using PANC-3 and APACHE-II scores. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of both the scoring systems were calculated and compared.

Results: A total of 80 patients with AP were included in the study. Most of the patients were in their early thirties (31-35 years), and alcohol consumption was the leading aetiological factor. The PANC-3 scores exhibited a strong predictive accuracy for severity of AP. There was excellent agreement between the PANC-3 and APACHE-II scores (κ =0.8855). Sensitivity (94.1% vs. 88.2%), PPV (94.1% vs. 93.8%) and NPV (98.4% vs. 96.9%) were higher in APACHE-II, but specificity was equivalent between both systems (both 98.4%).

Conclusions: Using PANC-3 scores, we were able to accurately predict the severity of AP in a tertiary care hospital setting. We observed that the performance in predicting the severity of AP was similar using the PANC-3 and APACHE-II scores.

Background: Hypertension is a major non-communicable disease of public health concern. In Nigeria, the rate is between 28% and 42.2%. Hypertension or the prolonged use of some antihypertensive drugs has been associated with hearing loss in studies. There is a paucity of studies on this in our environment.

Aims: Therefore, this study aims to evaluate the relationship between hearing thresholds and hypertension.

Materials and methods: This was a hospital-based cross-sectional comparative study of hypertensive and non-hypertensive patients. Ethical approval for the study was obtained. Informed consent was obtained from the participants. A researcher-administered structured pro forma was utilised to obtain demographic and medical history data. Blood pressure measurement and pure-tone audiometry were performed on all the participants. Data were analysed using SPSS version 25.

Results: One hundred and twenty-eight participants each were recruited from the hypertensive and control groups for the study. The age range of the hypertension group was 27-60 years. The frequency of hearing loss amongst the hypertension and control groups was 47.7% and 15.6%, respectively (P < 0.001). The mean pure-tone average for the hypertension group was 29.2 dB ± 18.5/28.3 dB ± 20.5 and 21.6 dB ± 8.7/20.6 dB ± 8 in the right and left ears of the hypertensive and control groups, respectively. The frequency of hearing loss in the controlled and uncontrolled hypertensive subjects was 44.7% and 52%, respectively (P = 0.424). Hearing loss frequency was 50% in hypertensive subjects on diuretic and/or beta-blockers and 46% in those on other antihypertensive drugs (P = 0.650).

Conclusion: The frequency of hearing loss in the hypertension group was significantly higher than in the control group.