Nigerian Postgraduate Medical Journal最新文献

Background: Chronotherapy optimises the management of hypertension by synchronising medication with circadian rhythms. When taken in accordance with biological patterns, the long-acting angiotensin II receptor blocker telmisartan may provide extra advantages, particularly for patients with diabetes mellitus who have hypertension.

Objective: The purpose of this study is to compare the effects of telmisartan 40 mg taken in the morning versus at bedtime on the mean blood pressure (BP) during the day and at night, as well as the BP response to exercise, in patients with diabetes mellitus.

Methods: Forty diabetic hypertensive patients were given telmisartan either in the morning or at bedtime for 8 weeks, followed by a 1-week washout and cross-over in a cross-over randomised controlled trial. In addition to treadmill exercise testing (Bruce protocol), ambulatory BP was measured.

Results: Bedtime dosing considerably reduced the systolic and diastolic BP at night when compared to morning dosing. Morning dosing was especially successful in lowering BP increases brought on by exercise. No noteworthy adverse events were observed.

Conclusion: Bedtime telmisartan dosage improves nocturnal BP control, but morning dosage more successfully lowers exercise-induced BP spikes. Individualised chronotherapy may improve outcomes and control hypertension in diabetic patients.

Background: Poor nutritional status among tuberculosis (TB) patients contributes to treatment failure and poor prognosis. However, no study has provided information on the nutritional conditions of Afghan TB patients. Using data from five TB care facilities in southern Afghanistan, this study aimed to determine the extent of undernutrition and examine its determinants in TB patients.

Methods: This was a cross-sectional study that utilised data from five TB care centres in four southern Afghan provinces. Data were collected between May and July 2025. Patients with TB who were aged ≥18 years were included in the analysis. Heights and weights were measured in metres (m) and kilograms (kg), respectively. Patients with a body mass index <18.5 kg/m2 were considered undernourished. Binary logistic regression was used to identify factors associated with undernutrition in TB patients.

Results: Of the 431 patients, 40.4% were undernourished. In adjusted models, odds of undernutrition were higher among females (adjusted odds ratio [AOR] 4.12; 95% confidence interval [CI] 2.41-7.04), rural residents (AOR 3.85; 95% CI 2.11-7.02), currently unmarried (AOR 1.86; 95% CI 1.11-3.13), smokers (AOR 11.06; 95% CI 5.27-23.21), patients with severe disease (AOR 2.23; 95% CI 1.16-4.28) and those with medical comorbidity (AOR 2.34; 95% CI 1.32-4.17).

Conclusion: In conclusion, the prevalence of undernutrition is alarmingly high in Afghan TB patients. Therefore, nutrition-focused education and support should be considered key elements of TB care in Afghanistan.

Background: Hepatitis B virus (HBV) is a major cause of liver-associated morbidity and mortality worldwide, accounting for over 354 million cases with high morbidity and fatalities. About 90% of infected people are unaware of their status. Efforts at significant reduction and elimination have come a long way; yet, more concerted efforts are still needed.

Objective: The objective of the study was to determine the prevalence of hepatitis B viral infections in Ondo State Nigeria.

Materials and methods: We conducted this study from May to December 2024 across the 3 senatorial districts in Ondo State, using a stratified random sampling technique. Subjects ranging from 20 years and above were randomly selected. After a brief health education at each location, 5 ml of fresh blood was aseptically collected from each subject who accepted screening. Double screening for hepatitis B surface antigen was done for each subject using rapid diagnostic kits. Each positive sample and 1 in every 10 negative subjects were also tested using hepatitis B enzyme linked immuno-sorbent assay antigen detection.

Results: Amongst the 1979 subjects recruited, 139 were positive for HBV, giving a prevalence rate of 7.02%, with a male-to-female prevalence ratio of 2:1. Male gender, monogamous marriage and singles had higher risks of HBV infection. Alignment with health education as personal prevention efforts significantly reduced HBV among the subjects. Inversely, lifestyles such as habitual alcohol intake and smoking were significant predictors of hepatitis B infection.

Conclusion: This study provides valuable insights into the epidemiology of HBV in Ondo State, Nigeria. Highlighting the need for more coordinated efforts towards the prevention and control of the spread of HBV as we move towards the elimination of viral Hepatitis.

Background: Medical residents have shown interest in artificial intelligence (AI) for their clinical and academic activities; however, research on the perception of speciality professors regarding AI is lacking.

Aims: To estimate the proportion of medical professors who perceive it necessary to include AI in the curricula of their specialities, along with their self-efficacy, perceived benefits and identified barriers to AI tools.

Subjects and methods: Cross-sectional study of 108 medical speciality professors in Monterrey, Mexico, in June 2024. We sent them a self-administered questionnaire that included questions about the professors' perceptions of the need to incorporate AI in the specialities' curricula, their self-efficacy, benefits, barriers to AI and other variables. We estimated relative frequencies, 95% confidence intervals (CI), measures of central tendency and dispersion. Self-efficacy, benefits and barriers scores were compared by interest variables using the Mann-Whitney or Student's t-tests. P < 0.05 was significant.

Results: Ninety-eight professors (90.7%, 95% CI: 85.3-96.2) considered it necessary to incorporate AI into their academic programmes. Self-efficacy scores were higher among those working in the private sector and those with a course, workshop or diploma in AI. In addition, those with a master's degree or a doctorate, who had completed a course, workshop or diploma, showed higher benefits scores.

Conclusions: Nine out of ten professors of medical specialities believe it is necessary to include AI in their curricula, with a high perception of its self-efficacy and benefits. Academic authorities in medical specialisation should examine the growing integration of AI in modern educational environments.

Background: Pulse pressure index (PPI) and high-sensitivity C-reactive protein (hs-CRP) are potential markers for vascular compliance and inflammation, respectively, and may predict diastolic dysfunction in hypertensive individuals.

Aims: This study aimed to evaluate the association of PPI and hs-CRP with diastolic dysfunction in newly diagnosed essential hypertensive patients.

Materials and methods: This prospective observational study included 82 patients aged >40 years with newly diagnosed hypertension. Baseline PPI and hs-CRP levels were measured, and two-dimensional echocardiography was performed to assess and grade DD. Patients received standard antihypertensive therapy, and follow-ups were conducted at 3 and 6 months to reassess parameters.

Results: At baseline, 74.4% of patients had diastolic dysfunction, predominantly Grade 1 and 2. hs-CRP showed a strong positive association with diastolic dysfunction (β = 0.885, P = 0.025), while PPI had a moderate correlation (β = 0.475, P = 0.035). Antihypertensive therapy significantly improved diastolic function over 6 months (P = 0.032), though PPI did not show a significant change (P = 0.435).

Conclusion: hs-CRP is a strong indicator of inflammation-driven diastolic dysfunction, while PPI serves as a surrogate for vascular stiffness. Early identification using these markers can enhance clinical assessment and guide timely intervention in hypertensive patients.

Background: Raised serum resistin is adjudged to increase the likelihood of insulin resistance (IR) and type 2 diabetes mellitus (T2DM) through multiple biochemical pathways.

Aims: The current study assessed the likelihood of IR and T2DM among Nigerians based on serum resistin status.

Materials and methods: This case-controlled study was conducted at a tertiary hospital in southern Nigeria, among 100 T2DM patients matched with age/gender controls. Sociodemographic, anthropometric, clinical, and laboratory data, including serum resistin status, were collected using standard protocols. T2DM diagnosis was made using recommended guidelines. Statistical analyses were conducted using descriptive statistics, logistic regression models, and area under the curve (AUC) of the receiver-operating characteristic curve at a 95% confidence level (CI) and an alpha value of <0.05.

Results: T2DM patients had higher mean values of body mass index (BMI), fasting plasma glucose (FPG), fasting serum insulin (FIN), homoeostatic model assessment of IR values (HOMA-IR) and serum resistin compared to controls (P < 0.05). Compared to the lowest quartile of serum resistin among T2DM patients, the likelihood of attaining IR status and T2DM risk increased with increasing quartiles of serum resistin, independent of matching factors (age/gender), occupation, BMI, FPG, FIN and HOMA-IR (Ptrend < 0.001). Increasing serum resistin had good predictive value on the likelihood of attaining IR status (AUC: 0.79; 95% CI: 0.72-0.85; P < 0.001) and T2DM risk (AUC: 0.89; 95% CI: 0.83-0.93; P < 0.001).

Conclusion: Current findings indicate a likelihood of IR and T2DM in association with increasing serum resistin, corroborating the role of resistin in T2DM through IR.

Background: Tinea capitis, also called dermatophytosis of the scalp, is the most common tinea infection in children within pre-pubertal age. The causative agents, Trichophyton, Epidermophyton and Microsporum spp., are highly predominant in Africa, Asia and Europe.

Aims: This study investigated the prevalence of tinea capitis among public primary school children and ascertained the epidemiological risk factors.

Materials and methods: Scalp lesions were collected from 102 pupils with suspected cases of dermatophytosis between March 2017 and August 2017 in Lagos, Ogun and Ekiti States. A structured pretested questionnaire was designed to gather data on sociodemographic and potential risk variables, followed by analysis using IBM SPSS version 20. Scalp lesion samples were analysed using culture and biochemical assay. The polymerase chain reaction was performed using the primer pairs 'DERM' F1 and 'DERM' R2 gene markers.

Results: Out of 102 samples, 95 (93.1%) were positive by microscopy and 75 (78.9%) by culture. Three fungal genera, Microsporum (65.3%), Trichophyton (29.3%) and Epidermophyton (5.3%) were identified. Amongst the dermatophytes isolated, Microsporum canis constituted 28%, followed by 9.1% Trichophyton rubrum and 9.1% Trichophyton verrucosum. All the isolates were confirmed to possess 'DERM' genes 1 and 2. Gender, age and place of hair shaving were among the risk factors that predisposed the participants to tinea capitis. A substantial statistical difference (P < 0.05) was seen between male and female learners who were infected with dermatophytes.

Conclusion: This study revealed a high prevalence of dermatophytes, with M. canis being the most predominant fungal pathogen. Risk factors such as gender and age predispose subjects to infections. Accurate and prompt surveillance of the burden of tinea capitis is essential to prevent further transmission.

Background: The COVID-19 pandemic has significantly disrupted the work-life balance of frontline workers by increasing workload, stress and exposure risks. Despite their crucial role, limited research has examined the specific factors influencing this balance, hindering the development of evidence-based interventions.

Aims: This study explored the challenges frontline workers faced during the pandemic.

Methods: A cross-sectional study was conducted amongst 112 frontline workers recruited through convenience sampling. Work-life balance, mental health and recreational activities were assessed using validated instruments. Data were analysed using factor analysis, multiple regression and ANOVA to identify determinants of work-life balance and evaluate the mediating role of recreational activities.

Results: Three key factors-responsibility, flexibility and hierarchical culture-were identified as significant influences on work-life balance. Regression analysis showed that the pandemic accounted for approximately 50% of the variance in balance scores, while ANOVA further confirmed its substantial disruptive effect. Recreational activities played a mediating role, with flexibility and supportive organisational culture contributing positively to both mental health and overall well-being.

Conclusion: The findings underscore the importance of organisational policies that promote flexible work arrangements, supportive supervisory structures and opportunities for recreational engagement. Such interventions are essential for protecting the well-being and resilience of frontline workers during health crises.

Background: Malnutrition is a major public health problem in India. Approximately 80% of the world's undernourished children are concentrated in 20 countries. In India, nearly 60 million children are underweight. Children with malnutrition contribute more to paediatric intensive care unit (PICU) admissions, and their outcomes may be affected by the degree of malnutrition. Malnutrition is also a risk factor for both, increase in length of stay in the PICU and higher Paediatric Respiratory Severity Score (PRESS) scores, thus increasing the need for respiratory support.

Aim: To assess the impact of the nutritional status of children admitted with respiratory illnesses on the duration of stay at the PICU in a tertiary care hospital catering to suburban population.

Materials and methods: A prospective descriptive study carried out over a period of 6 months analysed 49 children admitted with respiratory illness to PICU in a tertiary care hospital. All Data collected was entered in Excel sheet. All data analyses were performed using IBM Corp. IBM SPSS Statistics for Windows [computer software]. Version 21. Armonk, NY: IBM Corp.; 2012.

Results: During the study period, a total of 134 children were admitted to the PICU. Among them, 49 children (36.5%) were admitted due to respiratory tract infections, forming our study group. Based on the IAP weight-for-age growth charts, it was found that 30 (61.2%) of these children exhibited some degree of malnutrition. In our study, 63.3% of the study population were infants. The male gender was predominant (59.2%) in the demographic pattern. The mean hospital stay for all patients was 8.3 days. Mean hospital stay in malnourished patients was 10.85 days, whereas in normally nourished children, it was 4.33 days. The average duration of PICU stay was 4.46 days overall. For malnourished patients, the average stay in PICU was 5.82 days, compared to 2.29 days for patients with normal weight. A significant positive correlation (P < 0.05) was found between malnutrition and prolonged PICU stay, hospital stay and severity of PRESS score.

Conclusion: The grade of malnutrition was associated with greater severity of respiratory illness and a longer length of stay in PICU and Hospital. The assessment of grades of malnutrition at the time of admission can predict the impact on the length of stay in PICU and hospital.

Background: Over 85% of NCD-related deaths occur in low- and middle-income countries (LMIC), particularly Sub-Saharan Africa (SSA) where marked increases from preceding decades have been recorded. Physical inactivity and consumption of unhealthy diets are major precursors for hypertension, which has been reported as the most prevalent and important Cardiovascular diseases (CVD) risk factor. There are several reports on increased prevalence of hypertension, physical inactivity, and consumption of unhealthy diets among commercial vehicle drivers.

Aims: The study aimed to determine factors associated with hypertension and predict 10-year CVD risk in commercial vehicle drivers in Calabar, southern Nigeria.

Methods: This study was a cross-sectional investigation of 380 commercial drivers, recruited using systematic sampling. Data were collected using an adapted World Health Organization STEP instrument. Binary logistic regression analysis was done at 5% significance level.

Results: The prevalence of hypertension was approximately 40%. Age >44 years (odds ratio [OR] = 4.4, 95% confidence interval [CI]: 1.9, 5.4), high body mass index (OR = 3.1, 95% CI 1.9, 5.3), years of professional driving (>5 years) (OR = 1.8, 95% CI: 1.5, 3.0), and fasting blood sugar >7 mmol/L (OR = 1.7, 95% CI: 1.5, 2.9) were associated with developing hypertension. The long-distance drivers had nearly two-fold increased odds (OR = 1.8, 95% CI: 1.9, 2.7) of a 10-year CVD risk compared to the short-distance drivers.

Conclusion: The high prevalence of hypertension and a two-fold increase in the 10-year predicted risk of CVD events found among the study population necessitate frequent health awareness campaigns and periodic health screening among the higher-risk group. This will aid in the early detection of CVD risk factors and prompt treatment.