Nigerian Postgraduate Medical Journal最新文献

Background: Assessment drives candidates' learning and focuses on the main goals and objectives of the course. Over the years, determination of pass scores in medical education has evolved from the arbitrary 50% to the actual determination of the cut-off scores in the standard setting process in order to make a decision to pass/fail candidates presenting for licensure or credentialing purposes.

Materials and methods: The study aimed at assessing and comparing candidates' performance pre- and post-adoption of standard setting in the college. This was a comparative cross-sectional study with a time trend. Examination results of all candidates who registered and sat for examinations in the years 2016-2023 were included in the study. Secondary data from approved results of the various faculties from 2016 to 2023 were used. Data analysis was done using SPSS Version 26.

Results: There was a statistically significant difference in the mean pass rates pre- and post-adoption of standard setting in the primary examinations (P < 0.001), Part I examinations (P = 0.002) and Part II examinations (P < 0.001) with a higher mean pass rate post-adoption of standard setting.

Conclusion: The increased pass rates in the primary, Part I and Part II examinations post-adoption of standard setting may suggest improved examination performance. There is, however, the need to assess the acquired competencies and skills of the candidates post-certification. The significantly higher mean pass rates post-adoption of standard setting are consequent on improvement in the quality and robustness of items/questions and of the examination processes, brought about by the training and retraining of faculty examiners which preceded the implementation.

Background: Thyroid cancer, particularly papillary thyroid carcinoma (PTC), is the most common endocrine malignancy, with a growing incidence worldwide. Accurate differentiation between benign and malignant thyroid nodules is crucial for appropriate treatment and management. Histopathological analysis is the gold standard for definitive diagnosis, but immunohistochemistry (IHC) markers such as cytokeratin-19 (CK-19) have shown potential as valuable diagnostic aids in some cases with equivocal morphological appearances and have diagnostic dilemmas. CK-19 is known to be expressed in higher levels in malignant thyroid lesions, especially PTC.

Aims: To study the diagnostic accuracy of CK-19 immunomarker in the diagnosis of thyroid malignancy with histopathology as the gold standard.

Materials and methods: The present study was carried out in Pathology Department, Bharati Vidyapeeth Deemed University Medical College and Bharati Hospital and Research Centre, Pune. It is a cross sectional, analytical, prospective and retrospective study. A total of 42 cases of thyroid nodules were included. IHC staining for CK-19 was performed on the paraffin-embedded tissue sections of these nodules. CK-19 expression levels were evaluated and compared between malignant and benign lesions. Receiver operating characteristic (ROC) curve analysis was used to determine the sensitivity, specificity and overall diagnostic accuracy of CK-19.

Results: The study revealed that CK-19 expression was significantly stronger in malignant thyroid nodules, particularly in PTC, compared to benign nodules. Among the 42 cases included in the analysis, the sensitivity and specificity of CK-19 for detecting malignancy were both 92.9%. The ROC curve analysis showed an area under the curve of 0.971, indicating excellent diagnostic accuracy (P < 0.0001) with a 95% confidence interval of 0.922-1.000.

Conclusions: CK-19 is a highly sensitive and specific immunomarker for distinguishing malignant thyroid nodules from benign ones, particularly in cases of PTC. The findings support the use of CK-19 as an adjunctive diagnostic tool in routine clinical practice to enhance the accuracy of thyroid cancer diagnosis and improve patient outcomes.

Aims: The study aimed at establishing the normal Evans index (EI) in adults residing in Delta State, Nigeria.

Methods: Researchers sought ethical authorisation from a Nigerian University Teaching Hospital in Delta State, where this cross-sectional study was conducted. Computed tomographic images of the brain were retrieved from the hospital's radiological database. Brain computed tomography images of 195 adults (102 males and 93 females) were selected, and their axial slices were retrospectively analysed to determine the maximum width of the frontal horns (MWFHs) and the maximum intracranial transverse diameter (MITD). The ratio of MWFH to MITD was computed as the EI. Statistical Package for the Social Sciences version 27 was employed to evaluate the sex- and age-related differences in the quantitative variables and the association between them. These were regarded significant whenever P < 0.05.

Results: Male patients had larger MITD and MWFH than females (P < 0.05). However, the EI lacked significant sexual variances (P = 0.051). As age increased, the mean EI also significantly increased, although, it did not exceed 0.3; the internationally recognised diagnostic cutoff value. The EI and MWFH showed a weak positive relationship with age, whereas the MITD and age had a weak negative association (P < 0.05). Both EI and MITD had a positive correlation with MWFH (P < 0.05).

Conclusion: The normative EI values established in this study provide reliable references than will aid clinicians to accurately diagnose and monitor patients with ventriculomegaly associated with normal pressure hydrocephalus and neurodegenerative disorders, ensuring more effective management.

Background: Malaria remains the deadliest parasitic disease and continues to cause more than half a million deaths across the world each year, mainly victims are sub-Saharan children. Malaria is a common reason for paediatric hospitalisation.

Objective: The objective was to characterise malaria and describe the evolution after treatment in the paediatric department of the University Hospital Centre Amissa Bongo de Franceville.

Methods: This was a cross-sectional study conducted from 1 February 2023 to 15 May 2023. A clinical and biological diagnosis was made in febrile children aged from 6 months to 15 years.

Results: A total of 306 patients were included. The mean age was 50.4 ± 44.3 months, 94.3% had consulted within ≥48 h and self-medication was practiced by 83.3%. The prevalence of malaria was 17.3%. Fever ˃39°8C (adjusted odds ratios [aOR] = 2.68; 95% confidence interval [CI] = [1.32-5.48]; P < 0.01), chills (aOR = 2.14; 95% CI = [1.13-4.11]; P < 0.01) and nausea-vomiting (aOR = 2.03; 95% CI = [1.06-3.83]; P = 0.03) were the factors associated with the occurrence of malaria. The majority of children were treated for simple malaria with artemisinin-based combination therapy. A total of 16/53 was seen in post-therapeutic consultation. Of them, 2 patients had a positive thick drop.

Conclusion: Non-compliance with preventive measures and the misuse of antimalarials further complicate the clinical picture, requiring parenteral management for the most part.

Background: In Nigeria, violence against healthcare has adversely affected the access to and delivery of healthcare services with serious consequences for healthcare workers (HCWs). This study assessed the prevalence and patterns of violence against HCWs in areas of armed conflict, areas of other situation of violence and areas not affected by conflict in Nigeria.

Methodology: A cross-sectional study utilising a mixed method approach comprising both quantitative survey and qualitative data collection methods. All the categories of HCWs in public healthcare facilities participated in the study. Ethical approval for this study was obtained from the respective Health and Research Ethics Committees of the respective study sites.

Results: A total of 1,218 HCWs comprising Borno State, 407 (33.4%), Plateau State, 401 (32.9%) and the Federal Capital Territory 410 (43.7%) were interviewed. The overall prevalence of physical and psychological violence was 16.7% and 62.4%, respectively. Pushing and slapping were the predominant forms of physical violence. Weaponized violence with weapon was the highest in conflict areas. Verbal abuse, threats, bullying and harassment were the predominant forms of psychological violence. The major consequences of violent attacks on the HCWs were lack of job satisfaction, loss of confidence, low self-esteem, decreased productivity and post-traumatic stress disorder.

Conclusions: The overall prevalence of violent attacks on HCWs was high. The perpetrators of violent attacks were mainly patient relatives and patients/clients. The factors predisposing to violent attacks were patients-related issues, service delivery, working conditions of the hospitals, expectations of patient relatives and impatience of hospital staff.

Domestic resource mobilisation (DRM) is vital for achieving sustainable healthcare financing in Nigeria, where dependence on external funding and oil revenues has long hindered health sector progress. The Nigerian healthcare system faces persistent challenges, including inadequate funding, inefficiencies and limited access to essential services, particularly in rural areas. This paper explores the challenges and prospects of DRM as a means of financing healthcare in Nigeria. A Medline search and a search of other internet search engines were carried out for published studies on healthcare financing in Nigeria, Africa and worldwide, we also examined policy documents and healthcare financing data to analyse the potential of DRM in Nigeria. A total of 38 publications were reviewed revealing that mechanisms such as general tax revenue, social insurance systems and community-based health insurance are central to DRM efforts. However, challenges such as inadequate budgetary allocations, corruption, poor database management and the emigration of health workers persist. Despite these obstacles, there are promising prospects, including increased tax revenue, development of the domestic capital market and the potential for sustainable and equitable healthcare financing through public-private partnerships. To harness these opportunities, the Nigerian government must implement effective policies, strengthen governance structures and promote transparency and accountability. DRM offers a promising path towards reducing dependency on external aid and achieving a more resilient and equitable healthcare system in Nigeria.

Emergency medicine (EM) globally is a new medical speciality when compared with traditional medical specialities such as surgery, obstetrics, gynaecology and internal medicine. It is a medical speciality that deals with the management of acute illnesses and injuries in a timely and result-oriented manner. The International Federation of EM defines it as a field of practice based on the knowledge and care required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury, affecting patients of all age groups with a full spectrum of episodic, undifferentiated physical and behavioural disorders. Two types of EM are recognised: the out-of-hospital emergency medical services (OHEMS) and the in-hospital emergency medical services (IHEMS). OHEMS was introduced into the country in 1998 by the Lagos state government. IHEMS had been in place for much longer, but it was practised in a heterogeneous and substandard manner. The result of the latter is a casualty department with an overwhelming burden of patients and a high mortality rate. The World Health Assembly (WHA) resolution 60.22 of 2007 mandated every member state government to establish and monitor integrated EM care systems; it is therefore expected that the emergency medical services (EMS) in the country would wear a new look. However, anecdotal reports suggest that both OHEMS and IHEMS in the country are rudimentary and there is no strong evidence to show that EM is embraced by all as a medical speciality. The objective of this study is to examine the challenges and prospects of EM as a medical speciality in Nigeria. A review of the past literature searched in Google, Google Scholar, PubMed and African Journal online was conducted. A total of 40 relevant publications in addition to the authors knowledge and exposure in EM supported the information presented in this manuscript. Our study revealed that inadequate funding and ambulance services, nonavailability of trained bystanders, limited infrastructure and skilled manpower, inadequate and inequitable distribution of health resources, lack of standard emergency department, high out-of-pocket expenses and substandard implementation of EMS policies, are factors militating against a functional EMS in the country. In line with the philosophy of WHA resolution72.16 of 2019, it is recommended that the central government should put in place a mechanism for full and sustainable implementation of the NHIA Act (2022), National Emergency Medical Services and Ambulance System (NEMSAS) and the patient's bill of rights and direct the adoption of EM as a medical speciality in all federal and state hospitals. In addition, the central government should create public awareness, improve road networks, provide funding, and establish collaboration with local and international organisations.

Sickle cell disease is an autosomal recessive genetic disorder with the underlying pathology, resulting in sickling of the red blood cells in deoxygenated conditions. Osteonecrosis is a common orthopaedic manifestation of sickle cell disease, and total joint arthroplasty is the preferred option in managing patients with advanced disease. This article describes bilateral total hip arthroplasty and right total knee arthroplasty (TKA) in a 41-year-old woman, a known haemoglobin SS (HBSS) patient who presented to the outpatient clinic of National Orthopaedic Hospital, Igbobi, Lagos, with recurrent bilateral hip and right knee pain of 10-year duration, with associated stiffness, valgus deformity in the knee and severe limitation of function. She had sequential bilateral total hip replacement and right TKA. She had significant improvement in function in the follow-up period. The effectiveness of total hip and knee arthroplasties in HBSS patients with osteonecrosis is well demonstrated in this article.

Introduction: Previous studies have been conducted on medication adherence in Southwest Nigeria, but none of these has reported the relationship between highly active antiretroviral therapy (HAART) adherence, spirituality and viral load (VL) amongst people living with Human immunodeficiency virus (HIV)/AIDS, especially in rural settings of Southwestern Nigeria. This study assessed the pattern of medication adherence, spirituality and VL and ascertained the association of socio-demographics and spirituality on medication adherence amongst patients on HAART in rural Southwestern Nigeria.

Materials and methods: A hospital-based cross-sectional study involving 321 consented patients on HAART who were recruited by systematic sampling technique at the adult HIV clinic. Data were collected using an interviewer-administered questionnaire that assessed participants' socio-demographic profiles, medication adherence and spirituality. Their blood samples were collected and their VLs were determined. The data were analysed using SPSS version 20. Logistic regression was done to identify the independent predictors of medication adherence.

Results: The majority of the respondents reported a medium level of medication adherence (66.4%), a high level of spirituality (68.8%) and a low level of VL (67.3%). Amongst variables that had a statistically significant association with medication adherence were being educated, married, divorced, separated or widowed (P < 0.05). Furthermore, persons with high spirituality were 2.6 times more likely to be adherent to antiretroviral drugs when compared to persons with low spirituality (P < 0.05).

Conclusion: It was shown that high spirituality is a positive predictor of medication adherence amongst patients on HAART. It, therefore, suggests that efforts deployed to improve the spirituality of these patients would most likely improve their medication adherence.