Nigerian Postgraduate Medical Journal最新文献

Aims: This study aims to determine the clinical significance of autophagy in OS prognosis and explore the potential molecular mechanisms between it and tumour-infiltrating immune cells.

Materials and methods: Autophagy-associated gene (AAG) expression data were retrieved from The Cancer Genome Atlas to construct an AAG expression matrix for osteosarcoma (OS). Using univariate Cox and LASSO regression analyses, three key prognostic AAGs (CCL2, DDN and GJA5) were identified. Based on these genes, we calculated individual risk scores and established an autophagy-associated prognostic model. OS patients were stratified into high- and low-risk groups according to autophagy-related risk scores to explore prognosis-associated mechanisms. Gene enrichment analyses were conducted to investigate the involved biological pathways, a nomogram integrating clinical parameters was developed, and the tumour immune infiltration landscape was assessed. Furthermore, the differential expression of the three AAGs was experimentally validated by quantitative real-time polymerase chain reaction (qRT-PCR) in a normal osteoblast cell line (hFOB1.19) and OS cell lines (143B, MG63 and U2OS), supporting the predicted transcriptional trends.

Results: We integrated three autophagy-related prognostic genes to construct a nomogram, which demonstrated high predictive accuracy and robustness as evidenced by calibration curves and survival analyses. These AAGs exhibited dual functions in immune regulation and were implicated in multiple cytokine signalling pathways. Tumour immune infiltration analysis revealed distinct immune landscapes between risk groups, consistent with findings from pathway enrichment analysis. Furthermore, qRT-PCR validation in normal osteoblasts (hFOB1.19) and osteosarcoma cell lines (143B, MG63 and U2OS) confirmed that DDN was significantly upregulated, whereas CCL2 and GJA5 were downregulated in tumour cells, aligning with the transcriptional trends predicted by the model.

Conclusion: Our findings suggest that excessive autophagy is closely associated with poor prognosis and altered immune cell infiltration, particularly involving macrophages, in osteosarcoma. These results highlight the dual roles of autophagy in tumour progression and immune regulation. However, macrophage-related autophagy in OS remains poorly understood, warranting further mechanistic studies and experimental validation.

Background: The haematology module is an important component of the Athlete Biological Passport, which is being used by World Anti-doping Agency in doping detection. This module consists of complete blood count (CBC) parameters, which are measured in a longitudinal manner and deviation from the established pattern may indicate doping. There is a paucity of data on CBC parameters in Nigerian athletes.

Aims: The aim of this study, therefore, was to measure and analyse CBC parameters in a group of athletes and sports administrators in Ibadan, southwestern Nigeria.

Materials and methods: A cross-sectional descriptive study of 144 athletes and sports administrators in a training centre was undertaken. A closed-ended structured questionnaire was used to collect socio-demographic data, and samples were taken for CBC and D-dimer assay. The participants' blood samples were taken after a training session. CBC, reticulocyte count and D-dimer were run. OFF-hr score was calculated and values >125. 0 were considered to suggest doping. CBC parameters were compared between both genders using Student's t-test. Significance value was set at P ≤ 0.05.

Results: The athletes had relatively higher lymphocyte counts than neutrophil counts. The group OFF-hr score shows that the majority (134/154, 87.6%) had normal range values, while 5 (3.3%) had values >104.6. None of the participants had a score >125.6, which indicates doping. D-dimer level was comparable between both genders, but the median value (1.3, interquartile range: 3.4 µg/L) was significantly higher than that of the control sample <0. 4 µg/L).

Conclusion: Athletes tend to have higher lymphocyte counts than neutrophil counts. The OFF-hr score did not indicate doping in any athlete. More research should be conducted to understand the thrombotic status of athletes because of high dimer levels found in this study.

Background: Tuberculosis (TB) is caused by Mycobacterium tuberculosis. Treatment regimen with the first-line anti-tubercular drug remains the foundation of treatment for drug-sensitive TB. The fixed-dose combination of drugs regime is associated with adverse drug reactions (ADRs) such as drug-induced liver injury (DILI), myalgia, arthralgia, hearing loss, gastrointestinal disturbances, visual disturbances, central nervous disorders and hypersensitivity reactions.

Aims: This study aimed to analyse the spectrum and severity of ADRs with emphasis on DILI.

Methods: This retrospective study was conducted from 2015 to 2023 at a tertiary care teaching hospital. A total of 108 patients were included in the study. The spectrum of ADRs was classified as per the World Health Organization systems organ classes. The seriousness of the reaction was classified as serious and non-serious. The severity of DILI was categorized into five grades.

Results: A total of 126 ADRs were reported. DILI was the most reported ADR followed by vomiting and itching.

Conclusion: This study seeks to enhance the clinicians' understanding of the diverse ADRs linked to anti-TB treatment, encouraging them to provide better patient counselling, prioritise safety and actively report even mild ADRs.

Backgrounds: Knee osteoarthritis (KOA) is a highly prevalent and progressive joint disease. Given the diverse clinical presentations and multifactorial nature of KOA, alongside observed regional variations, a localised understanding of the disease is vital for effective healthcare planning.

Aims: This study aimed to identify the clinical characteristics and disease severity of patients diagnosed with KOA at the specialised tertiary centre in the Kurdistan Region.

Patients and methods: This study employed a cross-sectional design among patients who attended the 'Specialized Center of Rheumatic Diseases and Medical Rehabilitation' in Duhok City, Iraqi, Kurdistan and are diagnosed with KOA. In this regard, patients with any socio-demographic characteristics were included in the study. The patients with other rheumatic diseases were excluded from the study.

Results: The study involved 262 knee patients with KOA, predominantly females aged 40-69 years (81.29%). Most of the patients were retired (39.69%) with a body mass index (BMI) averaging 32.72 kg/m2, indicating overweight or obesity (based on the CDC criteria). Symptoms such as pain (98.85%) and difficulty walking (49.62%) were common, with pain severity averaging 6.77/10. Most commonly used treatments included NSAIDs (63.74%) and physical therapy (8.78%), with many patients affected by mild-to-severe functional limitations. Younger patients had lower disease grades and pain levels, whereas higher grades correlated with increased pain and activity restrictions.

Conclusions: Age and BMI impact KOA severity, including pain and functional limitations. The patients need for better diagnostic and nonpharmacological approaches to improve patient outcomes.

Background: Non-albuminuric diabetic kidney disease (NADKD) is increasingly recognised and strongly associated with heightened cardiovascular risk and rapid decline in estimated glomerular filtration rate (eGFR).

Aims: This single-centre retrospective cohort study aimed to determine the prevalence of NADKD, characterise clinical and laboratory features, assess microvascular and macrovascular complication rates and identify predictors of rapid progression.

Materials and methods: This retrospective cohort study analysed 44 NADKD patients from January 2018 to 2022, excluding chronic kidney disease stage 5, albuminuric DKD and <6 months of follow-up. The primary outcome was the prevalence and profile of rapid progressors (eGFR fall of >5 mL/min/1.73 m2/year) in NADKD and secondary outcomes were the onset of microvascular and macrovascular complications and risk factors for rapid progression.

Results: The median 1-year follow-up showed rapid eGFR drop in 36.4% of patients, with a median yearly decline of 8.0 mL/min/1.73 m2/year (Interquartile range [IQR]: 6.2-12.1) compared to 1.0 mL/min/1.73 m2/year (IQR: 0.5-1.8) in non-progressors (P < 0.001). Presence of hypertension (P = 0.04), cardiovascular disease (CVD) (P = 0.03), dyslipidaemia (P = 0.02) and acute kidney injury (AKI) incidents (P = 0.01), as well as the incidence of diabetic retinopathy (P = 0.01) and CVD (P = 0.04), were reported to be higher in rapid progressors. Rapid eGFR reduction was independently predicted by hypertension (Odds ratio [OR] 1.9, 95% confidence interval [CI]: 1.5-4.8), CVD (OR 2.8, 95% CI: 1.8-4.7, P = 0.01) in multivariate analysis.

Conclusion: One-third of NADKD were rapid progressors, and the prevalence of hypertension, dyslipidaemia, CVD, AKI episodes and incidence of diabetic retinopathy was higher in rapid progressors. Hypertension and CVD were found to be strong predictors for rapid eGFR decline.

Background: Suxamethonium, a rapid-acting muscle relaxant, has been conventionally preferred during rapid sequence induction (RSI). The priming principle, which uses non-depolarising muscle relaxants, is an alternative in situations where it is contraindicated. Unfortunately, its efficacy has not been sufficiently documented in Nigerian patients.

Aims: The study aimed to use atracurium and pacuronium to evaluate the efficacy of the priming principle.

Materials and methods: In this randomised controlled trial, ninety adults undergoing elective surgery under general anaesthesia were randomly allocated into three equal groups. Group A (Atracurium), Group P (Pancuronium) and Group C (control) received 0.05 mg/kg atracurium, 0.01 mg/kg pancuronium and 1 ml saline, respectively, as the priming agent. Three minutes after, anaesthesia was induced with 2 mg/kg propofol and then the intubating dose of pancuronium administered. The onset time of neuromuscular block, intubating condition and occurrence of muscle weakness during the priming interval were noted. Data were analysed using the Statistical Package for the Social Sciences version 25, and a P < 0.05 was considered statistically significant.

Results: The mean onset time in Groups A, P and C was 215.7 ± 59.9 s, 237.1 ± 76.5 s and 265.8 ± 72.0 s, respectively, P = 0.024. Post hoc analysis showed that the onset time was only significant between Groups A and C (P = 0.02). The intubating condition was comparable in all groups (P = 0.25). The incidence of muscle weakness during the priming interval was 6.67% in the priming groups.

Conclusion: In adults, priming with atracurium but not pancuronium shortens the onset time of pancuronium. However, during RSI, where a fast onset is crucial, the shortened onset time with priming is not clinically relevant.

Background: Low back pain (LBP) in low- and middle-income countries has received less attention.

Aims: To identify the prevalence of low back pain and associated factors in female hospital staff.

Methods: We included 320 female hospital staff in a tertiary medical setting in the Kurdistan Region.

Results: The study involved 320 participants aged 18-45 years, included doctors (37.19%), nurses (19.06%), administrative staff (11.88%) and others (31.88%). It found that 75% experienced LBP in the past year, with 60% reporting pain lasting 7-12 months. Pain severity was mostly mild (44.58%) or moderate (35%), and 80.83% experienced occasional pain. LBP interfered with daily activities for 45.42% of participants. Work-related factors contributing to LBP included prolonged standing (61.88%), sitting (39.38%), repetitive bending (22.19%), awkward postures (16.25%), crouching (16.25%) and stooping (16.25%). Those aged 31-35 are more likely to experience LBP than those aged 18-25 (odds ratio [OR]: 2.82; P = 0.0453) along with married individuals (OR: 2.34; P = 0.0136), doctors (OR: 3.06; P = 0.0136) and nurses (OR: 2.29; P = 0.0136), and healthcare workers (HCWs) compared to non-HCWs (81.67% vs. 66.43%; P = 0.0018). Evening or rotating shifts (OR: 8.23; P = 0.002) and awkward postures (OR: 2.41; P = 0.0358) also increased risk. Regular breaks reduced LBP likelihood (OR: 0.36; P = 0.0360), whereas a pregnancy history raised it (OR: 2.03; P = 0.0097).

Conclusions: The female hospital staff had a high prevalence of LBP, linked to increasing age, being an HCW, working evening or rotating shifts and involving inappropriate postures.

Background: Detection and characterisation of focal liver lesions (FLLs) remain challenging. Computed tomography (CT) provides crucial information on lesion number, location, nature and growth dynamics of FLLs over time.

Aim: The study evaluated the use of contrast-enhanced triple-phase CT (TPCT) amongst patients with suspected FLLs in a tertiary hospital setting.

Methods: This was a prospective, observational study. Patients with clinically suspected FLL or prior history of FLLs who underwent contrast-enhanced TPCT scans at the tertiary care centre between June 2022 and November 2023 were enrolled. Descriptive statistics were used for presenting study outcomes. Biopsy was performed selectively, particularly for representative lesions (up to 2 in number) in patients with multiple FLLs. Where histopathology was not feasible, diagnoses were confirmed through a composite reference standard. The accuracy and adequacy of TPCT in the diagnosis of FLLs were also evaluated. A P < 0.05 was considered statistically significant.

Results: Eighty patients were enrolled, the mean age was 54.1 ± 12.14 years and most were males (61.3%). Of the 299 FLLs, 154 were benign, while 145 were malignant. Metastases and haemangiomas were the most commonly identified malignant and benign lesions, respectively. The FLLs were categorised as hypovascular (59%) and hypervascular (41%). TPCT showed 100% sensitivity and specificity for diagnosing abscesses, cysts, intrahepatic cholangiocarcinoma and focal nodular hyperplasia. The specificity for diagnosing all cases was 100%.

Conclusions: This study further validates the significance of TPCT in assessing FLLs and characterising focal liver abnormalities across various pathological scenarios and stages of the disease.

Background: Gestational diabetes mellitus (GDM) is a major public health concern worldwide.

Aims: This study aimed to determine its current prevalence and identify contributing factors among pregnant women attending a health facility in Lagos, Nigeria.

Methods: This cross-sectional study was conducted at a tertiary health facility in Lagos, Nigeria, involving 400 consenting pregnant women with a gestational age of 24-28 weeks. Data on socio-demographic characteristics and obstetric history were collected. Participants underwent fasting plasma glucose and oral glucose tolerance tests, consuming 75 g of glucose in 300 ml of water. Glucose levels were measured using the oxidase-peroxidase method, and GDM was diagnosed according to the International Association of Diabetes and Pregnancy Study Groups/World Health Organization (IADPSG/WHO 2013) criteria.

Results: Participants' ages ranged from 18 to 51 years, with a mean age of 31.0 ± 5.3 years. A total of 76 participants met the IADPSG/WHO 2013 criteria, resulting in a GDM prevalence of 19.0%. The identified significant risk factors for GDM included macrosomia (χ2 = 4.33, P = 0.037), family history of diabetes (χ2 = 4.4, P = 0.036), previous miscarriages (χ2 = 15.8, P = 0.001) and congenital anomalies (χ2 = 6.4, P = 0.011). Notably, having previously delivered a macrosomic baby was independently and significantly associated with GDM (odds ratio 4.3, 95% confidence interval = 1.08-16.9, P = 0.039).

Conclusions: The high prevalence of GDM underscores the need to screen all pregnant women, particularly those with a history of macrosomia. Larger and longitudinal studies are encouraged to identify other relevant factors that could aid in effectively screening and identifying all affected pregnant women.