Nigerian Postgraduate Medical Journal最新文献

Objective: The objective of this study was to determine the prevalence of self-reported myopia in Trinidad and Tobago.

Materials and methods: This study was a cross-sectional design, and data were collected using a validated structured questionnaire from January to April 2024. Systematic random sampling was used to select participants aged 15 and above to participate. Descriptive statistics were used to summarise the variables and the Chi-square test was used to assess for associations (P < 0.05).

Results: A total of 350 participated in the study giving a response rate of 91.15%. Majority of the participants were female (n = 197, 56.3%), mixed race (n = 126, 36%), resided in urban areas (n = 172, 49.4%) and aged 18-35 years (n = 168, 48.3%). The prevalence of myopia was 40.9% and the prevalence was significantly associated with age group, ethnicity, level of education and religion (P < 0.05). Myopia was associated with family history, lifestyle, use of spectacles, daily use of computers, near work, outdoor activities, sleeping and having a father or mother with myopia (All P < 0.05). In addition, ocular diseases such as cataracts and glaucoma were among the most frequent reported conditions.

Conclusion: The myopia prevalence observed in our study validates age-related trends, offers estimates across diverse age groups, and reveals a significant association between myopia rates and family history, with a self-reported myopia rate higher than clinical testing surveys but in line with global prevalence reports.

The prognosis/mortality rate in mycosis fungoides (MF)/cutaneous T-cell lymphomas (CTCL) is alarming in resource-poor countries due to delayed diagnosis in meeting recognised criteria. We highlight the diagnostic accuracy of examining peripheral blood films (PBFs). We reviewed clinically diagnosed MF/CTCL cases in the Dermatology Clinic of Lagos University Teaching Hospital between January and October 2022 and analysed clinical, haematological and histology findings. Eight patients (male:female = 5:3) between 35 and 68 years had blood films with characteristic Sezary cells of <5%. Flow cytometry (FC) in 1 (12.5%) was inconclusive, and immunohistochemistry (IHC) on skin/lymph nodes in 5 (62.5%) was highly suggestive or confirmatory. Three patients had no biopsy. Patients had methotrexate, phototherapy (±psoralen) and systemic steroids with varying improvements. Since immunophenotyping (FC or IHC) is lacking in resource-poor countries or low- and middle-income countries, Sezary cells in PBF of clinically diagnosed patients with MF/CTCL should prompt treatment.

Context: The world over, there has been a paradigm shift in medical education from the traditional curriculum to Competency-Based Medical Education (CBME), of which the application of standard setting in assessments is an integral part. Standard setting is the process used to define an acceptable level of performance and to establish a pass score for the defined levels of performance in the competency domains assessed by an examination.

Aims: This study was designed to assess the opinions and experiences of key judges for implementation of standard setting and to outline its prospects from their perspective.

Settings and design: A descriptive cross-sectional study on the opinions, experiences and prospects for standard setting in the assessment of college examinations.

Methods: A total population survey of Faculty Officers for the year 2024.

Data analysis: Descriptive statistics using SPSS Version 27.

Results: The use of an arbitrary 50% pass mark was not supported as 80% of the respondents felt it was neither just nor equitable; 84% opined that it will not correctly separate competent from incompetent candidates and 76% felt it was not defensible. Over 90% of the respondents supported the shift to standard setting, though 31% and 51%, respectively, believed that it was difficult to implement and strenuous. Training and retraining of faculty and examiners was advocated by 98% of the respondents.

Conclusion: Standard setting is more appropriate in determining true competence than using arbitrary pass scores. Training and retraining of faculty and examiners is required to improve understanding of the process and concepts.

Introduction: Traumatic brain injury (TBI) is devastating to the victims, and an understanding of its prevalence, the demography and the causes help reduce the incidence and outcome. Adequate knowledge of such helps in developing preventive and management protocols in the region. The study aims to document the presentation and challenges of TBI in our centre.

Methods: A cross-sectional design was conducted at Lagos University Teaching Hospital, Nigeria. Only adult (≥18 years) patients were recruited consecutively from the emergency room following a diagnosis of TBI. Data were obtained with the aid of a study pro forma which recorded participants' sociodemographic information, pre-hospital indices and clinical examination/investigations. Imaging findings, surgical information and follow-up findings were also recorded. Data obtained were analysed using the IBM SPSS Statistics.

Results: A total of 125 TBI patients with male:female of 8:1 were recruited over 12 months. The mean age was 40.8 years standard deviation ± 16.86. Only 9 patients (7.2%) had health insurance. Eighty-four (67.2%) patients had TBI from road traffic accidents (RTAs). Fall from heights, assaults, industrial accidents and gunshots contributed 16%, 9.6%, 5.6% and 1.6% of patients' injuries respectively. One hundred and fourteen (91.2%) were brought to the hospital by non-healthcare workers.

Conclusion: RTAs remain the most common cause of TBI. Majority of the populace cannot afford the cost of TBI management. The scope of national health insurance needs to be broadened to help victims at the points of need.

Background: The mitochondrial DNA (mtDNA) G10398A polymorphism has been associated with bipolar disorder (BD). It leads to an amino acid substitution within NADH dehydrogenase subunit, thereby altering the mitochondrial complex I function. This exploratory case-control study assesses the association of mtDNA G10398A with the risk of BD and its relationship to clinical variables in Indian patients.

Methods: Cases met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of BD-I in remission and had a family history of BD or recurrent unipolar disorder in biological relatives. The healthy controls (HC) had no known illness and were screened negative for Family Interview for Genetic Studies. Participants were assessed using Clinical Pro forma, NIMH-Life Chart Method and Alda lithium response scale. The mtDNA G10398A was assessed with real-time polymerase chain reaction using TaqMan assay.

Results: A total of 82 participants were recruited across cases and controls, with 42 patients (50% with maternal history) and 40 healthy individuals with similar demographic profiles. The mean age of onset was 25.16 (standard deviation [SD] 7.6) years, with illness for 11.59 years (SD: 7.18). Allele A was found in 50% of cases compared to 32.5% HC (odds ratio = 2.08; 95% confidence interval [CI]: 0.85-5.09). Findings remain non-significant for patients with maternal mood disorders (allele A: 38.9%; 21/42). Cases with allele G had significantly higher body mass index (BMI) (P = 0.008) than those with allele A.

Conclusion: The study adds information on mtDNA 10398A amongst Indian patient samples and healthy individuals. No significant group difference was found with respect to mtDNA G10398A. The positive association of allele G with higher BMI has potential clinical relevance that can be further investigated in larger samples.

Objective: The objective of this study was to identify the factors associated with the outcome of the 2023 diphtheria outbreak in Jigawa State, Nigeria.

Methods: A descriptive cross-sectional study was conducted amongst all line-listed diphtheria cases reported from Jigawa State, Nigeria, using the 2023 Integrated Disease and Surveillance Response line list of cases that met the World Health Organization case definition of diphtheria. A total of 245 line-listed cases from January 2023 to December 2023 met the criteria for inclusion in the study. Data were analysed using IBM SPSS version 22.0 with a P value set at ≤5%. Binary logistic regression was used to identify the independent predictors of the outcome of the 2023 outbreak.

Results: The maximum age of the line-listed cases was 39 years, and the minimum was 1 year with a median of 8 (interquartile range = 5-8) years. More than two-thirds (68.2%) of the cases were ≥5 years of age. More than one-third of the cases (39.6%) were from the northeast senatorial zone of the state. Out of the total 245 cases, 14 died of the disease representing a case fatality rate of 6%, and an attack rate of 3.4 per 100,000 populations. The majority of the cases (95.5%) had fever, cough (81.2%), pharyngitis (86.9%), tonsillitis (96.7%) and laryngitis (82.0%). More diphtheria-related mortalities were recorded amongst cases <5 years of age (7.7%), female cases (5.9%), rural residence (7.7%) and cases from the northeast senatorial zone (8.2%) of the state. Significantly higher mortalities (8.8%, P = 0.003) were recorded amongst cases with nasopharyngitis. The odds of diphtheria-related mortality were higher amongst cases who presented clinically with nasopharyngitis and were 4 times more likely to die (adjusted odds ratio = 3.9; 95% confidence interval = 1.1-14.3) compared with those with no nasopharyngitis.

Conclusions: Significantly higher mortalities were recorded amongst diphtheria cases whose samples were not taken, and those with nasopharyngitis. These findings underscored the importance of improved immunisation uptake, early and prompt case detection, investigation and proper management.

Background: Odontogenic cysts (OCs) arise from the odontogenic epithelium and occur in the tooth-bearing regions of the jaws. Proliferation and/or degeneration of this epithelium lead to OC development.

Aim and objectives: The purpose of this study was to determine the prevalence, characteristics, distribution and clinicopathological features of OCs and compare with other studies.

Materials and methods: Records of OCs were retrieved, and patient's data, aetiology, clinical features, histopathological distribution, treatment, complications and recurrence were studied.

Results: A total of 218 OCs were studied in 200 patients. The mean age of patients was 35.74 years. The overall sex ratio (male: female) was 1.22:1. Second, third and fourth decades of life were commonly affected. The majority of the patients (85%) reported with a complaint of pain (with or without swelling). Radicular cyst was the most prevalent type (49.55%). The most common site involved was the anterior maxilla (41.75%). Dental complications such as displacement, mobility, discoloration and root resorption were diagnosed in 91 cysts (41.75%). Bony complications such as expansion and perforation were present in 136 cysts (62.38%). Dentition was non-vital in 61.46% of cysts. The most common treatment method performed was combination surgery (enucleation with or without endodontic treatment/extraction and apicoectomy). Recurrence rate was 3.20%.

Conclusion: The prevalence, characteristics and distribution features of OCs in India are similar to those of studies conducted in other parts of the world. There is a broad spectrum of OCs, with some cysts having a propensity for certain age, gender and site, whereas a few cysts have distinct properties to recur and have aggressive and invasive behaviour.

Background: Pre-diabetes is an important risk factor for the development of type 2 diabetes and is common in Nigeria. Effective intervention can reverse the underlying pathogenesis of insulin resistance in pre-diabetes. This study aimed to determine and compare the impact of moderate exercise and metformin interventions on insulin resistance among participants with pre-diabetes.

Materials and methods: Using a randomised placebo-controlled design, 54 Nigerians with pre-diabetes were selected using simple random sampling. They were offered metformin, moderate exercise or placebo treatment and followed up for 12 weeks. Insulin resistance was assessed before and after the interventions and the outcome was compared.

Results: Forty-nine participants with pre-diabetes completed the study. Participants in both the exercise and metformin groups had significantly decreased insulin resistance compared to placebo after 12 weeks of intervention. However, there was a decrease in insulin resistance by 77.3% (homeostasis model assessment-insulin resistance [HOMA-IR]) and an increase in insulin sensitivity by 81.2% (quantitative insulin sensitivity check index [QUICKI]) in the exercise group. In comparison, participants in the metformin group had a decrease in insulin resistance by 66.3% (HOMA-IR) and an increase in insulin sensitivity by 76.2% (QUICKI).

Conclusion: Amongst Nigerians with pre-diabetes, both moderate exercise and metformin have significantly higher efficacy than placebo in improving insulin resistance. However, moderate exercise improved insulin resistance more than the metformin intervention. Participants in this study need to be followed up for a longer period to assess the long-term effects of these interventions.

Background: Anterior fontanelles (AFs) of healthy newborn infants vary widely in size, this being a function of race, geographical location, gender, birth weight, mode of delivery and gestation. Abnormal variations in AF size portend a serious pathology of the cranium or intracranial structures. The established reference value for normal AF size is, therefore, an essential diagnostic tool. This study was conducted to determine the mean AF size and factors that are associated with its variability among apparently healthy term neonates in Lokoja, North Central Nigeria.

Methods: AF size was measured in 200 healthy inborn term neonates between 24 and 48 h post-delivery using a modified version of Mattur's method. Other parameters measured were head circumference, birth weight and length. Relevant statistical methods were used for data analysis, and P < 0.05 at a confidence interval of 95% was considered statistically significant.

Results: Eighty-six (43%) of the babies were males, and the mean birth weight and gestation were 3.09 (0.37) kg and 38.8 (1.2) weeks, respectively. Majority (72%) were delivered spontaneously per vagina. The mean (± SD) AF size of the study neonates was 2.62 (0.72) cm (2.53 [0.61] cm in males and 2.69 [0.79] cm in females). Neither gender nor mode of delivery affected AF size significantly. There was no significant correlation between AF size and occipitofrontal circumference.

Conclusion: AF size for term babies in our hospital differs from AF sizes reported from other parts of the world, further reiterating the utility of local/regional neonatal AF reference values.

Context: The mucociliary clearance system is an important component in the prevention of chronic inflammation of the nasal and paranasal sinus.

Aim: The study aims to establish the normal values of mucociliary clearance in our region and to study the variation in mucociliary activity in patients with chronic rhinosinusitis in Ilorin, North-central Nigeria.

Settings and design: This was a prospective, cross-sectional study using consecutive consenting participants in both the control and study groups carried out at both family medicine and otorhinolaryngology clinics among patients attending the clinics.

Subjects and methods: After ethical approval was sought, informed consent was obtained from patients, a modified version of the validated health questionnaire was filled, semi-structured questionnaires were also filled after which patient undergo anterior rhinoscopy, nasal patency test and spirometry was done. The saccharine test has been used to measure nasal-mucociliary clearance time in the past.

Statistical analysis: All information were entered into SPSS version 20 and analysed descriptively, and results were presented in tables and figures.

Results: Consecutive consenting 125 patients with rhinosinusitis (study group) and those without rhinosinusitis (control group) underwent naso-mucociliary clearance test. There were 34 males and 91 females with a male:female ratio of 1:2.6 among the study group and 55 males and 70 females with a male:female ratio of 1:1.3 for the control group. The age range was from 18 to 68 years with 18-40 years constituting the modal age group. The mean age for the studied group was 35.7 years while that of the control group was 33.1 years. The mean naso-mucociliary clearance time among the study group was 35.1 min standard deviation (SD = 12.32 ± 1.63), while among the control group, it was 14.8 min (SD = 5.59 ± 0.43).

Conclusion: Compared to the control group, there was a roughly 200% prolonged increase in the duration of naso-mucociliary clearance time among patients with rhinosinusitis. There was also a positive correlation with increasing age. Future studies comparing the pre-operative and post-operative treatment of rhinosinusitis will contribute to knowledge.