Nigerian Postgraduate Medical Journal最新文献

Background: Thyroid hormones, namely triiodothyronine (T3), thyroxine (T4) and thyroid-stimulating hormone (TSH), serve as pivotal regulators of energy metabolism and are subject to variation based on sex and adiposity.

Aims: This study aimed to elucidate the function of thyroid hormones in metabolic regulation and potential for clinical applications.

Materials and methods: A cross-sectional study was performed at the Department of Physiology, Regional Institute of Medical Sciences, Imphal, from September 2023 to June 2024, involving 168 healthy adults aged 20-60 years. Anthropometric parameters such as body mass index (BMI), waist circumference (WC) and waist-hip ratio (WHR) were assessed. Serum concentrations of TSH, T3 and T4 were quantified via enzyme-linked immunosorbent assay. Participants were categorised according to BMI (normal, overweight and obese), WC and WHR thresholds established by World Health Organisation and Asian Indian criteria. Statistical evaluations employed t-tests, ANOVA and Pearson's correlation, with significance established at P < 0.05.

Results: Males demonstrated larger body size compared to females, with no significant difference observed in BMI and thyroid hormones. Increased BMI, WC and WHR correlated with higher serum levels of TSH and T3 levels, while T4 showed minimal variation. Strong positive correlations were found between BMI and TSH (r = 0.46, P = 0.00) and T3 (r = 0.60, P = 0.00) across the total cohort.

Conclusion: This investigation demonstrates a significant correlation between adiposity markers and higher thyroid hormone concentrations, notably TSH and T3, indicating adaptive mechanisms to increased fat mass. These results highlight the necessity of taking into account for sex-specific anthropometric variations and central obesity metrics such as WHR in assessing thyroid function.

Infertility, defined as an inability to get pregnant following 12 months of regular, unprotected intercourse, is a significant problem, and 15% is unexplained. Autoimmune conditions such as anti-phospholipid syndrome (APS) and systemic lupus erythematosus cause infertility by altering implantation by thrombophilic mechanisms and immune derangement. Despite progress in assisted reproductive technologies, implantation failure continues to be a strong hindrance, determined by maternal health, immune tolerance and endometrial receptivity. Antiphospholipid antibodies (aPLs) compromise trophoblast function, enhance thrombosis risk and account for in vitro fertilisation (IVF) failure, recurrent pregnancy loss and pregnancy complications. A review of 45 peer-reviewed articles published over the past 8 years was performed on PubMed, Scopus, Web of Science and Google Scholar. MeSH terms used were 'antiphospholipid syndrome', 'in vitro fertilization', and 'infertility'. Non-English publications, case reports, editorials and conference abstracts were not included. Results suggest that APS and aPL inhibit implantation due to trophoblast malfunction, inflammation and thrombosis, causing infertility and recurrent pregnancy loss. In IVF, aPL correlates with reduced rates of implantation and live birth, with various subtypes of antibodies predicting adverse outcomes. Traditional therapies such as low-dose aspirin and low-molecular-weight heparin are routine, whereas novel therapies such as intravenous immunoglobulin, rituximab and eculizumab hold promise for resistant disease. Due to the inconclusive effect of aPL on IVF success, individualised risk stratification and focused anticoagulation regimens are important for maximising reproductive outcomes.

Background: In many industrial dispensaries, audiometric testing is often conducted in small, enclosed rooms, where ambient noise exceeds the maximum permissible ambient noise level (MPANL). This environmental noise can interfere with accurate audiometric testing, leading to overestimated hearing thresholds and false-positive diagnoses of hearing impairments.

Aim: The study aimed to compare audiometric results obtained in soundproof booths versus field settings with ambient noise and to assess the impact of environmental noise on hearing threshold assessments in the occupational settings.

Subject and methods: This cross-sectional study was conducted amongst 164 mine workers in Rajasthan, India. Audiometric tests were performed using a portable calibrated audiometer across frequencies ranging from 0.5 kHz to 8 kHz. Each participant underwent two audiometric assessments: One in a soundproof booth adhering to standards and the other in a field setting with ambient noise. Background noise levels were measured using a sound-level meter. Hearing impairment was determined based on the average hearing threshold across all the tested frequencies.

Results: The soundproof booth maintained acceptable background noise levels (International Organisation for Standardisation 8253-1:2010), while the field noise exceeded the MPANL. The mean hearing threshold differences between the booth and field conditions were statistically significant for all frequencies (P < 0.0001). The largest difference was at 0.5 kHz (21.22 dB) and the smallest at 4 kHz (7.52 dB). In the booth, 41.46% of participants showed hearing impairment, whereas 100% exhibited hearing loss in the field setting.

Conclusion: This study found that environmental noise in field conditions significantly increased hearing thresholds, leading to false-positive diagnoses of hearing impairment. These findings emphasise the need for soundproof booths in occupational audiometric testing to ensure accurate hearing assessment and avoid unnecessary diagnostic referrals.

Neuromuscular deficits persist after anterior cruciate ligament reconstruction (ACLR), limiting functional recovery and increasing re-injury risk. Plyometric training (PLYO) may address these gaps, but its multi-dimensional efficacy remains unclear. The objective of this study is to evaluate the effects of on neuromuscular function across subjective outcomes, limb symmetry, strength and dynamic balance in ACLR patients. Following PRISMA guidelines (PROSPERO), 7 randomised controlled trials (RCTs) were identified from PubMed/EMBASE/MEDLINE/CENTRAL/Scopus/Web of Science (up to June 2025). Random-effects meta-analyses synthesised standardised mean differences (SMDs) or mean differences (MDs) for the key outcomes. Evidence certainty was assessed using GRADE. A total of 267 patients were included across studies. Plyometric training significantly enhanced quadriceps strength (Peak Torque: 12.06; 3.65-20.57) and overall LSI gains were clinically marginal (8.2%; 0.51-15.89). Subjective function showed inconsistent effects, with benefits linked to longer training duration (β = 0.78) and athletic populations (β = 0.65). Dynamic balance demonstrated no significant overall effect (2.90; -1.88-7.67). Plyometric training enhances strength and complex task symmetry post-ACLR, but effects on subjective function and dynamic balance are task-and population-specific. Rehabilitation programmes should prioritise individualised PLYO protocols targeting advanced neuromuscular demands. Evidence certainty was 'very low' per GRADE, urging higher-quality RCTs.

Background: Dural puncture epidural (DPE) is a modification of the combined spinal-epidural (CSE) technique, in which a dural puncture is performed without intrathecal drug administration prior to the epidural injection. This approach has been shown to enhance the onset and caudal spread of analgesia compared to conventional epidural techniques, without the adverse effects often associated with CSE.

Aims: This study aimed to evaluate whether the DPE technique improves the onset and quality of labour analgesia in primiparous women, compared to the conventional epidural (CE) technique.

Methods: In this prospective, double-blind, randomized controlled trial, 80 ASA II nulliparous women in labour with cervical dilation of 3 -5 cm were randomly assigned to receive either DPE or CE analgesia. Epidural space was identified using the loss-of-resistance-to-air technique, followed by administration of 15 ml of 0.125% bupivacaine with fentanyl 2.5 μg/ml. Maintenance dosing was provided hourly. The primary outcome was the proportion of women reporting a pain score of NRS 3. Secondary outcomes included time to adequate analgesia, S2 blockade, sensory and motor block assessments, analgesic consumption, haemodynamic changes, adverse effects, and maternal satisfaction.

Results: Of 78 participants completing the study, significantly more in the DPE group achieved NRS 3 at 10 minutes (64.1% vs. 20.5%, P = 0.011). DPE resulted in faster onset, greater S2 blockade, and higher maternal satisfaction. Haemodynamic parameters remained stable, with no differences in adverse effects or labour outcomes.

Background: The synergistic effect of immune dysfunction and metabolic disorder has gradually become a research focus in osteoarthritis (OA).

Aims: This study investigated the causal role of metabolites mediating immune cells in OA through a Mendelian randomisation (MR) study.

Materials and methods: A mediation MR framework was employed, integrating data from 731 immune cell phenotypes, 1,400 metabolites and OA genome-wide association studies. Genetic instrumental variables strongly associated with immune phenotypes such as 'HLA DR+ CD4+ lymphocytes' (F ≥ 10, P < 5 × 10⁻⁸) were selected, and causal effects were validated using inverse-variance weighted (IVW), MR-Egger, and MR-pleiotropy residual sum and outlier methods, with metabolite-mediated proportions calculated.

Results: MR initially identified immune cells and metabolites causally associated with OA. Subsequent mediation analysis indicated that HLA DR+ CD4+ lymphocytes mediated 19.5% of OA risk through leucine levels (P = 0.030), involving mTORC1 signalling activation and epigenetic regulation. CD25 on CD45RA+ CD4 non-Treg cells exacerbated oxidative stress via S-carboxyethylcysteine (mediation proportion 12.5%, P = 0.033), whereas HLA DR+ NK cells exhibited protective effects through suberate (mediation proportion: -9.89%, P = 0.048). Sensitivity analyses confirmed the robustness of the findings.

Conclusion: This study establishes for the first time a genetic-level immune-metabolic-OA causal network, demonstrating causal links between immune cells and OA and highlighting the critical mediating role of metabolites.

Background: Chronic kidney disease (CKD) is capital-intensive and challenging to manage, thus, a need for a cost-effective and accessible marker. Monocyte lymphocyte ratio (MLR), a subset of leukocytes, is valuable as a surrogate tool of chronic systemic inflammation in evaluating and assessing CKD stages and complications. Elevated MLR is associated with worsening systemic inflammation and immune dysfunction in CKD.

Aim: To determine whether increase in MLR correlates with progression in CKD stages.

Subject and methods: Evaluate the relationship between the MLR and CKD stages. Cross-sectional. Tertiary care centre in Lagos, Nigeria. This is a cross-sectional study of 300 patients with CKD attending a teaching hospital in Lagos, Nigeria, conducted between January 2024 and July 2024. The patients' CKD stages were evaluated using the modification of diet in renal disease to calculate their estimated glomerular filtration rate with their corresponding MLR retrieved from their full blood count results. The data were analysed using the SPSS software version 23.0. The statistical significance was set at a P < 0.05.

Results: The mean age was 58.5 (5.7) with a male-female ratio of 1.6:1. The average MLR was 0.44 (0.14) the correlation between CKD stages and MLR was (r = 0.763, P = 0.001) subjects in CKD 2 and 3 compared to those on dialysis were 27.4 times likely to fall in fourth quartile of MLR.

Conclusion: Our study revealed that elevated MLR, an inflammatory marker, was strongly associated with worsening renal function across all CKD stages.

Background: Few studies have looked at the effect of periodontal therapy on the serum/saliva concentration of micronutrients.

Aims: The aim of this study was to evaluate the effect of non-surgical periodontal therapy (NSPT) on the serum and saliva levels of selenium, zinc, copper and iron in patients with periodontitis.

Materials and methods: Sixty participants were recruited for the study. Test group comprised 30 participants with periodontitis and the control group comprised 30 periodontally healthy participants. Periodontal parameters (clinical attachment loss and probing pocket depth) and periodontal inflamed surface area (PISA) were assessed for both groups at baseline and after 3 months. Blood and saliva samples were also collected at baseline and after 3 months to determine the levels of selenium, zinc, copper and iron in them. The test group had scaling and root planing with oral hygiene instructions and motivation while the control group had only oral hygiene instructions and motivation at baseline. Inter-group and intra group differences were determined using the independent t-test and paired t-test respectively. Statistical significance was set at P < 0.05.

Results: Fifty-one participants completed the study comprising 27 participants in the test group and 24 participants in the control group. The mean values of selenium and zinc increased from the baseline values. Copper and iron mean values however decreased from the baseline values.

Conclusion: The study showed an increase in the mean serum and salivary levels of zinc and selenium and a decrease in copper and iron following NSPT in patients with moderate-to-severe periodontitis.

Background: The COVID-19 pandemic negatively disrupted health and education systems in Nigeria, especially clinical education, which requires hands-on training and physical assessment of patients. As a result of this peculiarity, an innovative Virtual model to TRain and Assess Clinical Students (VTRACS), a learner centred approach for teaching clinical healthcare professionals acceptability of this virtual reality (VR) model for clinical students' training and examination, based on limited budget and cost, was developed to mirror a real-life in-class simulation.

Aims: The purpose of this study was to evaluate the feasibility, appropriateness and acceptability of this virtual model for clinical students' training and examination.

Methods: A mixed-methods research design was employed using both descriptive quantitative data and in-depth interviews. The participants comprised 24 students from dentistry, nursing, medicine, obstetrics and gynaecology programmes and eight faculty members at a public University in Southwest Nigeria. All the participants were exposed to VTRACS for training and assessment.

Results: The results showed a high level of feasibility (72%), appropriateness (85%) and acceptability (84%) for the virtual model. The findings from the qualitative data revealed varied views on the implementation of the virtual model for the training and assessment of clinical students. While a vast majority of the participants judged the intervention as effective in teaching and assessment, others expressed some challenges, including possible loss of empathy for patients, less effectiveness for complicated operations and unsuitability for some specific clinical examinations.

Conclusion: This study concluded that the model should be integrated and combined with physical training and assessment to optimise the benefits of Virtual Reality (VR) in medical education.

Adolescents and young women in sub-Saharan Africa (SSA) face disproportionately high rates of HIV infection and unintended pregnancy. As Internet access accelerates across SSA, its implications for adolescent sexual health demand urgent scrutiny. This correspondence examines the association between Internet use and risky sexual behaviours (RSBs) amongst 5920 unmarried, sexually active females aged 15-34, using Demographic and Health Survey (DHS) data from nine countries: Burkina Faso, Côte d'Ivoire, Ghana, Kenya, Lesotho, Madagascar, Mozambique, Rwanda and Tanzania. Data analysis employed logistic regression methods using R version 4.4.2. The prevalence of RSB was higher amongst Internet users (46.2% vs. 35.7%). It was as high as 72.2% in Lesotho, as low as 21% in Ghana. Internet users were 26% (adjusted odds ratio [aOR] = 1.26, 95% confidence interval [CI] = [1.09-1.45]) more likely to engage in RSBs. Additional drivers included age, media exposure, non-marital fertility, residence and country-specific factors. Relative to Kenya, elevated odds were found in Lesotho (aOR = 2.54, 95% CI = [1.88-3.46]), Burkina Faso (aOR = 2.13, 95% CI = [1.61-2.81]), Mozambique (aOR = 1.64 [1.26-2.13]) and Rwanda (aOR = 1.90, 95% CI = [1.35-2.70]). While digital platforms hold promise for expanding sexual education, these findings underscore the need for targeted content oversight and culturally responsive interventions to mitigate online health risks.