Nigerian Postgraduate Medical Journal最新文献

Objective: To compare the efficacy of single-dose antimicrobial prophylaxis (AMP) with multiple doses for caesarean section (CS) at Federal Teaching Hospital Gombe.

Subjects and methods: Parallel arm randomised controlled trial (1:1 allocation) comparing single and multiple dose AMP for CS. Federal Teaching Hospital Gombe, Nigeria. One hundred and seventy-six women undergoing elective and emergency CSs. Participants were randomised into two groups: single dose of intravenous amoxicillin/clavulanic acid before skin incision only (Group A) and multiple doses including post-operative doses (Group B). Surgical site infection (SSI) rate during a 30-day surveillance period.

Results: The SSI rate was 2.3% in Group A and 0.0% in Group B (P = 0.058). Febrile morbidity was 1.2% and 2.3%, respectively (P = 0.509). Urinary tract infection occurred in one patient in Group A (P = 0.494).

Conclusions: Single-dose AMP for CS is as effective as multiple doses in preventing SSI. This trial was registered in the Pan African Clinical Trial Registry (www.pactr.org) database with unique identification number PACTR202009483150226.

Background: Delayed tuberculosis (TB) care can have adverse effects on both patients and the community. Such delays can perpetuate transmission within the community and disrupt ongoing efforts to eliminate TB.

Objectives: The primary objective of this meta-analysis was to estimate the pooled proportion of pulmonary TB (P-TB) cases experiencing delays in seeking care across high-burden countries worldwide.

Materials and methods: Data extraction was conducted using three databases: PubMed, Scopus and DOAJ. This study was conducted as an extension of a scoping review, with the meta-analysis specifically aimed at estimating the pooled proportion of P-TB cases experiencing delays through quantitative data. The pooled proportion was calculated with a 95% confidence interval (CI) using a random-effects model, taking potential heterogeneity into account.

Results: Thirty-two full-text articles, selected from 831 articles, were included in the meta-analysis, representing China, India, Myanmar, South Africa and Nigeria. The total sample used across all the studies was 184,242 with a mean (standard deviation [SD]) of 5758 (17,236) and (median - 491, interquartile range - 271-1563). The highest total sample was from China (n = 176,642), and the lowest total sample was from Nigeria (n = 160). The pooled proportion of P-TB cases experiencing delays in China, India, Myanmar, South Africa and Nigeria was 50% (95% CI: 41-59), 50% (95% CI: 36-63), 38% (95% CI: 3-82), 47% (95% CI: 37-56) and 42% (95% CI: 34-50), respectively. The overall global proportion was 48% (95% CI: 41-55), with significant heterogeneity (I2 = 99.85%) observed among the studies.

Conclusions: This study estimated that half of the global P-TB cases experienced delayed care, which is concerning and necessitates a multi-faceted approach to support TB elimination efforts.

Background: To evaluate the impact of the coronavirus disease 2019 (COVID-19) lockdown on the demographic and clinical profile of patients presenting with ocular trauma.

Materials and methods: A retrospective comparative cross-sectional study of ocular trauma patients managed in the emergency department (ED) from 26 March 2020 to 31 June 2020 and the similar period in 2019. The differences in patients' data (age, presenting visual acuity, mechanism of injury, location of injury, class of trauma, presentation time post-injury and ocular interventions) were compared.

Results: There were 50 trauma patients pre-COVID-19 and 83 patients at lockdown with a trauma prevalence of 1.2% and 2.0%, respectively. The mean age of patients was 21.7 ± 18.8 and 21.1 ± 13.9 years pre-COVID-19 and at lockdown (P = 0.084). During lockdown, the proportion of children with eye injuries decreased from 58% to 50%, also patients with presenting visual acuity worse than 6/60 decreased from 70% to 60.3%. Regarding the mechanism of trauma, there was an increase in the percentage of domestic injuries, vegetative matter implicated and open globe injury (respectively from 44% to 62.7%, from 16% to 32.5% and from 36% to 41%). Injury-to-treatment time was longer during the lockdown. Presentation to the ED within 24 hours of injury reduced to 28.9% from 44% (P = 0.035). More patients (59%) were managed conservatively at lockdown compared to 46% pre-COVID-19 (P = 0.004).

Conclusion: The number and prevalence of ocular injuries increased during the COVID-19 lockdown. Injuries were more severe, mainly domestic and vegetative matter was most implicated. Patients presented later to the hospital and were mostly managed conservatively during the lockdown.

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are used for treating fever, inflammatory and painful conditions. Their use is more common in low-income settings where artisans and manual labourers take them for work-related pain. High doses and prolonged use can cause albuminuria.

Aim: The study assessed albuminuria, (a surrogate maker for kidney damage) in frequent NSAID use.

Subjects and methods: The cross-sectional study involved 100 frequent NSAID users and 100 age- and sex-matched healthy controls. History and examination were conducted. Urine samples were collected for analysis, microscopy and albumin-creatinine ratio and, blood samples were collected for creatinine-based glomerular filtration rate (GFR) and haematocrit.

Results: The mean age of NSAID users with albuminuria was 63.1 + 4.2 years, which was significantly higher than without albuminuria (41.8 + 4.5 years), P < 0.001. Albuminuria and GFR decline were more common in NSAID users than controls, P < 0.001 and P < 0.001, respectively. The mean systolic blood pressure of NSAID users was significantly higher than the controls, P < 0.001. Amongst the NSAID users, albuminuria was positively correlated with metabolic acidosis but negatively correlated with haematocrit, P = 0.04 and P = 0.002, respectively. Albuminuria was common in NSAID users who took herbal remedies and ibuprofen. Associates of albuminuria were advancing age (odds ratio [OR]: 2.17 [confidence interval (CI):1.36-4.52], P = 0.002), prolonged use (OR: 1.97 [CI: 0.05-2.09], P = 0.02), combination therapy (OR: 2.84 [CI: 1.03-6.29], P = 0.001) and ibuprofen use (OR: 1.93 [CI: 1.07-2.45], P = 0.02).

Conclusion: Albuminuria is common in frequent NSAID users, particularly with advancing age, herbal remedies, anaemia, ibuprofen use and prolonged and combination therapy. It is imperative that NSAIDs should be taken in low doses and for short period.

Background: Cirrhosis of the liver is a chronic condition that can be prevented through increased awareness and education. However, knowledge amongst clients admitted to gastroenterology units is often inadequate, necessitating structured educational interventions.

Aim: The aim of this study was to assess the effectiveness of a structured teaching programme (STP) in improving knowledge regarding the prevention of cirrhosis of the liver amongst clients admitted to the gastroenterology unit of a selected hospital in Bangalore.

Materials and methods: An evaluative research approach using a one-group pre-test post-test quasi-experimental design was employed. A convenience sample of 50 clients aged 30-70 years admitted to the gastroenterology unit was selected. A structured knowledge questionnaire was administered before and 7 days after delivering the STP, which covered causes, risk factors, symptoms, and preventive strategies for cirrhosis.

Results: Pre-test findings indicated that 74% of clients had inadequate knowledge, 20% had moderate knowledge and 6% had adequate knowledge regarding cirrhosis prevention. Post-test results showed significant improvement, with 38% having adequate knowledge, 38% moderate knowledge and 24% inadequate knowledge. The mean knowledge score increased significantly from 11.62 (standard deviation [SD] = 4.97) to 19.36 (SD = 5.39) post-intervention (P < 0.05). Significant associations were noted between post-test knowledge and demographic variables such as age, occupation and source of information.

Conclusion: The STP was effective in significantly enhancing clients' knowledge about the prevention of cirrhosis of the liver. Continued health education initiatives are recommended to sustain and further improve awareness amongst at-risk populations.

Aims: Gestational diabetes mellitus (GDM) can be defined as glucose intolerance with onset or first recognition during pregnancy. We aimed to estimate the proportion of GDM patients and to study the risk factors and their maternal and foetal outcomes.

Subjects and methods: Ours was a prospective observational study among women who were recruited from obstetrics and gynaecology department of a tertiary care hospital in Malappuram, Kerala. Pregnant women who completed at least 24-week gestation were included in our study. Women with postprandial blood sugar >140 mg/dl, after administration of 75 g glucose irrespective of their fasting status, were diagnosed to have GDM. These women were then followed up till delivery and outcomes were compared with non-GDM group.

Results: 252 pregnant women were recruited into the study and out of them 234 were followed up (92.8%). The prevalence of GDM was 11.9% in our study population. Age, pre-pregnancy body mass index using Asian cutoffs and family history of gestational diabetes were found to be significantly associated with GDM. There was a higher incidence of vaginal candidiasis, polyhydramnios and shoulder dystocia in the GDM patients.

Conclusion: Complications were higher in the GDM group. Risk stratification can help us to identify patients earlier and for better treatment.

Background: There has been a global noticeable increase in the occurrence of infectious disease outbreaks, compounded by both natural and human-induced disasters.

Aims: We aimed to examine the correlates of emergency preparedness and response to disease outbreaks in Kano, Northwest Nigeria.

Methods: A descriptive cross sectional survey that utilised a two stage sampling technique was conducted among 359 stakeholders from the Ministries of Agriculture, Environment and Health at both State and Local Government Area (LGA) levels. Data were collected through interviewer-administered questionnaires and analysed using SPSS version 22. P ≤0.05 was set to be statistically significant.

Results: Participants' ages ranged from 18 to 61 years, with a mean age of 41.0 years and a standard deviation of ±8.7 years. Most respondents (70.5%) reported the presence of an Epidemic Preparedness and Response Committee (EPRC) before 2020, while a slightly larger proportion (73.8%) indicated its existence at the time of the survey. Similarly, a higher number of stakeholders confirmed the current presence of rapid response teams (RRTs) during outbreaks (76.9%) compared to their presence before 2020 (71.6%). We found 44.3% of EPRCs and 41.8% of RRTs to be functional. The presence of RRTs during outbreaks was as an independent predictor of EPRC functionality. Areas with insufficient RRT deployment during outbreaks were significantly less likely to have a functional EPRC. Conversely, areas with timely RRT activation were 20% more likely to have a functioning EPRC (adjusted odds ratio [aOR] = 0.2; 95% confidence interval [CI]: 0.1-0.5). Similarly, RRT functionality was reported more frequently in areas where respondents were uncertain about RRT availability before 2020 (58.8%, P = 0.002). Prior availability of RRTs during outbreaks was identified as an independent predictor of RRT functionality. Areas where respondents were unsure of RRT presence during past outbreaks were 4.7 times more likely to have a functional RRT (aOR = 4.7; 95% CI = 1.2-18.4).

Conclusions: A fairly good proportion of EPRC and RRT were in place; however, their functionality was below optimal. We recommend urgent review of the available Standard Operating Procedure (SOP), and implementation of the relevant guidelines by all the relevant stakeholders for outbreak mitigation, prevention and timely response.

Background: Accurate detection of Helicobacter pylori infection is crucial for properly treating patients with dyspepsia. Several invasive and non-invasive diagnostic methods are being utilised.

Aims: This study aimed to determine the prevalence of H. pylori in adult patients with dyspeptic conditions and how it related to endoscopic findings, histological features and the relationship to urea breath test (UBT) results.

Methods: From 723, 100 adult dyspeptic outpatients who underwent UBT and endoscopy were investigated at the Department of Gastroenterology in Imam Al-Hujjah Hospital for gastroduodenal biopsy. A histopathological study was also used to identify H. pylori.

Results: The study included 68 females (37 H. pylori positive and 31 with H. pylori negative) and 32 males (13 with H. pylori and 19 without H. pylori) with a female-to-male ratio of 2.1:1. The most common endoscopic finding was nodularity in 28 patients (46%) H. pylori positive and 5 (10%) H. pylori negative, followed by gastritis, erosive gastritis, erythema, hiatus hernia and gastric ulcer. The most common histological feature was chronic gastritis in 52 cases (64%) in the positive bacterial cases and 20 (36%) in the negative group, with a statistically significant relationship. There was a significant difference between histopathological findings with both endoscopic examination and UBT results for H. pylori positive and negative patients.

Conclusions: Endoscopic and histological studies with UBT showed a significant ability to detect H. pylori. Early detection and treatment are crucial for the H. pylori infection to avoid major complications.

Background: Borderline Personality Disorder (BPD) is characterised by pervasive emotional instability and self-destructive behaviours, often presenting challenges for healthcare professionals. Negative attitudes among psychiatric service providers may affect care.

Aims: This study aimed to assess attitudes of psychiatric providers towards patients with BPD in Jammu and Kashmir, India.

Materials and methods: A cross-sectional online survey was conducted between September 2024 and February 2025 using the Attitude to Personality Disorder Questionnaire (APDQ) amongst psychiatrists, psychologists, nurses, trainees, interns and social workers in psychiatry departments. Sociodemographic data and APDQ responses were analysed using SPSS version 25.0.

Results: We had a total of 189 participants, the majority were female (59.78%). Psychology and nursing interns had highest positive transference scores, while psychiatrists scored lowest. A significant correlation (r = -0.14) was found between age and fear towards BPD patients. No significant associations were observed between service duration or gender and APDQ domains. The internal consistency of the APDQ was high (Cronbach's α =0.85).

Conclusion: Attitudes towards BPD patients vary by professional role. Interns and psychologists exhibited more positive engagement, whereas psychiatrists and PG trainees reported greater feelings of helplessness. Targeted training is recommended to create empathy, reduce stigma and enhance patient care for individuals with BPD.

Background: Musculoskeletal (MSK) disorders are common amongst elders. India's elderly population poses challenges in accessing health care, especially for physiotherapy services, which remains limited in primary care settings.

Aims: This study aimed to assess the effectiveness of a peer elder volunteers network in increasing physiotherapy service utilisation from a selected urban Primary Health Centre (PHC) and to elevate improvements in pain, range of motion (ROM) and muscle strength following physiotherapy.

Methodology: A parallel-arm quasi-experimental study was conducted amongst elders (≥60 years) having joint problems. Eligible participants were recruited from four municipal wards in JIPMER Urban Health Centre (JIUHC) service area. Two municipal wards each were randomly assigned to the intervention (where peer elder volunteers were involved in mobilising patients along with routine healthcare outreach activities) and control (routine health worker outreach activities) arms. Physiotherapy sessions were conducted at JIUHC, and utilisation was compared across the intervention arms. Pain scores, ROM and muscle strength were assessed at baseline and after 6 weeks of physiotherapy.

Results: Physiotherapy service uptake was 54% higher in the intervention arm (P < 0.001). Females were significantly more likely to avail services (adjusted risk ratio; 1.59, 95% CI: 1.10-2.29). Significant improvements were observed in ROM, muscle strength and pain reduction (P < 0.001) among elders seeking care for knee and shoulder joint problems.

Conclusion: Involving peer elder volunteers significantly increased physiotherapy service uptake from a selected urban PHC. This study can also conclude that incorporating physiotherapy services in primary care settings is feasible and effective for the elders with joint problems.