Nigerian Postgraduate Medical Journal最新文献

Background: Cognitive impairment is a growing public health challenge for older adults in nations like India due to demographic changes and chronic diseases, significantly impacting daily function. Despite its importance, there is limited research in quantifying the burden of cognitive impairment.

Aims: This study aims to assess the prevalence of cognitive impairment among the elderly in an urban area and to determine the associated factors.

Subjects and methods: A community-based cross-sectional study was conducted between July 2024 and February 2025 in an urban area of Chengalpattu district, Tamil Nadu. 300 participants aged 60 years and above were selected using two-stage random sampling. Data were collected using a sociodemographic questionnaire, Montreal Cognitive Assessment (MoCA), Katz index of independence of activities of daily living (ADL) and DASS-21 scale. Logistic regression analysis was used to identify factors associated with cognitive impairment (MoCA score ≤24).

Results: The prevalence of cognitive impairment was 36.67%. Mild Cognitive Impairment (MCI) was present in 11.67% of participants. Multivariate analysis revealed that engaging in leisure activities was protective against cognitive impairment (adjusted odds ratio [AOR] 0.332). Factors significantly associated with higher odds of cognitive impairment included gait disturbances (AOR 2.872), dependence in ADL (AOR 5.983) and depression (AOR 7.393).

Conclusions: Cognitive impairment is highly prevalent among the elderly in this urban South Indian community. Promoting leisure activities and addressing modifiable factors such as depression, functional dependence and gait disturbances are important strategies for mitigating cognitive decline in this population.

Background: The prevalence of sickle cell disease (SCD) is high in Nigeria, and macular thinning is one of its ocular complications. However, there are currently no local data in the literature on macular thickness in Nigerians with SCD. This study provides comparative baseline data on the macular thickness profile of an indigenous Nigerian population to address this gap.

Aims: To determine the macular thickness of participants with SCD and compare with their age- and sex-matched participants without SCD at the University College Hospital (UCH), Ibadan.

Materials and methods: This was a hospital-based comparative study conducted at the University College Hospital, Ibadan. Patients with SCD aged 18 years and above were age- and sex-matched with non-SCD controls (haemoglobin AA genotype). All participants underwent a full ophthalmic examination, refraction and A-scan biometry and macular thickness was measured with an Optovue iScan spectral-domain optical coherence tomography machine. Data from the left eye of each participant were analysed with IBM Statistical Package for Social Sciences (SPSS) version 25.0.

Results: Seventy participants were recruited into the study and 30 (42.9%) were males. The mean age of all the subjects in the study was 35.9 ± 11.0 years. Group 1 (SCD) comprised 19 (27.1%) Hb SS and 16 (22.9%) Hb SC, whereas Group 2 (non-SCD) were 35 (50%) Hb AA subjects. The SCD group had lower mean macular thickness (MMT) of 271.1 ± 20.2 µm compared to non-SCD group with MMT of 278.5 ± 13.5 µm, but this was not statistically significant (P = 0.076). Macular thickness was generally lower in SCD group in all the ETDRS map regions of the macular compared to the non-SCD group with values ranging from 3.0 to 11.5 µm, but statistically significant difference was observed only in the inner inferior macular (P = 0.026) and inner temporal macular (P = 0.046) regions. There was no statistically significant difference in distant visual acuity between non-SCD and SCD participants (P = 0.605).

Conclusion: This study observed focal macular thinning in SCD compared to non-SCD. However, focal macular thinning was not associated with poorer distant visual acuity in patients with SCD.

Objective structured clinical examination (OSCE) is a structured performance-based assessment of learners' competencies. These technical and non-technical competencies are evaluated by multiple examiners through uniformly timed, multiple stations. OSCE has been adapted in the assessment and training of post-graduate medical doctors in Ophthalmology in Nigeria. Leaning on current practice and evidence-based pedagogy from the existing literature, we explore how OSCE can be adapted to support learning, in post-graduate ophthalmology in Nigeria. We describe initiatives to modify the existing OSCE assessment method to balance 'assessment of' with 'assessment for' learning.

Background: Follicular thyroid cancers (FTC) are the second most common type of thyroid malignancy, particularly prevalent among females. Oestrogen receptor (OR) status is significant for both the pathogenesis and prognosis of FTC, as tumours showing this marker might be candidates for targeted medical therapies.

Aims: This study aimed to assess the OR status of FTC cases during the specified study period, providing insights into possible responses to medical-targeted therapy.

Methods: This research was a hospital-based retrospective multicentre study. Data were collected from surgical pathology cancer registries. Tissue samples from the relevant cases were reviewed and classified, followed by immunohistochemistry analysis. The Allred scoring system was used for evaluation, and the data were analysed with SPSS (Statistical Package for the Social Sciences) 20. Descriptive statistics were employed to calculate the frequencies of categorical variables, the mean and the mode of continuous variables. P value was set at ≤0.05.

Results: Among the 95 thyroid cancer cases reviewed, 34 (36%) were classified as FTC. The mean age was 49.8 years (±15.4), with a mode of 44.5 years, a median age of 42 years, and an age range from 32 to 70 years. A significant majority of the cases were female (and statistically significant), accounting for 64.7%, and minimally invasive FTC was the most frequently observed type. Out of the total cases, three (8.8%) tested positive for OR, all of whom were female. Of these, two cases had an OR score of 3 (5.9%), and one case had a score of 5 (2.9%).

Conclusions: The study revealed that the majority of follicular thyroid cancer cases were negative for ORs, with all positive cases occurring in females of reproductive age.

Stress is pervasive among medical students, driven by academic pressures, clinical responsibilities and personal challenges. This stress often leads to mental health issues such as anxiety, depression and burnout, exacerbated by the stigma surrounding mental health support. Addressing this stigma is critical to fostering well-being in future healthcare providers. Key themes include the prevalence and sources of stress, the impact of stigma on mental health help-seeking behaviours and innovative programmes integrating mental health education and stigma reduction. Insights are drawn from international practices and evidence-based interventions. Recommendations highlight the need for culturally sensitive and student-centric approaches to create an inclusive and supportive environment. By addressing stigma and enhancing mental health support, institutions can improve medical students' academic and personal outcomes.

Background: Nigeria adopted artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria in 2005.

Aims: This study aims to determine and compare the compliance of health workers with the National Guideline for the Diagnosis and Treatment of Malaria (National Guidelines) in uncomplicated malaria treatment in Global Fund for AIDS Tuberculosis and Malaria- Supported (GFS)and government-supported (GS) primary healthcare centres (PHCs) in Anambra State.

Materials and methods: This cross-sectional comparative study involved the review of 1536 case records, a questionnaire-based survey of 82 health workers and a health facility assessment in 32 PHCs in Anambra State. Data were analysed using IBM SPSS Statistics version 20. The Chi-square test of independence was used to determine the association between the categorical variables at a 0.05 statistical significance level.

Results: Compliance with National Guidelines in uncomplicated malaria treatment was 83.2% overall, 89.1% for GFS PHCs and 76.5% for GS PHCs (P = 0.00). ACT stock-out occurred in 43.8% of GFS versus 100.0% of GS PHCs, (P = 0.00). Amongst healthcare workers, access to National Guidelines was 48.8% in GFS PHCs versus 26.8% in GS, (P = 0.04); access to malaria case management aid was 90.2% in GFS PHCs versus 70.7% in GS, (P = 0.03) and supervision was received within the last 6 months of 2017 by 31.7% in GFS PHCs versus 2.4% in GS, (P = 0.00).

Conclusion: This study suggests that compliance with National Guidelines in uncomplicated malaria treatment amongst PHC workers was enhanced by increased free ACT availability, access to guidelines, case management aid availability and supervision frequency. This is evidence for Malaria Elimination Programme evaluation in Anambra State and Nigeria.

Objective: Unilateral sinonasal mass remains a common pathology and management is a prerequisite for effective outcome. This study aimed to determine the epidemiology, clinicopathological pattern and management outcomes of unilateral sinonasal masses at a tertiary centre in Nigeria.

Patients and methods: This was a prospective and hospital-based study of consented patients with unilateral sinonasal masses in Ear, Nose and Throat Department of Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria, carried out from January 2011 to December 2020. Data were obtained using the assisted self-administered structured questionnaire.

Results: All the studied age groups had unilateral sinonasal masses with peak age groups of >50 years at 41.1%. The second and third recurrent episodes occurred in 10.7% and 3.6%, respectively. The most common nasal manifestations were nasal blockage (71.4%). Majority of the extranasal manifestations were otological (39.3%) and ocular (7.1%). The most common affected nostril was the right nostril (62.5%). The most common site of origin was maxillary sinus (42.9%). Majority of the histological diagnoses were benign tumours in 71.4%. Majority of benign masses were inverted papilloma (32.1%) and majority of malignancies were squamous cell carcinoma (23.2%). Major surgical interventions were intranasal excisional biopsy (44.6%) and intranasal polypectomy (17.9%). There were 3.6% recurrence and 1.8% mortality recorded in this study.

Conclusion: Unilateral sinonasal mass is common and it can affect any of the nostril, with late presentations due to pre-hospital self-treatment. It could be benign or malignant and mainly surgical excision and chemo-radiotherapy are the treatment options in malignant types. Health education is advised to encourage early presentation and prompt treatment.

Background: Malaria remains a significant global health threat, with Africa bearing the highest burden. Pregnant women in Nigeria are particularly vulnerable due to the country's high malaria prevalence.

Objectives: The study examined the knowledge and utilisation of Malaria prevention strategies by pregnant women attending some selected primary health centres (PHCs) in Borno State, Nigeria.

Subjects and methods: The study was conducted using a cross-sectional descriptive survey in two local government areas: Maiduguri Metropolitan Council and Jere, in Maiduguri, Borno state, Nigeria. Furthermore, Fisher's formula determined the sample size, and data were collected from 407 pregnant women using a questionnaire recruited through a multistage Sampling. Finally, IBM SPSS version 27 statistical software was used for data analysis.

Results: The mean age ± standard deviation of 26 ± 4.08, and most (80.8%) of pregnant women have good knowledge of malaria prevention. The utilisation of malaria prevention strategies was low, with 79.1% showing an overall poor usage. 60.9% reported using long-lasting insecticide-treated nets, 20.6% had never used larval source management. 54.8% of the respondents were in their second trimester. Knowledge of malaria prevention was associated with the trimester of pregnancy (P = 0.0044), gravidity (P = 0.019) and education (P = 0.001). However, no relationship was found between maternal religion and knowledge of malaria prevention (P = 1.000).

Conclusions: Although pregnant women are aware of malaria prevention methods, there is a gap in their effective utilisation. To address this, targeted health education, intersectoral collaboration and supportive monitoring at PHC and community levels are recommended.

Background: Erectile dysfunction (ED) affects the physical and psychological health of a patient and his partner and can have a significant negative impact on their quality of life. Second-line therapies for ED include intracavernosal injections of vasoactive drug (ICIVAD) among others.

Aims: The aim of this study was to assess the efficacy of combination of papaverine and chlorpromazine (bimix) for the treatment of ED in patients who are unresponsive to 5-Phosphodiestrase inhibitors (PDE5-I).

Subjects and methods: This is a combined retrospective and prospective study to clinically assess the efficacy of the bimix for the treatment of ED unresponsive to PDE5-I who presented to our hospital from January 2017 to June 2024. All patients' demographic information, risk factors for ED, severity of the ED, dose of the drug used, duration of erection achieved and complications were retrieved/recorded.

Results: A total of 167 patients were recruited into the study. Their age ranged from 23 to 84 years, with a mean of 42 ± 9.7 years. Most patients were married (89.2%). The International Index of Erectile Function scores were 1-10 (18.6), 11-16 (43.7%), 17-21 (27.5) and 22-25 (10.2%). The duration of erection achieved at the office test was significantly associated with the severity of ED and the dose used; however, only 67.1% achieved strong at home and mostly at high doses (0.5-1 ml). About 4.2% reported some complications.

Conclusion: Intracavernous injection of bimix for the treatment of ED is effective in majority of patients unresponsive to PDEI; it is more effective in higher dose and in mild and moderate ED.

Background: Chronic kidney disease is one of the leading public health problems that affect millions of women and men worldwide.

Aims: This study aims to examine the effect of deep breathing to reduce discomfort amongst patient undergoing haemodialysis (HD).

Materials and methods: This randomised controlled experimental study was conducted consisted of 108 patients (54 in each group) who undergoing HD in hospitalised adults' patients between November 2024 and February 2025 to examine the effect of the deep breathing on the discomfort level during HD. The study data were collected using the structured information form, Discomfort questionnaire scale for discomfort. The data were analysed using the SPSS software version 27.

Results: The demographic characteristics of the individuals participating in this investigation spanned from 18 years of age and above, with a calculated mean age of (48.96 ± 12.490 in study group and 48.48 ± 13.729 in control group) years, and the majority of participants are male in the study group (70.4%) a. while control group was (64.8%) male.

Conclusions: Performing deep breathing exercises for 20 min, twice per day for a three weeks; can reduce maintenance HD patients' discomfort level.