Nigerian Postgraduate Medical Journal最新文献

Background: Patient's satisfaction with nursing care is thought to be a key component in determining how patients perceive service quality. Quantifying patient satisfaction in both private and public healthcare settings can offer essential evidence on performance; consequently, reflected on quality management.

Aims: This study aims to explore patients' satisfaction with the quality of nursing care.

Subjects and methods: A descriptive-cross-sectional study was conducted, involving 251 patients selected through a random selection method. Data were collected using the patient satisfaction with Nursing Care Quality Questionnaire, comprising a total of 20 items. The collected data were then analysed and interpreted using descriptive and inferential statistics. Data were analysed using SPSS V25.

Results: The findings of the current study show that more than half (52.6%) of subjects were somewhat satisfied with the provided nursing education. Similarly, more than half (55%) of subjects were somewhat satisfied with the provided nursing care. Correspondingly, (60.2%) of subjects were somewhat satisfied with the overall provided nursing services, including both the educational and the actual direct nursing care.

Conclusions: Overall, patients expressed general satisfaction with the inpatient nursing care they received, and their perceived needs and care expectations from nurses significantly influenced their satisfaction levels.

Background: Female genital cutting (FGC) causes permanent harm to women and the girl child. It is a threat to women's bodily integrity and a violation of their fundamental human rights. Nigerians still engage in this high-risk behaviour even though it is on the decline.

Aims: The objective of the study was to determine the prevalence of mother-to-daughter FGC and associated factors.

Materials and methods: A sample of 10,568 women who reported mother-to-daughter FGC from the 2018 Nigeria demographic and health survey were analysed. The prevalence of this outcome variable was estimated using percentages. The multivariable binary logit model was used to examine its associated factors.

Results: The weighted prevalence of mother-to-daughter FGC was 15.0%. Women having secondary or tertiary education had 27% reduction in the odds of mother-to-daughter FGC when compared with those with no formal education or primary. Non-poor women had 28% reduction in the odds of mother-to-daughter FGC when compared with poor women. Older women had higher odds of mother-to-daughter FGC when compared with mothers aged 15-19 years. Islamic women had 2.80 times higher odds of mother-to-daughter FGC when compared with Christian women. Those who are covered by health insurance had 51% reduction in the odds of mother-to-daughter FGC when compared with uninsured women. Ever-married women and those employed had higher odds of mother-to-daughter FGC when compared with single and unemployed women. Respondents who watch television or use the internet had 27% and 61% reduction in the odds of mother-to-daughter FGC when compared with those who do not watch television or use the internet, respectively.

Conclusion: The practice of mother-to-daughter FGC still persists in Nigeria. There is a need to implement multifaceted interventions such as educational programmes targeting women of low socio-economic status. Mother-to-daughter FGC can be addressed through empowerment.

Background: Diabetic retinopathy (DR) impairs retinal function and causes significant vision loss. Irisin has been recently implicated in the pathogenesis of DR. Intercellular adhesion molecule-1 (ICAM-1) is a cell surface glycoprotein that primarily facilitates leucocyte recruitment from circulation to inflammation sites.

Aims: This cross-sectional study aimed to explore the significance of circulatory irisin and ICAM-1 levels in DR.

Subjects and methods: This cross-sectional analytical study was conducted at a tertiary care hospital in Puducherry, India. Type 2 diabetes mellitus (T2DM) patients with retinopathy (n = 60) and without retinopathy (n = 60) were recruited. Apart from anthropometric data, blood samples were collected for routine biochemical tests and estimation of serum irisin and ICAM-1 by ELISA. Data were analysed using IBM SPSS version 20.0. The variables were compared using Independent Student's-t-test, Mann-Whitney U-test, one-way analysis of variance, or Chi-square test. Receiver operator curve (ROC) analysis evaluated irisin and ICAM-1 in differentiating proliferative DR (PDR) and non-proliferative DR (NPDR).

Results: Compared to T2DM patients without DR, Serum irisin was higher in those with DR, but no difference was observed in ICAM-1 between the 2 groups. Both irisin and ICAM-1 were decreased in vision-threatening DR (VTDR) compared to non-vision-threatening DR (non-VTDR). Decreased levels of irisin (P = 0.84) and ICAM-1 (P ≤ 0.001) were seen across DR stages. ROC analysis showed irisin differentiated NPDR and PDR (AUC = 0.7, P = 0.01).

Conclusions: Serum irisin and ICAM-1 increased in earlier stages of DR but decreased in later stages. They were decreased in pre-proliferative and proliferative stages of DR, suggesting roles in leucocyte migration and angiogenesis. Clinical management may have contributed, and further research is needed.

Background: Diabetes exacerbates frailty syndrome in elderly adults, with long-term protein and calorie deficiencies contributing to physical decline and worsening health outcomes.

Objective: To assess nutritional status and frailty amongst elderly people with diabetes mellitus and to find out the relation between these two variables.

Subjects and methods: An analytic cross-sectional study was conducted amongst 650 elderly with diabetes mellitus at two endocrine and diabetes centres in Baghdad City-Iraq from February to June 2024. Data were collected using 'Mini Nutritional Assessment questionnaire to assess the nutritional status and Physical Frailty Phenotype scale' to assess frailty status amongst the elderly. Data were analysed utilising the Statistical Package for the Social Sciences software (SPSS) version 28.

Results: Results of 650 elderly with diabetes revealed that 42.6% were aged between 60 and 69 years old, 59.8% were males, 72% lived in rural areas, 89.4% were married, 55.8% were not working, and 67.1% suffered from hypertension. The finding indicated that more than half of the elderly with diabetes suffered from malnutrition and frailty. There was a highly significant correlation between diabetes elderly nutritional status and their physical frailty amongst the elderly with diabetes.

Conclusion: Nutritional status is a pivotal determinant in the development of frailty amongst elderly individuals with diabetes, with malnutrition significantly contributing to the progression of their condition.

Objectives: Research examining the impact of anxiety and depression on the ideal number of children and birth frequency amongst men is needed.

Methods: Using the data from the 2022 Nepal Demographic and Health Survey and a sample of 4913 adult males, we performed multivariable logistic regression to examine whether depression and anxiety correlated with the desired number of children and frequency of having another child, adjusting for age, wealth status, religion and education. Depression and anxiety were evaluated using patient health questionnaire-9 and Generalised Anxiety Disorder-7 scales, respectively.

Results: Among all men, 546 (11.1%) had depression symptoms and 555 (11.3%) had anxiety symptoms. Wealth status significantly influenced the perceived ideal number of children; "poorer" men were more likely to desire more than two children compared to the poorest (odds ratio [OR] =1.83; 95% CI [1.12, 2.97]; P = 0.016). Muslim men were significantly more likely than Hindu men to desire more than two children (OR = 4.43; 95% confidence interval [CI] [2.47, 7.25]; P < 0.001). Higher anxiety levels were negatively associated with preferring to have another child within 3 years (OR = 0.89; 95% CI [0.82, 0.98]; P = 0.016), although depression levels didn't (P = 0.132).

Conclusions: Fertility improvement strategies should incorporate population-based preventive approaches addressing anxiety amongst adult males.

Background: Varicose veins are a common condition affecting millions of people worldwide. While they are often considered primarily a cosmetic issue, varicose veins can also lead to pain, swelling, and discomfort. Histopathological studies are valuable for examining the structure and composition of varicose veins. These studies provide important insights into the underlying causes of the condition and help inform treatment options for patients.

Aims: To evaluate the distribution of collagen and elastin in the venous walls using Masson's Trichrome and Verhoeff's Van Gieson staining.

Materials and methods: This study examines histological changes in varicose veins, focusing on the distribution of collagen and elastin through Masson's Trichrome and Verhoeff's Van Gieson staining methods. This study examined histological samples of varicose veins from 30 individuals. The tissue samples were fixed in formalin and stained with Hematoxylin & Eosin, Masson's Trichrome, and Verhoeff's Van Gieson stains, followed by analysis using light microscopy. Statistical analysis was performed with IBM SPSS version 23.0.

Results: Histological evaluation revealed significant changes in the tunica media, including a loss of smooth muscle (86.67%) and increased collagen deposition (76.67%). The intima exhibited prevalent intimal thickening (96.67%) and fibrosis (93.33%), while the adventitia showed notable adventitial fibrosis (86.67%) and vascular remodeling (53.33%). Elastic fiber impairment was observed in 13.33% of individuals, with collagen as the main structural component in all venous layers.

Conclusion: Histopathological studies offer valuable insights into the structural changes that occur in varicose veins through the use of special stains. These studies play a crucial role in the diagnosis and management of varicose veins by providing detailed information about tissue structure and pathology. This information helps healthcare providers deliver personalized care to patients affected by this condition. Continued research in this field will further enhance our understanding of varicose veins and improve patient outcomes.

Pregnant women with thalassemia are exposed to a wide range of unique challenges which calls for the need to give them added attention. As pregnant women with thalassemia are high-risk groups, there is an immense need to adopt targeted interventions to ensure that a successful pregnancy and outcome are accomplished. This must begin with the implementation of widespread preconception and antenatal screening to facilitate early detection of thalassemia carriers, predominantly in high-prevalence regions. The need of the hour is to raise awareness about thalassemia and the importance of early screening among the general population. In conclusion, pregnant women with thalassemia are prone to multiple adverse risks and complications. This calls for the need to implement specific public health interventions to minimise the associated risks leading to better maternal and neonatal outcomes.

Aims: To estimate the prevalence, describe causes and prescription needs of functional low vision (FLV) patients, and highlight the barriers these patients encounter to the uptake of multidisciplinary low vision rehabilitation (LVR) service.

Materials and methods: A mixed study design was adopted. Quantitative analysis consisted of a retrospective and cross-sectional review of 241 (FLV) patients managed at the National Eye Centre, Kaduna. Relevant data extracted from patient records were age, sex, occupation, best-corrected visual acuity, cause of low vision and low vision aids or rehabilitation prescribed. Qualitatively, 45 FLV patients were selected by systematic random sampling. Patient barriers to the uptake of LVR services were elicited through one-on-one interviews.

Results: The prevalence of FLV was 1.02% (95% confidence interval: 0.98-1.06). The mean age was 44.45 ± 20 years. One hundred and forty two (59%) were above 40 years old and 60.5% were unemployed. Major causes of FLV were glaucoma (31%), age-related macular degeneration (24%) and retinitis pigmentosa (12%). Prescription needs were magnifiers (29%), non-optical (23%) low vision aids, telescopes (17%), multiple aids (15%) and visual rehabilitation (28%). The uptake of LVRs was 67%. The most common barriers to LVR uptake were the cost of the device (97%), lack of family support (90%) and hesitancy using the device (84%).

Conclusion: FLV was caused by progressively worsening diseases like glaucoma. The major patient barrier to assessing a multidisciplinary LVR service was financial constraint.

Background: Patients with clinically localised prostate cancer (CaP) have a potentially curable disease. However, there are gaps in the quality of care these patients receive in Nigeria. Granular clinical data are needed to design interventions for quality improvement.

Aims: This study aimed to describe guideline concordance of cancer management and its association with patient outcomes.

Subjects and methods: A 3-year retrospective study of all patients with T1-T3a, N0, M0 CaP at three tertiary hospitals in Nigeria was conducted. Data on clinicopathologic characteristics, D'Ámico risk group, TNM staging, treatment practices, post-treatment PSA and survival were collected. Concordance with the 2022 European Association of Urology guideline was assessed. Primary endpoints were guideline concordance of staging and treatment, and associations between concordance and outcomes.

Results: This study included 110 patients with mean age of 68 years. Sixty-seven patients (60.9%) were high-risk, 34 (30.9%) were intermediate-risk and 9 (82%) were low-risk. Most patients were staged with abdominopelvic ultrasound (65%, n = 71). Guideline-concordant magnetic resonance imaging for T-staging was significantly higher in low-risk (44%, n = 4) than in high-risk (12%, n = 8) patients (P = 0.041). Guideline-concordant axial imaging for N and M staging was used in 11% (n = 7) of high-risk patients. In the overall cohort, 17 patients (15%) received guideline-concordant definitive treatment with either radical prostatectomy (n = 8; 9%) or radiotherapy (n = 9; 5%), whereas 52 patients (56%) received non-concordant androgen deprivation therapy (ADT) alone and 43 received no treatment. Median time to biochemical recurrence was not significantly different between those who received surgery (18 months), radiation therapy (median not obtained) or ADT alone (11 months) (log-rank P = 0.103). After a median follow-up of 36 months, median overall survival was similar for guideline-concordant and non-concordant treatment groups (37 and 34 months, respectively; log-rank P = 0.540).

Conclusion: CaP staging was suboptimal across all risk groups. Only a minority of patients received radical treatment for this potentially curable disease. Our results will inform the development of tailored multifaceted interventions to improve the quality of care.

Training and career issues in laboratory medicine within the Nigerian healthcare system often mitigate against efficient utilisation of scarce resources from in-fighting and friction among the different professionals. Within chemical pathology, there are three categories of practitioners: medical consultants (post-MBBS), laboratory scientists (post-PhD) and medical laboratory science officers (MLSOs). While the designation and career progression of the MBBS graduates and MLSOs are clear, there are no such guidelines for the PhD scientist, essentially because they (the latter) have no specific training and certification programmes resulting in frustration. To address this deficit, this review evaluates current local and international training programmes for the scientific and medical specialists in chemical pathology, in relation to the peculiarities in Nigeria. This review, therefore, suggests and outlines locally appropriate training and certification programmes for the scientists to enhance their career recognition and progress. For the medical specialists, the author suggests curricular reform to enhance relevance at the direct patient care interface.