Nigerian Postgraduate Medical Journal最新文献

Background: Improvements in sickle cell disease (SCD) care have resulted in the survival of many patients into adulthood, although this is accompanied by the increased incidence of end-organ damage, including chronic kidney disease (CKD).

Objectives: This study assessed the prevalence, pattern and predictors of renal dysfunction in SCD patients and investigated the associated renal histopathologic changes.

Methods: We evaluated 105 patients with SCD, for proteinuria, estimated glomerular filtration rate (eGFR), and tubular dysfunction. Renal biopsy was conducted on 22 patients who qualified. Data were analysed using SPSS package version 23.

Results: Thirty-seven (35.2%) of the 105 patients had CKD, as defined by an eGFR of 60 ml/min/1.73 m2 and/or proteinuria. The fractional excretion of potassium (FEK) was elevated in all patients, whereas the fractional excretion of sodium (FENa) was elevated in 98.1%. Glomerular filtration rate was negatively correlated with irreversible percentage sickle cell count (r = -0.616, P = 0.0001), FEK (r = -0.448, P = 0.0001) and FENa (r = -0.336, P = 0.004). Age, irreversible percentage sickle cell count, haemoglobin levels and FENa were the major predictors of CKD. The histological pattern in the 22 patients who had biopsies was consistent with mesangioproliferative glomerulonephritis 11 (50%), minimal change disease 6 (27.3%), focal segmental glomerulosclerosis 3 (13.6%) and interstitial nephritis 2 (9.1%).

Conclusions: CKD was prevalent in SCD patients, and it was characterised by tubular dysfunction and mesangioproliferative glomerulonephritis. The main predictors of CKD were increased age, severity of vaso-occlusive crisis, worsening anaemia and tubular dysfunction.

Background: This was a cross-sectional community-based survey to study the prevalence of serum antibodies against the severe acute respiratory syndrome coronavirus 1 (SARS-COV-1) and determine possible source of antibodies as to whether from vaccination or from natural infection as well as attempt to compare antibody levels in response to the different four types of vaccines administered in Nigeria.

Methods: A cross-sectional community-based study of the prevalence of serum antibodies against all four vaccine types used in Nigeria amongst a representative sample of people aged 18 years and above in the six geopolitical zones of the country using a multistage sampling technique covering 12 states of the country with two states being randomly selected from each geopolitical zone. High-throughput Roche electrochemiluminescence immunoassay system (Elecsys Anti-SARS-COV-1 Cobas) was used for qualitative and quantitative detection of antibodies to SARS-COV-1 in human plasma.

Results: There was no statistically significant difference between the proportions with seropositivity for both the vaccinated and the unvaccinated (P = 0.95). The nucleocapsid antibody (anti-Nc) titres were similar in both the vaccinated and the unvaccinated, whereas the Spike protein antibody (anti-S) titres were significantly higher amongst the vaccinated than amongst the unvaccinated. Antibody levels in subjects who received different vaccines were compared to provide information for policy.

Conclusion: While only 45.9% of the subjects were reported to have been vaccinated, 98.7% of the subjects had had contact with the SARS-COV-1 as evidenced by the presence of nucleocapsid (NC) antibodies in their plasma. The 1.3% who had not been exposed to the virus, had spike protein antibodies which most likely resulted from vaccination in the absence of NC antibodies. Successive vaccination and booster doses either through heterogeneous or homologous vaccines increased antibody titres, and this stimulation of immune memory may offer greater protection against coronavirus disease 2019.

The aim of the study: To describe the clinical and non-clinical characteristics of Gabon footballers in the Haut-Ogooue Polyclinic in Franceville, Gabon, during visits, to assess whether they are not contraceptive to sports.

Patients and methods: A descriptive and analytical cross-sectional study was conducted in the city of Franceville, Gabon, in May 2022. The first and second divisions of footballers were subjected to medical examinations to determine whether they had any contraindications for playing sports, including clinical examinations, rest electrocardiograms (ECG), rest cardiac ultrasounds, chest X-rays, Rick-Dickson and biological checks.

Results: The average age of 88 footballers (22-25 years) was 23 years. Blood pressure (BP) is abnormal in 19% of players, and alcohol and tobacco consumption is reported in 70% and 30%, respectively. Exercise adaptation was also closely associated with age (P = 0.00137724; P = 0.008974301), football position (P = 0.009957548; P = 0.006646182) and alcohol consumption (P = 0.000531971). Electrical and biological changes were 16% and 86.79%, respectively. Sinus bradycardia and first-degree atrioventricular block are the most common ECG abnormalities. Metabolic, inflammatory, infectious, electrolyte and anaemia syndromes were found in 22.64%, 24.53%, 19.81%, 7.55% and 12.26%, respectively. Midfielders and defenders have shown the greatest changes in biological parameters.

Conclusion: Medical checks are essential to determine if sports are contraindicated, as they can help identify physiological and pathological conditions and improve the monitoring of athletes.

Introduction: The burden of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome in Nigeria remains one of the highest in the world, with the country having the highest number of people living with the infection in the West African subregion. Recent estimates put the HIV prevalence rate in Nigeria at 1.9%. In the early years of the HIV epidemic, attention on the reproductive preferences of people living with HIV was not really considered because of the high risk of mortality and few options to reduce mother-to-child transmission.

Methodology: A descriptive cross-sectional study was carried out in November 2018 using quantitative and qualitative methods. A total of 400 participants were recruited for the quantitative part of the study and 10 respondents for each of the focus group discussion (FGD) sessions. Data were collected using an interviewer-administered questionnaire and a FGD guide. Frequencies and percentages were determined using descriptive analysis. Univariate analysis was used to explore the association between the outcome variables and the independent variables. The independent variables which showed a significant association in the univariate analysis were further subjected to multivariate analysis.

Results: The desire to have children since their HIV diagnosis had been mooted by 255 (63.8%) respondents in the past and 64.5% of the respondents admitted to wanting to have children at some point in the future. More than half of the respondents (61%) currently wanted more children while a significant proportion of the respondents who wanted children (68.4%) wanted more than one child.

Conclusion: The study observed that the desire to have children had largely not been affected by the HIV infection as respondents still had a fairly strong desire to continue to have more children in spite of the risks of transmission involved. The study recommended that government and HIV policymakers need to ensure that HIV prevention messages and programmes adopt cultural and socio-economic considerations when designing and planning HIV prevention programmes.

Objective: To evaluate the use of the Foetal Medicine Foundation (FMF) algorithm in routine practice for early pre-eclampsia (PE) screening in Libreville.

Materials and methods: We conducted a cohort study on pregnant women within their 11-13 + 6 weeks of gestation (WG). We had measured mean blood pressure (MBP), placental growth factor (PlGF), soluble Fms-like tyrosine kinase 1, Uterine Artery Pulsatility Index (UtA-PI) and resistance index (UtA-RI). Statistical analyses were considered significant for P < 0.05.

Results: There were 30 participants. At the first quarter (T1), 36.7% of them were at high risk of PE according to the FMF algorithm and were consequently prescribed aspirin (100 mg/d). By the end of the observation period, we have found a 13% incidence of PE. MBP was higher in the higher risk PE group than in the lower risk group as early as the T1 (90 ± 6 vs. 81 ± 6 mmHg; P = 0.0007, threshold is >86 mmHg/area under the curve (AUC) = 0.86; P = 0.0012). It was the same for PlGF (58 ± 24 vs. 88 ± 38 pg/ml; P = 0.03; threshold is <71.98 pg/ml/AUC = 0.73; P = 0.03). At the second quarter (20-27 WG), biochemical markers did not change between the two groups. UtA-RI, UtA-PI and notch were unconclusive individually, but they are still very important for FMF algorithm application.

Conclusion: Early detection of PE using the FMF algorithm is possible in routine practice in Gabon. MBP and PlGF levels at T1 seem to be very significant. However, the present study must continue to obtain the larger cohorts that would achieve more conclusive statistical analyses.

Background: Most of the predictive tools put up to prognosticate treatment outcomes in patients with chronic lymphocytic leukaemia (CLL) are not easily available and affordable in our resource-constrained environment.

Aim: The aim of this study was to evaluate the impact of staging and some tumour bulk on treatment outcomes of persons with CLL, Enugu, Nigeria.

Patients and methods: This is a 10-year review of the CLL data from the haemato-oncology unit of a Nigerian tertiary hospital to evaluate the impact of staging and tumour bulk indicators. Data were retrieved from the case notes of 102 patients with CLL receiving care at the facility. Data of interest include basic demographic variables, clinical features including spleen size and disease staging and blood counts. Statistical analysis was done using SPSS version 22.

Results: The median absolute lymphocyte count (ALC) was 108.05 (confidence interval [CI] = 50.8-201.3, interquartile range [IQR] = 124.4) ×109/L, and duration of survival for the study cohort was 5.5 (CI = 3.5-31.9, IQR = 27) months. Majority (69, 79.3%) were in Stage C. The Binet stage showed a significant association with the ALC (r = 0.338; P = 0.002) but not with spleen size (r = 0.198; P = 0.056). The duration of survival only showed a significant inverse relationship with the ALC (r = 0.35, P = 0.006) but with neither the Binet stage (r = 0.103, P = 0.431) nor spleen size (r = 0.184, P = 0.116).

Conclusion: In CLL patients, ALC at presentation correlates with the duration of survival. We recommend that the ALC at presentation be used as a prognostic marker in our clime.

Background: Vaccines, including COVID-19 vaccines, are known to be cost-effective interventions for disease prevention and control. However, adverse events following immunisation (AEFI) may challenge the acceptance of these vaccines. This study assessed the prevalence and severity of COVID-19-related AEFI amongst healthcare workers at tertiary health facilities in Nigeria.

Materials and methods: This descriptive, cross-sectional study was conducted among healthcare workers who had received the COVID-19 vaccine. A multi-stage sampling technique was used to select participants from six Tertiary Health Facilities in Nigeria. Ethical approval (NHREC/01/01/2007-19/07/2021) was obtained from NHREC. Data were analysed using IBM® SPSS version 25 and categorical variables were presented in tables/charts using frequencies and proportions.

Results: A total of 2130 respondents participated in the study, with a mean age of 37.4 ± 9.1 years. Most of the respondents, 1674 (78.6%), had two doses of the vaccine, and the overall prevalence of AEFI was 813 (38.2%). Common among the AEFI reported following the administration of the first dose of the vaccine were fever 649 (30.5%) and pain at the injection site 644 (30.2%), while it was pain at the injection site 216 (10.1%) and fever 173 (8.1%) for second dose. The higher proportions of AEFI were mostly mild to moderate.

Conclusion: The study observed a relatively low prevalence of AEFI, with the commonly reported ones being fever and injection site pain. It is crucial that countries continuously collect the data on AEFI and establish causality as a way to improve quality and guarantee vaccine safety.

Background: Hypertension is the leading risk factor for preventable cardiovascular-related complications and mortalities worldwide.

Materials and methods: A cross-sectional survey was conducted to assess the prevalence and factors associated with hypertension among 361 adults from four local government areas (LGAs) of Jigawa state identified to have high burden of kidney diseases. The Modified WHO STEPS questionnaire and multi-stage sampling technique were employed and data were analysed using IBM SPSS version 22.0.

Results: The age of the respondents ranged from 18 to 102 years with a median of 45 (interquartile range = 30-80) years. More than a quarter (34.9%) of the respondents were unemployed. Few reported history of alcohol ingestion (0.8%) and cigarette smoking (1.1%). The prevalence of systolic hypertension was 116 (32.1%), while that of diastolic hypertension was 133 (36.8%). Jahun LGA had higher cases (36.7%) of systolic hypertension, whereas Dutse LGA had higher cases (47.8%) of diastolic hypertension. Systolic hypertension was significantly higher (P < 0.001) among those >35 years of age. The odds of developing systolic hypertension were significantly lower among those between the ages of 18 and 35 years, and those between the ages of 18 and 35 years were less likely to have systolic hypertension than those above the age of 35 years (adjusted odds ratio = 9.0; 95% confidence interval = 4.6-17.6). Similarly, those who reported family history of diabetes and hypertension (P < 0.001) had a significantly higher proportion of systolic hypertension.

Conclusions: The prevalence of hypertension was alarming in the high burden kidney disease areas. The government should develop a sustainable model for the mass community screening of risk factors and community-based health insurance for the effective management of all identified cases.

Introduction: Tracheostomy is a life-saving procedure; the benefits and frequency of procedures being performed have led to frequent reviews of indication in many regions of the world. The aim is to establish the indications, diagnosis and complications of tracheostomy performed in the past 10 years in a tertiary hospital in Lagos.

Methods: This is a 10-year retrospective study of all patients who had tracheostomies for various indications from 2010 to 2019. Patient medical records were analysed for demographic profile, diagnosis, indication, elective or emergency tracheostomy, surgeon's rank, technique of decannulation and type of complications. All the variables in the data were imputed and analyzed using the IBM Statistical Package for the Social Sciences version 27. Continuous variables were presented as mean and standard deviation, whereas categorical variables were presented as frequency and percentage.

Results: Four hundred and eighty-six tracheostomies were carried out during the period under review, and 440 patients had complete data retrieved. The age group of 0-9 years constituted the most common age for tracheostomy (18%). The most common indication for tracheostomy was for relief of upper airway obstruction in 53.4%. Neoplasms (40%) and trauma (30.7%) constituted primary diagnosis requiring tracheostomies. Amongst the paediatric age group with upper airway obstruction, infections (31.8%) and foreign body inhalation (24.3%) constituted the most common primary diagnosis. Stoma infection and peristomal granulation tissue were the most common early complication (21.8%) and late complication (43.4%), respectively.

Conclusion: Relief of upper airway obstruction from neoplasm remains the most common indication for tracheostomy, and peristomal granulation infection was the most common complication.

This article provides insight into an aspect of the National Health Service (NHS) of the United Kingdom (UK) through the perspective of an overseas clinical observer. The NHS is a government-funded medical and health care service in the UK and has developed over the years providing a high standard of medical care and professionalism. The Clinical Observership Programme has been designed primarily for International Medical Graduates to experience how the NHS functions and the kind of services it offers. This article explores the overseas observer's experience in a surgical unit of the NHS including the organisational structure, delivery of care and challenges of the system. This article also highlights the observer's perspective of surgical care in the NHS compared to surgical care in low-resource income countries. The Clinical Observership is useful in learning about UK medical practice and gaining experience in a different cultural and professional environment. This is a reflective first-hand account based on personal experience.