Nigerian Postgraduate Medical Journal最新文献

Effective pain management is crucial during disasters as it significantly reduces physical suffering and improves survivor's quality of life. The purpose of the current article is to justify the need for effective pain management in disasters, identify common challenges encountered in disaster management during times of disasters and propose interventions for effective pain management during disasters. Adequate pain control can accelerate functional recovery and mobility and help disaster survivors to become independent earlier. During disasters, effective pain management becomes difficult, and this is attributed to resource limitations or logistics constraints. Acknowledging the importance of pain management during disasters and the presence of multiple challenges that can jeopardise the effective delivery of pain management, there is an indispensable need to implement measures to improve the existing scenario. In conclusion, pain management is an integral component of disaster management, and this must be effectively addressed to ensure that all disaster survivors are provided with the desired pain medications to reduce their suffering and improve their quality of life.

Background: Calcification of the left main coronary artery (LMCA) is a critical factor influencing outcomes after percutaneous coronary intervention (PCI) in both LMCA and other coronary arteries. Inadequate lesion preparation can lead to complications like stent thrombosis or restenosis, which result from poor stent expansion and apposition due to reduced vessel compliance.

Aims: This study aims to assess and monitor the short- and long-term outcomes of recent calcium modification techniques, specifically intravascular lithotripsy (IVL), Wolverine cutting balloon (WCB) and rotational atherectomy (RA).

Subjects and methods: The study included 120 consecutive patients who underwent LMCA angioplasty for angiographically significant LMCA disease between January 2017 and December 2019. Patients were pretreated using calcium modification strategies as adjuncts for lesion preparation, including WCB (n = 70), RA (n = 30), and IVL (n = 20). The presence of significant LMCA calcification was confirmed through coronary imaging techniques such as optical coherence tomography (OCT) or intravascular ultrasound (IVUS). Pre-angioplasty imaging was conducted to assess lesion severity, grade the extent of LMCA calcification, and determine the appropriate calcium modification modality for each patient. Post-stenting imaging was performed to evaluate stent expansion, edge dissection, and wall apposition.

Results: A total of 120 patients participated, with a mean age of 6634 years, and shared similar clinical profiles. In-hospital, 5.7% (4 patients) in the WCB group experienced stent thrombosis or required repeat PCI, whereas no such events were reported in the RA or IVL groups. At the 3-year follow-up, the rate of repeat PCI varied significantly across the three groups: WCB (24.3%), RA (6.6%) and IVL (20%). Similarly, the incidence of in-stent restenosis differed: WCB (20%), RA (6.7%) and IVL (25%) respectively. The rate of major adverse cardiovascular events (MACEs) - including myocardial infarction, stroke, heart failure and coronary artery bypass grafting (CABG) - also varied significantly, with the highest proportion observed in the IVL group (55%) compared to WCB and RA (42.9% and 30%, respectively). In-hospital mortality was zero for all groups, but by the end of the study, total mortality was highest in the IVL group (10.0%), compared to WCB (5.7%) and RA (6.7%). The success rate was marginally higher for both WCB and RA at 3 years compared to IVL but not statistically significant.

Conclusion: The IVL group experienced higher rates of MACE and mortality, while the WCB group had the highest rates of stent thrombosis, in-stent restenosis and target vessel revascularisation. Though outcomes for various study endpoints were marginally different for various calcium modification tools, the overall performance regarding the incidence of MACE and mortality

Background: Measurement of literacy gives an insight into a person's oral health awareness. Inclusion of psychological, emotional, behavioural and knowledge quotient can provide a holistic aspect to the measuring tool.

Aim: The aim of the study was to determine the enabling factor of oral health literacy (OHL) and predictors of oral health outcome among the adult population in Ahmedabad city.

Subjects and methods: This was a cross-sectional study of 427 eligible participants aged 35-44 years obtained through a multistage sampling method in three stages. Data about OHL were recorded with the help of a 14-item questionnaire, whereas socioeconomic status (SES), tobacco habit, oral hygiene status, dental caries experience, prosthetic status and oral precancerous lesions were collected with clinical examination. Multivariable regression was used to analyse enabling variables for OHL and predictor for oral health outcome.

Results: It was found that more than half (54.3%) of the study subjects had marginal OHL. Participants from upper SES had 1.053 greater odds (95% confidence interval [CI]: 1.053-1.167; P = 0.001) having adequate OHL relative to inadequate OHL. Participants with adequate OHL have 9.373 times greater odds (95% CI: 1.890-4.491; P = 0.006) having good oral hygiene relative to poor oral hygiene. OHL appeared to be a meaningful predictor for oral hygiene, dental caries experience, tobacco consumption, precancerous lesion and prosthetic status.

Conclusion: Adult education and SES are potential facilitators for adequate to marginal OHL, and OHL can fairly predict oral health.

Background: Despite the strict gun control policy in Nigeria, maxillofacial gunshot injuries are still alarming, and the profile of injuries varies based on rurality. This study assessed maxillofacial gunshot injury profile in a semi-urban and an urban teaching hospital in south-west, Nigeria.

Objectives: The study sought to determine patients' demographic profile, cause of injury, association between firearms used and injuries sustained, treatment characteristics and complications seen in the two centres.

Methodology: The study was a 10-year hospital-based retrospective multicentre study of 27 patients with gunshot injuries from two teaching hospitals located in Southwest Nigeria. Patients with gunshot injury to the face and other parts of the body and brought in dead were excluded. Data retrieved from patient's medical record include age and sex, mode of gunshot infliction, clinical presentation, treatment given and associated complications. Statistical significance was inferred at P < 0.05.

Results: Of the 27 patients recruited, semi-urban (18) accounted for twice the number of cases. The female-male ratio was (1:5.8). The mean age was 33.37 ± 10.47 years. Although injuries from hunting and firearm servicing were found only in the semi-urban cohort, police brutality and armed robbery were observed in both centres. Rifle injuries resulted more in avulsive soft-tissue injuries, whereas penetration occurred more as a result of Dane gun injuries. Mandibular body and orbital floor fracture were the most common sites of fracture. Fracture comminution of the involved bone was common with Dane gun compared to rifle, although the finding was not statistically significant (P = 0.550). Open reduction and internal fixation was the preferred treatment option in the urban cohort. The common complications were blindness and scar formation.

Conclusions: Victim of gunshot injury was mostly male in their prime age. Although there is dissimilarity between the cause of injury based on rurality, police brutality is becoming a disturbing societal issue in the semi-urban cohort. Sadly, the consequence of blindness resulting from indiscriminate use of firearm is grave coupled with the poor healthcare facilities in low- and middle-income country. There is a need for strict monitoring of firearm acquisition and use by untrained individuals as well as urgent police reforms.

Background: Some of the medicinal plants possess dipeptidyl peptidase-4 (DPP-4) inhibitory properties and could overcome the limitations of synthetic DPP-4 inhibitors.

Aim: We evaluated the anti-diabetic and myocardial-salvaging effects of a novel polyherbal combination (PHC) containing Terminalia arjuna, Commiphora mukul and Emblica officinalis in rats.

Methods: Male Wistar rats weighing 150-200 g and 8-10 weeks were randomised to negative control (NC; no disease induction/treatment), disease control (DC; disease induction but no treatment), vildagliptin (disease induction and treatment with vildagliptin 10 mg/kg) or PHC1000 (disease induction and treatment with PHC 1000 mg/kg). Diabetes was induced using the standard streptozotocin method while myocardial necrosis was induced using isoproterenol. All the data were represented descriptively. We used analysis of variance and Bonferroni's test to evaluate the difference between the study groups; a P ≤ 0.05 was considered statistically significant.

Results: Thirty rats were randomised (six in the NC group and eight each in the remaining three groups). Treatment with PHC1000 and vildagliptin significantly lowered the elevated blood glucose (P < 0.001). The creatine phosphokinase myocardial band levels were significantly lower in the PHC1000 and vildagliptin-treated rats versus the DC group (P < 0.001). The cardioprotective effect of PHC1000 was superior to that of vildagliptin (P < 0.05). PHC and vildagliptin treatment showed statistically significant DPP-4 inhibitory activity (P < 0.001). The biochemical parameters and histopathological observations endorsed the safety of PHC.

Conclusions: The PHC exhibited significant antidiabetic and cardioprotective efficacy. While their antidiabetic activities were comparable, PHC was found to have a superior myocardial-salvaging effect compared with vildagliptin.

Background: Incidence of cervical cancer can be reduced using screening tests such as Pap smear to detect the premalignant stage of the disease. Although there has been a preference for more expensive human papillomavirus DNA testing due to its higher sensitivity, the Pap smear remains still very relevant in low-resource settings being cheaper and more readily available, hence the need to study factors influencing its performance.

Objective: The objective of this study was to determine if there is a difference in the diagnostic performance of Pap smear performed during the proliferative and secretory phases of a menstrual cycle, using colposcopy as the gold standard.

Materials and methods: It was a community-based, comparative cross-sectional study conducted in Oghara, in Ethiope West Local Government Area, Delta State, Nigeria, over a 32-week period from January to July 2020. The participants had an integrated four-step procedure comprising Pap smear sample collection and colposcopy assessment performed during the proliferative and secretory phases of their menstrual cycle. Consenting participants who had an abnormal colposcopy finding during either phase of the cycle had cervical biopsy sampling.

Results: There was no significant difference in the sensitivities (0.00 vs. 0.00), specificities (99.04 vs. 97.14, P = 0.300), positive predictive values (0.00 vs. 0.00), negative predictive values (93.63 vs. 94.44, P = 0.672) and accuracies (92.80 vs. 91.60, P = 0.317) of Pap smears performed at proliferative and secretory phases of menstrual cycle.

Conclusion: Pap smear can be collected during either phase of a woman's menstrual cycle.

Background: Maternal Vitamin B12 deficiency during pregnancy is associated with adverse outcomes, including preterm delivery, spontaneous abortion, intrauterine growth restriction and reduced Vitamin B12 levels in neonates.

Aims: This study aimed to assess the impact of maternal Vitamin B12 levels on neonatal outcomes, particularly focusing on anthropometric measurements and Vitamin B12 status in newborns.

Subjects and methods: This prospective study was conducted from February 2023 to January 2024, involving antenatal mothers over 28 weeks of gestation admitted for delivery to a tertiary care hospital. After obtaining ethical clearance and informed consent, blood samples were collected to measure maternal Vitamin B12 levels, which were classified as deficient, insufficient or sufficient. Neonatal outcomes, evaluated immediately after birth, included birth weight, length, head circumference and Vitamin B12 status. Statistical analysis was performed using SPSS version 20.0. The Chi-square test was employed for analysing categorical variables, while one-way ANOVA was utilised for continuous variables.

Results: Among the 100 mothers studied, 72% had low Vitamin B12 levels, with 41% being deficient and 31% insufficient. Neonates born to mothers with low Vitamin B12 levels showed higher incidences of low birth weight (9%), small for gestational age (23%), short length (<10th percentile) (5%) and small head circumference (<10th percentile) (1%). Although 7% of newborns had low Vitamin B12 levels, no statistically significant association was found between maternal Vitamin B12 status and neonatal anthropometric measurements.

Conclusion: Maternal Vitamin B12 deficiency is associated with adverse neonatal outcomes, including lower birth weight rates. These findings emphasise the critical need for routine screening and supplementation of Vitamin B12 in pregnant women.

Pregnancy and the postpartum period have been acknowledged as crucial phases in the life of women. Addressing maternal health concerns during this period is the need of the hour, as this will improve pregnancy outcomes. The purpose of the current article is to explore the role of acupuncture in pregnancy and the postpartum period, identify the challenges in employing acupuncture and propose recommendations to overcome these identified challenges. Acupuncture in pregnancy and the postpartum period has been linked with multiple merits for pregnant women. Regardless of the utility, acupuncture has still not become part of an integral package of services offered by the healthcare delivery system to pregnant women. Acupuncture is a non-invasive and drug-free approach, it not only reduces dependence on pharmacological medications but even eliminates the potential side effects. In conclusion, acupuncture during pregnancy and the postpartum period can play a vital role in promoting a sense of wellness and positive pregnancy experiences. The need of the hour is to make concerted and collaborative efforts to ensure the integration of acupuncture into maternal health services and benefit pregnant women.

Background: Blood-borne infections remain a significant public health challenge globally. Understanding their prevalence and risk factors is crucial for implementing preventive measures.

Objective: The objective of the study was to determine the prevalence of blood-borne infections, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis, among patients attending public hospitals in Lagos, Nigeria.

Subjects and methods: This was a cross-sectional study involving 352 participants, recruited from the antenatal, gastroenterology clinics and prospective donors from the blood banks in four general and one tertiary hospital in Lagos, Nigeria. Data were collected on demographic characteristics, risk factors and disease prevalence using structured questionnaires, and laboratory testing was performed using the B21147-01 HIV-HCV-HBsAg-Syphilis Combo Rapid Test.

Results: The mean age of participants was 37.2 ± 11.0 years. The majority were female (66.8%) and married (80.7%). The prevalence of HIV, hepatitis B surface antigen (HBsAg) anti-HCV, and syphilis was 24.4%, 23.3%, 2.6% and 0.3%, respectively. There was significantly increased odds of HIV infection among participants with a history of sexually transmitted infections (adjusted odds ratio [AOR] = 2.3, 95% confidence interval [CI] = 1.0-5.1), and those who had skilled occupations (AOR = 4.5, 95% CI = 1.5-13.3). Participants with a family history of either HBV, HCV, chronic liver disease or hepatocellular carcinoma had significantly increased odds of being HBsAg positive (AOR = 7.8, 95% CI = 2.1-29.42).

Conclusion: Blood-borne viral infections are highly prevalent among people attending hospitals in Lagos, Nigeria. Enhanced screening, awareness and risk reduction education are recommended to reduce the burden of these infections.