Nigerian Postgraduate Medical Journal最新文献

Electronic waste (e-waste) comprises electronic devices and equipment and has become a cause of global public health concern. The objectives of the current article are to identify the health implications of e-waste, enumerate the current practices and limitations in the disposal of e-waste, and propose public health interventions to overcome these potential challenges. E-waste poses a significant risk to the health of people and the environment. The safe disposal of e-waste has been plagued with multiple challenges, and these must be overcome to safeguard human and environmental health. Acknowledging the huge load of e-waste that has been generated and the hazardous consequences on human and environmental health, there is an immense need to implement a comprehensive package of public health interventions to mitigate the impact. In conclusion, improper handling of e-waste has resulted in harmful health hazards to workers, nearby communities and the environment. The need of the hour is to adopt coordinated global efforts to promote safe and sustainable disposal of e-waste.

Background: Bacterial contamination of inanimate surfaces in the intensive care unit (ICU) and subsequent cross-transmission of the microorganisms may play a significant role in ICU-acquired infections.

Aim: The study aimed to evaluate the common organisms in the ICU and their sensitivity profile.

Subjects and methods: Ethical clearance was obtained from the Institution's Health Research and Ethics Committee. Sampling involved all the equipment and furniture with which the health workers and patients have greater contact within the ICU and also the air. Sample collection was done using the open plate method for air and the swab method for the surfaces of equipment and furniture. Microbial growths were isolated using the standard bacteriological methods such as lactose fermentation and gram stain while antibiotic sensitivity was achieved with the disc diffusion method.

Results: A total of 66 samples were collected and 36 (54.5%) yielded microbial growth, 4 (11.1%) were by open plate method, and 32 (88.9%) by swab method. 27 (61.4%) of the isolates were Gram-negative organisms while 9 (20.5%) were Gram-positive organisms. Escherichia coli was the most dominant isolate 26 (59.1%) followed by Staphylococcus spp. 9 (20.5%), fungi 8 (18.2%), and Klebsiella spp. 1 (2.3%). All the isolates were sensitive to ceftriaxone/sulbactam and ofloxacin, but they were resistant to augmentin, cefixime, cefuroxime, cefotaxime, erythromycin, azithromycin, and gentamycin. However, ciprofloxacin, levofloxacin, and imipenem were effective with all the isolates except Klebsiella.

Conclusion: The bacteria contamination rate in the ICU was relatively high, mostly by Gram-negative organisms. Frequent profiling and sensitivity testing of the microbial load in the ICU are advocated to guide treatment.

People living in rural, remote and underserved geographical locations are considered vulnerable for many reasons, including their inability to access essential medications at times of need for their ailments. The objectives of the article are to establish the necessity of telepharmacy, identify the existing challenges in the implementation and propose potential solutions to overcome these challenges. Telepharmacy refers to providing pharmaceutical care with the help of digital technology and telecommunication to persons who cannot access pharmacists physically. This becomes crucial in reducing healthcare disparities as we can ensure equitable access to pharmaceutical care for those in remote settings. Even though telepharmacy has a broad scope and massive utility in reducing healthcare disparities, multiple challenges have been reported in the process of implementation. In conclusion, telepharmacy is an approach to bridge the existing gaps in healthcare delivery, enabling patients to receive holistic pharmaceutical services irrespective of their geographical location. Acknowledging the merits of the approach, there is an indispensable need to address the existing challenges to enable the successful implementation and sustenance of these measures in remote communities.

Heart disease is one of the end organ damages noticed in patients with human immunodeficiency virus (HIV)/AIDS. Its incidence globally is 20%-40%. At least 300,000 children were newly infected as of 2020 in Nigeria. This review highlights the prevalence and management challenges of childhood HIV-associated heart disease in a developing country. A search for published data on HIV-associated heart disease was done through several search engines. Keywords such as 'HIV', 'heart disease', 'HAART', 'end organ involvement in HIV', 'echocardiography' and 'children' were used. The global prevalence of HIV-associated heart disease ranged from 38.2% to 75.9%. This includes left ventricular (LV) diastolic dysfunction (30.7%-36.4%); mean mitral valve peak E/A ratio 2.09 ± 0.46, Deceleration time (DT) 230.66 ± 36.27 ms and in vitro release test 110.40 ± 10.12 ms were higher in these children than controls (P < 0.001). LV systolic dysfunction was seen in 33.7%-35.4%, dilated cardiomyopathy (6.8%-33.7%) and pericardial effusion (4.5%-14.5%). Other cardiac abnormalities were LV hypertrophy, 7.5%-10%. Management challenges include a dearth of two-dimensional echocardiographic competence in Nigeria, as services are unavailable in some tertiary centres. The comorbidity with anaemia and low systemic vascular resistance from diarrhoeal disease in these children makes diuretics difficult to use. HIV-associated heart disease is one of the common end organ involvements in children with some management challenges. There is a need for routine screening for cardiovascular abnormality at baseline and at follow-up.

Noonan syndrome is a genetic disorder characterised by abnormalities of the facial, musculoskeletal and cardiovascular systems. Pulmonary stenosis is the most common abnormality seen. We describe a 48-year-old male with clinical features of Noonan syndrome, and severe pulmonary stenosis with cyanosis. A long-standing history of effort intolerance was noted since childhood. The cause of cyanosis was unclear since an initial echo did not reveal an obvious shunt by Doppler imaging. An agitated saline contrast study performed confirmed a patent foramen ovale (PFO) with right to left shunting. PFO should be suspected and screened for in patients with Noonan syndrome and unexplained cyanosis.

Background: A key player in the development of colorectal carcinoma is p63, a protein belonging to the p53 family. Tumorigenesis, invasion and metastasis are linked to its elevated expression in certain malignancies.

Aim: In this study, we aimed to investigate the immunohistochemical expression of p63 in colorectal carcinoma along with its correlation to clinicopathological parameters and its precursor lesion colorectal adenoma.

Materials and methods: This study used 49 formalin-fixed paraffin-embedded tissue sections: 16 surgically resected (14 carcinomas and 2 adenomas) and 33 colonoscopy biopsies (28 carcinomas and 5 adenomas). Tumour characteristics (size and location) and demographic data (age and sex) were obtained from the archive system. Haematoxylin- and eosin-stained sections were reassessed for histological grade, subtype, lymphovascular invasion, invasion depth, lymph nodes and metastasis. Statistical analysis was performed with Fisher's exact test, Microsoft Excel and SPSS Version 21. H-Score was used for immunohistochemistry.

Results: P63 expression was absent in normal mucosa, while P63 immunohistochemistry was positive in 43 (88%) cases. Forty-two (86%) out of 49 cases showed cytoplasmic expression of p63, of which 35 cases (83.3%) were carcinomas. P63 expression revealed a significant correlation with histological subtype (P < 0.001), histological grade (P < 0.001), distant metastasis (P = 0.033), tumour, node and metastasis/American Joint Committee on Cancer (TNM/AJCC) stage (P = 0.049) and between colorectal carcinoma and adenoma (P < 0.001).

Conclusion: Moderate-to-strong cytoplasmic p63 expression was seen only in malignancy, suggesting its role in carcinogenesis. Increased p63 staining intensity from low- to high-grade tumours indicates p63 as a marker of poor differentiation. The correlation between metastasis and stronger p63 expression with higher TNM/AJCC stages confirms elevated p63 in aggressive tumours.

Background: Daily salt consumption is one of the causal factors for hypertension. As per the World Health Organization estimates, 1.28 billion people aged 30-79 years have hypertension worldwide.

Aim: The aim of this study was to assess the effect of a low-salt food preparation demonstration (FPD) in reducing salt intake and blood pressure amongst patients with hypertension.

Subjects and methods: It was a pilot parallel-arm non-randomised controlled trial conducted in Puducherry, South India. Eligible participants were patients with hypertension, aged 30-59 years, seeking care at JIPMER Urban Health Centre and involved in home cooking. The data were collected through house-to-house visits. The intervention group (IG) received a low-salt FPD and routine health education (RHE), whereas RHE was given to the control group (CG). Differences-in-difference analysis was performed to assess the mean changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), daily salt intake and household salt consumption (HSC) across the groups.

Results: Out of 130 patients enrolled, 101 (77.6%) were included in the final analysis. Post-intervention, results were statistically significant in both IG and CG for SBP, DBP and HSC. However, the IG showed greater mean reduction in SBP of 2.1 mmHg (95% confidence interval [CI]: -3.0, -0.92), DBP of 2.2 mmHg (95% CI: -3.0, -1.4) and HSC of 112.7 g/day (95% CI: -169.4, -56.1).

Conclusion: Participants who received FPD reported greater reductions in blood pressure compared to those who received only RHE. Further studies with longer follow-up periods may confirm these findings and provide a better understanding of the impact of such interventions.

Cervical cancer (CC) remains a significant global health challenge, with the interplay between microbiome and cancer progression becoming increasingly evident. A comprehensive literature search was conducted across multiple databases, including Embase, NCBI, Google Scholar, Elsevier, Science Direct and PubMed, utilising the specific keywords such as 'cervical cancer', 'cervical microbiome', 'vaginal microbiome', 'Human papillomavirus', 'nanoparticles', 'drug delivery' and 'dysbiosis'. Studies published over the past 15 years were reviewed. A total of 400 articles were identified and 65 research articles were finally included. This systematic approach identified relevant studies, enabling an in-depth analysis of microbial species, such as Parabacteroides, Escherichia, Shigella, Gardnerella and Fusobacterium which are recognised as the potential biomarkers for CC diagnosis and progression. Dysbiosis is characterised by a reduction in helpful bacteria and a proliferation of harmful ones. It is linked to chronic inflammation and human papillomavirus infection, both of which facilitate the CC progression. Advanced nanotechnology presents innovative therapeutic options for CC treatment, enhancing drug delivery systems and targeting tumour cells more effectively. Moreover, incorporating nanocarriers into treatment regimens aims to improve the bioavailability and efficacy of existing therapies, potentially transforming the clinical approaches to CC management. This review highlights the dual role of the microbiome as both a diagnostic and prognostic biomarker and elucidates the potential of nanotechnology in optimising treatment strategies, advocating for further research on microbial interactions in cancer pathology.

Aims: The purpose of the study was to evaluate the safety and efficacy of a modified posteromedial oblique incision (POI) in the treatment of posterior cruciate ligament (PCL) tibial avulsion fractures.

Methods: A single-centre, single-arm, prospective study. Patients who met the inclusion criteria were collected between September 2022 and June 2024 at the First Affiliated Hospital of Guangxi Medical University. Patients were followed up to the study endpoint, and the safety and efficacy of the POI were inferred by analysing the follow-up data.

Results: The angle was 67.20 ± 3.16°, the |OM| was 2.48 ± 0.13 cm, the |ON| was 1.33 ± 0.12 cm. The incision length was statistically significant when compared with the two classic incisions, the 'S' and the inverted 'L' (P < 0.05). The difference in the comparison of KT-1000, Lysholm scores, International Knee joint Documentation Committee scores and posterior drawer test negative rate in pre-surgery and 3 months post-surgery were statistically significant (P < 0.05). The KT-1000 of the normal knee, the normal calf circumference, and the pre-surgery calf circumference were compared with the knee 3 months post-surgery, respectively, and the differences were not statistically significant (P > 0.05). Gastrocnemius strength in all patients was determined to be grade 5, which is normal strength.

Conclusion: The study has shown that using POI to treat PCL tibial avulsion fractures is safe and effective, because it avoids nearby nerves and blood vessels. Therefore, I believe that the modified POI technique is worthy of being considered for use and has a great potential for application.