West African journal of medicine最新文献

Background: Primary hyperparathyroidism (PHPT) is commonly treated surgically, though post-surgical hypoparathyroidism (PoSH) is a significant concern. Most studies focus on the auto-transplantation of healthy parathyroid glands, especially in multi-gland disease cases such as multiple endocrine neoplasia type 1 (MEN1) syndrome. However, limited data exist on auto-transplantation of pathological glands in single-gland disease due to concerns over recurrence.

Objectives: This case report describes the successful management of persistent PHPT using the auto-transplantation of adenomatous parathyroid tissue, preventing long-term hypoparathyroidism.

Methods: A male patient in his 40s presented with persistent PHPT after previous surgery and inadvertent excision of three normal parathyroid glands. Re-operative exploration with excision of the last remaining parathyroid gland was performed, and the excised tissue was transplanted into the forearm.

Results: Six months post-surgery, the patient was weaned off active vitamin treatments as hypoparathyroidism resolved. Five years after surgery, calcium and parathyroid hormone (PTH) levels remained normal, with no recurrence of hypercalcaemia.

Conclusions: This case illustrates that forearm auto-transplantation of pathological parathyroid tissue can restore parathyroid function, prevent long-term hypoparathyroidism and avoid recurrence over a five year period.

Background: Although endodontic treatment is intended to eliminate long-term pain, pain after this treatment is commonly reported. Non-opioid analgesics like non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol, have been used with great success in treating patients with endodontic pain.

Objectives: This study seeks to compare the effectiveness of doses of paracetamol, ibuprofen; each drug used alone, and a combination of both drugs in the management of post endodontic treatment pain.

Method: A randomized placebo-controlled single-blind comparative study involving 80 patients who had endodontic treatment (instrumentation) was conducted by putting the patients into four groups of 20 patients each: paracetamol group, ibuprofen group, paracetamol + ibuprofen group, and placebo group. Numerical rating scale (NRS) was used to measure pain intensity at 0, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5 and 6 h after drug administration. Inferential statistics included the Friedman's Test with Kruskal-Wallis H post-hoc test. Level of significance was set at 95% (p-value < 0.05).

Results: Paracetamol was more effective compared to ibuprofen, the combination and placebo in the relief of post-endodontic pain within the first 2 h after administration of medications (p < 0.05). Ibuprofen + paracetamol combination showed a better relief of pain than ibuprofen alone within the first 2 h after administration but this was not statistically significant (p > 0.05).

Conclusion: Paracetamol significantly reduced post-endodontic pain better than ibuprofen and its combination with paracetamol within the first two hours.

Background: Chlamydia Trachomatis infection often runs an asymptomatic course with long-term sequelae. It commonly affects the fallopian tubes and could result in tubal blockage. A study of antichlamydial antibodies, a marker of the disease's presence, could help understand the disease burden in a given population.

Objective: To determine the prevalence of anti-chlamydial antibodies, and its association with tubal infertility among female partners of infertile couples in Enugu, South-eastern Nigeria.

Methodology: It was a cross-sectional analytical study involving two groups of infertile women attending gynaecology clinics of two tertiary institutions in Enugu, south-eastern Nigeria. Group A (Study group) had tubal factor infertility (n = 143) while Group B (Control) had non-tubal factor infertility (n = 143). Data were obtained using a structured, interviewer-administered questionnaire. Peripheral blood samples were collected and analyzed for anti-chlamydial antibodies using Human chlamydial trachomatis ELISA kits. Statistical package for social science (SPSS) version 25.0 was used for analysis. P-value of <0.05 was statistically significant.

Result: The overall prevalence of chlamydial seropositivity was 28.0%. Women with tubal factor infertility were almost twice more likely to have chlamydial seropositivity than those with non-tubal factor infertility (33.6% vs 22.4%; OR = 1.75; 95% C.I = 1.03 - 2.96; p = 0.036). Bilateral tubal occlusion (66.4%) was the commonest tubal pathology identified in the hysterosalpingogram.

Conclusion: Anti-chlamydial antibodies were significantly associated with tubal factor infertility in Enugu, South-eastern Nigeria. It is recommended that serum anti-chlamydial antibody testing could be adopted as a screening test for tubal infertility in the study population.

Introduction: Family planning refers to a couple's ability to have the number of children they want by spacing out their children appropriately or a person's ability to avoid unintended pregnancies by using various contraceptive methods and infertility treatment. All hospitals in Rivers State, Nigeria, that provide primary care and offer family planning services were included in the study.

Aim: To describe the pattern of family planning service uptake in the hospitals in Rivers State.

Methodology: An 8-year retrospective review of data collection from the District Health Information System 2 (DHIS 2) platform in the Health Management Information System in Rivers State was conducted from 2014 - 2021. Data from 387 health facilities was obtained from the DHIS 2 platform and reviewed. The inclusion criteria were all the family planning data in the platform from the various health facilities in the LGAs in the State, during the time of review while the exclusion criteria was the health facilities that didn't provide any family planning data. Data was represented as frequencies, percentages, and charts.

Results: During the period under review, the Family Planning clinics counselled a total of 931,774 individuals, of whom 421,785 (45.3%) accepted family planning services. Condoms (65.3%) were the most widely utilized contraceptive, whereas bilateral tubal ligation (0.1%) was the least utilized. Methods like injectables, implants, oral contraceptive pills, and intrauterine contraceptive devices accounted for 16.1%, 9.4%, 7.8%, and 1.3%, respectively. A significant increase was observed in the trend of the use of condoms, injectables, and oral contraceptive pills between 2014- 2021.

Conclusion: There was an increasing trend in the utilization of family planning services among women of childbearing age in the State during this eight-year period. Condom being the most utilized indicated that it was the most accepted and approved by clients in family planning clinics in Rivers State. The knowledge of contraceptive utilization trends can be used to monitor and appraise the acceptance and approval of each method and family planning program over a period.

Background: Reports of hair density (HD) on healthy scalp of Africans is rare. Our study aimed to document normative scalp HD values in an African population.

Methods: A cross-sectional study of the healthy scalp of 909 individuals aged 5-45 years was conducted in 2023. Phototrichoscopic measurements were taken from four scalp sites (frontal, temporal, vertex and occipital). Hair parameters were compared between genders and across age groups. Data was analyzed using the IBM statistical package version 26.0.

Results: The mean age of the participants was 21.8 ± 11.02 years and they were 52.1% female. The number of hair strands (HS) from each pilosebaceous unit (PU) was 1 in 99.9% and 2 in 98% of the participants. HD ranged from 113 - 660/cm2 with a median (IQR) of 330.0 (301.0, 368.0) and was highest at the frontal scalp area. HD and total number of HS were significantly higher in all scalp sites in males (p=0.001) except for the frontal scalp site, p=0.283. HD and number of HS were highest in the fourth decade of life (median HD (IQR); 339 (301, 386), mean HS/PU; 37.09±6.96) and least in the first decade of life (median HD (IQR); 320 (292, 358), mean HS/PU; 35.18± 6.26) irrespective of the scalp site, P<0.001.

Conclusions: The hair density of Africans is high. The number of HS from each PU and HD varies with the scalp site, age and gender. These findings from the African scalp are relevant in the management of Africans who have hair loss and in those who require restoratives surgeries.

Sedation has been employed to improve patient's cooperation. This has contributed to quality of treatments as well as improving the patients' and practitioners' experience during some procedures especially among children. The price of some of the newer sedatives can hamper the use in resource-constraint environments, hence the need to explore other cost-effective options. We compared the safety of oral ketamine against oral midazolam among 100 ASA I and II children aged between 3 and 7 years requiring dental treatments in a tertiary hospital in Lagos, Nigeria. The patients were divided into 2 equal groups by balloting using the opaque envelope method. Group A received Ketamine (7.5 mg / kg) while group B received Midazolam (0.75 mg / kg). The intravenous formulation was mixed with apple juice and administered orally. The patient's vital signs were monitored and the behaviour during procedure was assessed using the Frankl behaviour rating scale. Time to respond to verbal stimulus was recorded. The demographic characteristics and ASA status were similar between the 2 groups (p>0.05). the behaviour of the patients was better among the children in the midazolam group (p=0.026). the ease of administration of local anaesthesia (p=0.012) and examination of the buccal cavity after the procedure (p=0.019) was better in the ketamine group but there was no significant difference in the overall assessment of adequacy of sedation (p= 0.196). The trend of vital signs was similar between the 2 groups (P>0.05). Recovery was longer in the ketamine group (p=0.001). Side effects like vomiting, nystagmus, hypersecretion and somnolence, were significantly higher among the ketamine group, p<0.05. there was no significant difference in the acceptability of both drugs to the dental surgeons and the guardians of the patients (p= 0.093 and 0.308, respectively). Both drugs provided adequate conditions for complete treatments in the study groups. Although the side effect profile was better in the midazolam group, both were acceptable to both dental practitioners and the guardians of the patients.

Background: Cervical cancer is a common cause of cancer-related morbidity and mortality among women in developing countries. HPV infection has been detected in more than 99% of cervical cancers throughout the world. Among the effective factors in the progression of HPV infection is oxidative stress which can influence the host immune responses to viral proteins and viral genes expression.

Aim: To determine the association between serum malondialdehyde concentration in women with cervical cancer and women with high-risk human papillomavirus infection at the Lagos State University Teaching Hospital, Lagos (LASUTH).

Methods: This was a comparative cross-sectional study where 90 women from the gynaecology and colposcopy as well as medical oncology clinics of LASUTH were recruited using convenience sampling method. This study comprised 30 women with histologically confirmed cervical cancer, 30 women with high-risk human papilloma virus infection and 30 apparently healthy women negative for high-risk human papilloma virus infection. Fasting blood samples of consenting women were obtained and serum malondialdehyde were measured using spectrophotometric method. Data was given as mean ± standard deviation (SD) and significant differences between means were assessed by Student's t-test. Analysis of data was carried out by using the statistical package for social sciences (SPSS) version 23 software. P-value of <0.05 was considered statistically significant.

Results: Results indicated that the mean serum malondialdehyde levels were significantly higher among women with cervical cancer (6.13 ± 4.1 nmol/l) and those with high-risk HPV infection (5.61±3.0nmol/l) compared to women negative for high-risk HPV infection (0.35±0.2nmol/l). A statistically significant association was observed between cervical cancer and negative high-risk HPV infection(p<0.001). However, no significant association was found between cervical cancer and positive high-risk HPV infection (p = 0.57).

Conclusion: The study's conclusion highlighted significantly elevated serum malondialdehyde levels in women with cervical cancer and high-risk HPV infection compared to those without high- risk HPV infection, indicating increased oxidative stress. It also noted no significant disparity in serum malondialdehyde levels between women with cervical cancer and those with high-risk HPV infection. The findings underscored the importance of conducting serum antioxidant studies in these women to mitigate oxidative stress.

Background: Intussusception occurs when a proximal bowel segment telescopes into the lumen of adjoining distal bowel. Adult intussusception (AI) is a rare cause of intestinal obstruction. The preoperative diagnosis remains a challenge due to the nonspecific nature of presenting symptoms.

Objective: To present our institutional experience with the presentation and management of AI.

Patients and methods: A retrospective analysis of 10 cases of AI managed between January 2015 and December 2024. Data were extracted from the patients' medical records and analysed using SPSS version 21. Results were presented in tables as frequency and simple percentages.

Results: During the study period, 10 cases of AI were managed, comprising of 5 males and 5 females, giving a male to female ratio of 1:1. The patients' ages ranged between 29 and 75 years with a mean age of 43.2 years. Most of the patients presented with symptoms of intestinal obstruction including nausea and vomiting. The symptoms' duration varied from 3 days to 180 days, with majority (60%) presenting with subacute symptoms. Ileocolic (40%) was the commonest variety. Lymphadenitis (30%) and idiopathic (20%) were the commonest lead points. Adenocarcinoma accounted for 10%. All 10 patients had surgical intervention that included right hemicolectomy (50%), segmental ileal resection (30%) and segmental ileal resection with subtotal colectomy (10%). There were two morbidities and one mortality.

Conclusion: AI is rare in our facility occurring equally in both sexes. Surgery was the mainstay of treatment. A high index of suspicion, aided by appropriate imaging techniques, is critical to achieving good management outcome.

Background: The mental health treatment gap in Nigeria remains wide, with only 20% of individuals accessing appropriate care. Integrating mental health services into the Primary Health Care (PHC) system has been identified as a strategy to address this problem. The Oyo State PHC Board recently appointed mental health desk officers across its 33 Local Government Areas to provide services and facilitate referrals.

Objectives: This study aimed to evaluate the roles and self-rated competence of PHC workers in mental health care delivery in Oyo State.

Methods: A cross-sectional study was conducted among 40 PHC workers including mental health desk officers across all the 33 Local Government Areas in Oyo State. Data on socio-demographic characteristics, self-rated competence, roles, training needs, and challenges were collected via a self-administered questionnaire. Data were subjected to bivariate and multivariate analysis using SPSS version 26 at p-value ≤0.05.

Result: About 57.5% of the respondents rated their competence as good, with notable competence in diagnosing mental illnesses and developing treatment plans, yet 32.5% lacked confidence in psychosis management. Only 20% identified their roles in sensitisation and awareness creation on mental health-related activities. Challenges included insufficient resources, funding, and stigma associated with mental health conditions. While a significant association was found between years as mental health desk officers and self-rated competence (P=0.000), this was not significant in multivariate analysis.

Conclusion: The study highlights the necessity for targeted interventions, training initiatives, and collaborative strategies to address gaps in competence and role identification among PHC workers, crucial for effectively addressing escalating mental health needs within communities.