West African journal of medicine最新文献

Background and objectives: To assess the pattern of eye diseases among newborn infants in newborn units in Calabar, Nigeria.

Materials and methods: This cross-sectional study of the eyes of newborns in 5 newborn units in Calabar, Cross River State, Nigeria was undertaken over a 10-week period extending from February 28, 2018 through May 9, 2018. Newborn whose parent gave informed consent were included, whereas those not consented for or too ill were excluded. The study was conducted with the help of a structured questionnaire and study protocol. Each newborn had basic ophthalmic examination. Ethical approval was obtained from the Health Research and Ethics Committee of the University of Calabar Teaching Hospital and the Cross River State Ministry of Health. Categorical variables were compared using Chi-Square Test and Fishers's Exact Test (FET).

Results: A total of 410 newborn were studied. The male: female ratio was 1:1.2 and the mean age was 7.02 days. The most common eye disease was sub-conjunctival haemorrhage 47(11.5%). This was followed by conjunctivitis 26 (6.3%), retinal haemorrhage 24(5.9%), congenital cataracts 8(2%) and clinical anophthalmia 2(0.5%). The least frequent findings were congenital glaucoma, congenital eyelid eversion, macular oedema, at 1 (0.2%) each respectively. Eye disease was associated with an abnormal antenatal period (11.218, p-0.001) birth weight (FET: 12.423, 0.007), and or eventful labour history (FET: 26.805, <0.001).

Conclusions: A significant proportion of eye disease in newborn is associated with an eventful perinatal period. Early detection of eye disease through instituted routine eye examinations may aid in preventing permanent disability from adverse sequelae, reducing the incidence of low vision or avoidable blindness.

Background and objectives: Antioxidants are often released to neutralise free radicals and oxidants generated in babies with perinatal asphyxia (PA). This study aims to determine the enzymatic and non-enzymatic antioxidants in babies with PA and the relationship between these antioxidants and hospital outcome at the Wesley Guild Hospital (WGH), Ilesa, Nigeria.

Methods: Consecutive term babies with or without asphyxia (defined as 5th minute Apgar score <7) were consecutively recruited into a comparative cross-sectional study at the labour ward of the WGH over a nine-month period. Babies were appropriately managed and outcome of hospitalisation documented. Five ml of cord blood was collected from the babies and analysed for enzymatic and non-enzymatic antioxidants using chromatography methods (Water Incorporate, California, U.S.A). Data obtained were analysed using SPSS version 21.

Results: A total of 168 babies (84 for each group) were recruited with male to female ratio of 1.2:1. Sixty-one (72.6%), 23 (27.4%) had moderate and severe PA respectively. Cord blood antioxidants were lower in babies with PA. The enzymatic [glutathione peroxidase r = -0.298, p=0.006, glutathione transferase r=-0.222, p=0.042] and non-enzymatic [TAS, r=-0.316, p=0.003] antioxidants showed negative correlation with the length of hospitalization. However, no significant relationship was observed between the antioxidants and severity of asphyxia, as well as mortality among babies with PA.

Conclusion: Low cord blood antioxidants (TAS and glutathione enzymes) may be useful indicators of increased length of hospital stay in Nigerian term babies admitted with PA. KEYWORDS: ; ; ;

Background: Contrast-induced nephropathy (CIN) is the third leading cause of acute kidney injury (AKI) in developed countries. With the increase in contrast-based radiologic studies in developing countries, its contribution to the burden of AKI is increasing. However, there are few researches conducted in this part of the world on AKI due to contrast administration. This study was aimed at determining the prevalence and risk factors of CIN in a tertiary health facility in northeastern Nigeria.

Methods: This prospective study was conducted at the Radiology department of the University of Maiduguri Teaching Hospital, Maiduguri, North eastern Nigeria. The study population consisted of 150 consenting adult patients referred for investigations involving contrast administration. Sociodemographic variables were obtained from each patient, and blood samples were collected before contrast administration, at 24, 48 and 72 hours after contrast administration and analyzed for creatinine. Serum creatinine obtained was used to calculate glomerular filtration rates (eGFR) using the CKD-EPI Creatinine 2012 Equation. Contrast induced nephropathy was defined as an absolute increase in serum creatinine ≥0.5mg/dl or ≥25% increase from baseline within 48 to 72 hours after administration of contrast media (CM).

Results: The prevalence of CIN was 30% (45 patients), and risk factors were; advancing age (OR=1.346, p=0.009), volume of contrast (OR=2.037, p=0.001), high serum creatinine at base-line (OR=1.601, p=0.006) and low eGFR at base-line (OR=1.767, p=0.003).

Conclusion: Contrast induced nephropathy is a common complication of radiologic contrast studies in Maiduguri, northeastern Nigeria. Risk factors identified were advanced age >60 years, large volume of contrast >60ml, baseline serum creatinine >150µmol/l and GFR <60ml/minute/1.73m2.

Background: Up to 60% of persons with idiopathic Parkinson's disease (PD) will develop psychosis spectrum symptoms at some point during the course of illness. These symptoms are often undetected by attending physicians but are associated with great distress to patients and their caregivers.

Objectives: To investigate the prevalence and association of positive psychosis symptoms with quality of life (QoL) and caregivers' burden among clinic attendees with PD at two tertiary general hospitals in South western Nigeria.

Method: A case-control study was conducted between February 2023 to June 2024. Cases (N=150) were neurology outpatients with PD. Controls (N=150) were neurologically healthy individuals matched for age, sex, education, and outpatient status. Psychosis, QoL, and caregiver burden were assessed using the Scale for the Assessment of Positive Symptoms (SAPS), PD-QoL questionnaire (PDQ-8), and Caregivers Strain Index (CSI), respectively. Adjusted odds ratios (aO.R) and standardized coefficients (aCoeff.) were estimated using regression analyses. Estimates were within 95% confidence intervals (C.I).

Results: Psychosis symptoms were present in 28% of cases. Hallucinations were the most frequent symptom (16.7%). Cases with Psychosis were more likely to be ≥60years (88.1%, p=0.020), ever users of alcohol (78.6%, p=0.012), had higher mean motor-severity scores (51.1±15.7, p<0.001), and probable dementia (21.4%, p=0.001). In unconditional logistic regression analyses, cases had approximately five-point increase in the independent odds psychosis (aOR=4.92, 95% C.I=2.20, 10.99), and two-point increase in the independent odds of requiring social support (aOR=1.95, 95% C.I=1.19, 3.21).

Conclusion: The near five-point increase in the odds of psychosis spectrum symptoms in PD and their greater requirement for social support underscores the need for multidisciplinary approaches that include not only neurologists but psychiatrists, and social workers.

Background and objectives: Rheumatic and musculoskeletal diseases (RMDs) are important causes of morbidity, disability, and mortality worldwide, including in sub-Saharan Africa. However, the spectrum of RMDs in this region has not been well documented due to a lack of data. This is particularly true since many of the diseases observed were previously considered rare among Africans. This study aims to identify the various RMDs seen in a private rheumatology facility in Lagos, Nigeria.

Method: The case records of the first 5,000 consecutive patients diagnosed with RMDs between January 2004 and May 2022 were reviewed. Diagnoses were made using standard rheumatology guidelines/consensus, societal guidelines, or clinical evaluation. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 26.

Results: The mean ± SD age of the 5,000 patients was 52.33 ± 16.15 years, with a female-to-male ratio of 1.7:1. The frequency of the common RMDs were degenerative joint diseases (54.16%), followed by inflammatory arthritis (14.52%), soft tissue rheumatism (13.28%) and connective tissue diseases (10.32%). Females were more commonly affected in all categories except crystal arthropathies and spondyloarthropathy. Septic arthritis, metabolic bone diseases, and orphan diseases were rarely seen, at 0.26%, 0.28%, and 0.82% of the total, respectively.

Conclusion: This study, which includes arguably the largest cohort of RMD patients in sub-Saharan Africa, revealed a wide spectrum of RMDs, contrary to previous assumptions that RMDs are rare among Africans. As this is a hospital-based study, large population-based studies are recommended to determine the burden of RMDs in the community to guide policy implementation and resource allocation.

Background: Diphtheria, a re-emerging public health threat, is a vaccine-preventable acute respiratory infection caused by toxigenic strains of Corynebacterium diphtheriae. Caregivers of this most vulnerable group must be knowledgeable of the disease, its risk factors, and preventive measures to curb its spread.

Objectives: To determine the knowledge, risk perception and prevention against diphtheria among caregivers of under fives.

Method: A cross-sectional descriptive study was conducted in January 2024. A total of 288 caregivers of children under five years of age were selected using a multi-stage sampling technique, and data were collected using an interviewer-administered questionnaire. The data were analyzed using SPSS version 27, and results were presented in tables. The chi-square test was used to test for association between the socio-demographic variables and dependent variables, and the level of statistical significance was set at a p-value of <0.05.

Results: The median age of the respondents was 32 ± IQR 10.8 years. About half (51.7%) of the respondents had good knowledge of diphtheria, positive perception of the risk of the disease was reported in 77.1% of the respondents and 75.6% had good practice of the preventive measures against the disease. A quarter (26.8%) of the respondent's children took the complete 3 doses of the pentavalent vaccine.

Conclusion: Despite positive diphtheria prevention behaviors, the identified gap in pentavalent vaccination coverage indicates a significant need for community immunization programs. Investigating the factors contributing to this low coverage is crucial for developing effective strategies to strengthen immunization programs.

Aim: Streptococcus mutans has been strongly associated with dental caries. The mother, the primary caregiver in the first year of life is the most significant source of the bacteria. The presence of S. mutans in infants from birth to 6 weeks of life was assessed.

Methodology: Prospective study of 24 women enrolled during their third trimester. Socio-demographic characteristics, oral hygiene, dietary practices and obstetric characteristics obtained using investigator-administered questionnaire. Saliva samples collection from neonates at birth and six weeks, investigated by cultural microbial analysis and polymerase chain reaction to detect S. mutans specific species genes.

Results: Total of 24 mother-child pairs assessed. Mothers mean age; 31.29 (+/- 4.6) years. Neonates' mean gestational age; 38.79 (+/-1.4) weeks, with 14 (58.3%) females and 10 (41.7) males. Microbiological culture analysis of the saliva sample of the neonates showed that 25% of the neonates had S. mutans at birth and 25% had it at 6 weeks post-delivery. Approximately 25% of salivary samples from the neonates showed S. mutans upon cultural analysis and correlated with the presence of the bacteria in 41.7% of the samples using Polymerase chain reaction. Streptococcus mutans detected at birth in 60% of neonates were identical to that of the mothers.

Conclusion: Maternal transmission is the primary source of S. mutans acquisition. Culture analysis of oral fluid revealed presence of viable and cultivable S. mutans in neonates asserting the acquisition of these species at birth and their presence before tooth eruption.

Background: Protein C, a vitamin K-dependent anticoagulant, regulates thrombin generation with its cofactor, protein S. Deficiencies in these proteins predispose individuals to thrombophilia, which may contribute to ischemic stroke. However, data on their role in Nigerian populations remain limited.

Objectives: To compare serum levels of protein C and protein S between adults with acute ischemic stroke and matched healthy controls; to assess associations between these deficiencies and stroke severity; and to evaluate their relationship with functional outcomes.

Methods: A hospital-based, cross-sectional case-control study was conducted involving 100 ischemic stroke patients and 100 age- and sex-matched healthy controls. Serum protein C and S levels were measured using enzyme-linked immunosorbent assay (ELISA). Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), while functional outcomes were measured using the Barthel Index and Modified Rankin Scale (mRS) on days 7, 14, and 30. Statistical analysis was performed using SPSS version 25, with significance set at p < 0.05.

Results: Among 200 participants (59 males, 41 females per group), the mean age of stroke patients was 61.24 ± 13.30 years. Median time to presentation was 48 hours. Protein C levels were significantly lower in stroke patients, while Protein S showed no significant difference. A weak positive correlation was observed between Protein C levels and stroke severity (rs = 0.201, p = 0.045), whereas Protein S did not show such a correlation. The functional outcome showed no significant association with either protein.

Conclusion: Protein C deficiency may serve as a marker for stroke severity but has limited predictive value for functional outcomes. Further research is needed to clarify its pathophysiological role in ischemic stroke.