West African journal of medicine最新文献

Background: Chronic Kidney Disease (CKD) among patients with Sickle Cell Disease (SCD) notably HbSS and HbSC are increasingly being recognized due to improved health care a comparative severity of CKD among these subgroups is not known in ABUTH Zaria.

Objective: This study was to assess the severity of kidney function among stable patients with HbSS and HbSC in ABUTH, Zaria.

Method: A cross-sectional descriptive study involving steady state 188 HbSS and 22 HbSC attending Haematology Clinic in ABUTH Zaria. The following parameters were assessed; Blood Pressure, estimated Glomerular Filtration Rates (eGFR), albuminuria, haematuria, pH, and specific gravity. SPSS version 17.0 for Windows was used Categorical data were represented as charts and tables while continuous variables were represented as mean and standard deviation. Relationships were tested using the student t-test and Pearson's Chi-square.

Results: It was observed that 188 (89.5%) have HbSS while 22 (10.5%) have HbSC. The eGFR < 60ml/min/1.73m was higher in participants with HbSC compared to participants with HbSS (13.8% vs. 8.0%, x = 8.5, p = 0.056). The prevalence of Albuminuria > 3mg/mmol among participants with HbSC and HbSS were (68.3% vs. 43.7%, x = 4.37, p =0.043). Haematuria in participants with HbSC and HbSS were (41% vs. 16%, x = 8.11, p = 0.004). There was no statistically significant difference in urine specific gravity, pH, and blood pressure among HbSS and HbSC.

Conclusion: This study has shown that patients with HbSC have worse albuminuria and haematuria than those with HbSS.

Background: The World Health Organisation's (WHO) 2013-2030 mental health action plan emphasized the complex relationship between mental disorders and non-communicable diseases (NCDs). The integration of mental health into the management of non-communicable diseases (NCDs) is crucial. This is a report of an integrated care project in primary care for the management of patients with hypertension and Type 2 diabetes. This practice quality improvement project was executed in a primary care hospital in Ghana under the World Organization of Family Doctors (WONCA) Integrating Care Leadership and Advocacy Programme.

Objective: To increase mental health help-seeking among adult patients with hypertension and Type 2 diabetes through service integration.

Project methods: The project duration was from September 2023 to April 2024. The project involved screening, providing information about common warning signs for mental health problems through posters, and available health personnel from whom patients can seek help. Adult patients with hypertension and/or Type 2 diabetes were screened using the PHQ-4 tool for anxiety and depression from October 2023 to January 2024 and Health education sessions on mental health were organized for patients once every three months.

Project outcomes: The project screened 205 patients from October 2023 to January 2024, of which 39 (19%) were found to have either anxiety or depression and were managed by a collaborative team of professionals through patient-centred approaches. Following management, 36 had resolution of symptoms and three transferred their care to other facilities. The findings underscore the importance of incorporating mental health into care for chronic diseases enhancing access to appropriate interventions through collaborative teams.

Conclusion: Integrating mental health into NCD management is essential for improving patient outcomes. This project demonstrates the necessity of such integration in primary care settings, advocating for policy with detailed guidelines for integrating mental health into NCD care in Ghana.

Introduction/background: There is still little data on clinical profile and atrial fibrillation (AF) characteristics in West Africa. Traditionally the risk factor for chronic AF in the sub-region is chronic rheumatic heart disease. However, with the rapid demographic and epidemiologic transition in the sub-region, the risk factors, clinical profile, and complications of AF appear to be changing.

Objective(s): The aim of this study is therefore to describe the contemporary clinical profile and characteristics of AF in Ibadan, Nigeria.

Methods: This is a prospective observational study that commenced on June 1, 2016. All adults aged 18 years and above with electrocardiographic diagnoses of AF were included in the study. The case report form included sociodemographic data, clinical information, risk factors, management, and clinical outcomes.

Results: Three hundred and fifty-seven (357) patients were recruited (mean age 63.4(14.6) years, males 189 (52.9%). In terms of clinical subtypes, the distribution is as follows: permanent- 219(61%), persistent - 88(25%), paroxysmal- 51(14%) There was none with lone AF in this cohort. 112 (31%) had previous AF. The common co-morbidities are hypertension, heart failure, and valvular heart disease. 318(89%) had a CHA2D2VASC score of 2 or more. In terms of management, rate control was the commonest strategy (64.4%), and beta-blockers and/or digoxin were commonly prescribed. 73(64.6%) were on anticoagulation, but only 30% achieved adequate anticoagulation.

Conclusions: Non-rheumatic, non-atherosclerotic conditions are the common risk factors for AF in Ibadan, Nigeria. Measures to prevent stroke as well as control of risk factors for AF should be emphasized. Keywords: Atrial fibrillation, lessons gleaned, Ibadan AF project.

Background: Sickle cell cardiomyopathy is becoming a neglected tropical cardiovascular disease, yet the most common cause of death in HbSS patients. Myocardial strain using speckle tracking has recently been validated as a tool for the detection of subclinical left ventricular systolic dysfunction. Its utility in sickle cell disease in Nigeria is unknown.

Objectives: The study aims to evaluate global longitudinal left ventricular (GL LV) strain pattern in black SCD patients in steady state, and correlate that with clinico-laboratory and electrocardiographic (ECG) measurements. Furthermore, we will evaluate the timeline for the earliest detectable cardiac changes in SCD detectable by ECG or speckle tracking.

Method: 60 sickle cell patients between ages 5 and 40 years will be matched with 60 controls. Baseline clinic-laboratory data will be collected. All participants will have electrocardiography and speckle-tracking echocardiography of the left ventricle. The primary outcome is the global LV longitudinal strain in HBSS and matched control. Secondary outcomes are the clinico-laboratory and electrocardiographic correlates of LV strain in black HBSS patients as well as tracking the earliest detectable cardiovascular change in the life spectrum from childhood to adulthood. Regression analysis and other statistical models will be used.

Conclusion: The simplicity of the study design is crafted to spark interest in life-threatening cardiovascular complications of sickle cell disease beyond pulmonary hypertension.

Background: Specific phobic anxiety disorder is characterized by severe and excessive fear that occurs constantly when exposed to one or more specific objects or situations. The fear is out of proportion to the threat, causing significant distress and impairment for the person.

Methods: A thorough history was taken; a mental state examination, and physical and systematic examinations were conducted. Investigations were conducted following the biopsychosocial approach, and finally, ICD 10 was used to make the diagnosis. Treatment was also approached biopsychosocially.

Result: We report a case of an adult lady who has been persistently displaying features of anxiety disorders since early childhood, specific to hedgehogs. She was diagnosed with a rare specific phobia anxiety disorder called Skatzochoirophobia and was successfully treated with systematic desensitization. Despite an extensive search, we were unable to retrieve a case of skatzochoirophobia, which makes it worthy of reporting as hedgehogs are small mammals commonly found in our environment, which in some areas are sources of protein.

Conclusion: This case report may help in creating awareness and helping clinicians be on the lookout for skatzochoirophobia, which may help in early detection and prompt treatment.

Introduction/background: Chronic heart failure (CHF) has important gender-specific aspects, which are worthy of note, as they influence the haemodynamic state of patients the choice of therapy, aetiology, and clinical outcomes. Women are less frequently represented in CHF studies and clinical trials than males. While some published data are conflictive, more studies tailored to this critical discourse are necessary to inform patient care and improve outcomes in patients with CHF.

Objectives: The study aims to describe the rationale, design and clinical presentations, profile, and 1-year outcomes of the first 1290 CHF in the Ibadan CHF project.

Materials/methods: We analyzed the differences between the genders regarding the aetiology of heart disease, comorbidities, triggers, left ventricle functional state, treatment, and all cause-mortality at 1 year.

Results: A total of 1290 patients (55.8% men) were included. The men were older than the women (p<.001) and had a higher prevalence of alcohol and cigarette use, comorbidities, and worse cardiac structural abnormalities (p<.001). The are also gender differences in the pattern of aetiology of HF. HHF, DCM, and pericardial diseases are more common in men. Women have higher rates of rheumatic heart disease. Mortality rates at 6- and 12 months were higher in men.

Conclusions: There is a gender difference in clinical profile and outcomes of CHF in this cohort. Males appear to have a worse clinical profile, structural cardiac abnormalities as well as worse one-year outcomes.

Introduction: In-hospital mortality is a critical indicator of healthcare quality, although most hospital deaths result from unavoidable morbid processes.

Objectives: This study aimed to examine cardiovascular mortality in working-age patients by analysing epidemiological, clinical, and paraclinical characteristics and identifying the key etiological factors associated with mortality.

Methodology: A descriptive and analytical retrospective study was conducted from September 2019 to August 2022 at the General Hospital Idrissa POUYE in Dakar. The study focused on patients aged 15 to 60 years who were hospitalised and subsequently died in the cardiology department. Bivariate analysis was used, with a p-value ≤ 0.05 considered statistically significant.

Results: A total of 73 patients were included, revealing a specific mortality rate of 8.8%. The majority of patients were male (sex ratio 1.2) with an average age of 44. The main cardiovascular risk factors identified were sedentarism (76.7%), hypertension (28.8%), and smoking (21.9%). Physical examinations showed signs of heart failure in 63%, while diagnostic tests revealed anemia (59%) and renal impairment (25%). Echocardiographic findings indicated impaired left ventricular ejection fraction (81%), pulmonary hypertension (78%), and kinetic abnormalities (40%). Cardiogenic shock (45.2%) and septic shock (37%) were the primary immediate causes of death. The analysis revealed significant associations between mortality and factors such as age, socio-economic status, ischaemic heart disease (p=0.034), pulmonary embolism (p=0.034), hypertension (p=0.009), smoking (p=0.011), diabetes (p=0.011), dyslipidaemia, obesity (p=0.001), and COVID-19 infection (p=0.017).

Conclusion: The high prevalence of ischaemic heart disease and pulmonary embolism in premature mortality highlights the need for intensified cardiovascular prevention measures. Keywords: Cardiovascular mortality, under 60 years, Dakar, Senegal.

Background: Iodine deficiency is a common cause of thyroid disease, prompting the World Health Organisation to recommend universal salt iodification. The iodine status of Rivers State is yet to be investigated following the implementation of this strategy.

Objective: To determine and compare the iodine nutritional status of children aged 2-14 years resident in selected upland and riverine communities in Rivers State, Nigeria.

Method: A descriptive cross-sectional and comparative analysis of the iodine status of 545 children in randomly selected riverine and upland communities of Rivers State was conducted between June to July 2023. The differences in the proportion of (a) children that had above and below the median urinary iodine excretion, (b) thyroid gland volume, and (c) use of iodised salt intake, between the two communities were analysed.

Results: A total of 126 (23.1%) children in the study population had moderate to mild iodine deficiency, and 69 (54.8%) of these were in the upland group, while 107 (39.5%) children in riverine area had excess urinary iodine with risk, p = 0.001. In the riverine area, 96.31 % of the children consumed packaged iodised salt in their household as compared to 98.54% in the upland, p = 0.100. No child in the study population had overt goitre but 22% had larger thyroid volumes when compared to the Nigerian ultrasound scan reference.

Conclusions: This study shows goitre endemicity in the state, more prevalent in the riverine than the upland regions with the goitres not yet detectable by physical examination but by thyroid ultrasonography.

Background: Strongyloidiasis is a soil-transmitted helminth infection caused by Strongyloides Stercoralis, mostly in tropical and sub-tropical regions, affecting over 600 million people worldwide. Infection is more prevalent among those who are socioeconomically disadvantaged, institutionalized, or residing in rural areas. Parasitic adult females reside in the duodenum or stomach and produce eggs that hatch in the mucosa. Chronic infection may be asymptomatic or be associated with dermatological, respiratory, or gastrointestinal symptoms. The diagnosis of S. stercoralis is often delayed due to the presence of subclinical or poorly symptomatic cases, the usually low parasite load and irregular larvae output, and the lack of a gold standard diagnostic test. We present an unusual case of a 13-year-old female patient with intestinal perforation due Strongyloides Stercoralis infection.

Case report: We present a 14year old female, who presented with features of acute abdomen and was operated on an account of intestinal perforation due to Typhoid ileitis in a private hospital, due to worsening condition the patient was referred to our Teaching Hospital, where she had laparotomy and small bowel resection due to probably typhoid ileitis not properly managed, the sample was submitted for histopathology test. An area of intestinal ulcers and perforation, adult worm, and ova of parasite lodged within the mucosa and crypts of small intestine consistent with Strongyloides Stercoralis was seen.

Conclusion: We report a rare case of intestinal perforation due Strongyloidiasis. In endemic areas, other Neglected Tropical Diseases should also be considered as differential diagnoses of acute abdomen and the associated unusual complications like intestinal perforation.

Background: Intimate partner violence in pregnancy is a hidden global pandemic, a hindrance to universal health. It interferes with the Sustainable Development Goals 3 and 5.

Objective: This study investigated the prevalence and factors contributing to intimate partner violence in pregnancy (IPVP) among antenatal attendees in a tertiary health facility in Anambra state.

Method: The study was a facility-based descriptive cross-sectional study conducted among 400 respondents at the Ante-Natal clinics of Nnamdi Azikiwe University Teaching Hospital.

Results: The mean age of respondents was 30.0 years (±5.3). The overall prevalence of IPVP was 27.3%. The prevalence of psychological, controlling behaviours, physical and sexual IPV were 17.0%, 16.0%, 5.3%, and 1.0% respectively. The factors associated with IPVP were experiencing IPV before pregnancy (OR:21.354, 95%CI:7.329-63.077, P =0.0001), the educational status of the partner (OR: 4.429; 95%Cl:1.616-12.136; P=0.009), justifying husband to beat spouse if she offends him (OR:4.376, 95% CI:1.737-11.024,C P <0.001), witnessed IPV during childhood or adolescence (OR:2.311, 95% CI:1.439-3.711, P <0.001).

Conclusion: Creating awareness, screening of pregnant women, and effective interventions will reduce IPV in pregnancy.