West African journal of medicine最新文献

Background: Depression represents a major international public health problem for both developed and developing countries. It is associated with increased risk of morbidity, suicide, decreased physical, cognitive and social function, and greater self-neglect, which in turn is associated with increased mortality.

Objective: The study objective was to determine the clinical characteristics and predictors of depression among the elderly attending the family medicine clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Northwestern Nigeria.

Methodology: The study was a hospital-based cross-sectional study of 391 elderly participants in the family medicine clinic of Usmanu Danfodiyo University Teaching Hospital, recruited through systematic sampling technique. Data was collected using a pre-tested, structured interviewer-administered questionnaire, and Folstein (MMSE). The GDS-30 was used to screen for depression. BMI was calculated and data analyzed using SPSS version 20. Test of associations was done using the Chi-square test, and logistic regression was done; P < 0.05 was considered statistically significant.

Results: The prevalence of depression among the elderly was found to be 41.2%. Following logistic regression, being married (OR=0.559, 95% CI=0.321-0.974), bereavement in the last six months (OR=2.35, 95% CI=1.138- 4.480), poor subjective health status (OR=0.141, 95% CI=0.057-0.348), and abnormal BMI (OR=0.425, 95% CI=0.221-0.818) were found to be predictors of elderly depression in the study.

Conclusion: The prevalence of depression among older adults was high, and the study recommends early screening, detection and management of risk factors of depressive disorder in older adults by primary care physicians.

Background: Laparoscopic cholecystectomy has evolved to become the gold standard treatment of calculous and acalculous cholecystitis.

Aim: This research aims to study the demographics, indications, types of cholecystectomies (early/interval), length of hospital stays, conversion to open surgery, use of drains, complications, and outcomes.

Patients and methods: This was a retrospective, descriptive study of all cases of laparoscopic cholecystectomy carried out from 1st January 2023 to 31st December 2023 at King Khalid hospital Hail, Saudi Arabia. The case files of all the patients who had laparoscopic cholecystectomy were retrieved from the Oasis health information management system of the hospital. Written informed consent was obtained from each patient before surgery. Ethical approval was obtained before embarking on the study. Information regarding demographics, indications and types of cholecystectomies, length of hospital stays, conversions to open surgery, use of drains, complications and mortality were analyzed with Statistical Package for Social Sciences version 26.

Results: A total of 351 cases of cholecystitis had laparoscopic cholecystectomy. There were 248 (70.7%) females and 103 (29.3%) males. The mean age of the patients was 39.5 ± 1.2 years. There was conversion to open cholecystectomy in four (1.1%) cases. The average duration of hospital stay was 1.5 ± 1.5 days. There was neither a case of bile duct injury nor mortality.

Conclusion: The outcome of laparoscopic cholecystectomy was good with no major morbidity or mortality.

Background and objectives: To ascertain the prevalence of knee pain in type 2 diabetic mellitus (T2DM) patients and to compare associated structural ultrasonographic arthritic changes with non-diabetic controls. Associations between T2DM knee pain, clinical variables and ultrasonographic arthritic changes were also investigated.

Methods: Using a high frequency linear ultrasound probe (7.5-12MHz), both knees of 78 consecutive T2DM patients and 30 age and sex matched non-diabetic controls without knee pain were scanned.

Results: Seventy-eight T2DM patients and 30 controls with mean ages of 63.0±10.4years (M:F = 1:1.9) and 2.3±10.5years (M:F = 1:0.9) respectively were studied. Forty (51.8%) T2DM patient presented with unilateral or bilateral knee pain while clinical pes anserinus tendinitis bursitis syndrome (PATBS) was diagnosed exclusively in 8 female T2DM patients, constituting 10.0% of the total T2DM group. At least 1 positive ultrasonographic arthritic change was found in 98.5% T2DM knees with pain, 86.8% T2DM knee without pain, and 69.2 % control knees (p< 0.05). Independent predictors of knee joint pain are age >60 years (OR=3.5), obesity (OR=2.9), and medial meniscal protrusion (OR=8.7).

Conclusions: Ultrasonographic arthritic changes are highly prevalent in T2DM patients with and without knee pain. Independent predictors of knee joint pains are age > 60 years, obesity, and medial meniscal protrusion.

Background: The implementation of cervical cancer screening programmes in Eswatini has been shown to be helpful in lowering both the occurrence and fatality rates associated with cervical cancer. However, there is a low level of screening participation among women.

Aim: To provide a comprehensive synthesis of the barriers and facilitators to the uptake of cervical screening services from the perspectives of the healthcare providers (supply side) and the individuals receiving the screening (demand side) in Eswatini.

Methods: The review followed the guidelines set out by the PRISMA scoping review criteria of peer-reviewed research publications that were published during the last five years. The publications included in the study were primarily centred on the documentation of Eswatini's nationwide endeavours in cervical cancer screening. A total of four databases were used, namely Medline, PubMed, CINAHL, and Google Scholar.

Results: A total of 16 records fulfilled the established criteria for inclusion. The research primarily examined many aspects related to the supply side of cervical cancer (CC) screening. These aspects included the training and skills of health workers, the extent of CC screening service coverage, the capacity of health services, and the resource limitations that contribute to inadequate implementation and delivery of CC screening services.

Conclusions: The outcomes of the review revealed the need for implementers to take into account the interplay between demand-side and supply-side elements that support the provision and acceptance of cervical cancer screening services.

Contribution: The review presents evidence on barriers, enablers and practice in cervical cancer screening in Africa.

Background: Stroke is a leading cause of disability and mortality worldwide, and post-stroke depression is a common neuropsychiatric complication. Post-stroke depression is associated with increased disability, diminished quality of life, and elevated mortality rates among stroke survivors. Recognizing how common depression is among stroke survivors and the factors associated with it are crucial for timely intervention and improved rehabilitation outcomes.

Methods: A hospital-based cross-sectional study conducted at Jos University Teaching Hospital, with 396 adult stroke survivors. Participants were screened for depression using the Patient Health Questionnaire-9 (PHQ-9) and the Beck Depression Inventory (BDI). Confirmatory diagnoses were established using the Structured Clinical Interview for DSM-4 (SCID-IV). Data were analysed using SPSS version 25.

Results: Among the 396 stroke survivors, 81.8% screened positive for depression on the PHQ-9, while 87.9% were classified as depressed using the BDI. The SCID-IV confirmed depression in 42.4% of participants. Factors associated with post-stroke depression included elevated waist-hip ratio (AOR = 8.226; 95% CI: 2.628-25.760; p < 0.001), repeat stroke (AOR = 5.034; 95% CI: 2.767-9.160; p < 0.001), elevated body mass index (AOR = 3.007; 95% CI: 1.872-4.828; p < 0.001), post-stroke dependency (AOR = 2.798; 95% CI: 1.738-4.508; p < 0.001), and diabetes mellitus (AOR = 2.145; 95% CI: 1.309-3.513; p = 0.003).

Conclusion: The frequency of depression among stroke survivors in Jos was high. The determinants of depression were obesity, previous history of stroke, diabetes mellitus and post-stroke disability. Early detection and targeted interventions are recommended to enhance better outcomes.

Introduction: Cardiovascular disease (CVD) has become the major cause of morbidity and mortality in Sub-Saharan Africa (SSA). Despite this, there is still very little data on the pattern of hypertensive heart disease in SSA.

Objective: This study described the characteristics of heart failure caused by hypertensive heart disease in Ibadan, Nigeria.

Methods: This was a hospital-based cross-sectional study conducted in the cardiology unit of the Department of Medicine, University College Hospital, Ibadan, Nigeria. Eligible patients were those presenting with chronic hypertensive heart failure to the cardiology unit or referred to the unit for the same purpose. Data collection started from August 1, 2016, to July 31, 2021. Analysis was done with the SPSS statistical package. A 2-tailed p-value of <0.05 was assumed to be statistically significant.

Results: A total of 753 subjects met the inclusion criteria for the study. The mean age of the population was 60.3 (range, 18-98 years). The most common co-morbidity was diabetes mellitus (13.9%). About 54% of the subjects had a previous history of heart failure. Serum sodium (p = 0.022), creatinine (p = 0.001), and total cholesterol (p = 0.004) were significantly higher in females. Men are more likely to have left-axis deviation (p=0.016) and left atrial abnormality (p=0.016). Heart failure with reduced ejection fraction was common in males.

Conclusion: HHF in Ibadan, Nigeria, affects a relatively younger population compared to their counterparts in high-income countries. Our findings are similar to data from other parts of sub-Saharan Africa. Preventive programmes should be utilised at all levels to stem the menace of hypertension.

Introduction: Preeclampsia is defined as hypertension occurring after 20 weeks of gestation with associated proteinuria. It remains one of the leading causes of maternal and perinatal morbidity and mortality in developing countries. The increased risk of atherosclerosis makes affected women more prone to cardiovascular and cerebrovascular complications. Carotid intima-media thickness (CIMT), measured non-invasively by high-resolution B-mode ultrasound, offers an opportunity for early identification of women with atherosclerosis, thereby allowing preventive measures and early intervention.

Methods: A prospective comparative study conducted at the Radiology Department of the University College Hospital, Ibadan. Seventy women with preeclampsia were consecutively recruited into the study, and an equal number of normotensive pregnant women, matched by maternal and gestational age were selected between August 2022 and January 2023. Carotid Intima-Media Thickness (CIMT) was assessed by ultrasound using the technique of 'multiple carotid sites measurement'. Data analysis was performed using IBM SPSS version 23, employing descriptive statistics, Chi-square test, and Student's t-test to evaluate associations and compare CIMT values. A p-value < 0.05 was considered statistically significant.

Results: Mean CIMT values were 0.639 ± 0.152 mm and 0.663 ± 0.156 mm for women with preeclampsia, and 0.610 ± 0.131 mm and 0.618 ± 0.126 mm for normotensive pregnant women on the right and left respectively (95% CI, -0.002-0.092; p= 0.061). In preeclamptic and control groups, mean CIMT values were lower in nulliparous women compared with multiparous women. There was a positive correlation between the age of the participants and CIMT on the right (r = 0.067) and left (r = 0.150). A positive correlation was also demonstrated between blood pressure and CIMT on both sides.

Conclusion: Mean CIMT values were higher on both sides in women with preeclampsia compared with normotensive pregnant women.

Background and objectives: Despite the burden and severity of AKI in ICU patients, there is limited epidemiologic information in Sub-Saharan Africa. Epidemiologic data on AKI in critically ill patients are required to advocate for government health policies that will reduce the burden of AKI. This study determined the incidence, aetiologies, and short-term outcomes of AKI in ICU patients in Southern Nigeria.

Methods: A multi-centre retrospective descriptive study of all patients with medical conditions, who developed AKI in the ICU of the participating hospitals during the study period. Data collected include socio-demographics, hospital-related data such as duration of stay in ICU, past and current medical history, and outcome of illness.

Results: Out of 473 cases, AKI was diagnosed in 203 (42.9%). Seventy-three (36.0%) were oliguric, 50.2% had non-oliguric AKI, while it was not specified in 13.8% patients. The most common causes of AKI were hypovolaemia (34.0%) and sepsis (27.6%). Factors associated with the development of AKI were sepsis [AOR:6.17; CI:2.33-16.32; p = <0.001] and need for inotropes [AOR:2.03; CI:1.34-3.94; P = 0.003]. Although dialysis was indicated in 34 (16.7%) of the AKI patients, 58.8% of them received it. One hundred and sixteen (57.1%) of the AKI patients were discharged with full renal recovery, while 40.9% died.

Conclusion: Four out of every 10 patients admitted into the ICU developed AKI, and the common aetiologies were hypovolaemia and sepsis. Regular critical care training is required to effectively identify at-risk patients and to take prompt measures towards mitigating these risks.