West African journal of medicine最新文献

Background and objectives: Aortic valve stenosis (AoS) is the most common valvular pathology in the elderly, many of whom are ineligible or high-risk for surgery due to comorbidities. Transcatheter Aortic Valve Implantation (TAVI) was developed as a less invasive alternative to Surgical Aortic Valve Replacement (SAVR) for patients with severe AoS. Its efficacy was first demonstrated in the landmark PARTNER trial, which compared TAVI to medical therapy in ineligible SAVR patients. Subsequent studies have validated its use in intermediate and low-risk groups. Despite its growing adoption, there has yet to be a report of a successful TAVI procedure in West Africa.

Methods: The procedure involved transcatheter aortic valve implantation using radial and femoral arterial access. A 14Fr Python sheath was introduced after vessel dilation, and the valve was crimped and positioned in the aortic annulus under fluoroscopic guidance. Serial aortograms confirmed accurate placement, and haemostasis was achieved using a Proglide suture, protamine administration, and manual pressure. The patient was transferred to the ICU post-procedure for monitoring.

Results: The patient's post-procedure imaging showed a well-seated valve with trivial central aortic regurgitation, no paravalvular leak, and an insignificant gradient of 12.25 mmHg. The patient remained stable, resumed anticoagulation, and was discharged with a follow-up scheduled in one week.

Conclusions: This case report details the successful prosthetic aortic valve implantation in an 83-year-old high-risk surgical candidate with hypertension and bilateral knee replacements. It marks a significant step toward adopting less invasive valvular heart disease management approaches in the region.

Background: Monitoring kidney function during pregnancy is vital, especially in women with hypertensive disorders like preeclampsia. Serum creatinine, although widely used, is limited in sensitivity due to physiological changes in pregnancy. Cystatin C, a novel biomarker, has emerged as a potentially superior and early indicator of glomerular filtration rate (GFR). The aim of this study was to evaluate the diagnostic performance of cystatin C compared to creatinine in pregnant women.

Methods: A cross-sectional comparative study was conducted among 180 pregnant women at a tertiary centre in Nigeria. Participants included 90 women with preeclampsia and 90 normotensive controls. The respondents were interviewed using a pre-tested, interviewer -administered, semi-structured questionnaire. Serum creatinine and cystatin C levels were measured, and estimated GFR was calculated using the CKD-EPI equation. Group comparisons and correlation analyses were performed.

Results: Mean serum cystatin C levels were significantly higher in preeclamptic women (1.09 ± 0.62 mg/L) compared to controls (0.80 ± 0.22 mg/L, p < 0.001). Although mean serum creatinine levels were slightly higher in the preeclamptic group (89.4 ± 52.5 µmol/L) than in the control group (86.9 ± 47.5 µmol/L), the difference was not statistically significant (p = 0.168). Cystatin C demonstrated a stronger inverse correlation with eGFR (r = -0.68) than creatinine (r = -0.49). Kidney dysfunction (eGFR < 60 mL/min) was detected in 11.1% of preeclamptic women using cystatin C-based threshold and absent in normotensive controls (p < 0.001).

Conclusion: Cystatin C outperforms serum creatinine in detecting early kidney dysfunction in pregnancy and may be a more reliable tool for antenatal screening, especially in high-risk populations. Its adoption could improve early diagnosis and clinical outcomes in resource-limited settings.

Background/purpose: The use of social media platforms for social and educational interactions has transformed the way information sharing takes place. However, this has also exposed the public to health-related misinformation, posing significant challenges for global health. This is particularly challenging in sub-Saharan Africa (SSA), where the burden of noncommunicable diseases (NCDs) now compounds existing challenges from communicable diseases. This review aimed to examine the growing challenge of health-related social media misinformation and the potential implications for NCD burden in SSA, and explore possible strategies for combating social media misinformation in the context of NCDs.

Data source: Useful data for this review were obtained by consultation of online sources of information using search engines and online databases.

Findings: Social media platforms serve various health-related purposes, including health interventions, health campaigns, medical education, disease outbreak surveillance, and behavior change. WhatsApp, Facebook, X (formerly Twitter), and YouTube are the leading platforms associated with health-related misinformation in SSA. Potential implications of health-related social media misinformation are misconceived clinical diagnosis, inappropriate self-medication and failure to adhere to evidence-based treatment modalities.

Conclusions: Social media misinformation in the area of NCDs can potentially influence people's health-related attitudes, behaviour and undermine appropriate implementation of evidence-based interventions. Collaboration among stake holders such as healthcare professionals, religious organizations and social media influencers, as well as public awareness campaigns and regulatory policies are plausible strategies for combating the issue. There is limited research on the implications of health-related social media misinformation on NCDs in SSA highlighting the need for further studies.

Background: Multiple injured patients are patients who sustained injury to more than one system in the body, while a polytraumatized patient is the one who sustained injury to two or more regions of a system in the body. Better patient outcomes and effective management depend on an understanding of the patterns and characteristics of limb injuries in the multiply injured individuals. This is especially important in places with little resources, like Southwestern Nigeria, where trauma is common and it's important to make the best use of the few available medical resources. Therefore, the aim of this research is to determine the common aetiology that led to various limb injuries in the multiple injured patients at UNIOSUN Teaching Hospital, Osogbo, Osun state.

Methodology: A prospective observational design was employed, involving multiple injured patients admitted to UNIOSUN Teaching Hospital from May 1st, 2022 to April 30th, 2024. Data collection includes demographic information, aetiology of the injury and type of injury sustained. SPSS Version 20 was employed to determine the frequency and distribution of data. Descriptive analysis revealed demographic characteristics, patterns of limb injury, highlighting the common causes, prevalence of different types of limb injuries, distribution of affected limbs and sides in the multiply injured patients.

Result: The study found a higher representation of males in road traffic accidents, with a diverse age group. Most participants were passengers or pedestrians, with 71.4% of injuries being closed. Most participants did not use seat belts and were not seated.

Conclusion: This study demonstrated that limb injuries from road traffic accidents predominantly affected young adult males, with motorcycle crashes being the leading cause. Fractures, especially of the lower limbs, were the most common injury types, and surgical intervention was frequently required. These findings show the significant burden of limb trauma managed at UNIOSUN Teaching Hospital and emphasize the demographic and clinical patterns associated with such injuries.

Introduction: Caregivers of patients in hospital experience enormous strain and discomfort while caring for their loved ones. The burden on caregivers while caring for a hospitalised patient is also varied and requires proper identification due to the significant role these caregivers play in the patient's outcome. Caregiver burden is related to the well-being of both the patient and caregiver; therefore, understanding the attributes associated with caregiver burden is important.

Aim: To assess the relationship between the social, emotional, financial, and family burden with life satisfaction of caregivers of patients.

Method: This was a cross-sectional study that recruited 248 adult caregivers (18 years and above) of patients with chronic diseases admitted into the Emergency Department of Obafemi Awolowo University Teaching Hospital Complex (OAUTHC). All caregivers who consented to participate in the study had an interviewer-administered questionnaire.

Results: The mean age of caregivers was 41.27 ±15.28 years with a range of 16-89 years. More were within the age groups 21-30 years, and were mostly family members (94%). Sons/daughters were the most prevalent (39.1%), with daughters constituting 24.5% and sons were 14.6%. Majority (77.0%) of the caregivers experienced caregiver burden. The mean burden score based on the Zarit Burden Interview was 17.85±7.67 and 21.8% of the caregivers were dissatisfied with life. The rural dwellers experienced high burden and were less satisfied with life compared to the urban dwellers (p =0.029). Also, caregivers who had cared for their sick patient for three months to one year experienced higher burden compared to those who had cared for shorter duration (p=0.020).

Conclusion: Caregiver burden was present among caregivers and the level of satisfaction with life can influence burden of care.

Background and objectives: Preterm births are leading contributors to neonatal, infant and under-five mortality globally. A significant proportion of mid-trimester pregnancy losses and preterm births are due to cervical insufficiency (CI). Cervical cerclage (CC) remains the mainstay of treatment for CI, but information about the clinical outcomes remains insufficient. This study appraised the perinatal outcome of pregnancies that had CC at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Nigeria.

Methods: In a retrospective study, relevant data of all patients who had CC between January 1, 2011, and December 31, 2021 was extracted using a purpose-designed proforma. The data was analysed using the IBM SPSS® 24.0. Associations between categorical independent variables and outcome variables were compared where applicable, using Chi-square, with level of significance set at <0.05.

Results: One hundred and thirty-five CCs were performed within the study period, at a mean gestational age (GA) of 15.7 ± 4.5weeks. Sixteen pregnancies (11.9%) were complicated by miscarriages at GA <25weeks. Ninety-six women (71.1%) delivered after GA of 34weeks, with an overall mean GA of 34.5 ± 5.9 weeks at delivery. Elective cerclage, cervical dilatation of ≤2cm at CC insertion and singleton pregnancy were significantly associated with delivery at EGA ≥34 weeks. (p=0.037, 0.040 and < 0.011 respectively).

Conclusion: If susceptible pregnant women are identified and CC inserted appropriately, pregnancies that are complicated with CI have about 70% chance of progressing beyond 34weeks. The role of tocolytics and antibiotic therapy as adjunctive treatment for CI however requires further evaluation.

Background: Poor adherence to prescribed anti-hypertensive treatments remains a significant public health challenge in Nigeria. This study assessed the barriers and enablers of anti-hypertensive medication adherence among hypertensives seeking care in public secondary health facilities in Delta State, Nigeria.

Methods: A mixed quantitative and qualitative method was employed to assess the barriers and enablers of anti-hypertensive medication adherence among a random multistage sample of 451 adult hypertensives. Data were collected using an interviewer-administered semi-structured questionnaire and a focus group discussion guide. Descriptive and inferential analyses of the data collected were carried out using the IBM SPSS version 26 software.

Results: The mean age of the study participants was 53.5 (SD = 9.9) years, with 80.7% (n = 364) reporting poor anti-hypertensive medication adherence. Those with good adherence were likely to be at least 50 years old (AOR = 2.625; 95% CI: 1.353 - 4.485; P = 0.014), have tertiary education (AOR = 7.797; 95% CI: 3.359 - 9.758; P = 0.009), belong to the upper socio-economic class (AOR = 2.546; 95% CI: 1.968 - 4.761; P < 0.001) and living with hypertension for at least five years (AOR=1.752; 95% CI: 1.367 - 7.456; P = 0.003).

Conclusion: Anti-hypertensive medication adherence was generally poor among the study participants. There is a need for concerted efforts by health providers to regularly screen for anti-hypertensive adherence and provide qualitative health education targeted at improving adherence to medication among hypertensives.

Background: The global increase in diabetes, especially in developing nations, has escalated complications like diabetic foot ulcers. Hypovitaminosis D is considerably prevalent among individuals with Type 2 Diabetes Mellitus (T2DM) and chronic vascular complications. The aim of this study was to determine the association between vitamin D levels and foot ulcers among patients with T2DM.

Methods: This study population comprised 88 individuals with diabetic foot ulcers (DFUs) and 88 individuals with T2DM without DFUs. Vitamin D levels were assayed using blood samples according to standard methods. An independent t-test was done to analyze the difference between serum vitamin D levels in both groups. Pearson's correlation coefficient and linear regression analysis were also performed.

Results: Majority of participants in the DFU group presented with Grade 2 and Grade 3 ulcers (Wagner's classification). There was a significant difference in serum vitamin D levels, indicating lower levels among cases (mean of 19.6 ng/ml ± 13.6) compared to controls (mean of 36.2 ng/ml ± 11.4) with a p-value of 0.014. Data shows 84.1% of persons with foot ulcers had deficient/insufficient serum vitamin D levels, while only 29.5% persons without DFU had deficient/insufficient vitamin D levels. Regression analysis shows that persons with DFU were 12.6 (6.0 - 26.2) times likely to have deficient/insufficient vitamin D levels. Chi-square analysis shows that the distribution of the DFU severity was significantly higher among persons with deficient serum Vitamin D levels (p = 0.0001).

Conclusion: Lower serum vitamin D levels are significantly associated with diabetic foot ulcers (DFUs). Screening for and correcting vitamin D deficiency may potentially improve the outcome in patients with diabetic foot ulcers.

Background: Hypertension with its associated sequelae is the most important risk factor for cardiovascular disease and the leading cause of mortality worldwide. The multifactorial associations of environmental influence on blood pressure seem to play a key role in the etiopathogenesis of hypertension and should be more intently investigated.

Objective: This study evaluated the prevalence of hypertension and electrocardiographic left ventricular hypertrophy of residents in three oil producing (exposed) communities in Rivers State (Mbodo-Aluu, K-Dere and Engeni) and a non-oil producing (control) community in Anambra State (Mgbeke-Uli).

Methods: A total of 570 subjects were recruited for this study. Sociodemographic, anthropometric, electrocardiographic parameters, and blood pressure were obtained from the subjects in a standardized manner.

Results: Showed that the mean value of the systolic and diastolic blood pressures of subjects in the exposed communities were higher (p<0.001) than those of the controls. Furthermore, the prevalence of hypertension and left ventricular hypertrophy in exposed communities were higher (p<0.001) when compared with the control.