West African journal of medicine最新文献

Introduction/background: Though CIDP and ATM are both inflammatory disorders of the nervous system with distinct features, they rarely occur together in the same individual.

Case presentation: A 41-year-old male trader was admitted with 10 10-day history of paraplegia and weakness of upper limbs. The illness started with lower limb paresthesia, weakness of the left leg, then the right leg after 5 days, proceeding to paraplegia, weakness of upper arms, urine retention, and constipation 3 days before presentation. There was a brief fever; no sore throat or cough; no travel outside the country; and no vaccination. He smoked 10 cigarette packs yearly and drank alcohol occasionally. He was unmarried. Vital signs were stable with normal mentation; oxygen saturation 98%; no cranial nerve deficits; flaccid paraplegia; flaccid bilateral upper limbs weakness (MRC 1/5) and symmetrical sensory loss to the level of T4. HIV, hepatitis B, and C antibodies were all negative; hematological, renal, and liver functions were normal. CSF cyto-albumin dissociation and hyperintensities of the cervical and upper thoracic spinal cord on MRI necessitated a diagnosis of mixed CIDP and ATM. Although the patient could not buy IV immunoglobulin, he has been on prednisolone; and 40 days later flaccid paraplegia and sensory loss persist, but tone and reflexes have returned to normal, and power is MRC 3/5. He remains conscious, is dyspnoeic, and is currently on a mechanical ventilator with a feeding nasogastric tube and urinary catheter in situ.

Conclusion: Both CIDP and ATM are distinct severe neuro-inflammatory diseases requiring emergency and intensive care management as each has potential for high mortality outcomes.

Background: Rates of drug use in Nigeria is one of the highest globally, with the use of opioids associated with increased morbidity and mortality more so with injecting drug use (IDU). MAT) can reduce the harmful effects of opioid use but usage in the country is low despite a country-specific guideline in place. A notable barrier to MAT uptake is professionals' knowledge and attitudes. This study aimed to evidence the opinions of Substance use professionals (SUPs) in Nigeria regarding MAT.

Objective: To ascertain the opinions of SUPs in Nigeria regarding MAT prescriptions for opioid dependence.

Methods: An online Google form was developed by the researchers to assess knowledge and attitudes towards MAT. This form was circulated among SUPs across the six geopolitical zones and the capital territory in Nigeria.

Results: Three hundred and twenty-nine professionals completed the questionnaire. Most were medical doctors (53.8%) and worked in the public sector (89%). Average work experience was 11 years and respondents estimated that nearly 1 in 10 OUD patients they cared for were IDUs. A majority (85.7%) endorsed the need for MAT in Nigeria, though had no previous experience (65.3%), training (74.2%) or knowledge of existing guidelines (68.7%). Over half (55%) endorsed a preference for the availability of buprenorphine and methadone. Most endorsed positive attitudes towards MAT prescriptions.

Conclusion: Substance use professionals endorsed positive attitudes towards MAT for OUDs and its rollout in Nigeria. Awareness of published guidelines and training are unmet needs arising from this study. Keywords: Medical assisted treatment (MAT), opioid use disorders, opinion and experiences.

Introduction: Carcinoma-ex-Pleomorphic Adenoma (CXPA) is a malignant tumour originating from the epithelial components of a primary or recurrent Pleomorphic Adenoma (PA). The minor salivary gland of the palate is not a common site of occurrence of this tumour. Approximately 6% of pleomorphic adenomas have the potential to transform into carcinoma ex pleomorphic adenoma (CXPA). It is typically a high-grade tumour and disease-related death is often being seen due to distant metastases.

Case presentation: A 52-year-old man presented with seven years history of a painless palatal mass which started insidiously and progressively increased in size over the years. There was no history of trauma, toothache, and no history of swelling in other body parts. His medical history was not significant for any disease and no history of irradiation or surgery. Examination of the oral cavity revealed a non-ulcerated palatal swelling, measuring 10x8x5cm, non-tender, firm, not freely mobile, and adherent to the underlying structures.

Pathologic findings: An ovoid tan brown firm tissue was received which measured 9x7x5cm and weighed 140g. Transections show yellow-white homogeneous to nodular areas. Microscopy showed co-existence of a pleomorphic adenoma with an area of transition to a carcinoma.

Conclusion: Pathological assessment is the gold standard for making a diagnosis and the main histopathological finding in CXPA is the co-existence of the benign characteristics of pleomorphic adenoma with malignant changes in the epithelial components of the tumour.

Background: Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycaemia from deficiencies in insulin secretion, action, or both. It reduces the quality of life and life expectancy in patients. Research shows that nutritional knowledge and nutritional status have a huge role in reducing its risk. The nutritional status of an individual is influenced by food intake and physical health.

Objectives: 1. To assess nutritional knowledge among diabetics in secondary health facilities (SHF), Kaduna metropolis. 2. To assess nutritional status among diabetic patients in SHF, Kaduna metropolis.

Methodology: A cross-sectional descriptive study was carried out with a multistage sampling technique in 184 respondents. Nutritional knowledge and Body mass index (BMI) were assessed. IBM SPSS Statistics (Version 26) was used for data analysis. Results were presented using frequency tables and charts; Chi-square/ Fisher's exact test was used to assess the relationship between dependent and independent variables (level of significance set at p<0.05).

Result: The mean age was 57.3 ± 12.67 years. Only 25.5% had good nutritional knowledge while 73.9% had fair knowledge. Normal BMI was found in 36.1%, and overweight and obesity were found in 39.1% and 19.5% respectively. There was no statistically significant relationship between the BMI and the nutritional knowledge (p = 0.876).

Conclusion: Only about a quarter of the respondents had good nutritional knowledge; more than half of the respondents were found to be either overweight or obese. Thus, there should be concerted efforts to address the gap in the nutritional knowledge of diabetic patients.

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), especially among those with chronic vascular complications.

Objectives: To determine the association between vitamin D levels and foot ulcers among patients with T2DM.

Methods: The study population comprised of 176 individuals (88 individuals with diabetic foot ulcers (DFUs) and 88 individuals with T2DM without DFU). Vitamin D levels were assessed using blood samples according to standard methods.

Results: The majority of participants in the DFU group presented with Grade 2 and Grade 3 ulcers. 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 vitamin D, while only 29.5% of 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 Vitamin D levels, compared to persons with sufficient Vitamin D levels (p = 0.0001).

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

Background: Chronic kidney disease is a long-term complication of sickle cell disease (SCD) in adults because of persistent recurrent vaso-occlusive crises, and hyperfiltration. SCD patients are in a steady state, although may be from crises, but may have deranged kidney function.

Objectives: This research studied the prevalence of chronic kidney disease among steady-state SCD patients in ABUTH, Zaria.

Method: A case-control cross-sectional study of 210 SCD patients and age/sex-matched healthy controls in ABUTH Zaria. The following parameters were assessed among participants: socio-demographic characteristics, facial puffiness, frothiness of urine, urine albumin: creatinine ratio, urine specific gravity, and glomerular filtration rates. Data were analysed using SPSS version 17.0 for Windows, and presented as mean ± SD for nominal variables, and as diagrams for categorical variables. Student t-test and Pearson's Chi-square were used to test for relationship with p<0.05 as significant.

Results: The study participants consisted of 113 males and 97 females pairs, with mean ages of 26.8 ± 8.2 vs. 25.7 ± 5.8 years, (p = 0.1) for cases and controls respectively. Prevalence of SCD patients with stage ≤ 3-5 CKD, facial swelling, frothy urine, SG <1.015, albuminuria, urine Hb <13g/dl, and stage were 8.6%,16.2%, 18.0%,33.3%, 47.2%, respectively. All controls had normal kidney functions (p< 0.05).

Conclusion: This study has shown the prevalence of 8.6% to 47.2% of features of CKD among steady-state adult SCD patients in ABUTH Zaria.

Background: Fetal malnutrition has been reported to result in developmental adaptations, which may lead to chronic diseases later on in life. Maternal body composition, nutritional stores, diet, and ability to deliver nutrients through the placenta determine nutrient availability for the fetus. Thus, this study aimed to determine and compare the dietary intake among pregnant women attending antenatal clinics in rural and urban primary health centres in the Uyo senatorial district of Akwa Ibom State.

Methods: This cross-sectional study was carried out in 6 primary health care (3 urban and 3 rural) facilities in Uyo senatorial district, Akwa Ibom, selected by a multi-staged sampling technique. An interviewer-administered semistructured questionnaire was used to obtain information on weekly food frequency and 24-hour dietary recall. Descriptive statistics were used, and a chi-square test was performed to examine the relationship between outcome variables. Statistical significance was set at a p-value of 0.05.

Results: The major findings from this study indicated that urban respondents had a significantly higher intake of highly processed carbohydrates, fruits, and vegetables compared to rural respondents (p=0.025 and 0.001, respectively). Overall, highly processed carbohydrates were the most consumed food group in both locations, with 42.2% consuming them over 5 times a week. The average iron and protein intakes were below the recommended nutrient intakes (RNI) in pregnancy at 72.4% and 69.1%, respectively, whereas carbohydrate and calcium intakes exceeded the RNI at 122.5% and 125.7%, respectively. Only protein intake was significantly different across the two locations, with urban respondents having higher intake (53.1g) compared to rural respondents (40.5g), p=0.013.

Conclusion: Based on the above findings, it is recommended that adequate nutrition education be taught during antenatal clinics. Micronutrition supplementation, especially iron supplementation, should also be emphasized during the antenatal period.

Background: Substance use and abuse of psychoactive substances, alcohol, and illicit drugs, result in dependence, crimes, illicit financial flows, corruption, and terrorism/insurgency.

Objectives: To evaluate the risk factors, prevalence, and patterns of substance abuse, among adult patients attending the Behavioural Medical Unit, Karu General Hospital, Abuja; for prevention and early clinical diagnosis.

Method: A hospital-based descriptive cross-sectional study conducted, from March 2022 to May 2022; involving 257 consenting adults, 18 years and above, selected through systematic random sampling. An interviewer-administered questionnaire was used to achieve all objectives. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) assessed the pattern of substance abuse. Data collected were analysed using SPSS version 24. Significance level: p<0.05.

Results: Mean age was 38.5±0.9; males (55.3%). Prevalence was 61.5%. Alcohol was mostly used, then tobacco, cannabis, and opioids at 31%, 15%, 14%, and 14% respectively. Multivariate analysis of the risk factors and pattern of substance abuse showed that gender (p 0.024, OR = 2.061 CI = 1.098 - 3.870), religion (p 0.008 OR = 0.392 CI = 0.197 - 0.781), alcohol intake (p <0.001 OR = 3.576 CI = 1.819 - 7.031), exposure to cigarette/smoking (p <0.001 OR = 4.074 CI = 1.986 - 8.359), having a medical condition (p <0.001 OR 3.309 CI = 1.758 - 6.228) and performance in life (p 0.012 OR 1.899 CI = 1.151 - 3.135) were predictors of substance abuse.

Conclusion: Gender, religion, alcohol intake, exposure to smoke, presence of medical condition, and performance in life were predictors of substance abuse.

Cultural practices and spirituality militate against effective utilization of healthcare facilities in Sub-Saharan Africa, especially in primary care settings. Spirituality history in clinical practice will help the health professional understand patients' values, religious beliefs, cultural practices, and preferences. It gives insight into proper counseling, and appropriate treatment and serves as an adjuvant to necessary therapeutic approaches. Family and social history have been a recognized feature of clerking patients over the years but effort is hardly been made in exploring their cultural practices and spirituality. This study aimed to Identify attitudes, socio-demographic, and professional predictors towards spirituality history in the management of patients at the Family Medicine department in Rivers State University Teaching Hospital. It was a cross-sectional study conducted over a period of six months, from January to June 2024. Out of 62 participants, 60 fully responded. The data from the questionnaire were entered into an Excel spreadsheet and analyzed using SPSS version 16. The respondents consisted of physicians (n, 55%), nurses (n, 8.3%), and Industrial Training (IT) Students (n, 36.7%). Health professionals within the age bracket of 45 -54 years and above were well willing to take spiritual history as against those within 18 - 24 years age group. Consultant physicians, senior registrars, and nurses with higher years of practice, exposure, and experience in service had a more positive attitude towards spirituality history than the younger ones. Spirituality history in clinical practice will make healthcare culturally acceptable with an increase in the utilization of available healthcare facilities. Training of health professionals in this regard is hereby advocated.

Background: Low immunization coverage in Nigeria accounts for 2.3 million children with zero doses, increasing morbidity and mortality. The government prioritizes 100 local government areas for strategic interventions aiming for a 15% reduction in zero-dose (ZD) children by 2024.

Objective: We set out to track immunization performance, identify priority indicators, estimate coverage, and generate evidence for informed decision-making.

Methods: A cross-sectional study using the validated behavioral and social drivers of immunization (BeSD) and lot quality assurance sampling (LQAs) frameworks was used in Kano, Sokoto, Borno, and Bauchi states that included 4, 028 children across 106 wards.

Findings: The mean age of caregivers was 28 years (SD+ 6 years) - slightly lower in Bauchi 26 years and higher in Borno 30 years. Over 97% had Islam as their religion and married. The prevalence of Zero Dose was 30.7%. About 66% of caregivers had no formal education with 84% of ZD had no education. About 51% of ZD caregivers are not engaged nor have they any source of income. Average Monthly income was found to be 3 times higher in NZD Caregivers than ZD caregivers. Home Delivery was 54% with Sokoto and Kano having 72.5 and 66.4% respectively. However, 71% of ZD Caregivers delivered at Home. Overall, 79% Uptake. ANC uptake was higher amongst NZD Caregivers than ZD caregivers. Sokoto and Kano (Sumaila) had the lowest uptake. About 73% of Sample children received at least one immunization antigen. Sokoto had the least 46%. Penta 1 coverage was at 66% with Bauchi having 77%. About 68.5% of Zero dose caregivers reported little or no intention to be vaccinated with all the childhood vaccines. About 69% of caregivers trust healthcare workers who vaccinate children. 560 (45%) of zero-dose caregivers do not. About 69% of caregiver's vaccinators said payment is "moderately" or "very" easy for the vaccination of their child. 47% of ZD caregivers reported challenges in affording vaccines for their children. Bauchi & Sokoto had the highest number of access challenges. Over 57% of zero dose caregivers live within a short distance (trekkable distance) to an RI service delivery point.

Conclusion/recommendation: Targeted outreach with financial aid, education, community leader engagement, and social support promotion can increase vaccinations. Improving service delivery, accessibility, and clear centre location information is crucial. Keywords: Immunization, Zero-dose children, Vaccine hesitancy, Nigeria.