West African journal of medicine最新文献

Introduction and objectives: Erectile dysfunction (ED) is common among men over 40years and prevalence increases with age. ED occurs at an earlier age in the diabetic population and strongly associated with serum testosterone, age, hypertension and obesity. The aim of this study was to determine the predictors of ED among type 2 diabetic Nigerian men.

Materials and methods: A cross-sectional hospital-based study done among patients with ED and diabetes. ED was assessed using International Index of Erectile Function (IIEF) 5 questionnaire. Age, BMI serum testosterone, glycosylated haemoglobin and fasting lipid profile were measured in each group.

Results: A total of 102 participants were recruited; 51 participants in each study group. Majority, were >55 years in the diabetic and non-diabetic groups respectively (p = 0.456). The BMI and the waist circumference of the two groups showed statistically significant difference (0.006 and 0.007 respectively). The weight, hip circumference and waist/hip ratio of the two groups showed no statistical significance. The median value of serum testosterone for the non-diabetic group (622.2ng/ml) was significantly higher than the diabetic group (288ng/ml) (p=0.001). Multivariate logistic regression analysis showed increased risk of ED in diabetic patients aged > 60years ( OR 4.9), serum testosterone <270ng/ml (OR 3.8), hypertension (OR 2.93), fasting blood glucose (FBS) >125mg/dl (OR 2.6), low density lipoprotein (LDL) > 160mg/dl (OR 6.3) and triglyceride >150mg/dl (OR 2.9).

Conclusion: The study showed that age, serum testosterone, hypertension, elevated FBS and dyslipidaemia are independent predictors of ED among type 2 diabetic men.

Background: Malocclusion is an abnormality of teeth alignment from interactions of hereditary and environmental factors, associated with stimuli present at the period of formation and development of the face and oral tissues.

Objectives: To determine the prevalence and determinants of malocclusion among preschool children in Maiduguri, Borno State.

Methods: This study involved 239 pre-school children selected by systematic random sampling. The independent variables were 'presence / absence of sucking habits', 'type of sucking habit', 'molar relationship' and 'nutritional status. The dependent variable was presence of malocclusion and 'type of malocclusion. Frequency distribution of independent and dependent variables were presented. Association between the independent and dependent variables were obtained using Chi-Square test. Statistical significance was placed at 95% confidence intervals, p value ≤ 0.05. Data was analysed using SPSS for Windows (version 23).

Results: Majority of participants were in the higher social class, (P=0.07), never had a dental visit (78.2%), P=0.08 and did not have any sucking habit (82.4%), P= 0.03. Most had mesial step (42.7%) or flush terminal molar relationship (37.7%), P=0.05. Prevalence of malocclusion was 4.5%, majority were cross bite (64.4%) SE=0.04. Distal step and flush terminal molar relationship were associated with prevalence of malocclusion (12.5% and 4.4% respectively), P=0.08.Fifty percent of those with digit sucking habit had cross bite, P=0.01.

Conclusions: Prevalence of malocclusion among preschool children in this study was low and majority had cross-bite. Digit sucking was significantly associated with cross bite. Children with distal step occlusion exhibited higher proportion of malocclusion. There is need for dental awareness on malocclusion among the population.

Objective: To compare the effectiveness of two oral health educational (OHE) methods in improving the oral health status of adolescents in Lagos State.

Methods: A cluster-randomized controlled trial involving 220 adolescents in selected Lagos State secondary schools in Nigeria was conducted. Structured oral health education was delivered didactically to two intervention groups (T1 and T2). Additionally, (T2) received regular weekly oral health messages via WhatsApp and Facebook for three months. The third (control) group (T3) received nothing. OHI-S scores and DMFT findings were recorded following WHO standards, and oral health knowledge and practice were assessed using a questionnaire on Day 1, and subsequently at 1, 3, 6, and 12 months. The statistical test included a Student's t-test, ANOVA, and chi-square test. The critical significance level was set at p < 0.05, and the confidence interval at 95%.

Results: Of 220 participants, 88 were males, and females constituted 132, with a mean age of 16.11±0.6 years. The mean OHI-S score at baseline was 0.76±0.44, 0.80±0.59, and 0.81±0.52 in intervention 1(T1), 2(T2) and control (T3) groups respectively. There was no significant difference between the three groups at various periods (F>0.05), though the group with social media reinforced oral hygiene messages had a significant improvement in oral hygiene at the end of the study. There was a good level of oral health knowledge, but oral health practice was poor in the three groups (T1)74.7%, 51.8%, (T2)80.7%, 66.3%, (T3)72.2%, 51.9%) respectively, with no significant difference between them at the beginning, and end of the study. Similarly, there was no significant difference in the mean DMFT of the three groups at the beginning and end of the study.

Conclusion: OHE using the didactic and social media-reinforced mode of delivery was just as effective as the didactic method alone in improving the oral health status of adolescent school children in Lagos State.

Background: Effective pain relief after caesarean section (CS) is desirable but pentazocine which has been a common component of multimodal analgesia may delay early mobilization and mother-child interaction due to its side effects.

Objective: This study compared the efficacy of paracetamol-diclofenac with pentazocine-diclofenac for post- CS analgesia.

Methods: A double-blind randomized controlled trial of three hundred and eighteen consenting parturients who had elective or emergency caesarean section were randomly assigned to two groups. A total of 159 participants were assigned to each group: one group received 750 mg of intravenous paracetamol, while the other received 30 mg of intravenous pentazocine. Both also had 100 mg of rectal suppository diclofenac as multimodal post-caesarean section analgesia in the first 24 hours after surgery. Post-operative pain was assessed by a visual analogue scale six hourly post-operatively. Data obtained was analysed using SPSS 26 and statistical significance was at p < 0.05. The study is registered with the Pan African Clinical Trials Registry with trial number PACTR202501703002153.

Results: The median pain scores in both groups ranged from 2.5 to 4 across all periods of assessment. However, at the first assessment conducted at six hours post-operatively, the scores were higher-4.5 in the pentazocine-diclofenac arm and 5 in the paracetamol-diclofenac arm. Pain relief was slightly better in the pentazocine-diclofenac group, but this was not statistically significant. The pentazocine-diclofenac group experienced significantly more side effects, specifically nausea and drowsiness, compared to the paracetamol-diclofenac group (P < 0.001). Patient satisfaction with pain relief was not significantly different between both groups (p=0.101).

Conclusion: Pentazocine-Diclofenac provided better analgesia than Paracetamol-Diclofenac in the first 24 hours after caesarean section but was associated with more side effects.

Background: Triple-negative breast cancers (TNBC) have been particularly challenging to manage due to their lack of intrinsic cellular receptors and a consequent lack of targetable therapy. Recently, the programmed cell death 1/programmed cell death ligand 1 (PD-1/PD-L1) immune checkpoint pathway has become the focus of immunotherapy in general, and especially for TNBCs. This study aimed to determine the pattern of expression of PD-L1 in TNBC cases in Benin City.

Methods: Formalin-fixed, Paraffin-embedded tissue blocks of TNBC cases diagnosed in the Department of Anatomical Pathology, University of Benin Teaching Hospital, Benin City, Nigeria from 1st January, 2017 to 31st December, 2019 were re-sectioned for PD-L1 immunohistochemistry.

Result: Ninety-two cases of TNBCs were tested for PD-L1 expression. Thirteen (14.1%) of the TNBC cases were PD-L1 positive of varying degrees in tumour cells. Diffuse tumoural PD-L1 staining was seen in four (30.8%) of the PD-L1 positive cases. PD-L1 expression was significantly associated with increasing age up to the fifth decade (p =0.030). All the PD-L1 positive TNBCs were invasive breast carcinomas of no special type and mostly grade 2 tumours; however, there was no significant association between PD-L1 expression and histological subtype or grade.

Conclusion: PD-L1 expression was shown to occur at a relatively lower rate among TNBC cases in this southern region of Nigeria, and was significantly associated with increasing age. About 14.1% (1 in 7) of our TNBC patients could potentially benefit from immune checkpoint inhibitor therapy. We therefore recommend further PD-L1 immunohistochemistry assay for TBNC cases and the use of appropriate immune therapy when indicated.

Background: The 'Boko Haram insurgency' is one of the most devastating armed conflicts that the Nigerian State has experienced in the post-civil war era. The quantum of destruction in terms of lives and property is beyond rational comprehension as it left in its trail both physical and psychological traumata. Post-traumatic stress disorder (PTSD) is one of the psychological sequelae of violent conflicts globally, with prevalence rates of up to 72% in sub-Saharan Africa.

Objectives: The main objectives of this study were to assess the prevalence rate of PTSD as well as to examine its psychosocial correlates among the residents of Maiduguri, which is the epicentre of the armed insurrection.

Methods: This was a multi-staged, cross-sectional, community-based random study conducted among the residents of Maiduguri. A total of 378 residents of Maiduguri Metropolitan Council were interviewed in 2017, eight years after the onset of the insurgency. Predesigned Sociodemographic Proforma, Modified version of the Communal Traumatic Events Inventory (CTEI), PTSD checklist civilian version (PCL-CV), PTSD Module of the Composite International Diagnostic Interview (CIDI), Rosenberg Self-Esteem scale (RSES), and the Connor-Davidson Resilience Scale (CD-RISC) were administered. Bivariate analyses were used to explore the associations between the psychosocial variables and PTSD diagnosis, while Binary logistic regression was conducted to determine the independent predictors of PTSD.

Results: The prevalence of PTSD among the residents of Maiduguri was 54.49% using the PTSD Module of CIDI. The study also found that 57.2% (CI 53.4 - 60.1) of the study participants had experienced between 5 to 10 traumatic events. PTSD was significantly associated with; gender, exposure to multiple traumatic events (P <0.001), history of Abuse (p = 0.032), lower self-esteem (p <0.001), and lower levels of resilience (p <0.001).

Conclusion: Sub-syndromic PTSD was experienced by over two-thirds of the study participants, while over 50% of them had CIDI-diagnosable and clinically matched PTSD based on the ICD-10 criteria. This study, therefore, recommends the need for the incorporation of mental health and psychosocial support and the prioritization of the mental health of populations exposed to any form of armed insurrection.

Adolescents form a key subgroup of the population of People Living with HIV and studies have shown relatively poorer viral suppression rates in this population compared with their adult counterparts. Factors including physical, physiological and psychological changes associated with this phase of development significantly influence their viral suppression. Over time, interventions such as Enhanced Adherence Counseling (EAC) that is provided to unsuppressed clients have improved viral suppression amongst Adolescents Living with HIV (ALHIV). This case series reports 11 adolescent clients with unsuppressed viral load outcomes (>1000 copies/ml) who were offered Enhanced Adherence Counseling by multiple skilled EAC providers over a period of 3 to 5 months. Descriptive statistics including final viral load outcomes were summarized. The 11 unsuppressed adolescent clients had a mean age of 15.36 years. Majority were female (81.8%), Christians (54.5%) and had at least primary education (90.9%). Most of them (90.9%) had a fair knowledge of their status and the basis of their treatment and live in a primary family setting (63.6%) - with their biological parent(s). All participants had recent high viral load results and some (54.5%) had a recurring history of viral un suppression in the past. After EAC services were provided by multiple EAC providers; 10 (90.9%) of the 11 unsuppressed adolescents achieved viral re-suppression. Multiple provider EAC techniques may yield improved treatment outcomes amongst ALHIV.

Background and objectives: Work-related stress has been described as a global epidemic of the 21st century. University lecturers are observed to be exposed to various degrees of occupational stress which influence their multiple roles to impart knowledge and skills to students. This study assessed the prevalence of work-related stress and the factors influencing it among university lecturers in Lagos.

Methods: A cross-sectional study design among 424 respondents using a multi-stage sampling technique was conducted. Work Stress Questionnaire (WSQ) tool, covering 4 main domains, (Influence at work, Indistinct organization and conflict, Individual demand and commitment, & Leisure time interference) was used to assess work-related stress among university lecturers in LASU, Ojo, Nigeria. Data was collected with KoboCollect app using an interviewer-administered questionnaire, and analyzed using SPSS software version 25 software. Data was presented using descriptive (percentages, summary measures) and inferential statistics (Chi-square test). Level of statistical significance set at p-value<0.05.

Results: Mean age of respondents was 49.9+8.2SD years. Male respondents were twice as more than female respondents. Majority (93.4%) of respondents were married and average work experience was 16.7+8.6SD years. Overall prevalence of work-related stress was (80.5%). However, stress due to leisure time interference was (36.1%). There was a statistically significant association between work-related stress and family size(p<0.05), gender(p<0.05), marital status(p<0.05) and work experience(p<0.05).

Conclusion: The prevalence of work-related stress was high. High family size, male gender, being single and shorter work experience, were statistically significantly associated with work-related stress. Adequate awareness of work-life balance measures should be entrenched with enabling environment.

Background: Hypoestes rosea, an endemic shrub in Nigeria and Cameroon with documented anti-inflammatory properties, has been shown to modify disease progression in transgenic mouse models with Parkinson's Disease PD. We investigated the efficacy and side effect profile of Hypoestes rosea (Peko-D forte) in improving motor performance of PD patients.

Methods: This double-blind, randomized, placebo-controlled, proof-of-concept (phase I) study involved 19 patients with mild to moderate PD. Routine dopaminergic therapy was maintained. Following randomization, half of the patients received 4 capsules each of 350 mg Peko-D forte tablets, and the other half, 4 capsules of matching placebo (USP-grade starch) for 8 weeks. After a wash-out period of 4 weeks, patients were switched over (cross-over design). The effects of the medication on motor activity were analyzed using the Unified Parkinson's Disease Rating Scale (UPDRS).

Results: Overall, 14 patients completed the study, comprising 93% males with a mean age of 72 (13.2) years. Their median (IQR) UPDRS score at baseline of 18 (13-20) improved significantly with both Peko-D forte 12 (6 - 16) and placebo 12.5 (9- 15) (p<0.001). Compared to baseline, Peko-D forte improved bradykinesis, rest tremor amplitude and frequency, and rigidity. There was no significant difference between the median UPDRS score with the use of Peko-D forte compared to placebo. The test drug had 93% tolerability with a good side effect profile.

Conclusion: Peko-D forte improved motor functions in PD, and it is safe and tolerable. Its efficacy is unclear due to the lack of significant difference between the test drug and placebo. Larger studies will be needed to confirm its efficacy. Clinical Trials.org (NCT04858074).