West African journal of medicine最新文献

Background: Traditionally, delayed primary and secondary wound closure are commonly used for the treatment of open fractures especially before the advent of modern antibiotics. Despite the availability of antibiotics, primary wound closure is still not frequently used even for the treatment of low-energy open tibia shaft fractures especially in developing countries.

Materials and methods: Sixty-four patients with GustiloAnderson type I and II tibia fractures were recruited for this randomized prospective intervention study to compare the infection rate, duration of wound healing, duration of hospital stay, and cost of treatment between primary and delayed primary wound closure. We randomized 68 patients into two blocks of 34 participants each using a randomization plan generated on the website, randomization.com. Each random number in a sealed serially numbered brown envelope. Clinical information and clinical findings were entered into a proforma, and data obtained were analyzed.

Results: The majority of cases, 54 (84.4%), were Gustilo-Anderson type II. The infection rate was higher for primary wound closure (9.6%) than for delayed primary wound closure (3.0%). The mean duration of wound healing was 14.8 (±3.8) days for primary wound closure, which was significantly shorter than the 16.1 (±2.0) days recorded for delayed wound closure (p= 0.08). Also, the mean duration of hospital stay was shorter for patients treated with primary wound closure (4.1 ±3.6) days than for delayed wound closure patients 4.7 (±1.3); with a p value of 0.37. The mean cost of treatment for primary wound closure (N34,487 ±4911.4) was significantly less than that for delayed primary wound closure (N 40,536 ±1709.0), with a p-value of 0.01.

Conclusion: Primary wound closure for low-energy open tibia shaft fractures is both more cost-effective and associated with a shorter time to wound healing compared to delayed primary closure. Therefore, primary wound closure should be used for low energy tibia shaft fracture even in low and middle-income countries. KEY WORDS: Open fracture, Tibia shaft, Wound closure, Management.

Background: Chemotherapy-induced cardiomyopathy is one of the most important adverse effects in cancer treatment. Many chemotherapeutic agents are known to be cardiotoxic, including anthracyclines, monoclonal antibodies, alkylating agents, and protein kinase inhibitors.

Objective: It is intended to indicate a mechanism of multiple cardiac injury after exposure to various chemotherapeutic agents with cardiotoxic potential. This article illustrates the case of a 70-year-old male patient diagnosed with non-Hodgkin's lymphoma with multiple relapses and malignant transformation to diffuse large B-cell lymphoma who received multiple cycles of chemotherapy with periods of complete remission, who presented to the hospital emergency with decompensated reduced ejection fraction heart failure (EF:40%).

Results: During the hospitalization the patient suffered refractory electrolyte imbalances and hospital-acquired infections. Although the patient received hypertonic saline solution, multiple potassium challenges, and extended spectrum antibiotics, the patient passed away.

Conclusion: Exposure to different chemotherapeutic agents with cardiotoxic potential included in non-Hodgkin lymphoma treatment schemes can trigger myocardial injury by different mechanisms. Cardiooncology is a field that is emerging and working on new strategies for the diagnosis, prevention, and management of chemotherapy-induced cardiotoxicity.

Background: Chemotherapy-induced oral changes are common complications after receiving chemotherapy. These complications are often not prioritized in clinical practice, particularly in resource-limited settings like Nigeria. However, they impact patients' quality of life and overall treatment outcomes This study determined the prevalence and types of chemotherapy-induced oral changes, the relationship between chemotherapeutic agents and oral changes, and the associated risk factors.

Methods: An analytical cross-sectional study with a convenience sampling method was designed at the Department of Oral Medicine and Oral Pathology, Obafemi Awolowo University, Osun State, Nigeria. The oral cavity of 82 patients aged 6 years and above who received cancer chemotherapy at the Paediatric Medicine, Haematology, and Surgical Units of the hospital were examined for pathologies associated with chemotherapy.

Results: Dysgeusia was present in 60 (73.17%), oral pain in 47 (57.32%), and oral mucositis (OM) in 44 (53.66%). Forty-two (95.45%) of the total 44 (100%) persons with OM complained of oral pain (p < 0.001), 41 (93.18%) had dysgeusia (p < 0.001), and 31 (70.45%) had fungal infection (p = 0.002). Methotrexate based regimens (MBR) were the most involved in oral changes, with 11 (91.67%) out of 12 having dysgeusia (p ≤ 0.001), 11 (91.67%) had oral pain(p=0.073), and 10 (83.33%) had mucositis (p=0.012). Age was not associated with oral changes (p =0.755), likewise cancer duration (p=0.483) and type of cancer (p=0.353). Multivariate analysis identified mucotoxic drugs (OR 3.6, CI 1.37, 9.19, p=0.009) and solid tumours (OR 2.5, CI 1.04, 6.02, p=0.040) as risk factors for severe OM.

Conclusion: Chemotherapy-induced oral changes are prevalent among patients with cancer. Mucotoxic agents and solid tumours are risk factors for severe mucositis. Early identification and prioritizing of oral care strategies are crucial to improving quality of life and treatment outcomes, particularly in resource-limited settings.

Introduction: Sickle Cell Anaemia (SCA) is the homozygous state of heamoglobin SS gene. It is highly prevalent in Sub-saharan Africa with Nigeria ranking highest for people living with the disease. Blood pressure recording in individuals with SCA has been known to be influenced by certain factors such as age, sex, body mass index and hemoglobin level.

Aim: The study seeks to examine the relationship of certain pre-selected factors -age, gender, body mass index, disease severity and microalbuminuria/proteinuria on the blood pressure of children with SCA and document the relationship (if any) between above factors and the blood pressure readings of Nigerian children with SCA.

Methodology: A cross-sectional hospital-based study that consecutively recruited 106 children with sickle cell anaemia (HbSS) aged 3-17 years in steady state as well as age and sex-matched controls with HbAA genotype. Sociodemographic, clinical and anthropometric parameters were obtained. Severity of the disease and renal complication were assessed using Adeleke scoring method and microalbuminuria/ proteinuria assay. Subjects in crisis or had crisis in the past 4 weeks or genotype HbSC were excluded. For controls (genotype AA), those on management for congenital heart disease (CHD), hypertension and renal pathology were excluded.

Results: Weight and body mass index (BMI) were significantly lower in subjects compared to controls (p = 0.010 & 0.029 respectively). In subjects, the most common clinical attributes at presentation was bone pain (31.1% subjects), previous hospital admission (74.5%) and known steady state PCV (33.9%). Most of the subjects (87.74%) had mild SCA disease severity. Only two subjects (1.8%) had elevated BP while one subject (0.9%) had hypertension.Microalbuminuria (28.2%) and proteinuria (13.2%) were seen in subjects. While one control had elevated BP, none had hypertension. There was an initial positive relationship between increasing age (p= 0.007), low BMI (p= 0.008), presence of microalbuminuria/ proteinuria (Renal injury) p= 0.03 and raised blood pressure,but none of these associations was found to be an independent predictor of hypertension.

Conclusion/ recommendation: Elevated diastolic blood pressure and diastolic hypertension in children with SCA were shown to have an initial positive association with increasing age, low BMI and renal injury. These should be guarded against by instituting screening program and measures to stall progression.

Background: Wrong-site surgery (WSS) is the most frequent sentinel event, accounting for 13.4 % of all sentinel events, with an incidence of 0.09 - 4.5 per 10,000 surgeries. Adherence to recommendations for surgical site marking to prevent WSS remains poor, with paucity of data on WSS due to underreporting.

Methods: The first institutional audit of preoperative site marking in Nigeria was prospectively conducted in the 11 surgical and obstetrics and gynecology units of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, between March-April 2024. Data obtained was analysed using the Statistical Product and Service Solutions (SPSS) version 25. Associations between surgical characteristics and operative site marking were ascertained using chi square, with the level of significance set at a P value of <0.05.

Results: Surgical site marking was done for only 36.4 % of surgeries involving laterality. Surgical site was marked in 90.2 % of cases by junior resident doctors (RDs) and nurses, and paper tape was used for marking in 92.2 % of cases. There were significant associations between surgical site marking and surgical specialty (P<0.001) and urgency of surgery (P=0.001), with ophthalmology (94.0 %) and general (17.6 %) surgeries, elective surgeries (41.8 %), consultant/attending-led surgeries (41.1 %), and major surgeries (43.8 %) involving laterality being significantly more likely to be marked compared to emergency (0.0 %), RD-led (29.3 %) and minor (30.3 %) surgeries.

Conclusion: The practice of surgical site marking in OAUTHC is low. There is need for institutional and national protocols on surgical site marking and the education of surgical and theatre staff on its benefits, to engender a change of practice for patient safety.

Background: Oral mucositis (OM) is a debilitating complication commonly experienced by patients undergoing chemotherapy and/or radiotherapy for head and neck cancers. The pathogenesis of OM involves multifaceted interplay of inflammatory, immune, and cellular damage pathways triggered by cancer therapy. The pathogenesis of OM can be delineated into five overlapping phases: initiation, signaling, signal amplification, ulceration, and healing.

Metabolomics: The large-scale study of metabolites which are small molecules involved in cellular processes, has emerged as a powerful tool in understanding complex conditions like oral mucositis (OM). This detailed literature review synthesizes current knowledge on the metabolomics of OM, with a focus on its application to understanding the pathogenesis, identifying predictive biomarkers, and exploring therapeutic strategies.

Conclusion: The field of metabolomics has revolutionized the understanding of oral mucositis by providing a dynamic snapshot of the metabolic alterations associated with it. It is a powerful tool for identifying potential biomarkers for early diagnosis, monitoring, and treatment optimization.

Background: Although, survival rates have improved in breast cancer care, cardiotoxicity from chemotherapy used for breast cancer has emerged as an important cause of morbidity in these individuals. This study evaluated early myocardial dysfunction using two-dimensional (2D) speckle tracking echocardiography in breast cancer patients treated with anthracyclines.

Methodology: Sixty-two patients with anthracycline naïve breast cancer and 62 controls were studied. All patients were treated with standard regimens containing epirubicin. Echocardiography was done at three time points (baseline, one month and three months). Left ventricular ejection fraction and global longitudinal strain were measured.

Results: The mean age of the subjects was 47.6±10.46 years, obesity was the most common co-morbidity (27.4%) followed by hypertension (14.5%). Over the three month-follow-up period, the left atrial volume increased from 21.4±6.90mls/m2 at baseline to 24.8±6.38mls/m2, the mean left ventricular ejection fraction decreased from 62.4±9.35% at baseline to 54.8±7.22%, and the average left ventricular global longitudinal strain decreased from -19.0±5.91% at baseline to -16.1±3.70% by three month-follow-up. The percentage change in GLS at one month was 15.98% compared to 4.06% change in ejection fraction at one month follow-up. Thirty-five patients (56.5%) developed cardiotoxicity; however, no significant predictor of cardiotoxicity was noted.

Conclusion: This study showed reduced left ventricular ejection fraction, reduced left ventricular global longitudinal strain, and increased left atrial volume over a period of three months in breast cancer patients treated with anthracycline-based chemotherapy. It also confirms the usefulness of speckle tracking echocardiography in evaluating breast cancer patients pre-, intra-, and post-chemotherapy.

BACKGROUND: Kartagener Syndrome is a rare autosomal recessive genetic disorder, belonging to the larger group of diseases of primary ciliary dyskinesia, including situs inversus. This underdiagnosed disease, especially in developing settings, may be potentially responsible for the impairment of the quality of life of patients and can even be life-threatening. We report on two patients with this condition in Benin, in whom the diagnosis had not previously been made, despite a long history of upper and lower respiratory symptoms. The patients were admitted with complications, a superinfection of bronchiectasis complicated by pneumonia and purulent pleurisy in a 30-year-old male and by a refractory hypoxemia, acute pulmonary heart disease in another 32-year-old male. Treatment outcome was favourable in the first case, but less satisfactory in the second one.

Background: Coronary artery fistulas (CAFs) are rare defects in the coronary circulation with majority being asymptomatic. A coronary cameral fistula (CCF) is a type of CAFs with an abnormal communication with a cardiac chamber. It is often diagnosed while patients are being investigated for coronary artery disease and diagnosis requires high index of suspicion especially in patients with angina with no obstructive lesions. Symptomatic cases have variable clinical manifestation which depends on the size, origin and drainage site. Coronary computerised tomographic angiography (CCTA) has emerged as investigation of choice in investigating CAFs due to its high spatial and temporal resolution facilitating accurate assessment of the complex anatomy of CAFs. Treatment strategy for CCF is individualised with consideration for its symptomatology, haemodynamic significance and potential complication. Early diagnosis and treatment can improve outcomes in symptomatic patients.

Case report: We report the first case of coronary cameral fistula in Nigeria diagnosed by angiography and confirmed by coronary CTA. The patient was managed conservatively with antiplatelets and long-acting nitrates and monitored closely at outpatient follow up.