Background: The policies and methods for preliminary evaluation of Mycobacterium tuberculosis (MTB) are evolving as TB becomes resistant to drugs worldwide. Evaluating the effectiveness of New GeneXpert as a first-line protocol for replacing AFB/ZN microscopy in TB evaluation for more system future rollout was paramount for effective TB detection. Aim: The research was a retrospective analytical cohort study, evaluating the detection rates of MTB using Direct-AFB microscopy and GeneXpert among samples from TB suspects. Materials and Methods: Data were collated from the National TB and Leprosy Control Programme register and laboratory records. The study period was from February 2015 to October 2017. The study period was divided into three, 11 months each, representing different preliminary testing policy. Proportions and rates were determined using Microsoft Excel and Chi-square analysis. A P ≤ 0.05 was considered statistically significant. Results: A total of 1931 sample results were analyzed, of which 99.9% were sputum. Nearly 502,578 and 177 samples underwent AFB/ZN microscopy technique, whereas 0, 40, and 634 samples underwent GeneXpert for the respective three cohort periods. The results showed that MTB was present at rates of 8.17%, 5%, and 3.39% for ZN, whereas GeneXpert was 15% and 12.6% for the 2nd and 3rd cohort periods only. In addition, 10% detected by GeneXpert were rifampicin drug resistant, and 50% (4) were placed on therapy for resistant strain GeneXpert improved TB detection significantly. Conclusion: GeneXpert could improve the detection of MTB/RIF strains in developing countries through partnership and global funding for TB/ART centers.
{"title":"Analytical evaluation of Mycobacterium tuberculosis detection in a local comprehensive tuberculosis center following the introduction of genexpert: A cartridge-based nucleic acid amplification test","authors":"George Duke Mukoro, WandaliArhyel Dibal","doi":"10.4103/njm.njm_114_22","DOIUrl":"https://doi.org/10.4103/njm.njm_114_22","url":null,"abstract":"Background: The policies and methods for preliminary evaluation of Mycobacterium tuberculosis (MTB) are evolving as TB becomes resistant to drugs worldwide. Evaluating the effectiveness of New GeneXpert as a first-line protocol for replacing AFB/ZN microscopy in TB evaluation for more system future rollout was paramount for effective TB detection. Aim: The research was a retrospective analytical cohort study, evaluating the detection rates of MTB using Direct-AFB microscopy and GeneXpert among samples from TB suspects. Materials and Methods: Data were collated from the National TB and Leprosy Control Programme register and laboratory records. The study period was from February 2015 to October 2017. The study period was divided into three, 11 months each, representing different preliminary testing policy. Proportions and rates were determined using Microsoft Excel and Chi-square analysis. A P ≤ 0.05 was considered statistically significant. Results: A total of 1931 sample results were analyzed, of which 99.9% were sputum. Nearly 502,578 and 177 samples underwent AFB/ZN microscopy technique, whereas 0, 40, and 634 samples underwent GeneXpert for the respective three cohort periods. The results showed that MTB was present at rates of 8.17%, 5%, and 3.39% for ZN, whereas GeneXpert was 15% and 12.6% for the 2nd and 3rd cohort periods only. In addition, 10% detected by GeneXpert were rifampicin drug resistant, and 50% (4) were placed on therapy for resistant strain GeneXpert improved TB detection significantly. Conclusion: GeneXpert could improve the detection of MTB/RIF strains in developing countries through partnership and global funding for TB/ART centers.","PeriodicalId":52572,"journal":{"name":"Nigerian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49408611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pott's disease also known as tuberculosis (TB) spondylitis is the most dangerous form of musculoskeletal TB. It is associated with neurological deficits. Multiple myeloma (MM) is characterised by bone degradation and suppression of the immune system. It often presents itself as bone pain and anaemia. Coexistence of Pott's disease and TB is a rare occurrence. However, we present a patient with persistent back pain and anaemia, who was initially diagnosed with TB. Despite treatment with anti-TB medication for six months, he developed bone pains, lower limb numbness, and pallor. On radiographic, laboratory, and pathologic investigations, MM with Pott's disease was diagnosed. This case points out the fact that MM may coincide with active or recurrent TB. Due to the similarity of their clinical symptoms, one of them may be ignored, and this will lead to serious complications for the patient.
{"title":"Pott's disease and multiple myeloma in the bone marrow: A rare coincidence","authors":"E. Osho, P. Osho, O. Oluwatosin","doi":"10.4103/njm.njm_72_22","DOIUrl":"https://doi.org/10.4103/njm.njm_72_22","url":null,"abstract":"Pott's disease also known as tuberculosis (TB) spondylitis is the most dangerous form of musculoskeletal TB. It is associated with neurological deficits. Multiple myeloma (MM) is characterised by bone degradation and suppression of the immune system. It often presents itself as bone pain and anaemia. Coexistence of Pott's disease and TB is a rare occurrence. However, we present a patient with persistent back pain and anaemia, who was initially diagnosed with TB. Despite treatment with anti-TB medication for six months, he developed bone pains, lower limb numbness, and pallor. On radiographic, laboratory, and pathologic investigations, MM with Pott's disease was diagnosed. This case points out the fact that MM may coincide with active or recurrent TB. Due to the similarity of their clinical symptoms, one of them may be ignored, and this will lead to serious complications for the patient.","PeriodicalId":52572,"journal":{"name":"Nigerian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45616325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Kiridi, P. Oriji, C. Okechukwu, A. Ubom, Datonye Briggs, J. Ugwoegbu, P. Bosrotsi, A. Addah, I. Abasi, A. Adesina
Background: With the invention of more sophisticated ultrasonography techniques, there is room to explore and better comprehend the link between gestational age (GA), fetal weight (FW), and the diameter of the umbilical vein (UV). Aim: To explore the relationship between umbilical vein diameter (UVD) and GA as well as FW in normal pregnancy. Materials and Methods: This descriptive, cross-sectional study was conducted between February and August 2022 at the obstetric units and radiology departments of two tertiary health facilities: one secondary facility and one radiodiagnostic facility in the state. A transabdominal ultrasound scan was used to assess the UV. The relationship between UVD and GA and between UVD and estimated fetal weight (EFW) was explored using Pearson's correlation analysis. A nomogram was constructed, and the level of significance was set at P < 0.05. Results: There was a very strong, positive and significant relationship between UVD and GA (r =0.63; P = 0.001) and between UVD and EFW (r = 0.57; P = 0.001). For every unit change in GA, there was a 39% change in UVD (r2 = 0.39), while every unit change in FW was associated with a corresponding 33% change in UVD (r2 = 0.33). The regression coefficients for GA were 0.257 (β0) and 0.015 (β1), while β0 and β1 for FW were 0.590 and 0.069, respectively. Conclusion: Our study revealed a very strong, positive and significant relationship between UVD and GA and between UVD and EFW.
{"title":"Ultrasound measurement of umbilical vein diameter in normal pregnancy and correlation with gestational age and fetal weight","authors":"E. Kiridi, P. Oriji, C. Okechukwu, A. Ubom, Datonye Briggs, J. Ugwoegbu, P. Bosrotsi, A. Addah, I. Abasi, A. Adesina","doi":"10.4103/njm.njm_104_22","DOIUrl":"https://doi.org/10.4103/njm.njm_104_22","url":null,"abstract":"Background: With the invention of more sophisticated ultrasonography techniques, there is room to explore and better comprehend the link between gestational age (GA), fetal weight (FW), and the diameter of the umbilical vein (UV). Aim: To explore the relationship between umbilical vein diameter (UVD) and GA as well as FW in normal pregnancy. Materials and Methods: This descriptive, cross-sectional study was conducted between February and August 2022 at the obstetric units and radiology departments of two tertiary health facilities: one secondary facility and one radiodiagnostic facility in the state. A transabdominal ultrasound scan was used to assess the UV. The relationship between UVD and GA and between UVD and estimated fetal weight (EFW) was explored using Pearson's correlation analysis. A nomogram was constructed, and the level of significance was set at P < 0.05. Results: There was a very strong, positive and significant relationship between UVD and GA (r =0.63; P = 0.001) and between UVD and EFW (r = 0.57; P = 0.001). For every unit change in GA, there was a 39% change in UVD (r2 = 0.39), while every unit change in FW was associated with a corresponding 33% change in UVD (r2 = 0.33). The regression coefficients for GA were 0.257 (β0) and 0.015 (β1), while β0 and β1 for FW were 0.590 and 0.069, respectively. Conclusion: Our study revealed a very strong, positive and significant relationship between UVD and GA and between UVD and EFW.","PeriodicalId":52572,"journal":{"name":"Nigerian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48472752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David T. Ejenobo, N. Ameh, Joseph M. Otubu, B. Ola, I. Wada, A. Onuh
Background: Poor ovarian reserve has been shown to be associated with poor outcomes of in-vitro fertilization (IVF) treatment. Women who can be reliably identified as expected poor responders can be advised on chances of poor outcomes that may dissuade them from wasting resources on IVF using their own eggs; and offered donor eggs, especially in a resource-poor country like Nigeria. Many centres routinely perform basal follicle-stimulating hormone (FSH) assay before IVF; however, basal antral follicle count (AFC) has emerged as a more reliable test of ovarian reserve that can be provided at a reduced cost compared to FSH in an IVF clinic setting. The determined predictive values of basal AFC compared to FSH in Nigerian women can be used to predict poor ovarian response during IVF treatment; and also to influence local clinical practice in IVF by offering a more reliable and affordable test, thereby avoiding wastage due to duplicate and unnecessary investigations. Aim: The aim is to determine the diagnostic accuracy of basal AFC compared to basal FSH for the prediction of ovarian response during the IVF cycle in Nigerian women. Patients, Materials and Methods: This was a hospital-based prospective comparative study in two private fertility centres in Abuja. Consecutive 166 women that underwent IVF treatment cycles who met the inclusion criteria were recruited. On day 2 to day 4 of a normal cycle, FSH assay and AFC using the Broekmans' systematic process were done. They had controlled ovarian hyperstimulation by antagonist or agonist and occasionally long protocols. The poor response was defined as <4 follicles of >17 mm on the day of human chorionic gonadotropin trigger or ≤3 oocytes retrieved. Receiver operating characteristics (ROC) analysis was done to determine the level of the area under the curve (AUC) and optimum cut-off values of FSH and AFC in predicting poor ovarian response. Results: Twenty-eight (16.9%) had poor responses. ROC analysis demonstrated that AFC had the largest (AUC = 0.707, P = 0.001) relative to FSH (AUC = 0.591, P = 0.128). The ROC analysis showed that the optimum cut-off value for the prediction of poor response for AFC was ≤10, which had a higher accuracy of 67.5%, while for FSH was ≥8.15 mIU/ml with a lower accuracy of 61.5%. They both had the same sensitivity of 60.7%; however, AFC had better specificity, negative and positive predictive value, and higher odds ratio for the prediction of poor ovarian response. The positive and negative likelihood ratios of both cut-off values suggest that they may not be useful as diagnostic tests. Conclusion: ROC analysis estimated that AFC more accurately predicts poor ovarian response by its larger and more significant AUC compared to FSH in our population of women.
{"title":"Prediction of poor ovarian response during In vitro fertilization in Nigerian women: A comparison of basal antral follicle count and follicle-stimulating hormone","authors":"David T. Ejenobo, N. Ameh, Joseph M. Otubu, B. Ola, I. Wada, A. Onuh","doi":"10.4103/njm.njm_18_22","DOIUrl":"https://doi.org/10.4103/njm.njm_18_22","url":null,"abstract":"Background: Poor ovarian reserve has been shown to be associated with poor outcomes of in-vitro fertilization (IVF) treatment. Women who can be reliably identified as expected poor responders can be advised on chances of poor outcomes that may dissuade them from wasting resources on IVF using their own eggs; and offered donor eggs, especially in a resource-poor country like Nigeria. Many centres routinely perform basal follicle-stimulating hormone (FSH) assay before IVF; however, basal antral follicle count (AFC) has emerged as a more reliable test of ovarian reserve that can be provided at a reduced cost compared to FSH in an IVF clinic setting. The determined predictive values of basal AFC compared to FSH in Nigerian women can be used to predict poor ovarian response during IVF treatment; and also to influence local clinical practice in IVF by offering a more reliable and affordable test, thereby avoiding wastage due to duplicate and unnecessary investigations. Aim: The aim is to determine the diagnostic accuracy of basal AFC compared to basal FSH for the prediction of ovarian response during the IVF cycle in Nigerian women. Patients, Materials and Methods: This was a hospital-based prospective comparative study in two private fertility centres in Abuja. Consecutive 166 women that underwent IVF treatment cycles who met the inclusion criteria were recruited. On day 2 to day 4 of a normal cycle, FSH assay and AFC using the Broekmans' systematic process were done. They had controlled ovarian hyperstimulation by antagonist or agonist and occasionally long protocols. The poor response was defined as <4 follicles of >17 mm on the day of human chorionic gonadotropin trigger or ≤3 oocytes retrieved. Receiver operating characteristics (ROC) analysis was done to determine the level of the area under the curve (AUC) and optimum cut-off values of FSH and AFC in predicting poor ovarian response. Results: Twenty-eight (16.9%) had poor responses. ROC analysis demonstrated that AFC had the largest (AUC = 0.707, P = 0.001) relative to FSH (AUC = 0.591, P = 0.128). The ROC analysis showed that the optimum cut-off value for the prediction of poor response for AFC was ≤10, which had a higher accuracy of 67.5%, while for FSH was ≥8.15 mIU/ml with a lower accuracy of 61.5%. They both had the same sensitivity of 60.7%; however, AFC had better specificity, negative and positive predictive value, and higher odds ratio for the prediction of poor ovarian response. The positive and negative likelihood ratios of both cut-off values suggest that they may not be useful as diagnostic tests. Conclusion: ROC analysis estimated that AFC more accurately predicts poor ovarian response by its larger and more significant AUC compared to FSH in our population of women.","PeriodicalId":52572,"journal":{"name":"Nigerian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46519019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Umeh, C. Ogbuagu, C. Okafor, V. Abhulimen, Joseph Abiahu, A. Biambo, A. Isah, O. Ekwunife
Aims: We conducted a cost-benefit analysis of a population-based prostate-specific antigen (PSA) mass testing for prostate cancer (PCa) from a provider's perspective to give further insights into the programme's sustainability at scale-up. Materials and Methods: A cross-sectional study design was adopted. The cost and benefit of the population-based-specific antigen mass testing were estimated using activity-based costing and participants' willingness to pay (WTP), respectively. The study was conducted in a primary health-care facility in Anambra State, Nigeria. A total of 412 asymptomatic males between 40 and 74 years who had not had a PSA screening within the past five years were recruited for the study. A one-month population-based PSA mass screening for PCa was performed at the primary health-care facility. The cost of population-based PSA mass testing was presented as cost/male screened while benefit was measured as the participants' minimum WTP analysis amount. Benefit-cost ratio (BCR) served as the primary outcome, with values higher than one signifying a self-sustainable programme. Results: The cost/male screened was USD 13.43 ± 2.26, while the participants' WTP amount of US$3.99 ± 4.49 to calculate the BCR gave a BCR ratio of 0.3. Conclusion: The estimated BCR showed that the programme would not be sustainable if funding were based solely on participants' out-of-pocket expenses. Other financing mechanisms, such as donor funds, will be necessary to sustain such public health programmes in Nigeria.
{"title":"Cost-benefit analysis of a population-based prostate-specific antigen mass testing for early detection of prostate cancer in Anambra State, Nigeria: A health provider's perspective","authors":"I. Umeh, C. Ogbuagu, C. Okafor, V. Abhulimen, Joseph Abiahu, A. Biambo, A. Isah, O. Ekwunife","doi":"10.4103/njm.njm_122_22","DOIUrl":"https://doi.org/10.4103/njm.njm_122_22","url":null,"abstract":"Aims: We conducted a cost-benefit analysis of a population-based prostate-specific antigen (PSA) mass testing for prostate cancer (PCa) from a provider's perspective to give further insights into the programme's sustainability at scale-up. Materials and Methods: A cross-sectional study design was adopted. The cost and benefit of the population-based-specific antigen mass testing were estimated using activity-based costing and participants' willingness to pay (WTP), respectively. The study was conducted in a primary health-care facility in Anambra State, Nigeria. A total of 412 asymptomatic males between 40 and 74 years who had not had a PSA screening within the past five years were recruited for the study. A one-month population-based PSA mass screening for PCa was performed at the primary health-care facility. The cost of population-based PSA mass testing was presented as cost/male screened while benefit was measured as the participants' minimum WTP analysis amount. Benefit-cost ratio (BCR) served as the primary outcome, with values higher than one signifying a self-sustainable programme. Results: The cost/male screened was USD 13.43 ± 2.26, while the participants' WTP amount of US$3.99 ± 4.49 to calculate the BCR gave a BCR ratio of 0.3. Conclusion: The estimated BCR showed that the programme would not be sustainable if funding were based solely on participants' out-of-pocket expenses. Other financing mechanisms, such as donor funds, will be necessary to sustain such public health programmes in Nigeria.","PeriodicalId":52572,"journal":{"name":"Nigerian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46905919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anjali B. Susan, J. Varghese, V. Agarwal, Dimple R. Bhatia, S. Singla, A. Varghese, P. Paul
Background: There had been an increasing incidence of mucormycosis during the COVID-19 pandemic. Aim: This study evaluates the pattern of radiological imaging, endoscopic and histopathological features of rhino-orbital cerebral mucormycosis in patients with COVID-19 infection. Materials and Methods: The study included 31 patients with culture/biopsy-proven mucormycosis and COVID-19 infection from November 1, 2020, to December 31, 2021, in a single tertiary care centre. This study was approved by institutional ethics committee. Computed tomography (CT)/magnetic resonance imaging (MRI) images, endoscopic, and histopathological findings were retrospectively analyzed to look for the extent and pattern of disease. Statistical analysis was performed through descriptive statistics. Results: The imaging spectrum showed paranasal sinus involvement (n = 31; 100%), nasal involvement (n = 14; 45.16%), oral and palatal involvement (n = 6; 19.3%), deep neck/face space involvement (n = 25; 80.6%), orbital involvement (n = 20; 64.5%), vascular complications (n = 9; 29%), skull base involvement (n = 12; 38.7%), and cerebral involvement (n = 10; 32.2%). Endoscopy showed black necrotic tissue and slough mostly affecting middle turbinate, maxillary, and sphenoid sinuses. CT showed 100% sensitivity and specificity for the detection of sinonasal osseous erosion. Histopathology examination revealed mucormycosis as broad aseptate, predominantly 90° branching hyphae with macrophage and neutrophilic infiltration in 93.5%, granuloma in 61.3%, cavity formation in 48.4%, and angioinvasion in 77.4%. Diabetes mellitus was the predominant coexisting morbidity for mucormycosis. The mean time interval between COVID-19 diagnosis and mucormycosis was 18 days. Conclusion: CT revealed hyperdense contents within sinuses with osseous erosion; while MRI showed T2 hypointense, heterogeneously enhancing lesions with adjacent structural infiltration, orbital inflammation, cavernous sinus and internal carotid artery thrombosis, and intracranial complications such as infarct, hemorrhage, meningitis, and abscess. Neutrophilic infiltration and angioinvasion were predominant histopathological characteristics while necrosis with eschar formation was demonstrated through endoscopy.
{"title":"The spectrum of radiological findings of rhino orbital cerebral mucormycosis with endoscopic and histopathological features in patients with COVID 19: A descriptive study","authors":"Anjali B. Susan, J. Varghese, V. Agarwal, Dimple R. Bhatia, S. Singla, A. Varghese, P. Paul","doi":"10.4103/njm.njm_121_22","DOIUrl":"https://doi.org/10.4103/njm.njm_121_22","url":null,"abstract":"Background: There had been an increasing incidence of mucormycosis during the COVID-19 pandemic. Aim: This study evaluates the pattern of radiological imaging, endoscopic and histopathological features of rhino-orbital cerebral mucormycosis in patients with COVID-19 infection. Materials and Methods: The study included 31 patients with culture/biopsy-proven mucormycosis and COVID-19 infection from November 1, 2020, to December 31, 2021, in a single tertiary care centre. This study was approved by institutional ethics committee. Computed tomography (CT)/magnetic resonance imaging (MRI) images, endoscopic, and histopathological findings were retrospectively analyzed to look for the extent and pattern of disease. Statistical analysis was performed through descriptive statistics. Results: The imaging spectrum showed paranasal sinus involvement (n = 31; 100%), nasal involvement (n = 14; 45.16%), oral and palatal involvement (n = 6; 19.3%), deep neck/face space involvement (n = 25; 80.6%), orbital involvement (n = 20; 64.5%), vascular complications (n = 9; 29%), skull base involvement (n = 12; 38.7%), and cerebral involvement (n = 10; 32.2%). Endoscopy showed black necrotic tissue and slough mostly affecting middle turbinate, maxillary, and sphenoid sinuses. CT showed 100% sensitivity and specificity for the detection of sinonasal osseous erosion. Histopathology examination revealed mucormycosis as broad aseptate, predominantly 90° branching hyphae with macrophage and neutrophilic infiltration in 93.5%, granuloma in 61.3%, cavity formation in 48.4%, and angioinvasion in 77.4%. Diabetes mellitus was the predominant coexisting morbidity for mucormycosis. The mean time interval between COVID-19 diagnosis and mucormycosis was 18 days. Conclusion: CT revealed hyperdense contents within sinuses with osseous erosion; while MRI showed T2 hypointense, heterogeneously enhancing lesions with adjacent structural infiltration, orbital inflammation, cavernous sinus and internal carotid artery thrombosis, and intracranial complications such as infarct, hemorrhage, meningitis, and abscess. Neutrophilic infiltration and angioinvasion were predominant histopathological characteristics while necrosis with eschar formation was demonstrated through endoscopy.","PeriodicalId":52572,"journal":{"name":"Nigerian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47384356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Lemboye-Bello, D. Awonuga, A. Odewabi, T. Ogunfunmilayo, Oluseyi Aderinwale, O. Jimoh
Background: The search for the ideal analgesia following caesarean section remains elusive but opioids provide good postoperative analgesia. Intramuscular opioid induces pain at the site of injection and its repeated administration proved to be more demanding for caregivers. Oral opioids especially morphine have become increasingly accessible in our environment and may be more effective than the conventional parenteral opioids for postcaesarean analgesia. Aim: To compare the efficacy of multiple doses of 10 mg oral morphine with that of 50 mg intramuscular pethidine in treatment of postcaesarean pain among parturients in Abeokuta, Nigeria. Patients, Materials and Methods: The study was a randomised controlled trial among parturients who had elective caesarean section in Abeokuta between November 2019 and August 2020. A total of 136 consenting and eligible pregnant women were randomised into two groups. Group A received multiple doses of 10 mg oral morphine while Group B had multiple doses of 50 mg intramuscular pethidine. The summed pain intensity difference (SPID) of the two groups was calculated and compared using the Chi-square and P < 0.05 was statistically significant. Results: The mean ± standard deviation (SD) of SPID at rest for morphine group and pethidine group was 6.00 ± 76.25 and 8.51 ± 77.60, respectively (t = −0.439 P = 0.662); the mean ± SD of SPID on movement for morphine and pethidine group was 29.13 ± 75.25 and 25.52 ± 28.47 (t = 0.139, P = 0.890). The median maternal satisfaction reported was similar in both groups (χ2 = 2.773, P = 0.4963) and somnolence was experienced in 3.1% of parturients in morphine group. Conclusion: The efficacy and maternal satisfaction of oral morphine in the control of postcaesarean section pain was similar to that of intramuscular pethidine. Hence, oral morphine is an acceptable alternative to intramuscular pethidine in management of pain following Caesarean section.
{"title":"Randomised control trial of oral morphine and intramuscular pethidine for post-caesarean section analgesia in South-Western Nigeria","authors":"R. Lemboye-Bello, D. Awonuga, A. Odewabi, T. Ogunfunmilayo, Oluseyi Aderinwale, O. Jimoh","doi":"10.4103/njm.njm_105_22","DOIUrl":"https://doi.org/10.4103/njm.njm_105_22","url":null,"abstract":"Background: The search for the ideal analgesia following caesarean section remains elusive but opioids provide good postoperative analgesia. Intramuscular opioid induces pain at the site of injection and its repeated administration proved to be more demanding for caregivers. Oral opioids especially morphine have become increasingly accessible in our environment and may be more effective than the conventional parenteral opioids for postcaesarean analgesia. Aim: To compare the efficacy of multiple doses of 10 mg oral morphine with that of 50 mg intramuscular pethidine in treatment of postcaesarean pain among parturients in Abeokuta, Nigeria. Patients, Materials and Methods: The study was a randomised controlled trial among parturients who had elective caesarean section in Abeokuta between November 2019 and August 2020. A total of 136 consenting and eligible pregnant women were randomised into two groups. Group A received multiple doses of 10 mg oral morphine while Group B had multiple doses of 50 mg intramuscular pethidine. The summed pain intensity difference (SPID) of the two groups was calculated and compared using the Chi-square and P < 0.05 was statistically significant. Results: The mean ± standard deviation (SD) of SPID at rest for morphine group and pethidine group was 6.00 ± 76.25 and 8.51 ± 77.60, respectively (t = −0.439 P = 0.662); the mean ± SD of SPID on movement for morphine and pethidine group was 29.13 ± 75.25 and 25.52 ± 28.47 (t = 0.139, P = 0.890). The median maternal satisfaction reported was similar in both groups (χ2 = 2.773, P = 0.4963) and somnolence was experienced in 3.1% of parturients in morphine group. Conclusion: The efficacy and maternal satisfaction of oral morphine in the control of postcaesarean section pain was similar to that of intramuscular pethidine. Hence, oral morphine is an acceptable alternative to intramuscular pethidine in management of pain following Caesarean section.","PeriodicalId":52572,"journal":{"name":"Nigerian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44156458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Kiridi, P. Oriji, Emily Gabriel Enefia Kiridi, A. Ubom, J. Ugwoegbu, I. Abasi, P. Bosrotsi
Background: Tubal patency testing is essential in the evaluation of infertile women, and the preferred investigation for determining tubal patency is hysterosalpingography (HSG). Aim: The aim of the study was to compare the effectiveness of intramuscular diclofenac and paracervical block for pain alleviation during and after HSG. Patients, Materials and Methods: This research was carried out at the Infertility and Radiology Units of four health facilities, from January 2021 to April 2022. The Pan African Clinical Trials Registry received this trial's registration (PACTR202203726718710). Through simple randomization, 520 women billed for HSG were assigned into Groups I (control) and II (study). Group I had 75 mg of intramuscular diclofenac, while Group II had paracervical block with 2% lignocaine hydrochloride. At various stages of HSG, pain scores were obtained. Statistical Product and Service Solutions for Windows® version 25 (SPSS Inc.; Chicago, USA). The Chi-square test was used to examine the number of women in Groups I and II who experienced pain at the various stages of HSG, while the Student's t-test was used to compare sample means. Results: The step that caused the most pain was injection of contrast media, with a mean pain score of 3.85 ± 1.43 in Group I, and 5.00 ± 0.63 in Group II. Group I reported considerably lesser pain during speculum insertion, contrast media injection, and 24 h after the surgery (P = 0.001, P = 0.001, and P = 0.005, respectively). Conclusion: Intramuscular diclofenac is more effective than paracervical block (with lignocaine) for pain alleviation, both during and after HSG.
{"title":"Comparison of intramuscular diclofenac and paracervical block during and after hysterosalpingography in women with infertility in South-South Nigeria: A randomized controlled trial","authors":"E. Kiridi, P. Oriji, Emily Gabriel Enefia Kiridi, A. Ubom, J. Ugwoegbu, I. Abasi, P. Bosrotsi","doi":"10.4103/njm.njm_81_22","DOIUrl":"https://doi.org/10.4103/njm.njm_81_22","url":null,"abstract":"Background: Tubal patency testing is essential in the evaluation of infertile women, and the preferred investigation for determining tubal patency is hysterosalpingography (HSG). Aim: The aim of the study was to compare the effectiveness of intramuscular diclofenac and paracervical block for pain alleviation during and after HSG. Patients, Materials and Methods: This research was carried out at the Infertility and Radiology Units of four health facilities, from January 2021 to April 2022. The Pan African Clinical Trials Registry received this trial's registration (PACTR202203726718710). Through simple randomization, 520 women billed for HSG were assigned into Groups I (control) and II (study). Group I had 75 mg of intramuscular diclofenac, while Group II had paracervical block with 2% lignocaine hydrochloride. At various stages of HSG, pain scores were obtained. Statistical Product and Service Solutions for Windows® version 25 (SPSS Inc.; Chicago, USA). The Chi-square test was used to examine the number of women in Groups I and II who experienced pain at the various stages of HSG, while the Student's t-test was used to compare sample means. Results: The step that caused the most pain was injection of contrast media, with a mean pain score of 3.85 ± 1.43 in Group I, and 5.00 ± 0.63 in Group II. Group I reported considerably lesser pain during speculum insertion, contrast media injection, and 24 h after the surgery (P = 0.001, P = 0.001, and P = 0.005, respectively). Conclusion: Intramuscular diclofenac is more effective than paracervical block (with lignocaine) for pain alleviation, both during and after HSG.","PeriodicalId":52572,"journal":{"name":"Nigerian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43150347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. David, M. Duguru, P. Akpa, P. Davwar, Atta Okwute, J. Makpu, B. Dallang, P. Omaiye, E. Okeke
Schistosomiasis is a parasitic infection which commonly affects the intestine. Colonic polyps associated with intestinal schistosomiasis are not commonly reported in young people. Our case report describes a 20-year-old man from North-Central Nigeria who presented with recurrent passage of loose, mucoid, bloody stool, and weight loss. His biochemical profile and stool tests were unremarkable. A colonoscopy showed multiple ulcers and polyps with ulcerated surfaces in the transverse and sigmoid colon. Histopathology revealed islands of colonic-type mucosa containing numerous benign colonic glands in a densely inflamed lamina propria containing lymphocytes, eosinophils, and histiocytes, with numerous ova and calcified parasite bodies of Schistosoma. The patient was treated with praziquantel and showed marked clinical improvement.
{"title":"Intestinal schistosomiasis with colonic polyps","authors":"N. David, M. Duguru, P. Akpa, P. Davwar, Atta Okwute, J. Makpu, B. Dallang, P. Omaiye, E. Okeke","doi":"10.4103/njm.njm_92_22","DOIUrl":"https://doi.org/10.4103/njm.njm_92_22","url":null,"abstract":"Schistosomiasis is a parasitic infection which commonly affects the intestine. Colonic polyps associated with intestinal schistosomiasis are not commonly reported in young people. Our case report describes a 20-year-old man from North-Central Nigeria who presented with recurrent passage of loose, mucoid, bloody stool, and weight loss. His biochemical profile and stool tests were unremarkable. A colonoscopy showed multiple ulcers and polyps with ulcerated surfaces in the transverse and sigmoid colon. Histopathology revealed islands of colonic-type mucosa containing numerous benign colonic glands in a densely inflamed lamina propria containing lymphocytes, eosinophils, and histiocytes, with numerous ova and calcified parasite bodies of Schistosoma. The patient was treated with praziquantel and showed marked clinical improvement.","PeriodicalId":52572,"journal":{"name":"Nigerian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44470439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A middle-aged homemaker, known sickle cell anaemia patient presented with complaints of reduced vision and night blindness since childhood along with recent-onset hearing impairment in both ears. Anterior segment findings revealed lens opacities more in the left eye, whereas fundus findings showed widespread bone spicule pigmentation in both eyes. Pure-tone audiometry indicated bilateral sensorineural hearing loss. With improvement in visual acuity after refraction, the corrective spectacle was prescribed along with a hearing aid. She presently maintains a follow-up appointment with the sickle cell, ophthalmology, and ear, nose, and throat clinics for a routine checkup. She has improved in her general health and has been crisis-free since the presentation.
{"title":"Sickle cell disease with hearing defect and retinitis pigmentosa","authors":"Stanley Sano","doi":"10.4103/njm.njm_103_22","DOIUrl":"https://doi.org/10.4103/njm.njm_103_22","url":null,"abstract":"A middle-aged homemaker, known sickle cell anaemia patient presented with complaints of reduced vision and night blindness since childhood along with recent-onset hearing impairment in both ears. Anterior segment findings revealed lens opacities more in the left eye, whereas fundus findings showed widespread bone spicule pigmentation in both eyes. Pure-tone audiometry indicated bilateral sensorineural hearing loss. With improvement in visual acuity after refraction, the corrective spectacle was prescribed along with a hearing aid. She presently maintains a follow-up appointment with the sickle cell, ophthalmology, and ear, nose, and throat clinics for a routine checkup. She has improved in her general health and has been crisis-free since the presentation.","PeriodicalId":52572,"journal":{"name":"Nigerian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42011376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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