Annals of Ibadan postgraduate medicine最新文献

Background: Globally, leprosy is one of the most stigmatized diseases and this affects the quality of life of people living with the disease, yet research on this issue in Nigeria is scarce.

Objective: To understand the relationship between stigma and quality of life among people living with leprosy in Nigeria.

Methods: A cross-sectional study conducted among 53 persons living with leprosy in Oke-Igbala and Ago-Ireti leprosy settlements in July, 2024 using a semi-structured tool to measure sociodemographic information, quality of life using the WHOQOL-BREF, and stigma using the SARI Stigma Scale. Descriptive statistics, chi-square tests and logistic regression were used to examine the data; p<0.05 was considered significant.

Results: The quality of life or general well-being was very poor for 94.3% of the respondents. The prevalence of stigma was 60.4%. Significant associations were found between source of income and quality of life (p=0.036), occupation and stigma (p=0.010). No statistical association was found between stigma and quality of life (p=0.239).

Conclusion: Addressing the source of income and livelihood options of people living with leprosy may improve their quality of life. Future qualitative research to gain a deeper understanding of their experiences may be beneficial to reduce stigma.

Background: Even though there has been significant success in reducing maternal mortality worldwide, Nigeria alone still accounted for about 28% of the global maternal deaths in the year 2020. Hence, we aim to assess the relationship between maternal health literacy and quality of care for pregnant women attending antenatal care (ANC) services in Primary Health.

Methods: We conducted a cross-sectional study among 570 women attending ANCs in Primary Healthcare centers, Private hospitals and homes of Traditional Birth Attendants (TBA) in Ikorodu LGA of Lagos state. We included 8 PHCs, 2 private hospitals and 15 TBAs. We excluded facilities that did not offer both ANC and delivery services. We described respondents? sociodemographic characteristics using summary statistics. The maternal literacy tool had 14 items with a 3 points likert scale and it was adapted from a past study on maternal literacy. We calculated the mean score as 37.0. Quality of care received was measured using 13 services to be provided during ANC visits based on guidelines from WHO and other literature. Using the raw scores, we conducted linear regression to check for association between maternal health literacy and ANC service quality.

Results: More than half (64.2%) of the respondents were aged 25 to 34 years, with a mean age of 27.9, and about three-quarter (76.7%) of them were Yorubas. Three hundred and fifty (61.4%) of the women scored equal or higher than the mean maternal literacy score (37.0) and 350 (61.4%) received at least 9 out of the 13 expected services. The mean ANC service score received by women was 9.8 ± (3.6) and was higher in PHCs (10.5 ± 3.0) compared with private (9.7 ± 3.6) and TBA (7.3 ± 4.2) facilities (p<0.001). Maternal literacy was positively associated with quality of care. Similarly, women residing in urban settlement had higher odds to receive higher quality of care compared to those residing in rural areas.

Conclusion: Our study shows that the type of healthcare facility a woman attended was a determining factor to the quality of ANC services received. The likelihood of receiving higher quality ANC service is greater in primary health centres than in private hospitals or homes managed by TBAs. The government, therefore, must adopt a multidimensional approach that includes interventions targeting individuals, households, communities, and other facility types in other to improve maternal and child health outcomes.

Background: Atrial Fibrillation (AF) is the most common form of sustained arrhythmia observed in clinical practice, and the incidence is rising in both developing and developed countries. It has been noted to contribute a major quota to the disability and death associated with cardiovascular diseases worldwide. Studies have shown that the pathophysiology of AF broadly revolves around electrical remodeling of the cardiac musculature, structural remodeling, calcium ion handling abnormalities, and autonomic nerve activation/remodeling. However, newer entities like inflammatory markers are emerging.

Objective: The paper aims to review the current epidemiology of AF and the role of inflammatory markers in the pathogenesis of the condition.

Methodology: This is a narrative review of the literature. We reviewed the contemporary epidemiology, pathophysiology, with a focus on the role of inflammatory markers such as interleukin-2, interleukin-6, C-reactive protein, and tumor necrosis factor.

Results: Atrial fibrillation affects about 52.55 million individuals worldwide; prevalence and incidence increased by 137% and 124% between 1990 and 2021. The role of inflammation in the pathogenesis of AF and atrial flutter is increasingly being recognised. Elevated CRP predicts an increased risk of developing AF. TNF is associated with the pathogenesis of chronic AF, and levels in the plasma and left atrial tissue have a positive correlation with left atrial diameter. On the other hand, low IL-2 levels are associated with reduced incidence of postoperative AF. Interleukin 6 is associated with the generation and perpetuation of AF, and high levels correlate with the presence and duration of AF, as well as associated with the occurrence of AF post coronary artery bypass graft.

Conclusion: Inflammatory markers are associated with increased incidence and prevalence of AF. Targeting this may offer novel insights into the prevention and treatment, thereby potentially reducing complications and improving patient outcomes in diverse settings.

Background and objective: Left ventricular hypertrophy (LVH) is an increase in left ventricular mass due to an increase in cardiomyocyte size. It is said to be a strong predictor of cardiovascular diseases. Detection of LVH is important as early diagnosis and initiation of measures can reduce/halt progression or even cause regression, resulting in prevention or delay of unfavourable cardiovascular outcomes. There is limited data on the frequency of electrocardiographic LVH in hospital population (in-patient and out-patient) in Nigeria. Therefore, the study aimed to estimate the frequency of ECG-diagnosed LVH in hospital patients in Ibadan.

Method: The study was conducted at the cardiology unit of UCH, Ibadan. 12-Lead ECGs done between 01/01/2023 to 30/06/2023 for adult men and women 18 years and above were studied. Diagnosis of LVH was based on either Sokolow- Lyon or Cornell voltage criteria.

Results: A total of 1678 tracings were analyzed (male - 701, female - 977). LVH was present in 399 tracings (23.8%, 238 cases per thousand), and was significantly more frequent in males than females (28.8% vs. 20.16%). Frequency increased with increasing age. LVH was noted to be significantly associated with incident atrial fibrillation (AF), other arrhythmias, and left atrial enlargement with odds ratios of 3.29 (95% CI: 1.60-6.80), 1.74 (95% CI: 1.17-2.58) and 3.35 (95% CI: 2.52-4.46) respectively.

Conclusion: The frequency of ECG-detected LVH was 23.8% in UCH. It was predominantly seen in males and significantly associated with AF, other arrhythmias and left atrial enlargement.

Background: Cervical cancer and human immunodeficiency virus are diseases of public health concern as they both have debilitating effects on human health. Human immunodeficiency virus worsens the carcinogenicity of HPV, thereby elevating the risk of cervical cancer. A previous study conducted at our center two decades ago reported a low prevalence of HIV among cervical cancer patients.

Objective: This study is aimed at determining the current prevalence of HIV among patients with cervical cancer presenting for radiation treatment and comparing it with our previous findings 20 years earlier in order to assess changes in epidemiological trends.

Methods: A retrospective analysis of patients with histologic diagnosis of cervical cancer seen between 2017 and 2019 was carried out. HIV statuses were determined using the Determine test kit for screening and Western blot for confirmation, and data was analyzed using appropriate statistical methods including the chi-square test for categorical variables and t-tests for continuous variables. P-values < 0.05 were considered statistically significant.

Results: A total of 156 patients were seen with a mean age of 54.9± 11.4 years (range from 33-90 years). The prevalence of HIV was found to be 6.4%, slightly higher than our previous finding with prevalence of 2.7%. The HIV positive patients were younger (mean age 44.7 ± 6 years) than the HIV negative patients (55.14 ± 10.84 years) by about 10 years which was statistically significant (p=0.003). Most of the patients presented with an advanced disease, with 50% of the patients presenting with stage III disease, while 10% had stage IV disease. The HIV positive patients presented with more early stage (Stages I and II) diseases (60%). Squamous cell carcinoma was the most common histological type accounting for 89.7.

Conclusion: As a follow up study, it appears that not much has changed from our previous findings as there.

Background: Candiduria, though often innocuous, may be an indication of invasive or disseminated Candida infection necessitating further investigation and therapeutic intervention. This study determined the prevalence of candiduria, the species ofCandida and factors that predict the presence of candiduria among hospitalized patients with urinary tract infections (UTI).

Methods: A cross-sectional study was conducted on 220 consenting hospitalized adult patients with UTI at the University College Hospital, Ibadan, Oyo State from April 2020 - January 2021. Urine samples were examined microscopically, cultured on supplemented Sabouraud dextrose agar andCandida species were identified by microscopy, germ tube test and CHROMagar Candida. Chi-square test was used to identify factors associated with candiduria.

Results: The age range of participants was 18-80 years (mean 44.5±19 years) while the male to female ratio was 1:1.4. About 80% had a history of recent antibiotics, 26% were on catheter, and 3.2% were known diabetics. The prevalence of candiduria was 16.4% and the most common species of Candida wasC. albicans (83%), while the others wereC. krusei. Candiduria was significantly higher (p<0.05) among patients with history of antibiotic use, indwelling urinary catheter, prolonged catheterization and surgical procedures while the elderly age, long duration of admission, and male gender had higher prevalence, but no statistically significant associations.

Conclusion: Candiduria among this population is high and associated mostly with antibiotics use, catheterization, long duration of catheter use and surgical procedures. In addition to limiting antibiotic consumption, urethral catheterization and its duration, we recommend that patients with UTI who are at high risk of developing candiduria should be assessed for its presence to identify those who will benefit from treatment.

Background: Pentalogy of Cantrell (POC) is a collection of five congenital malformations involving the heart, pericardium, diaphragm, sternum, and anterior abdominal wall. This is a spectrum, and could be incomplete or complete; naked or covered cordis or can be classified based on the location of the heart, and in this index patient-thoraco-abdominal ectopia cordis. We aim to highlight this finding of covered incomplete pentalogy of Cantrell and the peculiarities of management in our sub-region that relies solely on out of pocket payment.

Case presentation: A 30-hour old female admitted with history and clinical examination findings in keeping with a covered pentalogy of Cantrell (Thoraco-abdominal ectopia cordis) in a term neonate. Attached is a video link at presentation https://youtu.be/0vQuzq14G9Q.

Conclusion: Pentalogy of Cantrell is a complex anomaly. The constraints we encountered in the initial management of this neonate is not uncommon in surgical practice within Nigeria, and other resource constrained countries especially amongst carers of paediatric patients. Other factors at play in our sub-region are ignorance, high rate of illiteracy, superstitious beliefs, and varied cultural practices, and this partly hindered further evaluation of this vulnerable neonate in our sub-region.

Introduction: The pons is the largest and a vital part of the brainstem between the midbrain and medulla oblongata. Due to the versatility of its function, various stroke syndromes have been described as a result of pontine infarction. Notable among these is the lateral pontine syndrome, which was first described in 1922 as a stroke when the anterior inferior cerebellar artery becomes occluded, leading to an infarction in the lateral inferior part of the pons, middle cerebellar peduncle, and the floccular region, resulting in ipsilateral limb ataxia, facial weakness, hearing loss, facial anaesthesia, contralateral hemihypoaesthesia, vertigo, and nystagmus. This case report aims to contribute to the limited existing literature on a rare brainstem stroke syndrome, which to the best of our knowledge, has not been reported in Africa.

Case presentation: The patient was a 66-year-old stroke survivor who developed sudden onset vertigo, dysarthria, right limb ataxia, facial weakness, and hearing impairment. Brain MRI revealed an acute infarct in the right lateral part of the lower pons.

Conclusion: Secondary stroke prevention is vital for survivors. An MRI should be chosen if available when a brainstem stroke is suspected, especially in low-resource settings where patients can afford only one imaging session.

Background: Ankyloglossia is a congenital oral anomaly with varying timing and modality of presentation. This study aimed to determine the epidemiology, clinical presentations, and management of children and adolescents with ankyloglossia at an otorhinolaryngological practice at a tertiary institution in Nigeria.

Methods: This was a cross-sectional, hospital-based study of all children and adolescent patients who presented with tongue-tie in the Ear, Nose and Throat Department of Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria. The study was carried out over a period of 10 years. Structured interviewer-administered questionnaires were administered to consenting patients to obtain data. Data obtained were collated and analysed using SPSS version 23. Data were expressed using frequency tables, percentages, bar and pie charts.

Results: A total of 18,431 patients were seen over the study period (2014 to 2023) out of which 94 (0.51%) presented with complaints of tongue-tie and 43 (0.23%) were diagnosed with ankyloglossia. Among the patients who presented with tongue tie, the peak age group was 1-5 years. There was male preponderance with a maleto- female ratio of 2.8:1.0. Urban dwellers accounted for 59.6%. There was no family history of ankyloglossia in the majority of the cases. Parents brought the patients in 45(47.9%) of the cases. The commonest presenting complaint was challenge with verbal communication among the patients as seen in 51(54.3%) of the patients presenting with tongue tie. No prior intervention was instituted in 8.5% while family physicians treated 43.6%. Normal tongue was recorded in 51(54.3%) cases. Ankyloglossia was diagnosed in 43(45.7%) cases, and other diagnoses included delayed developmental milestones in 23.4% and articulation disorder in 19.1%. In those with confirmed ankyloglossia, the commonest degree of ankyloglossia was mild (class 1) ankyloglossia. The commonest surgical treatment offered to patients diagnosed with tongue- tie was frenulotomy in 33(76.7%) cases.

Conclusion: Understanding the anatomical definition of ankyloglossia is significant in the diagnosis and management of patients because many patients were wrongly diagnosed and treated for ankyloglossia. Hearing assessment should be done on children with suspected ankyloglossia because of possible articulation problems. Some of the patients that could not communicate properly were found to have hearing problems and not ankyloglossia.

Introduction: Bertolotti's Syndrome (BS) is a rare cause of low back pain in adolescents, often associated with lumbosacral transitional vertebrae (LSTV). This condition results in structural changes at the lumbosacral junction, leading to pain through altered biomechanics and pseudoarthrosis. Due to its rarity and overlapping symptoms with other lumbar pathologies, BS is frequently undiagnosed.

Case presentation: This case report discusses a 12-year-old male patient that developed BS following trauma to the perineal region, presenting with low back pain and difficulty walking. Imaging studies revealed an enlarged left transverse process of the L5 vertebra articulating with the sacrum, consistent with Type II LSTV according to the Castellvi classification.

Conclusion: This case highlights the importance of considering BS in the differential diagnosis of low back pain in young patients, particularly in the context of trauma. While conservative management can offer significant relief, surgical intervention may be necessary in refractory cases. Early diagnosis and tailored treatment are crucial for optimal outcomes, and further research is needed to establish standardized treatment guidelines and improve patient care.