Annals of Ibadan postgraduate medicine最新文献

Background: Nigeria faces a critical shortage of dental professionals, which exacerbates oral health disparities nationwide. Understanding the factors influencing secondary school students' interest in dentistry is essential for designing targeted interventions to expand the dental workforce. This study aimed to assess the willingness to pursue dentistry as a career and identify associated factors among senior secondary school students in Ibadan, Nigeria.

Methods: A cross-sectional study was conducted among 370 senior secondary school science students selected from five randomly selected (balloting) schools in Ibadan, Nigeria. Data on sociodemographic characteristics, knowledge, and attitudes toward choosing dentistry were collected using a validated intervieweradministered questionnaire. Data analysis was performed with SPSS version 26, employing bivariate and multivariate analyses at p < 0.05.

Results: The participants' mean age was 15.2 (± 1.1) years, with 77.6% being males. Only 14.2% had good knowledge of dentistry, while 86.2% had a positive attitude towards the dental career. Only 15.6% were very familiar with dentistry, and 39.6% were willing to choose it as a career. Predictors of willingness to choose dentistry included female gender (aOR=2.60; 95%CI=1.43-4.73) and being very familiar with dentistry (aOR=4.17; 95%CI=1.94-8.96).

Conclusion: Over one-third of students expressed interest in studying dentistry. Despite high awareness and positive attitudes, knowledge and familiarity with the profession were limited. These findings highlight the need for structured career guidance and early exposure to dentistry in secondary schools.

Background: Acantholytic squamous cell carcinoma (ASCC), also known as adenoid squamous cell carcinoma, typically affects elderly men in the skin of the head and neck region especially due to exposure to sunlight. It rarely occurs in the oral mucosa but when it does, it is characterized by aggressive biological behaviour and the ability for distant metastasis with very poor prognosis.

Method: We report the case of a 73-year-old man diagnosed with ASCC of the left maxillary region who died three (3) months following presentation.

Results: Histopathology revealed component cells made up the nests, which were mostly basaloid and slightly pleomorphic with discohesiveness of the epithelial cells at the center of the nest. This histology appearance mimics vascular neoplasms like angiosarcoma with a cellular event like vascular invasion. An immunohistochemistry for AE1/AE3 and CD 34 was employed to resolve the diagnostic challenge encountered within the histology evaluation and distinguish it from other similar entities.

Conclusion: This case report highlights the need for immunohistochemical study of the unique and rare oral ASCC whose definitive diagnosis may be missed because of similarities with other entities.

Background: Obstetric epidural anesthesia is a widely used technique for managing labor pain, offering effective relief while allowing women to remain conscious during childbirth. Despite its benefits, utilization remains suboptimal, often hindered by knowledge gaps, misconceptions, and healthcare system barriers.

Objective: This study aimed to assess the knowledge, perception, and utilization of obstetric epidural anesthesia among pregnant women at the University of Calabar Teaching Hospital (UCTH).

Method: A parallel-group randomized controlled trial design was employed, targeting pregnant women aged 15 to 49 years. Participants were randomly assigned to an intervention group, receiving obstetric epidural anesthesia during labour, or a control group, following standard pain management protocols. Simple random sampling selected participants, and data were collected via structured questionnaires administered at baseline, postintervention, and during postpartum follow-up, along with clinical assessments.

Results: Awareness of obstetric epidural anesthesia was high, with 97.6% of intervention group participants and 95.2% of control group participants informed about it. Positive perceptions of its effectiveness for labour pain relief were notably higher in the intervention group (48.8%) compared to the control group (27.7%). Utilization rates were also high, with 81.7% of the intervention group and 85.5% of the control group reporting prior use.

Conclusion: This randomized trial demonstrated that targeted antenatal education significantly improved women's knowledge and perception of epidural anesthesia and promoted its informed utilization. These findings support integrating pain management education into routine antenatal care in Nigeria. These results underscore the need for comprehensive education and counseling strategies to empower pregnant women in making informed decisions about pain management during childbirth, ultimately enhancing their birth experience and satisfaction.The findings highlight the importance of education and counseling in enhancing knowledge, perception, and utilization of obstetric epidural anesthesia among pregnant women. Integrating targeted awareness strategies into antenatal care is essential for addressing misconceptions and optimizing labour pain management, ultimately improving maternal health outcomes.

Background: Access to safe surgery and anaesthesia remains a challenge, particularly in low-middle income countries. Lack of anaesthetic and surgical safety causes significant burdens on the healthcare systems, leading to high morbidity and mortality. To address these issues, the WHO introduced the Surgical Safety Checklist (SSC) in 2009. This study aims to investigate the knowledge, attitude, and availability of the SSC to members of the surgical team in Africa.

Methodology: A cross-sectional study design was used to sample members of the surgical team across tertiary hospitals in 6 African countries. A p-value less than 0.05 was considered significant for associations between dependent and independent variables.

Results: Of the 227 respondents, 55% are male and 45% are female. Students (Medical and Nursing) accounted for 30% while the remaining 70% comprised other professionals in the surgical team. Overall, 74% of the participants were aware of the WHO SSC with Anaesthetists and Surgeons having the highest awareness and medical and nursing students reporting the least awareness. Of the respondents aware, 93% had good knowledge and 88% had a positive attitude towards the WHO SSC. Of those who primarily use the WHO SSC, 82% said it was readily available. Awareness, Knowledge, Attitude and Availability of the WHO SSC were all associated with the university hospital of the respondents.

Conclusion: The result of the study calls for increased training and education on the WHO SSC should be provided to all members of the surgical team, regardless of their professional roles and training levels.

Background: Wait times for healthcare specialists are inevitable due to demand-supply imbalances. However, tailoring wait times to individual patient needs based on illness severity is crucial for equitable care. The relationship between illness severity and referral wait times therefore has significant consequences for patient outcomes and the overall efficiency of the healthcare system.

Objective: This study assessed the relationship between illness severity and referral wait times among patients with Non-Communicable Diseases (NCDs) referred to selected specialist clinics in a tertiary healthcare centre in South-West Nigeria.

Methods: A cross-sectional study of 310 adult patients with NCDs referred from the General Outpatient (GOP) clinic of the Department of Family Medicine to the Medical, Surgical and Psychiatry specialty outpatient clinics was conducted. Illness severity was assessed using the Duke Severity of Illness (DUSOI)/WONCA Checklist, and wait times were obtained through followup phone calls. Data was analysed using the Statistical Package for Social Sciences (SPSS) Version 28.

Results: The median wait time was 27 days, and about half of the patients had intermediate illness severity levels. The relationship between illness severity and wait times was not statistically significant.

Conclusion: Referral wait times were not significantly associated with patients' illness severities. This highlights the need for a critical review of referral and triage practices with a multi-pronged approach to improve wait time experiences for patients.

Background: Breast masses often cause anxiety in women due to concerns about cancer. Fine Needle Aspiration (FNA) is a common technique used to diagnose breast lumps before surgery. Cell blocks, created from the aspirates, are important for preserving cell structure and characteristics, as well as for further testing with immunohistochemistry. This study aimed to evaluate the efficacy of FNA and cell blocks in diagnosing breast lesions.

Methods: This one-year prospective study included 90 patients with palpable breast lesions who presented at Irrua Specialist Teaching Hospital from December 1, 2020, to November 30, 2021. FNA and cell block procedures were performed on each patient, with samples stained using haematoxylin and eosin (H&E). The breast lesions were classified as malignant or benign based on fine needle aspiration cytology (FNAC) and cell block results, which were then compared with the histological diagnosis of tissue biopsies.

Results: The study found that FNAC had a diagnostic accuracy of 82.5% for breast lesions, with a sensitivity of 76.0% and specificity of 98.5%. The positive predictive value (PPV) was 88.9% and the negative predictive value (NPV) was 82.7%. Cell blocks showed a higher diagnostic accuracy (94.0%), with a sensitivity of 95.0% and specificity of 98.5%. The PPV and NPV for cell block diagnosis were 94.1% and 91.8%, respectively.

Conclusion: The cell block method is a more accurate diagnostic tool for breast tumours than FNAC. It allows for the study of tissue architecture and may eliminate the need for invasive biopsies.

Objectives: The objective of this study was to determine the relationship of Oro-dental health parameters and fungal infection with the severity of oral mucositis (OM) in cancer patients receiving chemotherapy.

Study design: This cross-sectional study was carried out among cancer patients receiving chemotherapy at a tertiary institution in south western Nigeria. Oral pain, oral hygiene status, periodontitis, gingivitis and fungal infection and their relationship with OM were investigated.

Results: Among 82 patients that were assessed, OM was present in 44 (53.66%) participants. Oral pain was present in 47 (57.32%) participants and 42 (95.45%) of those with OM (p <0.001). Periodontitis was present in 9(20.25%;p=0.947), severe gingivitis in 3 (6.82%; p =0.067) and poor oral hygiene in 6(13.64%; p =0.214) participants with OM. Severe OM (Grades 3 and 4) was present in 5 (6.09%) participants. All participants with severe OM had severe pain (pd" 0.001). In patients with severe mucositis, periodontitis was present in 2 (p =0.750), while severe gingivitis was observed in 1 (p =0.359) participant. Four out of the five participants with severe mucositis had poor oral hygiene (p =0.004). Fungal infection was present in 45(54.88%) participants and 31 (70.45%) of those with OM (p =0.002). Ordered logistic regression also showed that fungal infection was associated with a fourfold risk of increased severity of OM (OR 3.9, CI 1.57, 9.87,p = 0.004).

Conclusion: Our study showed that increased severity of OM was associated with a higher grade of pain and poor oral hygiene. Fungal infection was associated with increased prevalence and a fourfold risk of increased severity of OM.

Background: Seasonal variation has been shown to affect hemorheological mechanisms and blood pressure regulation which may contribute to stroke incidence. An understanding of the seasonal variation of acute stroke may guide the design of a year-long pragmatic acute stroke care plan, especially in regions with meager resources. We investigated the seasonal pattern of acute stroke admissions and outcome in Ibadan, Southwest Nigeria.

': A multi-center retrospective study was performed. Anonymized information on stroke admissions from Jan 01, 2022 - Dec 31, 2022, was extracted from each hospital's admission records. According to the Nigerian Meteorological Department guidelines, using the average monthly temperatures, the year was divided into the wet (rainy) and dry (harmattan) seasons. The student t-test was used to assess differences between groups. The level of statistical significance was fixed at P<0.05.

Results: Of 3001 acute medical admissions, there were 406 (13.5%) acute stroke admissions. Stroke admissions had two peaks: early to mid-wet season and mid-dry season. The proportion of stroke admissions was slightly higher in the wet season 207 (51%) than in the dry season 199 (49%). While stroke admissions, subtype, and outcome did not differ significantly by season, the mean (SD) ischemic stroke count vs hemorrhagic stroke count was slightly higher in the wet season [Ischemic:18.00 (4.15)], hemorrhagic: 18.50 (4.60)] compared to the dry season [ischemic: 14.67 (4.63), hemorrhagic: 16.50 (7.34)], p value 0.218 and 0.584 respectively.

Conclusion: Acute stroke has two seasonal peaks - mid-dry (harmattan) and early to mid-wet seasons. Besides prevailing variations in ambient temperatures and humidity, the bi-annual peaks may also be due to suboptimal risk factor control/surveillance, as the two peaks are incidentally the yuletide seasons in Nigeria. Our findings may therefore help acute care planning during risk periods requiring varying adaptations in local infrastructure and resource allocation.

Background: Obstetric anaesthesia is an important anaesthesia subspecialty. The challenges presented by parturients requiring anaesthesia, analgesia, or both make the role of the obstetric anaesthetist both challenging and rewarding. This audit was undertaken to review obstetric anaesthesia services at the University College Hospital, Ibadan, over 2 years and thus identify areas for improvement.

Methods: This was a two-year retrospective, cross-sectional study of obstetric anaesthesia services at University College Hospital, Ibadan. Data were collected from the anaesthesia record and entered into an Excel spreadsheet. The collected data included age, American Society of Anesthesiology (ASA) class, type and urgency of surgery, anaesthetic technique, outcomes, and critical incidents. Data was analysed using the Python programming language within the Jupyter Notebook environment.

Results: One thousand eight hundred and seventy anaesthetics were administered at the labour ward complex during this period, with 93.3% being for caesarean deliveries. The majority of patients were classified as ASA II. Previous caesarean delivery was the most common indication for surgery, accounting for approximately a quarter of the reasons. Of these procedures, 92.4% were performed under subarachnoid block (SAB), while 6.7% were conducted under general anaesthesia. Only four patients received labour epidural analgesia (LEA). The immediate post-operative outcome was satisfactory in nearly all cases. Hypotension was the most frequently reported intraoperative critical incident.

Conclusion: Subarachnoid block remains the major anaesthetic technique in obstetric anaesthesia. However, minimal labour epidural analgesia is being provided.