Annals of Ibadan postgraduate medicine最新文献

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.

Background: Thoracic aortic aneurysm is an increasingly recognized condition that is sometimes diagnosed incidentally on imaging examinations performed to evaluate other unrelated conditions. Symptomatic presentations of thoracic aortic aneurysms may be due to mass effect on the airway, esophagus, recurrent laryngeal nerve and the thoracic spine. Alternatively, they may present with the dreaded complication of aortic dissection or rupture.Occasionally abnormalities of the aortic contour or size can be detected on routine chest x-ray. However, it is difficult to confidently diagnose thoracic aortic aneurysm on chest x-rays as mediastinal masses may mimic aortic aneurysms. Computed tomography (CT) or magnetic resonance (MR) aortography, with the advantage of obtaining 3D volumetric data, remains the gold standard of imaging with sensitivity and specificity approaching 100%.

Objective: To emphasize beauty of cross-sectional images in unraveling confusing opacities on chest radiographs and its sensitivity in identifying potentially lethal chest pathologies.

Method: This is a case report of a 58-year-old man with breathlessness and features of congestive cardiac failure. Preliminary chest X-ray revealed a huge soft tissue opacity in the left upper zone of the lung which was conformed as aneurysmal dilatation of the thoracic aorta on chest computed tomography.

Conclusion: This case elucidates the importance of cross-sectional imaging in unravelling confusing opacities on chest radiographs and its sensitivity in identifying potentially lethal chest pathologies.

Background: Hepatocellular carcinoma (HCC) is associated with high mortality, ranking third among cancer deaths. This study aimed to spotlight the risk factors, treatment modality and clinical outcomes over a 5-year period in our hospital.

Methodology: This retrospective study was done at the University College Hospital, Ibadan. All the patients with HCC diagnosed between 1st January 2019 and 31st December 2023 had their demographics, clinical information, and investigations collected. The outcome was overall survival, defined as time from diagnosis till death or lost to follow up. Data obtained was analyzed using SPSS version 20.

Results: A total of 138 patients were studied, 117 males (85%) and 21 females (15%). The median age was 46 years (IQR 14). Hepatitis B Virus infection was the main risk factor, found in 102 patients (73.9%). Among males, 35% took alcohol. Three patients (2.2%) with Barcelona Clinic Liver Cancer stage A, 2 underwent surgical resection, while the other one had palliative care. Of six (4.3%) stage B patients, two had levantinib, one of which also had TACE and four had palliative care only. Ten of the sixty-three patients with stage C (45.7%) received chemotherapy, while all 64 (46.4%) in stage D received supportive care. Two (1.4%) unclassified patients received symptomatic treatment. Median survival times were 1.2 months for palliative care, 3 months for chemotherapy, and 18 months for resection (P < 0.005).

Conclusion: Hepatitis B Virus was the main risk factor for HCC in our environment. Hepatic resection offered the best opportunity for survival.

Background: The overwhelming global burden of Intimate Partner Violence (IPV) is borne by women and is highly prevalent across the globe. Despite all the efforts to eliminate IPV in Nigeria, its prevalence in 2018 was 36% higher than the value recorded in 2013 (25%). Understanding the regional difference will help the Government to deploy appropriate intervention and attain the SDG targets for the elimination of violence against women and girls by the year 2030. We, therefore, examined the regional disparities across the spectrum of Intimate Partner Violence (IPV) in Nigeria.

Methods: This research was conducted among women aged 15 to 49 years using 2018 Nigeria Demographic Health Survey dataset. The IPV spectrum are sexual violence, emotional violence, less severe violence, and severe violence. Data were analyzed using logistic and generalized linear regression models (α_0.05).

Results: IPV prevalence was 35.9% in Nigeria, and it was higher in the South- East (48.3%) than in any other regions in Nigeria (North-Central (47.4%), North-East (47.3%), South-South (46.5%), North-West (27.0%), and South- West (19.8%)). The likelihood of sexual, emotional, and severe IPV was higher in the North-Central, North-East, North-West, South-East, and South-South than South-West. The common predictors across all the spectrums of IPV include region, education, husband/partner drinking alcohol, and childhood experience of parental violence.

Conclusion: The level of IPV and its spectrum is high in Nigeria, but prominent disparities existed between the regions with North-East and South-East mostly affected. We advocate for regional-specific programs that aim to mitigate IPV in Nigeria.

Background: The neuropathological process responsible for neurocognitive disorders in people living with HIV (PLHIV) on long-term antiretroviral therapy (ART) is not well elucidated. Presently, there is a dearth of information on the roles of altered immune response in the pathogenesis of HIV-associated neurocognitive disorders. To investigate the interplay between immune response alteration and neuropathological mechanisms underlying neurocognitive disorders in PLHIV on long-term ART, neurocognition, phagocytic activity and plasma levels of tumor necrosis factor-related apoptosis inducing ligand (TRAIL) and nitric oxide (NO) were determined in PLHIV on long-term ART.

Methods: Eighty eight adults comprising 48 PLHIV on long-term ART and 40 controls, were enrolled into this case-control study. Neurocognition was assessed using the Mini-Mental State Examination (MMSE) while the plasma levels of TRAIL and nitric oxide were determined using ELISA and spectrophotometric method respectively. Phagocytic activity was determined using the neutrophil Nitroblue Tetrazolium (NBT) Reduction Test.

Results: The plasma TRAIL level and phagocytic activity were significantly lower while the plasma level of NO was significantly higher in PLHIV compared with the controls. However, the mean MMSE score was similar in PLHIV and controls. There were no significant differences in the mean TRAIL levels, phagocytic activity, NO and MMSE score in PLHIV who have been on ART for less than 10 years compared with patients who have been on ART for 10 years or more.

Conclusion: Phagocytic activity and plasma levels of TRAIL and NO are altered in PLHIV on long-term ART. However, these alterations appear not to be forerunners to neurocognitive impairment in Nigerians living with HIV on longterm ART.