Annals of Ibadan postgraduate medicine最新文献

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.

Background: Adolescent behavioural problems can be burdensome for parental figures. The lack of good parental responses and coping strategies may worsen adolescent mental health issues. Research in this domain can be informative for effective management of adolescents' behavioural problems in resourcelimited settings like Nigeria.

Aim: We assessed parental responses and coping strategies for adolescents with behavioural problems.

Methods: A cross-sectional community-based survey with cluster sampling was conducted. Coping strategies were assessed using the Brief Cope Inventory (BCI), dichotomized into Emotional-Based Strategies (EBS) and Problem- Based Strategies (PBS) coping. The Strength and Difficulty Questionnaire (SDQ) assessed adolescent behavioural problems. Data were analyzed using descriptive and inferential statistics.

Results: Four hundred and ten (410) parental figures of adolescents aged 14.8±2.3 years were recruited. Parental response to adolescent problem behaviours included corporal punishment in 44% and few (5.8%) sought medical or spiritual help for the adolescent. The most deployed parental coping strategy was 'active' coping (69%) while 'instrumental support' was the least adopted coping strategy. The age, gender, educational level and income of parental figures, were associated with the choice of utilizing PBS coping.

Conclusion: Parental figures employed more corporal punishment and utilized active coping, and planning as coping strategies when dealing with adolescents' problem behaviours. Interventions to discourage corporal punishment and promote more effective parental coping are needed.

Background: Adherence to medications in chronic medical conditions such as systemic hypertension has been a major challenge globally. A number of factors responsible for this have been documented, but there are only few researches that explore the role spirituality can play in medication adherence.

Objective: To determine the relationship between spirituality and medication adherence in patients with hypertension.

Method: This was a hospital-based cross-sectional study. Data collection was done using interviewer-administered questionnaires. Patients' spirituality levels and medication adherence were assessed using validated questionnaires. The relationship between participants' medication adherence and related variables was obtained while logistic regression was used to determine the independent predictors of poor medication adherence of respondents.

Results: A total of 376 patients were interviewed with 62.8% being female. Two-thirds of the participants (65.7%) had low medication adherence while the remaining one-third (34.3%) had high medication adherence. More than half of the participants (61.2%) had low levels of spirituality, 123 of them (32.7%) had moderate levels of spirituality while just 6.1% had high spirituality levels. The higher the level of spirituality, the lower the medication adherence (p=0.001).

Conclusion: There is both poor medication adherence and low level of spirituality among the respondents. Spirituality was found to have an inverse relationship with medication adherence.

Background: Postoperative anaemia is associated with increased postoperative morbidity. The optimal timing for postoperative packed cell volume (PCV) assessment remains unclear and varies across surgical units.

Objective: This study compared PCV values on postoperative days 1 and 2 to determine their relationship with the expected postoperative PCV.

Methods: A cross-sectional study was conducted among patients who had elective gynaecological surgeries at a tertiary Hospital in Southern Nigeria. PCV was measured preoperatively and at 24 and 48 hours postoperatively. Data on intraoperative blood loss, type of surgery, and anaesthesia were recorded.

Results: The mean PCV on postoperative day 1 was 30.87 ± 3.85%, while on day 2, it was 30.33 ± 3.70%, with a significant difference (p = 0.005). The expected postoperative PCV was 31.02 ± 2.68%. The difference between day 1 PCV and the expected PCV was not statistically significant (p = 0.682). Similarly, the day 2 PCV was not significantly different from the expected value (p = 0.064).

Conclusion: Although a significant decline in PCV occurred between postoperative days 1 and 2, the day 1 PCV was closer to the expected postoperative value. This suggests that day 1 may be a more reliable time for routine PCV monitoring after gynaecological surgeries.

Stiff Person Syndrome (SPS) is a rare neurological disorder characterized by muscle stiffness and painful muscle spasms. The symptoms often progress slowly and can cause disability. Auto-antibodies to glutamic acid decarboxylase (anti-GAD) have been reported in up to 80% of the classic type of SPS. Delayed diagnosis may occur especially in low-resource settings if a high index of suspicion is not applied when individuals manifest characteristic symptoms. We report a case of a 63-year-old Nigerian female who presented with progressive onset low back pain, lower body rigidity and painful muscle spasm with subsequent loss of ambulation and development of depression. Serologic tests detected high-titer anti-GAD, confirming the diagnosis of SPS. Due to limited availability and the financial implications of out-of-pocket treatment, escalation therapy to immunebased therapy for this neurological disorder was hindered in our case.