Annals of Ibadan postgraduate medicine最新文献

Background: Acute Respiratory Infections (ARIs) significantly contribute to infant morbidity and mortality worldwide, especially in developing countries like Nigeria, where factors such as inadequate nutrition, poor environmental conditions, and partial immunization increase their incidence, while exclusive breastfeeding (EBF) offers immune protection that can reduce their incidence and severity. Therefore this review assessed the role of breastfeeding, especially exclusive breastfeeding, in reducing the risk and severity of ARIs in Nigerian infants, while also evaluating factors influencing breastfeeding practices.

Methods: A systematic review was conducted following PRISMA guidelines, involving a comprehensive search of databases such as PubMed, Scopus, ScienceDirect, Google Scholar, and African Journals Online. Twelve studies conducted between 2004 and 2024 focusing on breastfeeding practices and their impact on ARIs in Nigerian infants aged 0-6 months were selected. The review focused on primary studies with observational and cohort designs.

Results: The review found that exclusive breastfeeding significantly reduces the risk of ARIs in infants, with non-exclusively breastfed infants facing a fourfold increase in ARI risk. Breast milk contains immunologically active components like secretory IgA, lactoferrin, and lysozyme, which enhance immune defenses and reduce the severity of ARIs such as pneumonia. However, only 25-40% of infants in Nigeria are exclusively breastfed for six months due to cultural beliefs, maternal employment, lack of education etc.

Conclusion: Exclusive breastfeeding significantly protects Nigerian infants against ARIs, but cultural misconceptions, socioeconomic barriers, insufficient maternal education etc hinder optimal practices, necessitating targeted public health initiatives and policy interventions to improve infant health outcomes.

Background: Antibiotic-resistant genes (ARGs) pose a significant challenge in modern medicine, rendering infections increasingly difficult to treat as bacteria acquire mechanisms to resist antibiotics. Addressing ARGs necessitates a multifaceted approach, encompassing surveillance efforts to monitor their presence and the development of strategies aimed at managing and curbing the spread of antibiotic resistance. Hence, this study characterized the genetic determinants of antibiotic resistance among isolates responsible for Lower Respiratory Tract Infections (LRTIs) in People Living with HIV/AIDS (PLWHA) in Uyo.

Methods: Sputum samples were collected from 61 LRTI suspects, with bacterial isolates identified using VITEK-2 technology. Polymerase chain reaction assays were employed to detect resistance genes within the isolates.

Results: Results revealed a bacterial etiology in 39.3% of the samples, with a majority (79.2%) originating from St. Luke Hospital, Anua (SLHA), and the remainder (20.8%) from the University of Uyo Teaching Hospital (UUTH). Staphylococcus aureus emerged as the predominant isolate (46.6%), while resistance was notably high against Gentamicin and Sulphamethazole/Trimethoprim. Conversely, Azithromycin, imipenem, clindamycin, erythromycin, and ceftriaxone displayed relatively lower resistance levels across all isolates. Notably, four resistance genes CTX-M, Aac, KPC, and MecA were identified, with CTX-M detected in all multidrug-resistant isolates. This underscores the predominantly community-acquired nature of resistance as conferred by CTX-M.

Conclusion: In conclusion, this study underscores the critical importance of continued vigilance and proactive measures in combating antibiotic resistance, particularly within vulnerable populations such as PLWHA. By elucidating the genetic mechanisms underlying antibiotic resistance, informed targeted interventions can be mitigated to curb threats posed by multidrug-resistant bacteria in clinical settings.

Background: Pneumatic reduction, as a non-operative mode of treating intussusception, is traditionally done under fluoroscopy guidance. However, fluoroscopy guidance is fraught with exposure to ionizing radiation and fluoroscopy machines may not be routinely available especially in low-and-middle-income countries. The aim of this study was to evaluate the efficacy, safety and predictive factors of successful reduction of intussusception using the ultrasound-guided pneumatic technique.

Materials & methods: This was a prospective cohort study of children, 3 to 36 months of age, who were confirmed to have intussusception by abdominal ultrasonography and had pneumatic (air) reduction under ultrasound guidance between December 2018 to December 2020. Patients with bowel perforation, peritonitis, non-responsive shock or recurrent intussusception were excluded. Success rate, time to reduction, complication (recurrence and perforation) rate, and predictive factors for successful reduction were evaluated.

Results: Thirty (36.1%) out of 83 patients who presented with intussusception during this period had ultrasound-guided pneumatic reduction. The mean age was 6.1±1.6 (range: 4 to 9) months. Male to female ratio was 2.3:1. About one-third of the patients presented within ≤48 hours of onset of symptoms. 21 patients (70%) had a successful reduction. The mean time to reduction was 10.51 ± 4.19 (range: 3 to 16) minutes. One patient had recurrence giving a recurrence rate of 3.3%. There was no case of perforation. Patients who had successful reduction significantly had palpable abdominal mass (p = 0.0139), serum sodium >135mmol/l (p = 0.0419) and serum potassium >3.5mmol/l (p = 0.0318). Only serum potassium >3.5mmol/l (Odd ratio (OR), 6.9; 95% confidence interval (CI), 1.2 - 40.3; p = 0.03) was significantly associated with successful reduction on multivariable analysis.

Conclusion: Ultrasound-guided pneumatic reduction of ileocolic intussusception is feasible, effective and safe. It may be used in the treatment of children who present with ileocolic intussusception. Serum potassium >3.5mmol/l may suggest the likelihood of successful reduction.

Background: Tobacco use is a leading preventable cause of morbidity and mortality and poses a significant burden on fragile health systems in low- and middleincome countries (LMICs), including Nigeria. Adolescents are particularly at risk of starting to use tobacco due to factors such as misinformation and insufficient knowledge about its harmful effects. There is an urgent need for culturally appropriate, acceptable, and sustainable interventions to enhance knowledge, correct misconceptions, and promote positive behavior change regarding tobacco use. This study describes the development and validation of culturally tailored, Health Belief Model (HBM)-based educational materials (posters and notebooks) for tobacco-related health education among adolescents in Nigeria.

Methodology: The Design-Based Research (DBR) approach was used to develop posters and notebooks featuring tobacco-related messages. These messages were adapted from the World Health Organization's (WHO) Tobacco Control Manual for Schools, based on the HBM constructs, and tailored to fit the Nigerian context. The materials underwent validation through reviews by a multidisciplinary panel of experts who assessed their clarity, cultural relevance, and theoretical alignment. Subsequently, they were pre-tested among 150 adolescents from public and private schools in Ibadan, Nigeria. Feedback from the adolescents guided iterative refinements, culminating in the development of the final versions of the materials.

Results: The educational materials conveyed information on different tobacco forms, the harmful constituents, health effects, and skills to avoid tobacco use. Expert reviewers confirmed the materials' alignment with HBM constructs. Participants in the pre-test rated the materials highly, with 89.3% describing the information as ?very good? and 80.7% supporting their integration into the school curriculum.

Conclusion: The tobacco control educational posters and notebooks were found to be contextually appropriate and addressed gaps in tobacco-related knowledge and behavior change strategies. They offer a scalable model for school-based interventions in LMICs and could contribute to broader public health education efforts.

Background: Soft tissue cartilaginous choristoma (STC) is a mass of mature hyaline cells occurring in abnormal location. It is also referred to as extraskeletal choristoma; a rare lesion that frequently occurs on the tongue in orofacial region.The objective is to bring to the attention of Clinicians especially in secondary health care facilities the need of thorough investigations of tissue specimen to prevent misdiagnosis and avail themselves every diagnostic tool in the management of all oral swellings.

Case presentation: A 7-year old boy presented in Dental clinic in a secondary health care facility with history of an asymptomatic, non-tender and slow-growing swelling on the dorsum of the tongue of 3 years duration. Surgical excision was done under general anaesthesia. Histopathological and immunohistochemical evaluations were the tools used to establish its diagnosis.

Conclusion: Soft tissue choristoma is rare benign swelling that mostly occur in the anterior two-third of the tongue and can be misdiagnosed clinically but diagnostic tools like histopathology and immunohistochemistry will help confirm it.

Introduction: Verrucae are benign squamous epithelial lesions affecting the skin and mucous membranes, as a result of infection with low-risk Human Papilloma virus, with an estimated 10% of the world's population affected. This work studies the clinicopathology of all histologically diagnosed warts at the Jos University Teaching Hospital between 1st January 2013 and 31st December 2022.

Methodology: The study was a descriptive study of all histologically diagnosed cases of verrucae during the study period. Patients with histological diagnosis of verrucae were included, while those with inadequate biodata (age and sex), inadequate clinical information, and missing archival slides and tissue blocks were excluded from the study. Patients' age, gender, clinical characteristics (site and symptoms) and histological diagnosis were obtained from the records.

Results: All 61 cases are of histologically diagnosed verrucae met the criteria for the study. These consisted of males 28 (45.9%), and 33 (54.1%) females. The age range, mean, median and modal age of the study were 1-70 years, 34.81+19.28years, 35.0 years, and 13.0 years, respectively. As much as 28 (45.9%) warts were seen between 30years and 49years of age. According to the anatomical site of occurrence, the lesions were broadly classified into cutaneous warts, 23 (37.7%) and anogenital warts, 38 (62.3%). Specifically, the vulva, penis, and other parts of the perineum were the sites with the highest frequency of wart accounting for 17 (27.9%), 6(9.8%), and 6 (9.8%) cases respectively. Bleeding, pain, itching, and cosmesis as a direct consequence of the lesion were reasons for clinical presentation, with cosmesis predominating (84.4%).

Conclusion: Warts in our environment is commoner in the anogenital region, the third and fourth decade of life, and in the female gender. Bleeding, pain, itching, and cosmesis were reasons for clinical presentation. Vaccination against the etiological agent of the disease is advised on a wide scale to reduce the incidence of this disturbing and distressing pathology.

Introduction: Involuntary childlessness, a pas de deux is perceived as a stigma in many developing countries and often leads to marital disharmony due to the high premium placed on childbearing emanating from deep rooted socio-cultural beliefs. Nurses play a pivotal role in patient management due to their close contact and association with patients and their relatives. A nexus therefore exists in the uptake of clinical services by patients because of the disposition of nurses towards certain services. Efforts at improving perception about assisted conception services through education and information for both patients and health workers cannot be over-emphasized.

Methodology: A cross-sectional study of consecutive clinical nurses from the general-outpatient, surgical, medical, paediatric, and gynaecology clinics of the University College Hospital, Ibadan. One hundred and ninety-six nurses were recruited into the study using a self-administered questionnaire. Data collected was analyzed using the Statistical Package for Social Sciences version 23. Descriptive analysis generated was presented with the aid of a pie chart and frequency tables. Chi-square statistic was used in testing for associations between categorical variables and P value was set at 0.05.

Result: The mean age of the respondents was 41.47 ± 9.24 years with a mean duration of clinical nursing service of 15.18 ± 8.70 years. Majority (86.7%) of the nurses were married and were predominantly of the Christian faith. One hundred and sixty nurses (81.6%) were of Yoruba extraction. Majority (94.8%) demonstrated good knowledge about assisted conception services and therefore had a positive attitude towards advanced fertility management (P>0.05). Age, marital status, religion, and years of service were not significantly associated with a positive attitude.

Conclusion: The recent establishment of an in vitro fertilization centre at the University College Hospital, Ibadan, has resulted in a paradigm shift in the management of infertility. Continuous education and enlightenment of clinical nurses will not only enlist their support but promote better patient engagement through constructive and informative interactions, thus eliminating barriers to the uptake of assisted conception services in a country strongly influenced by socio-cultural beliefs and taboos.

Background: Effective control of malaria is anchored on accurate diagnosis. Conventional Methods of diagnosis include microscopy, and malaria rapid diagnosis. Many factors, particularly human error, diagnostic inaccuracies of microscopy due to human errors. The study reports the results of an online survey designed to assess the perception of health workers on artificial intelligence methods in the diagnosis of malaria.

Methodology: An online, cross-sectional survey, conducted in April to August 2022. The study was conducted using Google forms. The knowledge of conventional methods of malaria diagnosis and willingness to accept artificial intelligence-based automated malaria diagnosis and parasite counts were assessed. The form (questionnaire) was delivered to emails and several WhatsApp groups.

Results: Sixty seven responses were received over the study period, comprising medical doctors (30, 44.8%), medical laboratory scientists (18, 26.9%), postgraduate students (8, 11.9%), nurses (7, 10.4%), and students (4, 6.0%). All the respondents knew about conventional methods of malaria diagnosis. Majority of the respondents (41/67, 61.2%) reported that light microscopy was the most commonly used conventional method of malaria diagnosis. All the respondents reported that they were unaware of artificial intelligence-based malaria diagnosis. The respondents affirmed that artificial intelligence based malaria diagnosis will be a better alternative to the conventional methods and will improve the accuracy of malaria diagnosis.

Conclusion: None of the respondents had knowledge of artificial intelligence-based malaria diagnosis; however, respondents affirmed that artificial intelligence-based malaria diagnosis will be a better alternative to conventional methods of malaria diagnosis.

Background: The knowledge of an individual about oral health and the practice of good oral hygiene will go a long way in determining the oral health status of such an individual. Frequent intake of refined carbohydrates, without optimum oral hygiene procedure, has been implicated in the aetiology of oral diseases such as dental caries and periodontitis. The aim of the study was to assess the oral health knowledge of some secondary school students in two LGAs in Ibadan, Oyo State.

Methodology: This descriptive cross-sectional study was done using multistage sampling techniques and conducted across the classes in the selected senior secondary school. A pretested, self-administered, structured questionnaire with 12 items, adopted from Sternberg et al, was used for the data collection. A total of 248 participants consisting of 97 (39.1%) males and 151 (60.9) females completed and submitted the questionnaires. Data analysis was done using the statistical product and service solutions (SPSS 26.0).Statistical significance was set at p < 0.05.

Results: Knowledge assessment of oral health education; 94.4% of the participants had good knowledge, while 5.6% of the participants had poor knowledge. More females (60.3%) than males (39.7%) had good knowledge of oral health. The age range of participants was from 11 to 19 years, with a mean (SD) -14.68 (±1.45). On the knowledge of oral health, 234(94.4%) of participants perceived excessive consumption of sweet food can cause dental caries; 9(3.6%) did not; and; 5(2.0%) undecided. On teeth brushing at least twice daily 238 (96.0%) participants agreed, and 6(2.4%) did not, and 4(1.6%) were undecided. Participants from public schools had a higher frequency of refined carbohydrate intake, with a low pattern of 9.2%, a moderate pattern of 52.7%, and a high pattern of 38.1%. The socio-demographic characteristics of the participants were not statistically significant against the pattern of intake of refined carbohydrates following bivariate analysis.

Conclusion: The supposedly good knowledge of oral health education of respondents in this study was not matched equally with a good pattern of refined carbohydrate intake. This calls for a concerted effort towards improving oral health campaigns among secondary school students.

Introduction: Herniation of a full-term pregnancy is a rare event that poses risks for both mothers and babies. This condition can lead to lower uterine segment rupture and intrauterine foetal death.

Case presentation: We present a case of an incisional hernia with a full-term pregnancy. Despite initial plans for elective surgery, she presented in labour, requiring emergency laparotomy, caesarean delivery, and simultaneous hernia repair with successful outcomes for both the mother and baby.

Conclusion: Emergency laparotomy with caesarean delivery and simultaneous hernia repair is a feasible option for a gravid patient with incisional hernia in labour.