Annals of Ibadan postgraduate medicine最新文献

Background: Orofacial Cleft (OFC) is the predominant congenital facial malformation with an incidence of 1 in 600-700 for every live birth. This unexpected condition often provokes adverse emotional and social reactions from the families and the larger society. OFC optimal management require extensive parental care such as feeding coupled with multiple complex medical, surgical and dental treatment needs which; thus, imposed further strain on the mothers and family carers. Sadly, OFC impacts negatively on many families in rural sub-Saharan African communities signaling an urgent imperative to address this as a public health policy emergency. However, there is scant qualitative data regarding this problem in rural northwest Nigeria. The purpose of this study was to explore the psychosocial lived experiences of family carers of children with OFC in the northwest, Nigeria.

Materials and method: Twenty-two participants from four collaborating tertiary specialised hospitals in northwest Nigeria were recruited into the study between 2017 and 2020. Semi-structured in-depth interviews were conducted and inductive thematic analysis of verbatim transcribed textual data was utilized.

Results: The participants were largely from rural farming districts; mothers constituted more than three-quarters of the participants (n=15). Three major themes emerged: emotional experiences, social challenges and the support system. The study identified covert discrimination and negative stereotypes of children with OFC were identified.

Conclusion: The study findings showed that mothers were emotionally and socially more impacted by OFC.

Introduction: Endoscopic endonasal transsphenoidal surgery (EETSS) is an established technique for the resection of pituitary tumors and is well-domesticated in our center due to its numerous benefits. This study aimed to provide insights into the anaesthetic management of patients with pituitary tumors for EETSS, analyze the perioperative complications, and associations between demographic data, perioperative complications, intensive care unit (ICU) management, and outcomes.

Methods: This prospective descriptive study includes all patients who underwent EETSS for pituitary adenoma under general anaesthesia in a tertiary center. Data collected through a semi-structured proforma from patients and patient medical records included socio-demographic data, peri-operative complications, ICU management, and outcome.

Results: There was a total of 60 patients (Male: Female was 1:1), an age range between 18 to 76 years, and the mean age was 30.9 (± 12.8 years). Most patients (65%) presented with visual complaints. Hypertension (30%) was the most common intercurrent illness. The American Society of Anesthesiologists (ASA) physical status II and III were 56.7% and 43.3% respectively. Intraoperative complications were hypertension 30%, hypotension 5%, and bradycardia 15%. 30% (15) of the patients were admitted into the ICU and 13 (21.7%) of those admitted were ventilated. ICU length of stay was between 1-6 days. Overall mortality was 10%. Bivariate analysis revealed a significant association was observed between mortality and tumor size (p=0.046), ventilator use (p=0.05), and ICU admission (p=0.008).

Conclusion: The tumor size, postoperative complications that necessitated ICU admission, and ventilator use in the ICU significantly impact the overall perioperative outcome.

Background: Sickle cell disease (SCD) in pregnancy constitutes a high-risk pregnancy, associated with increased risk of adverse outcomes.

Objective: To describe the outcome of pregnancy in SCD women managed at the University College Hospital, Ibadan, Nigeria.

Materials and methods: A retrospective review of the health records of sixty-three SCD pregnant women managed between January 1, 2016 and December 31, 2020. The information extracted included sociodemographic and obstetric characteristics, clinical presentations, mode of delivery, maternal and fetal outcomes. The data was analyzed using the IBM Statistical SPSS Statistics for Windows, version 23.0. Test of association was done using Chi-square and level of significance was p<0.05.

Results: Prevalence of SCD in pregnant women was 0.65%. Mean age was 28.8±4.1years, 63.5% were haemoglobin SS while 36.5% were haemoglobin SC. Most of the women had tertiary education (61.8%) and booked for antenatal care (ANC) (60%). About 72.4% delivered at term while 46.1% had caesarean delivery. Most common complication was anaemia (79.4%) while vaso-occlusive crisis was the most common type of crisis (55.6%). Most of the women (92.5%) had live-birth with 15.2% of neonates requiring Neonatal Intensive Care Unit (NICU) admission. Maternal death rate was 6.3%. Good maternal and fetal outcomes occurred in 71.4% and 61.9% of participants respectively. Good maternal outcome was significantly associated with tertiary education(p=0.01). Good fetal outcome was associated with tertiary level of education(p=0.04) and multigravida status(p=0.03).

Conclusion: SCD pregnant women have good fetal-maternal outcomes, however not receiving ANC and lower level of education were associated with poor pregnancy outcomes. Health education, access to ANC, prompt diagnosis, treatment of complications and multi-disciplinary team management will improve the pregnancy outcomes.

Background: Transurethral resection of the prostate is the gold standard for treating benign prostate enlargement that presents with complications or worsening lower urinary tract symptoms despite medical treatment. We report the experience of transurethral resection of the prostate in indigenous community in the sub-Saharan Africa.

Methods: Arrangements were made with selected communities for transportation of endoscopic instruments by road. Medical officers were taught on the inclusion and exclusion criteria for men suitable for transurethral resection of prostate. Scheduled visits were arranged between January 2016 and December 2019.

Results: Fifty-five men age range 45-98years underwent TURP. The mean prostate volume, preoperative infection rate, operation time, hospital stay, postoperative day of catheter removal, and incidental prostate cancer were 52.5 cm3, 9%, 41.3 minutes, 2 days, 5 days, and 5.5% respectively. There was an increase in TURP per year from 4 to 20 patients. The postoperative complication rate was 4%.

Conclusion: TURP in the indigenous and pensioners community is feasible, accessible, with satisfactory outcome. The government needs to support this initiative of scheduled community outreach to ensure modern day treatment is brought to the doorstep of her citizens.

Objective: To evaluate the effectiveness of our awareness campaign strategies and identify the most effective strategy for our environment.

Design: This was a cross-sectional descriptive study using a 15-item intervieweradministered questionnaire.

Setting: The orofacial cleft clinic of a tertiary health institution in Lagos, Nigeria.

Participants: The sample population was all consenting parents and adult patients attending the orofacial cleft clinic within the study period.

Main outcome measures: The primary outcome measures was the percentage contribution of the various outreach modalities to the source of referral to the clinic.

Results: A total of 107 respondents were recorded in this study. Forty-six percent of the respondents received information about the availability of treatment and referrals from the maternity centers where the child was delivered (45.8%, n = 49), while the media campaign contributed 13.1% to our patient referrals. Seventy percent (n = 75) of the participants lived within the state of Lagos. Eighty-five percent (n=91) utilized public transport for clinic visits. The median approximate distance travelled from their home to the clinic was 23 (IQR 11-42) km, with a range of 1.5-988 km. The median approximate cost of public transportation to the clinic from their homes was 2000 (IQR 1500-4375) Naira (~ 4 USD), with a range of 200-120,000 Naira (~ 0.4-250 USD) per visit.

Conclusion: The results of this study show that campaigns focused on maternity homes and peripheral hospitals appear to be the most effective strategy and the single largest source of referrals to our cleft care programme.

Background: Incarceration has been known to increase the transmission of some blood-borne viruses such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Correctional centres are thought to be the reservoir of these infections, thereby constituting a risk to the larger society when the individuals are released. Objectives: The study determined the seroprevalence of HBV, HCV, and HIV and associated factors for infections among people living in a correctional centre (PLCC) in Southern Nigeria.

Methodology: This was a cross-sectional study involving PLCC. An objectively structured questionnaire was administered to obtain socio-demographic information and data about the history of recreational drug use, previous incarceration, and duration of incarceration. Blood samples were screened for hepatitis B virus, hepatitis C virus and HIV.

Results: A total of 302 PLCC participated in this study with a male: female ratio of 12:1. The sero-prevalence of hepatitis B (HBV), hepatitis C (HCV) and HIV infections were 6.6%, 2% and 3.6% respectively. The co-infection rate of HBV/ HCV was 0.3% and HIV/HBV co-infection also 0.3%. There was a significant association between gender, ethnicity, monthly income and HBV status. History of genital rashes/discharge was also significantly associated with HCV status while 'HIV status' was associated with sharing of personal belongings, history of genital rashes/discharge and cigarette smoking.

Conclusion: HBV, HCV and HIV infections are prevalent among PLCC. The infections were associated with some socio-demographic and clinical variables.

[This corrects the article on p. 24 in vol. 21 PMChttps://pmc.ncbi.nlm.nih.gov/articles/PMC10811715.].

Background: Electrocardiogram (ECG) is an important non-invasive tool for cardiac disease evaluation, both for routine cardiac evaluation or in life-threatening emergency settings. Cardiovascular diseases remain the most common cause of death worldwide. It is therefore important that medical doctors should be proficient in ECG interpretation. This scoping review therefore sets out to identify approaches to improving ECG learning and competence among medical and postgraduate trainees.

Methods: We performed this review using the preferred reporting items for systematic reviews and meta-analysis guidelines/checklists. The following databases were searched; PubMed, Scientific Electronic Library Online (SciELO), and African Journals Online (AJOL), and all articles investigating the methods of improving ECG learning and competence among medical students and postgraduate trainees published between 1st January 2000 and 31st December 2022 were included. Data was screened and extracted by at least three independent reviewers.

Results: A total of 25 articles (19 randomized control trials, one cohort studies and 5 cross-sectional studies were identified. Most studies were from Europe while 20% of them were from the United States. Various modalities of ECG learning were identified which varied from traditional lecture based or electronic learning, formative vs summative methods, multiple integrated/ blended methods, internet versus non-internet methods, computersimulated program or traditional teaching leads and so on.

Conclusion: We concluded that no single method of ECG learning is superior, however, a combination of conventional and electronic methods works better than either one as a standalone. Therefore, trainers should identify and adopt the most effective methods to enhance ECG competence among their trainees.

Background: Many criteria have been developed to predict left ventricular hypertrophy using an electrocardiogram (ECG). However, one major common limitation of all has been their low sensitivity. Recently, a novel criterion has been proposed, which is believed to have higher sensitivity without a compromise in specificity.

Objective: Therefore, in our study, we aimed to test this novel ECG criterion prospectively in large, unselected cardiac patients in Ibadan, Nigeria.

Methods: Patients who were referred to our echocardiography laboratory due to various aetiologies were prospectively enrolled. The novel Peguero-Lo Presti criterion was assessed along with other established ECG criteria. The left ventricular mass index was calculated using echocardiography. The performance of each index was evaluated.

Results: Overall, 336 patients were included in the final analysis. The mean age was 57.94±14.98 and 178 (53.0%) of them were males. The sensitivity and specificity of the Peguero-Lo Presti criterion were 59% and 66%, respectively. Although the highest sensitivity belonged to the Peguero-Lo Presti criterion, in ROC analysis, it showed modest predictive capability, which was similar to the established Cornell voltage criterion.

Conclusion: Although this novel criterion had higher sensitivity, the overall performance was similar to the current indices. Further adjustments, particularly based on age and body mass index, may yield better results.