Annals of Ibadan postgraduate medicine最新文献

Background: Background: The prevalence of obesity is increasing globally, making it a growing pandemic affecting adults and children. Obesity is associated with multiple morbidities and mortalities increasing the burden on the health care system.

Objective: There is inadequacy of data in Nigeria on the prevalence of obesity among adult patients with hypertension and adequate data on these conditions would help in their comprehensive management.

Methods: This was a cross-sectional study of 354 patients with hypertension, and the systematic sampling technique was used to recruit patients. The data were analysed using SPSS software version 23. Logistic regressions and linear regressions were done to determine the predictors of obesity and blood pressure levels.

Results: The mean age of the respondents was 52.60(SD±8.26) years and the prevalence of obesity was 53.1%. After adjusting for other variables, the predictors of obesity were female sex. Females were about six times more likely to be obese than males (OR=6.23; 95%CI= 3.16 - 12.32). For every 1 unit increase in triceps skinfold, there was a statistically significant increase in diastolic blood pressure by about 2.77units (95% C.I equals 2.63 to 2.91, p-value= 0.0001). Also, for every 1 unit increase in biceps skinfold, there was a statistically significant increase in systolic blood pressure by about 5.78 units (95% C.I equals 5.46- 6.10, p-value= 0.0001).

Conclusion: The prevalence of obesity was high, and the predictors of obesity were female sex. Triceps skinfold measurements were predictors of diastolic blood pressure while biceps skinfold measurements were predictors of systolic blood pressure.

Background: Molecular diagnosis though faster and more sensitive than phenotypic techniques, is more expensive. Resource limited settings are thus limited to using more of phenotypic rather than molecular methods in the routine detection of Extended Spectrum beta lactamases (ESBL).

Aim: This study aimed to evaluate the performance of double disc synergy test (DSST) and Epsilometer (E) test with Polymerase Chain Reaction (PCR) and to detect the risk factors associated with ESBL producing organisms among in-patients at Babcock University Teaching Hospital, Ilishan-Remo, Nigeria.

Methodology: Hospital-based cross-sectional study in which bacterial isolates of 165 in-patients were collected fromMarch 2018 to September 2019. The isolates were evaluated for ESBL production by the use of DDST, Etest and PCR. The performance evaluation was done. Questionnaire was used to assess the risk factors associated with ESBL, IBM SPSS Version 23 was used to analyze the data.

Results: The participants' isolates yielded 50/165 (30.3%) that were ESBL positive by DDST, 47/165 (28.9%) by E-test and 48/165(29.1%) by PCR. Sensitivity and specificity of DSST was 100% and 98.3% while that of E-test was 98% and 100% respectively. Age, antibiotics intake without prescription, being on ventilator, urethral catheterization and nasogastric tubes were all significantly associated with presence of ESBL (p value <0.05).

Conclusion: Phenotypic tests remain reliable for the routine detection of ESBL in the absence of molecular methods. Rational use of instrumentation and antibiotics is advocated based on the risk factors detected from this study.

Background: Erectile dysfunction (ED) is a common problem among heart failure (HF) patients but is usually ignored in busy clinics in developing countries like Nigeria. Evidence abound that it has a great impact on the quality of life, survival, and prognosis of HF patients.

Objective: This study sought to evaluate the burden of ED among HF patients at the University College Hospital, Ibadan.

Methods: This pilot cross-sectional study was conducted in the Cardiology clinic of the Medical Outpatient Unit of the Department of Medicine, University College Hospital, Ibadan. Consenting male patients with chronic HF were consecutively recruited into the study between June 2017 and March 2018. The International Index of Erectile Function-version five (IIFE-5) was used to access the presence and degree of ED. Statistical analysis was done with SPSS version 23.

Results: A total of 98 patients were recruited with a mean± standard deviation (SD) age of 57.6 ±13.3 years, and age range of 20-88 years. The majority of the participants were married (78.6%), and the mean ± SD duration of HF diagnosis was 3.7 ±4.6years. The overall frequency of ED was 76.5%, and those with previous self-reported ED were 21.4%. Mild erectile dysfunction, mild to moderate erectile dysfunction, moderate erectile dysfunction, and severe erectile dysfunction were present in 24(24.5%), 28(28.6%), 14(14.3%), and 9(9.2%) respectively.

Conclusion: Erectile dysfunction is common among chronic heart failure patients in Ibadan. Therefore, adequate attention is needed for this sexual health issue among males with heart failure to improve their quality of care.

Background: External hernias and scrotal swellings are diverse in presentation and are described in many subjective ways.

Aim: To create an objective classification of inguinoscrotal swellings in the rural setting.

Patients and methods: It was a prospective study on the measurement of inguinoscrotal swellings volume/contents in a cohort of surgical patients in a provincial general hospital in the north of Sierra Leone over a three-year period. For inguinal hernias and other scrotal swellings, the volume ranges of 0- 500ml were used in the classification; for femoral and other external hernias which generally do not reach 'huge' sizes, the volume ranges of 0-100 ml were used.

Results: A total of 962 external hernias and hydroceles were classified over a 3- year period. Most, 610 (63.4%) were inguino-scrotal hernias, others were hydroceles, 303 (31.0%) and femoral hernias, 42 (4.3%). The remaining small number consisted of umbilical (4) and epigastric (3) hernias. For the common conditions of hydroceles, inguinal and femoral hernias, about 50% were 'small', more than 40% were 'large', the rest were giant. The same findings were true for epigastric and umbilical hernias.

Conclusion: Using the scale that we adopted, majority of the groin hernias and hydroceles were in the small and large categories with a few giant varieties. Volumetric-based classification of hernias and hydroceles can help surgeons communicate more clearly based on standard rather than arbitrary ascription of descriptive terminologies to these very common surgical entities.

Background: Background: Hypotension is a common complication of spinal anaesthesia and occurs due to the sympatholytic effect of local anaesthesia on the cardiovascular system and consequence effects on the autonomic nervous system. Heart rate variability (HRV) is currently a well-known predictive tool for hypotension and the commonly associated bradycardia.

Objective: To evaluate the relationship between preoperative measured HRV and hypotension with bradycardia among patients undergoing elective surgeries under spinal anaesthesia.

Methods: Eighty-four patients aged between 18 and 65 years were recruited. HRV measurements were taken immediately after electrocardiographic (ECG) tracing according to the North American Society for Pacing and Electrophysiology (NASPE). Pre and intraoperative heart rate (HR), systolic and diastolic blood pressure and mean arterial blood pressure were monitored and recorded every 5 minutes from induction of spinal anaesthesia till the end of surgery. Multivariate analysis was used to determine the association between development of hypotension, bradycardia and age, systolic and diastolic blood pressure and Heart Rate Variability in the low frequency (LF) and high Frequency (HF) domains.

Results: Hypotension occurred in 55 patients (65.5%). Age (p= 0.015), base line systolic blood pressure (p=0.003) and base line diastolic pressure (p=0.027) were significantly associated with the development of hypotension. Low frequency (LF) was significantly associated with the development of hypotension, while high frequency (HF) was significantly associated with bradycardia.

Conclusion: Heart rate variability was useful in predicting development of hypotension and bradycardia in patient undergoing elective surgery under spinal anaesthesia.

Background: The choice of specialty by medical students and early career doctors affects health workforce distribution in any country. In addressing healthcare needs of the populace, appropriate distribution of manpower across board is essential. Several factors come into play in making these choices. This study assessed factors affecting the career choices of final year medical students and how curricular changes may have influenced these.

Methods: This was a cross-sectional study conducted among 236 final year medical students of the University of Ibadan by convenience sampling using self-administered semi-structured questionnaires. Questions were on sociodemographic characteristics, career counselling, preferred future career, and factors affecting these choices. Data were analyzed using SPSS version 21 software.

Results: A total of 236 medical students participated in the study. The mean age of participants was 23.6(±1.9) years. Only 112(47.5%) respondents had received any form of career counseling/guidance in the course of their medical training. The commonest first choice specialties were obstetrics and gynecology 54(22.9%), surgery 44(18.6%), and psychiatry 18(7.6%). Personal interest most often (185, 78.4%) influenced career choice overall, showing significance in obstetrics and gynecology (p=0.02), family medicine (p=0.02), and public health (p<0.001).

Conclusion: The predominant choices of future specialty among final year medical students were obstetrics and gynecology, surgery and psychiatry. The change in curriculum for medical students may have affected the pattern of their choices with more interest shown in previously neglected areas.

Background: Unintended pregnancies contribute to the high burden of unsafe abortion, maternal deaths and morbidities among undergraduates.

Objective: To assess the determinants of good knowledge and evaluate the trends in the practice of Emergency Contraception (EC) among female undergraduates.

Methods: This was a cross sectional study involving four hundred and twenty female undergraduates from two universities in Ibadan, Nigeria. Participants were recruited from their hostels and classrooms. Data collection was done using self-administered questionnaires and good knowledge was defined as three correct answers to five questions testing knowledge. The questionnaires also addressed their practices of EC. The data was stored on the computer, cleaned and analyzed using the Statistical Package for the Social Sciences (SPSS) version 22. Statistical significance was set at p <0.05.

Results: Two hundred and fourteen (51.0%) participants were aware of EC and the common sources were friends (43.4%), media (42.9%) and pharmacies (42.0%). One hundred and sixty-four participants (39.1%) had good knowledge of EC. Participants in the age group 20-24 years, second year of study, those who were aware of EC and had ever used EC were associated with good knowledge. Less than half (48%) of the sexually active participants used EC in the past six months and Levonogestrel (51%) was the commonest EC used. Menstrual irregularity and abdominal pain were the major side effects of EC.

Conclusion: The practice of EC is poor and with poor knowledge demonstrated among female undergraduates. There is therefore the need to improve information and access to EC in the university community.

Introduction: Removable denture still stands as the preferred option in the management of completely edentulous arch in the developing society. The prosthodontist is challenged with providing a retentive denture to the patient, alleviating the effect of tooth loss. The retention of these prostheses is influenced by the material used for it fabrication and the edentulous ridge height, hence the need to assess the retention of acrylic and flexible complete denture and the effect of edentulous ridge height.

Aim: This study was to assess and compare the effect of ridge height on retention of flexible and acrylic complete upper dentures.

Materials and methods: Ten patients with complete upper edentulous arches were recruited and randomly allocated into two groups (A and B). Acrylic and flexible, complete maxillary dentures were fabricated for each participant. Group A wore the acrylic denture first, while group B wore the flexible denture first. Each participant was recalled after using the denture for one week, one month, and three months for data collection.At cross over time (3 months after wearing the first denture), individuals in group A were given flexible dentures, while those in group B received acrylic dentures. The patients were recalled again for data collection by one of the researchers. Kapa Intra examiner reliability test was 83.3%. Information related to denture retention were obtained and entered into IBM SPSS software version 23 for analysis. Paired t-test and linear regression were used to test for association between quantitative variables. A P-value of 0.05 was regarded as significant.

Results: Ten individuals with mean age of 66.5±9.7 years and mean anterior ridge height of 15.5 ± 2.95 mm participated in this study. The subjective and objective assessments of the dentures showed that acrylic denture possessed a better retention than flexible denture. The effect of anterior ridge height on retention, showed a statistically significant difference (p= 0.006 for acrylic denture, p = 0.001 for flexible denture).

Conclusion: This study suggested that acrylic denture possesses better retention compared to the flexible type and far better in situation with lower ridge heights.

Background: Trichomonas vaginalis is one of the common non- viral sexually transmitted infections that infect both men and women worldwide. It is largely asymptomatic and its association with the risk of HIV transmission has made it a compelling public health concern. Therefore, this study aims to determine the prevalence and the risk factors associated with T. vaginalis among asymptomatic undergraduate students at Babcock University, Ilisan-Remo, Ogun state, Nigeria.

Materials and methods: This is a descriptive cross-sectional study involving 246 asymptomatic students of Babcock University between February 2019 to April 2020. Information on socio-demographic and associated risk factors was obtained by structured-questionnaire in an interview-based manner. First-void urine was collected from each participant for the detection of T. vaginalis using the traditional wet prep method and TV in-pouch. The data were analyzed by SPSS Version 23.

Results: The overall prevalence of T. vaginalis among the participants was 12.2% (30/246). The use of wet-preparation showed 8.5% (21/246) while the use of TV inpouch yielded 12. 2% (30/246) prevalence of positive results. The results of the wet prep in comparison to the in-pouch technique was statistically significant among the study population. (P < 0.001). Sexual intercourse, use of hormonal contraceptives and practice of internet-based sex seeking behaviour were factors that had increase likelihood of T. vaginalis infection on multivariate analysis.

Conclusion: The occurrence of T. vaginalis and, its associated risk factors among the asymptomatic population in this study is very high. We advocate for the screening of young people.